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Rameckers SA, van Emmerik AAP, Grasman RPPP, Arntz A. Non-fear emotions in changes in posttraumatic stress disorder symptoms during treatment. J Behav Ther Exp Psychiatry 2024; 84:101954. [PMID: 38479086 DOI: 10.1016/j.jbtep.2024.101954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/31/2023] [Accepted: 02/19/2024] [Indexed: 05/15/2024]
Abstract
BACKGROUND AND OBJECTIVES Posttraumatic stress disorder (PTSD) is not only associated with fear but also with other emotions. The present study aimed to examine if changes in shame, guilt, anger, and disgust predicted changes in PTSD symptoms during treatment, while also testing if PTSD symptoms, in turn, predicted changes in these emotions. METHODS Participants (N = 155) with childhood-related PTSD received a maximum of 12 sessions of eye movement desensitization and reprocessing or imagery rescripting. The data was analyzed using Granger causality models across 12 treatment sessions and 6 assessment sessions (up until one year after the start of treatment). Differences between the two treatments were explored. RESULTS Across treatment sessions, shame, and disgust showed a reciprocal relationship with PTSD symptoms, while changes in guilt preceded PTSD symptoms. Across assessments, anger was reciprocally related to PTSD, suggesting that anger might play a more important role in the longer term. LIMITATIONS The individual emotion items were not yet validated, and the CAPS was not administered at all assessments. CONCLUSIONS These findings partly differ from earlier studies that suggested a unidirectional relationship in which changes in emotions preceded changes in PTSD symptoms during treatment. This is in line with the idea that non-fear emotions do play an important role in the treatment of PTSD and constitute an important focus of treatment and further research.
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Affiliation(s)
- Sophie A Rameckers
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands.
| | | | - Raoul P P P Grasman
- Department of Psychological Methods, University of Amsterdam, Amsterdam, the Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
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2
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Rameckers SA, van Emmerik AAP, Boterhoven de Haan K, Kousemaker M, Fassbinder E, Lee CW, Meewisse M, Menninga S, Rijkeboer M, Schaich A, Arntz A. The working mechanisms of imagery rescripting and eye movement desensitization and reprocessing: Findings from a randomised controlled trial. Behav Res Ther 2024; 175:104492. [PMID: 38359658 DOI: 10.1016/j.brat.2024.104492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 10/10/2023] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
We studied the mechanisms of eye movement desensitization and reprocessing (EMDR) and imagery rescripting (ImRs). We hypothesized that EMDR works via changes in memory vividness, that ImRs works via changes in encapsulated beliefs (EB), and that both treatments work via changes in memory distress. Patients (N = 155) with childhood-related posttraumatic stress disorder (Ch-PTSD) received 12 sessions of EMDR or ImRs. The vividness, distress, and EB related to the index trauma were measured with the Imagery Interview. PTSD severity was assessed with the Impact of Events Scale-Revised and the Clinician-Administered PTSD Scale for DSM-5. We conducted mixed regressions and Granger causality analyses. EMDR led to initially stronger changes in all predictors, but only for distress this was retained until the last assessment. No evidence for vividness as a predictive variable was found. However, changes in distress and EB predicted changes in PTSD severity during ImRs. These findings partially support the hypothesized mechanisms of ImRs, while no support was found for the hypothesized mechanisms of EMDR. Differences in the timing of addressing the index trauma during treatment and the timing of assessments could have influenced the findings. This study provides insight into the relative effectiveness and working mechanisms of these treatments.
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Affiliation(s)
- Sophie A Rameckers
- Department of Clinical Psychology, University of Amsterdam, the Netherlands.
