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Schreuder MJ, Schat E, Smit AC, Snippe E, Ceulemans E. Monitoring emotional intensity and variability to forecast depression recurrence in real time in remitted adults. J Consult Clin Psychol 2024:2024-65209-001. [PMID: 38512172 DOI: 10.1037/ccp0000871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
OBJECTIVE Recurrent depressive episodes are preceded by changing mean levels of repeatedly assessed emotions (e.g., feeling restless), which can be detected in real time using statistical process control (SPC). This study investigated whether monitoring changes in the standard deviation (SD) of emotions and negative thinking improves the early detection of recurrent depression. METHOD Formerly depressed adults (N = 41) monitored their emotions five times a day for 4 consecutive months. During the study, 22 individuals experienced recurrent depression. We used SPC to detect warning signs (i.e., changing means and SDs) of four emotions (positive and negative affect with high or low arousal) and negative thinking. RESULTS SD-based warning signs only preceded 23%-36% of recurrences, but almost never reflected a false alarm (0%-16%). Correspondingly, SD-based warnings had a high specificity (at the cost of sensitivity), while mean-based warnings had a higher sensitivity (but lower specificity). There was little overlap in mean- and SD-based warning signs. For the majority of emotions, monitoring for high SDs alongside monitoring changes in mean levels improved the detection of depression (p < .015) compared to when only monitoring for changing mean levels. CONCLUSIONS Warning signs for depression manifest not only in changing mean levels of emotions and cognitions but also in increasing SDs. These warnings could eventually be used to detect not just who is at increased risk for depression but also when risk is rising. Further research is needed to evaluate the clinical utility of depression SPC. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Marieke J Schreuder
- Faculty of Psychology and Educational Sciences, Katholieke Universiteit Leuven
| | - Evelien Schat
- Faculty of Psychology and Educational Sciences, Katholieke Universiteit Leuven
| | - Arnout C Smit
- Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam
| | - Evelien Snippe
- Interdisciplinary Center Psychopathology and Emotion Regulation, University Center for Psychiatry, University Medical Center Groningen, University of Groningen
| | - Eva Ceulemans
- Faculty of Psychology and Educational Sciences, Katholieke Universiteit Leuven
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Smit AC, Snippe E. Real-time monitoring of increases in restlessness to assess idiographic risk of recurrence of depressive symptoms. Psychol Med 2023; 53:5060-5069. [PMID: 35833374 PMCID: PMC10476069 DOI: 10.1017/s0033291722002069] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 07/30/2021] [Revised: 03/10/2022] [Accepted: 06/16/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND This confirmatory study aimed to examine whether we can foresee recurrence of depressive symptoms using personalized modeling of rises in restlessness. METHODS Participants were formerly depressed patients (N = 41) in remission who (gradually) discontinued antidepressants. Participants completed five smartphone-based Ecological Momentary Assessments (EMA) a day, for a period of 4 months, yielding a total of 21 180 observations. Statistical Process Control by means of Exponentially Weighted Moving Average (EWMA) control charts was used to detect rises in the EMA item 'I feel restless', for each individual separately. RESULTS An increase in restlessness was detected in 68.3% of the participants with recurring depressive symptoms, and in 26.3% of those who stayed in remission (Fisher's exact test p = 0.01, sensitivity was 68.3%, specificity was 73.7%). In the participants with a recurrence and an increase in restlessness, this increase could be detected in the prodromal phase of depression in 93.3% of the cases and at least a month before the onset of the core symptoms of depression in 66.7% of the cases. CONCLUSIONS Restlessness is a common prodromal symptom of depression. The sensitivity and specificity of the EWMA charts was at least as good as prognostic models based on cross-sectional patient characteristics. An advantage of the current idiographic method is that the EWMA charts provide real-time personalized insight in a within-person increase in early signs of depression, which is key to alert the right patient at the right time.
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Affiliation(s)
- Arnout C. Smit
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Faculty of Behavioral and Movement Sciences, Clinical Psychology, VU Amsterdam, Amsterdam, The Netherlands
| | - Evelien Snippe
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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3
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George SV, Kunkels YK, Smit A, Wichers M, Snippe E, van Roon AM, Riese H. Predicting recurrence of depression using cardiac complexity in individuals tapering antidepressants. Transl Psychiatry 2023; 13:182. [PMID: 37253734 DOI: 10.1038/s41398-023-02474-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 05/02/2023] [Accepted: 05/12/2023] [Indexed: 06/01/2023] Open
Abstract
It is currently unknown whether the complexity and variability of cardiac dynamics predicts future depression and whether within-subject change herein precedes the recurrence of depression. We tested this in an innovative repeated single-subject study in individuals who had a history of depression and were tapering their antidepressants. In 50 individuals, electrocardiogram (ECG) derived Interbeat-interval (IBI) time-series data were collected for 5 min every morning and evening, for 4 months. Usable data were obtained from 14 participants who experienced a transition (i.e., a clinically significant increase in depressive symptoms) and 14 who did not. The mean, standard deviation, Higuchi dimension and multiscale entropy, calculated from IBIs, were examined for time trends. These quantifiers were also averaged over a baseline period and compared between the groups. No consistent trends were observed in any quantifier before increases in depressive symptoms within individuals. The entropy baseline levels significantly differed between the two groups (morning: P value < 0.001, Cohen's d = -2.185; evening: P value < 0.001, Cohen's d = -1.797) and predicted the recurrence of depressive symptoms, in the current sample. Moreover, higher mean IBIs and Higuchi dimensions were observed in individuals who experienced transitions. While we found little evidence to support the existence of within- individual warning signals in IBI time-series data preceding an upcoming depressive transition, our results indicate that individuals who taper antidepressants and showed lower entropy of cardiac dynamics exhibited a higher chance of recurrence of depression. Hence, entropy could be a potential digital phenotype for assessing the risk of recurrence of depression in the short term while tapering antidepressants.
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Affiliation(s)
- Sandip V George
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- Department of Computer Science, University College London, London, UK.
| | - Yoram K Kunkels
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arnout Smit
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marieke Wichers
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Evelien Snippe
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arie M van Roon
- Department of Vascular Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harriëtte Riese
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Bos FM, van der Krieke L, Wichers M, Bruggeman R, Snippe E. [Ecological momentary assessment as a clinical tool in psychiatry: promises, pitfalls, and possibilities]. Tijdschr Psychiatr 2023; 65:54-59. [PMID: 36734692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ecological momentary assessment (EMA) is a promising method to gain insight into the daily lives of people with mental disorders. EMA can be used to monitor mood, symptoms, and experiences multiple times per day. Using advanced statistical methods, such as network analysis, as EMA feedback might result in novel insights that are relevant to psychiatric care. AIM To investigate the promise, pitfalls, and possibilities of EMA and network analysis for psychiatric care. METHOD Empirical network studies, reviews, and qualitative research were employed to investigate the state of research and the perspectives of patients and clinicians on EMA and network analysis. Furthermore, an empirical study will be discussed, in which twenty patients with bipolar disorders completed five EMA diaries per day for four months within treatment. RESULTS Studies using network analysis demonstrated conflicting results. Qualitative research indicated that bipolar patients and clinicians are aware of the added benefit of EMA for psychiatric care, especially for improving insight and self-management. At the same time, EMA was seen as burdensome. Personalization and integration with existing treatment protocols emerged as necessary requirements for adequate implementation of EMA in psychiatric care. CONCLUSION EMA can have added value for psychiatric care, provided it is adequately implemented. BACKGROUND Ecological momentary assessment (EMA) is a promising method to gain insight into the daily lives of people with mental disorders. EMA can be used to monitor mood, symptoms, and experiences multiple times per day. Using advanced statistical methods, such as network analysis, as EMA feedback might result in novel insights that are relevant to psychiatric care. AIM To investigate the promise, pitfalls, and possibilities of EMA and network analysis for psychiatric care. METHOD Empirical network studies, reviews, and qualitative research were employed to investigate the state of research and the perspectives of patients and clinicians on EMA and network analysis. Furthermore, an empirical study will be discussed, in which twenty patients with bipolar disorders completed five EMA diaries per day for four months within treatment. RESULTS Studies using network analysis demonstrated conflicting results. Qualitative research indicated that bipolar patients and clinicians are aware of the added benefit of EMA for psychiatric care, especially for improving insight and self-management. At the same time, EMA was seen as burdensome. Personalization and integration with existing treatment protocols emerged as necessary requirements for adequate implementation of EMA in psychiatric care. CONCLUSION EMA can have added value for psychiatric care, provided it is adequately implemented.