| | | | | | | | - Eva Fassbinder
- Department of Psychiatry and Psychotherapy, Kiel University, Germany
| | - Christopher W Lee
- Faculty of Health and Medical Sciences, University of Western Australia, Australia
| | | | | | - Marleen Rijkeboer
- Department of Clinical Psychology, University of Amsterdam, the Netherlands; Department of Clinical Psychological Science, Maastricht University, the Netherlands
| | - Anja Schaich
- Department of Psychiatry and Psychotherapy, Kiel University, Germany; Department of Psychiatry and Psychotherapy, Lübeck University, Germany
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, the Netherlands
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Fereidooni F, Daniels JK, D Krause-Utz A, Hagenaars MA, Smeets T, Heins J, Dorahy MJ, Emmerik AAPV, de Jong PJ, Hoekstra S, Warrens MJ, Lommen MJJ. Childhood maltreatment and adulthood victimization: An evidence-based model. J Psychiatr Res 2023; 167:46-62. [PMID: 37832203 DOI: 10.1016/j.jpsychires.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 09/12/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023]
Abstract
There is ample evidence showing that childhood maltreatment increases two to three fold the risk of victimization in adulthood. Various risk factors, including posttraumatic stress disorder (PTSD) symptoms, dissociation, self-blame, and alcohol abuse are related to revictimization. Although previous research examined associations between risk factors for revictimization, the evidence is limited and the proposed models mostly include a handful of risk factors. Therefore, it is critical to investigate a more comprehensive model explaining the link between childhood maltreatment and adulthood (re)victimization. Accordingly, this study tested a data-driven theoretical path model consisting of 33 variables (and their associations) that could potentially enhance understanding of factors explaining revictimization. Cross-sectional data derived from a multi-wave study were used for this investigation. Participants (N = 2156, age mean = 19.94, SD = 2.89) were first-year female psychology students in the Netherlands and New Zealand, who responded to a battery of questionnaires and performed two computer tasks. The path model created by structural equation modelling using modification indices showed that peritraumatic dissociation, PTSD symptoms, trauma load, loneliness, and drug use were important mediators. Attachment styles, maladaptive schemas, meaning in life, and sex motives connected childhood maltreatment to adulthood victimization via other factors (i.e., PTSD symptoms, risky sex behavior, loneliness, emotion dysregulation, and sex motives). The model indicated that childhood maltreatment was associated with cognitive patterns (e.g., anxious attachment style), which in turn were associated with emotional factors (e.g., emotion dysregulation), and then with behavioral factors (e.g., risky sex behavior) resulting in revictimization. The findings of the study should be interpreted in the light of the limitations. In particular, the cross-sectional design of the study hinders us from ascertaining that the mediators preceded the outcome variable.
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Affiliation(s)
- Fatemeh Fereidooni
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, the Netherlands
| | - Judith K Daniels
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, the Netherlands.
| | - Anne D Krause-Utz
- Department of Clinical Psychology, Leiden University, the Netherlands
| | | | - Tom Smeets
- Department of Medical and Clinical Psychology, Tilburg University, the Netherlands
| | - Jenna Heins
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Martin J Dorahy
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | | | - Peter J de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, the Netherlands
| | - Steven Hoekstra
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, the Netherlands
| | - Matthijs J Warrens
- Department of Educational Sciences, University of Groningen, the Netherlands
| | - Miriam J J Lommen
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, the Netherlands
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Aschieri F, van Emmerik AAP, Wibbelink CJM, Kamphuis JH. A systematic research review of collaborative assessment methods. Psychotherapy (Chic) 2023; 60:355-369. [PMID: 36972083 DOI: 10.1037/pst0000477] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Collaborative assessment methods (CAMs) involve working with clients during all phases of the assessment process, from goal definition to interpretation of the testing results to the recommendations and conclusions. In this article, we define CAMs, provide clinical examples, and then meta-analyze the published literature to assess their effectiveness on distal treatment outcomes. Our meta-analytic results indicate that CAMs have positive effects on three outcome domains: a moderate effect on treatment processes, a small-to-moderate effect on personal growth, and a small effect on symptom reduction. There is little research evidence on the immediate, in-session effects of CAMs. We include diversity considerations, training implications. and therapeutic practices grounded in this research evidence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Filippo Aschieri
- European Center for Therapeutic Assessment, Universita Cattolica del Sacro Cuore
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Arntz A, Mensink K, Cox WR, Verhoef REJ, van Emmerik AAP, Rameckers SA, Badenbach T, Grasman RPPP. Dropout from psychological treatment for borderline personality disorder: a multilevel survival meta-analysis. Psychol Med 2023; 53:668-686. [PMID: 36453183 PMCID: PMC9975988 DOI: 10.1017/s0033291722003634] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Dropout from psychotherapy for borderline personality disorder (BPD) is a notorious problem. We investigated whether treatment, treatment format, treatment setting, substance use exclusion criteria, proportion males, mean age, country, and other variables influenced dropout. METHODS From Pubmed, Embase, Cochrane, Psycinfo and other sources, 111 studies (159 treatment arms, N = 9100) of psychotherapy for non-forensic adult patients with BPD were included. Dropout per quarter during one year of treatment was analyzed on participant level with multilevel survival analysis, to deal with multiple predictors, nonconstant dropout chance over time, and censored data. Multiple imputation was used to estimate quarter of drop-out if unreported. Sensitivity analyses were done by excluding DBT-arms with deviating push-out rules. RESULTS Dropout was highest in the first quarter of treatment. Schema therapy had the lowest dropout overall, and mentalization-based treatment in the first two quarters. Community treatment by experts had the highest dropout. Moreover, individual therapy had lowest dropout, group therapy highest, with combined formats in-between. Other variables such as age or substance-use exclusion criteria were not associated with dropout. CONCLUSION The findings do not support claims that all treatments are equal, and indicate that efforts to reduce dropout should focus on early stages of treatment and on group treatment.
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Affiliation(s)
- Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Kyra Mensink
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Wouter R. Cox
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Rogier E. J. Verhoef
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Sophie A. Rameckers
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Theresa Badenbach
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Raoul P. P. P. Grasman
- Department of Psychological Methods, University of Amsterdam, Amsterdam, The Netherlands
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Rameckers SA, Verhoef REJ, Grasman RPPP, Cox WR, van Emmerik AAP, Engelmoer IM, Arntz A. Effectiveness of Psychological Treatments for Borderline Personality Disorder and Predictors of Treatment Outcomes: A Multivariate Multilevel Meta-Analysis of Data from All Design Types. J Clin Med 2021; 10:5622. [PMID: 34884324 PMCID: PMC8658126 DOI: 10.3390/jcm10235622] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/17/2022] Open
Abstract
We examined the effectiveness of psychotherapies for adult Borderline Personality Disorder (BPD) in a multilevel meta-analysis, including all trial types (PROSPERO ID: CRD42020111351). We tested several predictors, including trial- and outcome type (continuous or dichotomous), setting, BPD symptom domain and mean age. We included 87 studies (N = 5881) from searches between 2013 and 2019 in four databases. We controlled for differing treatment lengths and a logarithmic relationship between treatment duration and effectiveness. Sensitivity analyses were conducted by excluding outliers and by prioritizing total scale scores when both subscale and total scores were reported. Schema Therapy, Mentalization-Based Treatment and reduced Dialectical Behavior Therapy were associated with higher effect sizes than average, and treatment-as-usual with lower effect sizes. General severity and affective instability showed the strongest improvement, dissociation, anger, impulsivity and suicidality/self-injury the least. Treatment effectiveness decreased as the age of participants increased. Dichotomous outcomes were associated to larger effects, and analyses based on last observation carried forward to smaller effects. Compared to the average, the highest reductions were found for certain specialized psychotherapies. All BPD domains improved, though not equally. These findings have a high generalizability. However, causal conclusions cannot be drawn, although the design type did not influence the results.
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Affiliation(s)
- Sophie A. Rameckers
- Department of Clinical Psychology, University of Amsterdam, 1018 WS Amsterdam, The Netherlands; (W.R.C.); (A.A.P.v.E.); (A.A.)
| | - Rogier E. J. Verhoef
- Department of Developmental Psychology, University of Utrecht, 3584 CS Utrecht, The Netherlands;
| | - Raoul P. P. P. Grasman
- Department of Psychological Methods, University of Amsterdam, 1018 WS Amsterdam, The Netherlands;
| | - Wouter R. Cox
- Department of Clinical Psychology, University of Amsterdam, 1018 WS Amsterdam, The Netherlands; (W.R.C.); (A.A.P.v.E.); (A.A.)
| | - Arnold A. P. van Emmerik
- Department of Clinical Psychology, University of Amsterdam, 1018 WS Amsterdam, The Netherlands; (W.R.C.); (A.A.P.v.E.); (A.A.)
| | - Izabella M. Engelmoer
- Institute for Personality Disorders and Behavioral Problems, de Viersprong Amsterdam, 1115 HG Duivendrecht, The Netherlands;
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, 1018 WS Amsterdam, The Netherlands; (W.R.C.); (A.A.P.v.E.); (A.A.)