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Snippe E, Smit AC, Kuppens P, Burger H, Ceulemans E. Recurrence of depression can be foreseen by monitoring mental states with statistical process control. J Psychopathol Clin Sci 2023; 132:145-155. [PMID: 36808958 DOI: 10.1037/abn0000812] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Detecting early signs of recurrence of psychopathology is key for prevention and treatment. Personalized risk assessment is especially relevant for formerly depressed patients, for whom recurrence is common. We aimed to examine whether recurrence of depression can be accurately foreseen by applying Exponentially Weighted Moving Average (EWMA) statistical process control charts to Ecological Momentary Assessment (EMA) data. Participants were formerly depressed patients (n = 41) in remission who (gradually) discontinued antidepressants. Participants completed five smartphone-based EMA questionnaires a day for 4 months. EWMA control charts were used to prospectively detect structural mean shifts in high and low arousal negative affect (NA), high and low arousal positive affect (PA), and repetitive negative thinking in each individual. A significant increase in repetitive negative thinking (worry, negative thoughts about the self) was the most sensitive early sign of recurrence: this was detected in 18 out of 22 patients (82%) before recurrence and in 8 out of 19 patients (42%) who stayed in remission. A significant increase in NA high arousal (stress, irritation, restlessness) was the most specific early sign of recurrence: this was detected in 10 out of 22 patients (45%) before recurrence and in 2 out of 19 patients (11%) who stayed in remission. These mean changes were detected at least a month before recurrence in the majority of the participants. The outcomes were robust across EWMA parameter choices, but not when using fewer observations per day. The findings demonstrate the value of monitoring EMA data with EWMA charts for detecting prodromal symptoms of depression in real-time. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Evelien Snippe
- University Medical Center Groningen, University of Groningen
| | - Arnout C Smit
- University Medical Center Groningen, University of Groningen
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Helmich MA, Wichers M, Peeters F, Snippe E. Daily dynamics of negative affect: indicators of rate of response to treatment and remission from depression? Cogn Emot 2022; 36:1594-1604. [PMID: 36175174 DOI: 10.1080/02699931.2022.2129593] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
More instability (MSSD) and variability (SD) of negative affect (NA) have been related to current and future depressive symptoms. We investigated whether NA instability and variability were predictive of the rate of symptom improvement during treatment and of reaching remission status. Forty-six individuals with major depressive disorder completed six days of ecological momentary assessments (10 beeps/day) before starting a combination of pharmacotherapy and supportive therapy. During and after treatment, the Hamilton Depression Rating Scale (HDRS) diagnostic interview was performed monthly for 18 months. The rate of change in HDRS scores over five months (during treatment) and remission status (HDRS ≤ 7) over eighteen months were predicted by the SD, MSSD and Mean of NA, and relevant baseline predictors. Higher Mean NA and baseline symptom severity, but not NA variability or instability, predicted stronger depressive symptom reduction during treatment. Higher odds of remitting were only associated with lower Mean NA. Higher mean NA may indicate more room for improvement and thus for a steeper rate of symptom change, while lower mean NA levels may imply that remission status is more readily reached. To resolve the inconclusive findings for instability and variability as predictors of symptom improvement replication in larger samples is required.