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Rameckers SA, van Emmerik AAP, Bachrach N, Lee CW, Morina N, Arntz A. The impact of childhood maltreatment on the severity of childhood-related posttraumatic stress disorder in adults. Child Abuse Negl 2021; 120:105208. [PMID: 34332332 DOI: 10.1016/j.chiabu.2021.105208] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/23/2021] [Accepted: 07/03/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Childhood maltreatment is relatively common and is related to a range of negative consequences, such as Posttraumatic Stress Disorder (PTSD). There are indications that various maltreatment types are related to PTSD severity, although not all types, such as emotional abuse, meet the PTSD Criterion-A. OBJECTIVE The aim of the present study was to examine the relationship between 5 types of childhood maltreatment (i.e., sexual, physical, and emotional abuse, and physical and emotional neglect) and the severity of adult PTSD and PTSD symptoms. PARTICIPANTS AND SETTING Adult participants (N = 147) with Childhood-related PTSD (Ch-PTSD) recruited from clinical sites completed the Childhood Trauma Questionnaire-short form (CTQ-sf) and 2 PTSD measures: The Clinician Administered PTSD Scale for DSM-5 (CAPS-5) and the PTSD Checklist for DSM-5 (PCL-5). METHODS Childhood maltreatment predictors and 2 covariates, age and gender, were analysed in multivariate multilevel models as participants were nested within sites. A model selection procedure, in which all combinations of predictors were examined, was used to select a final set of predictors. RESULTS The results indicated that emotional abuse was the only trauma type that was significantly related to severity of PTSD and to the severity of specific PTSD symptom clusters (r between 0.130 and 0.338). The final models explained between 6.5% and 16.7% of the variance in PTSD severity. CONCLUSIONS The findings suggest that emotional abuse plays a more important role in Ch-PTSD than hitherto assumed, and that treatment should not neglect processing of childhood emotional abuse.
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Affiliation(s)
- Sophie A Rameckers
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands.
| | | | - Nathan Bachrach
- GGZ Oost Brabant, RINO Zuid and Tilburg University, Helmond, the Netherlands
| | - Christopher W Lee
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
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Vinke YD, Truijens F, van Polanen Petel E, van Emmerik AAP. The efficacy of a single imaginal exposure-writing assignment in reducing posttraumatic stress and depressive symptoms: A pilot study. J Clin Psychol 2019; 75:1519-1526. [PMID: 31141176 DOI: 10.1002/jclp.22802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 03/31/2019] [Accepted: 05/04/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This online study examined the effects of a single imaginal exposure-writing assignment on posttraumatic stress (PTS) and comorbid depressive symptoms. METHOD Forty-six participants with PTS were allocated to either a single imaginal exposure-writing assignment, a nontrauma writing assignment, or to a nonwriting control condition, and were reassessed 2 and 5 weeks after baseline. Of the 49 participants, 36 were female, with an average age of 23. Participation was conducted through Qualtrics. Effects were assessed with the Posttraumatic Diagnostic Scale (PDS) and the Beck Depression Inventory-II (BDI-II). RESULTS PTS and depressive symptoms decreased over time regardless of the study condition. CONCLUSIONS We found no support for the efficacy of a single imaginal exposure-writing assignment in reducing PTS or comorbid depressive symptoms. Suggestions are given for future studies that attempt to identify a minimal dose of imaginal exposure writing for PTS.
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Affiliation(s)
- Yvonne D Vinke
- HSK, Mental Health Care Institution, Lelystad, The Netherlands
| | - Femke Truijens
- Department of Psychology and Pedagogical Science, University of Ghent, Ghent, Belgium
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Affiliation(s)
| | - Kim de Jong
- Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Stefan G Hofmann
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
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van Emmerik AAP, Hamaker EL. Paint it Black: Using Change-Point Analysis to Investigate Increasing Vulnerability to Depression towards the End of Vincent van Gogh's Life. Healthcare (Basel) 2017; 5:healthcare5030053. [PMID: 28869542 PMCID: PMC5618181 DOI: 10.3390/healthcare5030053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 11/26/2022] Open
Abstract
This study investigated whether Vincent van Gogh became increasingly self-focused—and thus vulnerable to depression—towards the end of his life, through a quantitative analysis of his written pronoun use over time. A change-point analysis was conducted on the time series formed by the pronoun use in Van Gogh’s letters. We used time as a predictor to see whether there was evidence for increased self-focus towards the end of Van Gogh’s life, and we compared this to the pattern in the letters written before his move to Arles. Specifically, we examined Van Gogh’s use of first person singular pronouns (FPSP) and first person plural pronouns (FPPP) in the 415 letters he wrote while working as an artist before his move to Arles, and in the next 248 letters he wrote after his move to Arles until his death in Auvers-sur-Oise. During the latter period, Van Gogh’s use of FPSP showed an annual increase of 0.68% (SE = 0.15, p < 0.001) and his use of FPPP showed an annual decrease of 0.23% (SE = 0.04, p < 0.001), indicating increasing self-focus and vulnerability to depression. This trend differed from Van Gogh’s pronoun use in the former period (which showed no significant trend in FPSP, and an annual increase of FPPP of 0.03%, SE = 0.02, p = 0.04). This study suggests that Van Gogh’s death was preceded by a gradually increasing self-focus and vulnerability to depression. It also illustrates how existing methods (i.e., quantitative linguistic analysis and change-point analysis) can be combined to study specific research questions in innovative ways.
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Affiliation(s)
- Arnold A P van Emmerik
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, University of Amsterdam, Nieuwe Achtergracht 129, Amsterdam 1018 WS, The Netherlands.
| | - Ellen L Hamaker
- Department of Methodology and Statistics, Faculty and Social of Behavioural Sciences, Utrecht University, Padualaan 14, Utrecht 3584 CH, The Netherlands.
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Abstract
Although several hundreds of apps are available that (cl)aim to promote mindfulness, only a few methodologically sound studies have evaluated the efficacy of these apps. This randomized waiting-list controlled trial therefore tested the hypothesis that one such app (the VGZ Mindfulness Coach) can achieve immediate and long-term improvements of mindfulness, quality of life, general psychiatric symptoms, and self-actualization. One hundred ninety-one experimental participants received the VGZ Mindfulness Coach, which offers 40 mindfulness exercises and background information about mindfulness without any form of therapeutic guidance. Compared to 186 control participants, they reported large (Cohen’s d = 0.77) and statistically significant increases of mindfulness after 8 weeks and small-to-medium increases of the Observing, Describing, Acting with awareness, Nonjudging, and Nonreactivity mindfulness facets as measured with the Five Facet Mindfulness Questionnaire (Cohen’s d = 0.66, 0.26, 0.49, 0.34, and 0.43, respectively). Also, there were large decreases of general psychiatric symptoms (GHQ-12; Cohen’s d = −0.68) and moderate increases of psychological, social, and environmental quality of life (WHOQOL-BREF; Cohen’s d = 0.38, 0.38, and 0.36, respectively). Except for social quality of life, these gains were maintained for at least 3 months. We conclude that it is possible to achieve durable positive effects on mindfulness, general psychiatric symptoms, and several aspects of quality of life at low costs with smartphone apps for mindfulness such as the VGZ Mindfulness Coach.
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Affiliation(s)
- Arnold A P van Emmerik
- 1Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS Amsterdam, The Netherlands
| | - Fieke Berings
- Department of Quality and Innovation, Health Insurance Company VGZ, Nieuwe Stationsstraat 12, 6811 KS Arnhem, The Netherlands
| | - Jaap Lancee
- 1Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS Amsterdam, The Netherlands
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Bojahr LS, van Emmerik AAP. Traumatic events and trauma-related psychopathology in former drug cartel soldiers in Rio de Janeiro: A pilot study. Psychol Trauma 2016; 8:34-40. [PMID: 25793319 DOI: 10.1037/tra0000021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This pilot study investigated the occurrence of traumatic events and trauma-related psychopathology in former drug cartel soldiers (FDCS) in Rio de Janeiro. Furthermore, the authors examined the relationship between the number of traumatic events and symptom severity, and compared symptom severity in perpetrators versus victims of traumatic events. They found high exposure rates to traumatic events, with 83.5% of the FDCS (n = 97) and 57.9% of the controls (n = 95) having experienced more than 5 events. FDCS had higher mean scores for trauma exposure, posttraumatic stress (PTS), depressive symptoms, and general mental health problems, compared to controls. More FDCS than controls satisfied DSM-IV symptom criteria for posttraumatic stress disorder (36.4% vs. 15.8%) and reported severe depressive symptoms (25.8% vs. 8.3%). The number of traumatic events was strongly related to PTS among FDCS (r = .48). Furthermore, more FDCS than controls (23.7% vs. 10.5%) identified themselves as a perpetrator of 1 or more traumatic events. Among FDCS, perpetrators reported more PTS than victims. It is concluded that being a (former) drug cartel soldier is associated with elevated trauma exposure and severe trauma-related psychopathology.
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Affiliation(s)
- Lisa S Bojahr
- Department of Clinical Psychology, University of Amsterdam
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13
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Morina N, van Emmerik AAP, Andrews B, Brewin CR. Comparison of DSM-IV and proposed ICD-11 formulations of PTSD among civilian survivors of war and war veterans. J Trauma Stress 2014; 27:647-54. [PMID: 25418442 DOI: 10.1002/jts.21969] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 07/22/2014] [Accepted: 08/04/2014] [Indexed: 11/10/2022]
Abstract
The World Health Organization recently proposed a reformulation of posttraumatic stress disorder (PTSD) for the 11(th) edition of the International Classification of Diseases (ICD-11), employing only 6 symptoms. The aim of this study was to investigate the impact of this reformulation of PTSD as compared to criteria according to Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV; American Psychiatric Association, 1994) on the prevalence of current PTSD as well as comorbid major depressive episode and anxiety disorders other than PTSD. Study 1 involved previously collected interviews with 560 Kosovar civilian war survivors; Study 2 employed a previously collected sample of 142 British war veterans. Results revealed no change in the diagnostic status under the criteria proposed for ICD-11 in 87.5% of civilian war survivors and 91.5% of war veterans. Participants who only met the newly proposed criteria showed lower rates of comorbid major depressive episode than participants who only met DSM-IV criteria (13.6% vs. 43.8% respectively). Rates of comorbid anxiety disorders did not significantly differ between participants who lost or gained a PTSD diagnosis under the proposed criteria.