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Affiliation(s)
- Marieke A Helmich
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marieke Wichers
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frenk Peeters
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Evelien Snippe
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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7
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Bos FM, von Klipstein L, Emerencia AC, Veermans E, Verhage T, Snippe E, Doornbos B, Hadders-Prins G, Wichers M, Riese H. A Web-Based Application for Personalized Ecological Momentary Assessment in Psychiatric Care: User-Centered Development of the PETRA Application. JMIR Ment Health 2022; 9:e36430. [PMID: 35943762 PMCID: PMC9399881 DOI: 10.2196/36430] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/11/2022] [Accepted: 05/06/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Smartphone self-monitoring of mood, symptoms, and contextual factors through ecological momentary assessment (EMA) provides insights into the daily lives of people undergoing psychiatric treatment. Therefore, EMA has the potential to improve their care. To integrate EMA into treatment, a clinical tool that helps clients and clinicians create personalized EMA diaries and interpret the gathered data is needed. OBJECTIVE This study aimed to develop a web-based application for personalized EMA in specialized psychiatric care in close collaboration with all stakeholders (ie, clients, clinicians, researchers, and software developers). METHODS The participants were 52 clients with mood, anxiety, and psychotic disorders and 45 clinicians (psychiatrists, psychologists, and psychiatric nurses). We engaged them in interviews, focus groups, and usability sessions to determine the requirements for an EMA web application and repeatedly obtained feedback on iteratively improved high-fidelity EMA web application prototypes. We used human-centered design principles to determine important requirements for the web application and designed high-fidelity prototypes that were continuously re-evaluated and adapted. RESULTS The iterative development process resulted in Personalized Treatment by Real-time Assessment (PETRA), which is a scientifically grounded web application for the integration of personalized EMA in Dutch clinical care. PETRA includes a decision aid to support clients and clinicians with constructing personalized EMA diaries, an EMA diary item repository, an SMS text message-based diary delivery system, and a feedback module for visualizing the gathered EMA data. PETRA is integrated into electronic health record systems to ensure ease of use and sustainable integration in clinical care and adheres to privacy regulations. CONCLUSIONS PETRA was built to fulfill the needs of clients and clinicians for a user-friendly and personalized EMA tool embedded in routine psychiatric care. PETRA is unique in this codevelopment process, its extensive but user-friendly personalization options, its integration into electronic health record systems, its transdiagnostic focus, and its strong scientific foundation in the design of EMA diaries and feedback. The clinical effectiveness of integrating personalized diaries via PETRA into care requires further research. As such, PETRA paves the way for a systematic investigation of the utility of personalized EMA for routine mental health care.
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Affiliation(s)
- Fionneke M Bos
- Rob Giel Research Center, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Lino von Klipstein
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ando C Emerencia
- Research Support, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Erwin Veermans
- Rob Giel Research Center, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Tom Verhage
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Evelien Snippe
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Grietje Hadders-Prins
- Rob Giel Research Center, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Marieke Wichers
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Harriëtte Riese
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Zuidersma M, Müller F, Snippe E, Zuidema SU, Oude Voshaar RC. Feasibility, usability and clinical value of intensive longitudinal diary assessments in older persons with cognitive impairment and depressive symptoms. Aging Ment Health 2022:1-10. [PMID: 35876158 DOI: 10.1080/13607863.2022.2102143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 11/01/2022]
Abstract
OBJECTIVES To evaluate the feasibility, usability and clinical value of daily diary assessments combined with actigraphy in older persons with cognitive impairment. METHODS For 63 days, patients ≥60 years with cognitive impairments filled out a daily diary (including standardized questionnaires and cognitive test battery), and wore an actiwatch (sleep). After the study, participants and clinicians received personal feedback about patterns and daily triggers of depressive symptoms, sleep and cognitive performance. We assessed feasibility (participation rate, compliance and subjective burden), usability (variability and floor- or ceiling effects) and clinical value for patients and their clinicians (questionnaires). RESULTS Of 96 eligible patients, 13 agreed to participate (13.5%). One patient dropped out after 2 days, another after 37 days, and another did not complete the cognitive test battery. Compliance rate was high (6.7-10% missing values). Subjective burden was relatively low. Time-series data showed sufficient variability and no floor- or ceiling effects, except for one relevant ceiling effect on the One Back task. The personal feedback report was considered insightful by 4 out of 11 participants and 5 out of 7 clinicians. CONCLUSION Daily assessments are suitable for a minority of cognitively impaired older persons, but is helpful to increase insight into their symptoms.
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Affiliation(s)
- Marij Zuidersma
- Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Fabiola Müller
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Evelien Snippe
- Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Richard C Oude Voshaar
- Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Bos FM, Schreuder MJ, George SV, Doornbos B, Bruggeman R, van der Krieke L, Haarman BCM, Wichers M, Snippe E. Anticipating manic and depressive transitions in patients with bipolar disorder using early warning signals. Int J Bipolar Disord 2022; 10:12. [PMID: 35397076 PMCID: PMC8994809 DOI: 10.1186/s40345-022-00258-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 03/01/2022] [Indexed: 11/30/2022] Open
Abstract
Background In bipolar disorder treatment, accurate episode prediction is paramount but remains difficult. A novel idiographic approach to prediction is to monitor generic early warning signals (EWS), which may manifest in symptom dynamics. EWS could thus form personalized alerts in clinical care. The present study investigated whether EWS can anticipate manic and depressive transitions in individual patients with bipolar disorder. Methods Twenty bipolar type I/II patients (with ≥ 2 episodes in the previous year) participated in ecological momentary assessment (EMA), completing five questionnaires a day for four months (Mean = 491 observations per person). Transitions were determined by weekly completed questionnaires on depressive (Quick Inventory for Depressive Symptomatology Self-Report) and manic (Altman Self-Rating Mania Scale) symptoms. EWS (rises in autocorrelation at lag-1 and standard deviation) were calculated in moving windows over 17 affective and symptomatic EMA states. Positive and negative predictive values were calculated to determine clinical utility. Results Eleven patients reported 1–2 transitions. The presence of EWS increased the probability of impending depressive and manic transitions from 32-36% to 46–48% (autocorrelation) and 29–41% (standard deviation). However, the absence of EWS could not be taken as a sign that no transition would occur in the near future. The momentary states that indicated nearby transitions most accurately (predictive values: 65–100%) were full of ideas, worry, and agitation. Large individual differences in the utility of EWS were found. Conclusions EWS show theoretical promise in anticipating manic and depressive transitions in bipolar disorder, but the level of false positives and negatives, as well as the heterogeneity within and between individuals and preprocessing methods currently limit clinical utility. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-022-00258-4.
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Affiliation(s)
- Fionneke M Bos
- Department of Psychiatry, Rob Giel Research Center, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands. .,Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Marieke J Schreuder
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sandip V George
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Computer Science , University College London , London, United Kingdom
| | - Bennard Doornbos
- Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands
| | - Richard Bruggeman
- Department of Psychiatry, Rob Giel Research Center, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Lian van der Krieke
- Department of Psychiatry, Rob Giel Research Center, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.,Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bartholomeus C M Haarman
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marieke Wichers
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Evelien Snippe
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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10
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Snippe E, Doornbos B, Schoevers RA, Wardenaar KJ, Wichers M. Individual and common patterns in the order of symptom improvement during outpatient treatment for major depression. J Affect Disord 2021; 290:81-88. [PMID: 33993084 DOI: 10.1016/j.jad.2021.04.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/28/2019] [Revised: 02/19/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Research so far provided few clues on the order in which depressive symptoms typically remit during treatment. This study examined which depressive symptoms improve first, and whether symptoms changed before, simultaneous with, or after the core symptoms of depression (i.e., sad mood, loss of pleasure, and loss of interest). METHODS Participants were 176 patients with Major Depressive Disorder (MDD) receiving outpatient treatment (a combination of pharmacotherapy and psychological interventions) for depression. Participants filled out the Inventory of Depressive Symptomatology - Self Report (IDS-SR) for 16 to 20 consecutive weeks. For each symptom, the timing of onset of a persistent improvement was determined for each single-subject separately. RESULTS Which symptoms improved first differed markedly across patients. The core depression symptoms improved 1.5 to 2 times more often before (48% - 60%) than after (19% -28%) depressive cognitions ('view of myself' and 'view of the future'), anxiety symptoms ('feeling irritable' and 'feeling anxious / tense') and vegetative symptoms ('loss of energy', 'slowed down', and 'physical energy'). Only improvements in suicidal thoughts were more likely to occur before (46% - 48%) than after (29%) improvements in the depression core symptoms. LIMITATIONS Not all 'core depression-non-core symptom' combinations could be tested because some symptoms did not improve in a sufficient number of patients. CONCLUSIONS Which improvements mark the start of symptom remission differed between patients. Improvements in the core depression symptoms 'sad mood', 'loss of interest', and 'loss of pleasure' were more likely to occur before than after improvements in non-core symptoms.