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Affiliation(s)
- Nexhmedin Morina
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
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14
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Truijens FL, van Emmerik AAP. Visual Feedback in Written Imaginal Exposure for Posttraumatic Stress: A Preliminary Study. Journal of Loss and Trauma 2014. [DOI: 10.1080/15325024.2013.794664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Normann N, van Emmerik AAP, Morina N. The efficacy of metacognitive therapy for anxiety and depression: a meta-analytic review. Depress Anxiety 2014; 31:402-11. [PMID: 24756930 DOI: 10.1002/da.22273] [Citation(s) in RCA: 157] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 03/14/2014] [Accepted: 03/18/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Metacognitive therapy (MCT) is a relatively new approach to treating mental disorders. The aim of the current meta-analysis was to examine the efficacy of MCT in patients with mental disorders. METHOD A comprehensive literature search revealed 16 published as well as unpublished studies on the efficacy of MCT, of which nine were controlled trials. These studies report on 384 participants suffering from anxiety or depression. Treatment efficacy was examined using a random effects model. RESULTS On primary outcome measures the aggregate within-group pre- to posttreatment and pretreatment to follow-up effect sizes for MCT were large (Hedges' g = 2.00 and 1.65, respectively). Within-group pre- to posttreatment changes in metacognitions were also large (Hedges' g = 1.18) and maintained at follow-up (Hedges' g = 1.31). Across the controlled trials, MCT was significantly more effective than both waitlist control groups (between-group Hedges' g = 1.81) as well as cognitive behavior therapy (CBT; between-group Hedges' g = 0.97). CONCLUSIONS Results suggest that MCT is effective in treating disorders of anxiety and depression and is superior compared to waitlist control groups and CBT, although the latter finding should be interpreted with caution. The implications of these findings are limited by small sample sizes and few active control conditions. Future studies should include larger sample sizes and also include comparisons of MCT with other empirically supported therapies.
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Affiliation(s)
- Nicoline Normann
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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van Emmerik AAP, Reijntjes A, Kamphuis JH. Writing therapy for posttraumatic stress: a meta-analysis. Psychother Psychosom 2013; 82:82-8. [PMID: 23295550 DOI: 10.1159/000343131] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 08/20/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Face-to-face psychological treatments have difficulty meeting today's growing mental health needs. For the highly prevalent posttraumatic stress (PTS) conditions, accumulating evidence suggests that writing therapy may constitute an efficient treatment modality, especially when administered through the Internet. We therefore conducted a meta-analysis to investigate the efficacy of writing therapies for PTS and comorbid depressive symptoms. METHODS The literature was searched using several structured and unstructured strategies, including key word searches of the PubMed, Web of Science, PsycINFO, and PILOTS databases. Six studies met eligibility criteria and were included in the analyses. These studies included a total of 633 participants, of which 304 were assigned to writing therapy. RESULTS Across 5 direct comparisons of writing therapy to waiting-list control, writing therapy resulted in significant and substantial short-term reductions in PTS and comorbid depressive symptoms. There was no difference in efficacy between writing therapy and trauma-focused cognitive behavioral therapy, but we caution that this finding was based on only 2 direct comparisons. CONCLUSIONS Writing therapy is an evidence-based treatment for PTS, and constitutes a useful treatment alternative for patients who do not respond to other evidence-based treatments. Internet adaptations of writing therapy for PTS may be especially useful for reaching trauma survivors in need of evidence-based mental health care who live in remote areas or who prefer to retain their anonymity.