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Affiliation(s)
- Evelien Snippe
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands.
| | - Bennard Doornbos
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands; GGZ Drenthe Mental Health Institute, Department Affective disorders, Assen, The Netherlands
| | - Robert A Schoevers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands; GGZ Drenthe Mental Health Institute, Department Affective disorders, Assen, The Netherlands
| | - Klaas J Wardenaar
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
| | - Marieke Wichers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
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Bos F, Schreuder M, Doornbos B, Snippe E, Bruggeman R, Van Der Krieke L, Haarman B, Wichers M, George S. Prospective early warning signals to detect transitions to manic and depressive episodes in bipolar disorder. Eur Psychiatry 2021. [PMCID: PMC9471093 DOI: 10.1192/j.eurpsy.2021.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction For patients with bipolar disorder, early recognition of impending mood episodes is crucial to enable timely intervention. Longitudinal digital mood monitoring using ecological momentary assessment (EMA) enable prospective study of early warning signals (EWS) in momentary affective estates prior to symptom transitions. Objectives The present study examined in a unique longitudinal EMA data set whether EWS prospectively signal transitions to manic or depressive episodes. Methods Twenty bipolar type I/II patients completed EMA questionnaires five times a day for four months (average 491 observations per person), as well as weekly symptom questionnaires concerning depressive (Quick Inventory for Depressive Symptomatology) and manic (Altman Self-Rating Mania Scale) symptoms. Weekly data was used to determine transitions (i.e., abrupt increase in symptoms). Prior to these transitions, EWS (autocorrelation at lag-1 and standard deviation) were calculated in moving windows over 17 affective EMA states. Kendall’s tau was calculated to detect significant rises in the EWS indicator prior to the transition. Results Eleven patients reported one or two transitions to a mood episode. All transitions were preceded by at least one EWS. Average sensitivity for detecting EWS was slightly higher for manic episodes (36%) than for depressive episodes (25%). For manic episodes, EWS in thoughts racing, being full of ideas, and feeling agitated showed the highest sensitivity and specificity, whereas for depression, only feeling tired showed high sensitivity and specify. Conclusions EWS show promise in anticipating transitions to mood episodes in bipolar disorder. Further investigation is warranted. Disclosure No significant relationships.
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Wichers M, Smit AC, Snippe E. Early Warning Signals Based on Momentary Affect Dynamics can Expose Nearby Transitions in Depression: A Confirmatory Single-Subject Time-Series Study. J Pers Oriented Res 2021; 6:1-15. [PMID: 33569148 PMCID: PMC7842626 DOI: 10.17505/jpor.2020.22042] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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] [Indexed: 11/20/2022] Open
Abstract
Background In complex systems early warning signals such as rising autocorrelation, variance and network connectivity are hypothesized to anticipate relevant shifts in a system. For direct evidence hereof in depression, designs are needed in which early warning signals and symptom transitions are prospectively assessed within an individual. Therefore, this study aimed to detect personalized early warning signals preceding the occurrence of a major symptom transition. Methods Six single-subject time-series studies were conducted, collecting frequent observations of momentary affective states during a time-period when participants were at increased risk of a symptom transition. Momentary affect states were reported three times a day over three to six months (95-183 days). Depressive symptoms were measured weekly using the Symptom CheckList-90. Presence of sudden symptom transitions was assessed using change point analysis. Early warning signals were analysed using moving window techniques. Results As change point analysis revealed a significant and sudden symptom transition in one participant in the studied period, early warning signals were examined in this person. Autocorrelation (r=0·51; p<2.2e-16), and variance (r=0·53; p<2.2e-16) in ‘feeling down’, and network connectivity (r=0·42; p<2.2e-16) significantly increased a month before this transition occurred. These early warnings also preceded the rise in absolute levels of ‘feeling down’ and the participant’s personal indication of risk for transition. Conclusions This study replicated the findings of a previous study and confirmed the presence of rising early warning signals a month before the symptom transition occurred. Results show the potential of early warning signals to improve personalized risk assessment in the field of psychiatry.