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van Emmerik AAP, Kamphuis JH, Noordhof A, Emmelkamp PMG. Catch me if you can: do the five-factor model personality traits moderate dropout and acute treatment response in post-traumatic stress disorder patients? Psychother Psychosom 2012; 80:386-8. [PMID: 21968691 DOI: 10.1159/000329111] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 05/09/2011] [Indexed: 11/19/2022]
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Huijts I, Kleijn WC, van Emmerik AAP, Noordhof A, Smith AJM. Dealing with man-made trauma: the relationship between coping style, posttraumatic stress, and quality of life in resettled, traumatized refugees in the Netherlands. J Trauma Stress 2012; 25:71-8. [PMID: 22354510 DOI: 10.1002/jts.21665] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study investigated the relationship between coping style, posttraumatic stress disorder (PTSD) symptoms, and quality of life in traumatized refugees (N = 335). Participants had resettled in the Netherlands on average 13 years prior and were referred to a Dutch clinic for the treatment of posttraumatic psychopathology resulting from persecution, war, and violence. The majority (85%) of the research sample met diagnostic criteria for PTSD. Path analysis suggested a model in which PTSD symptoms (β = -.61, p < .001), social support seeking (β = .12, p < .05), and emotion-focused coping (β = .13, p < .01) have a direct effect on quality of life. The role of avoidant and problem-focused coping could be interpreted in 2 ways. Either these coping styles are influenced by PTSD severity and have no effect on quality of life, or these coping styles influence PTSD severity and therefore have an indirect effect on quality of life. Intervention strategies aimed at modifying coping strategies and decreasing PTSD symptoms could be important in improving the quality of life of traumatized refugees.
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Affiliation(s)
- Irene Huijts
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
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van Emmerik AAP, Kamphuis JH. Testing a DSM-5 reformulation of posttraumatic stress disorder: Impact on prevalence and comorbidity among treatment-seeking civilian trauma survivors. J Trauma Stress 2011; 24:213-7. [PMID: 21438018 DOI: 10.1002/jts.20630] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors investigated a recent reformulation (Brewin, Lanius, Novac, Schnyder, & Galea, 2009) of posttraumatic stress disorder (PTSD) in treatment-seeking civilian trauma survivors. Diagnostic data from a randomized controlled trial (N = 170) were subjected to the criteria according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994) and the Brewin criteria for PTSD. Results revealed no change in PTSD prevalence, though substantial but equal (13%) proportions of participants lost or gained a PTSD diagnosis under the Brewin criteria. Rates of comorbid depression and other anxiety disorders were consistently marginally lower under the Brewin criteria, but these differences did not reach significance in the authors' sample. It was concluded that the 8-item Brewin criteria for PTSD altered the diagnostic status of a substantial number of participants without influencing overall PTSD prevalence or comorbidity.
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van Emmerik AAP, Kamphuis JH, Emmelkamp PMG. Prevalence and prediction of re-experiencing and avoidance after elective surgical abortion: a prospective study. Clin Psychol Psychother 2009; 15:378-85. [PMID: 19115456 DOI: 10.1002/cpp.586] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study investigated short-term re-experiencing and avoidance after elective surgical abortion. In addition, it was prospectively investigated whether peritraumatic dissociation and pre-abortion dissociative tendencies and alexithymia predict re-experiencing and avoidance. METHOD In a prospective observational design, Dutch-speaking women presenting for first trimester elective surgical abortion completed self-report measures for dissociative tendency and alexithymia. Peritraumatic dissociation was measured immediately post-abortion. Re-experiencing and avoidance were measured 2 months post-abortion. RESULTS Participants reported moderately elevated levels of re-experiencing and avoidance that exceeded a clinical cut-off point for 19.4% of the participants. Peritraumatic dissociation predicted intrusion and avoidance at 2 months. In addition, avoidance was predicted by the alexithymic aspect of difficulty describing feelings. CONCLUSIONS Re-experiencing and avoidance after elective surgical abortion represent a significant clinical problem that is predicted by peritraumatic dissociation and alexithymia. Psychological screening and intervention might be a useful adjunct to elective abortion procedures.