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Affiliation(s)
- Marieke Wichers
- University of Groningen, University Medical Center Groningen (UMCG), Dept. of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands
| | - Arnout C Smit
- University of Groningen, University Medical Center Groningen (UMCG), Dept. of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands
| | - Evelien Snippe
- University of Groningen, University Medical Center Groningen (UMCG), Dept. of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands
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Wichers M, Riese H, Hodges TM, Snippe E, Bos FM. A Narrative Review of Network Studies in Depression: What Different Methodological Approaches Tell Us About Depression. Front Psychiatry 2021; 12:719490. [PMID: 34777038 PMCID: PMC8581034 DOI: 10.3389/fpsyt.2021.719490] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
The network theory of psychopathology proposes that mental disorders arise from direct interactions between symptoms. This theory provides a promising framework to understand the development and maintenance of mental disorders such as depression. In this narrative review, we summarize the literature on network studies in the field of depression. Four methodological network approaches are distinguished: (i) studies focusing on symptoms at the macro-level vs. (ii) on momentary states at the micro-level, and (iii) studies based on cross-sectional vs. (iv) time-series (dynamic) data. Fifty-six studies were identified. We found that different methodological approaches to network theory yielded largely inconsistent findings on depression. Centrality is a notable exception: the majority of studies identified either positive affect or anhedonia as central nodes. To aid future research in this field, we outline a novel complementary network theory, the momentary affect dynamics (MAD) network theory, to understand the development of depression. Furthermore, we provide directions for future research and discuss if and how networks might be used in clinical practice. We conclude that more empirical network studies are needed to determine whether the network theory of psychopathology can indeed enhance our understanding of the underlying structure of depression and advance clinical treatment.
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Affiliation(s)
- Marieke Wichers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, Netherlands
| | - Harriëtte Riese
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, Netherlands
| | - Taylor M Hodges
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, Netherlands
| | - Evelien Snippe
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, Netherlands
| | - Fionneke M Bos
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, Netherlands.,University of Groningen, University Medical Center Groningen, Department of Psychiatry, Rob Giel Research Center, Groningen, Netherlands
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14
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Ghafoerkhan RS, van Heemstra HE, Scholte WF, van der Kolk JRJ, ter Heide JJF, de la Rie SM, Verhaak LM, Snippe E, Boelen PA. Correction to: Feasibility and predictors of change of narrative exposure therapy for displaced populations: a repeated measures design. Pilot Feasibility Stud 2020; 6:110. [PMID: 32774877 PMCID: PMC7398339 DOI: 10.1186/s40814-020-00651-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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15
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Bos FM, Snippe E, Bruggeman R, Doornbos B, Wichers M, van der Krieke L. Recommendations for the use of long-term experience sampling in bipolar disorder care: a qualitative study of patient and clinician experiences. Int J Bipolar Disord 2020; 8:38. [PMID: 33258015 PMCID: PMC7704990 DOI: 10.1186/s40345-020-00201-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/08/2020] [Indexed: 11/10/2022] Open
Abstract
Background Self-monitoring has been shown to improve the self-management and treatment of patients with bipolar disorder. However, current self-monitoring methods are limited to once-daily retrospectively assessed mood, which may not suit the rapid mood fluctuations in bipolar disorder. The experience sampling method (ESM), which assesses mood in real-time several times a day, may overcome these limitations. This study set out to assess the experiences of patients and clinicians with the addition of ESM monitoring, real-time alerts, and personalized feedback to clinical care. Participants were twenty patients with bipolar disorder type I/II and their clinicians. For four months, patients completed five ESM assessments per day on mood, symptoms, and activities. Weekly symptom questionnaires alerted patients and clinicians to potential episodes. After the monitoring, a personalized feedback report based on the