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van Emmerik AAP, Kamphuis JH, Emmelkamp PMG. Treating acute stress disorder and posttraumatic stress disorder with cognitive behavioral therapy or structured writing therapy: a randomized controlled trial. Psychother Psychosom 2008; 77:93-100. [PMID: 18230942 DOI: 10.1159/000112886] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Writing assignments have shown promising results in treating traumatic symptomatology. Yet no studies have compared their efficacy to the current treatment of choice, cognitive behavior therapy (CBT). The present study evaluated the efficacy of structured writing therapy (SWT) and CBT as compared to a waitlist control condition in treating acute stress disorder (ASD) and posttraumatic stress disorder (PTSD). METHODS A randomized controlled trial was conducted at an outpatient clinic. Participants (n = 125) (a) satisfied DSM-IV criteria for ASD or PTSD, (b) were 16 years or older, (c) were sufficiently fluent in Dutch or English, (d) had no psychiatric problems except ASD or PTSD that would hinder participation or required alternative clinical care, and (e) received no concurrent psychotherapy. Treatment consisted of five 1.5-hour sessions of CBT or SWT for participants with ASD or acute PTSD and ten 1.5-hour sessions for participants with chronic PTSD. Outcome measures included the Structured Clinical Interview for DSM-IV, Impact of Event Scale, Beck Depression Inventory, State-Trait Anxiety Inventory and the Dissociative Experiences Scale. RESULTS At posttest and follow-up, treatment was associated with improved diagnostic status and lower levels of intrusive symptoms, depression and state anxiety, while a trend was noted for the reduction of avoidance symptoms. Treatment did not result in lower levels of trait anxiety or dissociation. No differences in efficacy were detected between CBT and SWT. CONCLUSIONS The present study confirmed the efficacy of CBT for ASD and PTSD and identified SWT as a promising alternative treatment.
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Verschuur MJ, Spinhoven P, van Emmerik AAP, Rosendaal FR. Participation in a trauma-focused epidemiological investigation may result in sensitization for current health problems. Soc Psychiatry Psychiatr Epidemiol 2008; 43:132-9. [PMID: 17968479 DOI: 10.1007/s00127-007-0278-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Accepted: 10/04/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Participation in health survey research may result in a worsening of self-assessed health status and enhanced service-use by increasing self-awareness of current health status. The present study investigated whether participation in a trauma-focused epidemiological study sensitized participants for health problems irrespective of trauma exposure. METHODS A total of 1,019 rescue workers and 453 residents involved in varying degrees in a large scale aviation disaster participated. Data collection took place between December 2000 and April 2003. There were two measurements: one during the epidemiological investigation at a general hospital and one 12 weeks after the first measurement. Follow-up data were gathered in 80% of a randomly selected group of rescue workers and in 62% of the residents. Main outcome measures were: health anxiety, somatic sensitivity, the tendency to be reassured by a physician, psychopathology, post-traumatic stress symptoms, fatigue and quality of life. RESULTS Both rescue workers and residents reported less reassurance, and increased health anxiety and somatic sensitivity 12 weeks after the investigation compared to the first measurement. Exposure to the aviation disaster was not predictive of these changes in health perception, but higher levels of psychological and physical symptoms at baseline were. Only 0.2-1.6% of the residents and rescue workers indicated at baseline that the investigation had had a very negative impact on their mental and/or physical well-being. No evidence for systematic trends or changes in baseline scores for anxiety about health or subjective complaints during the 15 months inclusion period were found. CONCLUSIONS Participation in an epidemiological study of the long-term sequelae of disaster exposure does not lead to very strong negative reactions in most of the participants, but can result in an increased awareness of somatic sensations, enhancement of health worries and lowered reassurability by physicians, especially in participants with higher levels of psychological and physical symptoms at baseline. Future studies are needed to investigate the temporal stability of these inadvertent and unobtrusive negative consequences.
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Affiliation(s)
- Margot J Verschuur
- Dept. of Psychology, Division of Clinical Health and Neuropsychology, Leiden University, Leiden, RB, The Netherlands.
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Abstract
BACKGROUND Despite conflicting research findings and uncertain efficacy, single session debriefing is standard clinical practice after traumatic events. We aimed to assess the efficacy of this intervention in prevention of chronic symptoms of post-traumatic stress disorder and other disorders after trauma. METHODS In a meta-analysis, we selected appropriate studies from databases (Medline Advanced, PsychINFO, and PubMed), the Journal of Traumatic Stress, and reference lists of articles and book chapters. Inclusion criteria were that single session debriefing had been done within 1 month after trauma, symptoms were assessed with widely accepted clinical outcome measures, and data from psychological assessments that had been done before (pretest data) and after (post-test data) interventions and were essential for calculation of effect sizes had been reported. We included seven studies in final analyses, in which there were five critical incident stress debriefing (CISD) interventions, three non-CISD interventions, and six no-intervention controls. FINDINGS Non-CISD interventions and no intervention improved symptoms of post-traumatic stress disorder, but CISD did not improve symptoms (weighted mean effect sizes 0.65 [95% CI 0.14-1.16], 0.47 [0.28-0.66], and 0.13 [-0.29 to 0.55], respectively). CISD did not improve natural recovery from other trauma-related disorders (0.12 [-0.22 to 0.47]). INTERPRETATION CISD and non-CISD interventions do not improve natural recovery from psychological trauma.
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