patient’s data was discussed between patient and clinician. Three months later, patient and clinician were both interviewed. Results Thematic analysis of the transcripts resulted in four themes: perceived effects of the monitoring, alerts, and feedback, and recommendations for implementation of ESM. ESM was perceived as helping patients to cope better with their disorder by increasing awareness, offering new insights, and encouraging life style adjustments. ESM was further believed to facilitate communication between patient and clinician and to lead to new treatment directions. However, high assessment burden and pre-occupation with negative mood and having a disorder were also described. Patients and clinicians advocated for increased personalization and embedding of ESM in care. Conclusions This study demonstrates that long-term ESM monitoring, alerts, and personalized feedback are perceived as beneficial to the treatment and self-management of patients with bipolar disorder. Future research should further test the clinical utility of ESM. Clinically relevant feedback and technology need to be developed to enable personalized integration of ESM in clinical care.
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Affiliation(s)
- Fionneke M Bos
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands. .,Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Evelien Snippe
- Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Bennard Doornbos
- Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Outpatient Clinics, Assen, The Netherlands
| | - Marieke Wichers
- Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lian van der Krieke
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.,Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Abstract
Scientific evidence in the field of psychiatry is mainly derived from group-based ("nomothetic") studies that yield group-aggregated results, while often the need is to answer questions that apply to individuals. Particularly in the presence of great inter-individual differences and temporal complexities, information at the individual-person level may be valuable for personalized treatment decisions, individual predictions and diagnostics. The single-subject study design can be used to make inferences about individual persons. Yet, the single-subject study is not often used in the field of psychiatry. We believe that this is because of a lack of awareness of its value rather than a lack of usefulness or feasibility. In the present paper, we aimed to resolve some common misconceptions and beliefs about single-subject studies by discussing some commonly heard "facts and fictions." We also discuss some situations in which the single-subject study is more or less appropriate, and the potential of combining single-subject and group-based study designs into one study. While not intending to plea for single-subject studies at the expense of group-based studies, we hope to increase awareness of the value of single-subject research by informing the reader about several aspects of this design, resolving misunderstanding, and providing references for further reading.
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Affiliation(s)
- Marij Zuidersma
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Harriëtte Riese
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Evelien Snippe
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sanne H. Booij
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Developmental Psychology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Marieke Wichers
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Elisabeth H. Bos
- Department of Developmental Psychology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, Netherlands
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17
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Bastiaansen JA, Kunkels YK, Blaauw FJ, Boker SM, Ceulemans E, Chen M, Chow SM, de Jonge P, Emerencia AC, Epskamp S, Fisher AJ, Hamaker EL, Kuppens P, Lutz W, Meyer MJ, Moulder R, Oravecz Z, Riese H, Rubel J, Ryan O, Servaas MN, Sjobeck G, Snippe E, Trull TJ, Tschacher W, van der Veen DC, Wichers M, Wood PK, Woods WC, Wright AGC, Albers CJ, Bringmann LF. Time to get personal? The impact of researchers choices on the selection of treatment targets using the experience sampling methodology. J Psychosom Res 2020; 137:110211. [PMID: 32862062 PMCID: PMC8287646 DOI: 10.1016/j.jpsychores.2020.110211] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/15/2020] [Accepted: 07/31/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE One of the promises of the experience sampling methodology (ESM) is that a statistical analysis of an individual's emotions, cognitions and behaviors in everyday-life could be used to identify relevant treatment targets. A requisite for clinical implementation is that outcomes of such person-specific time-series analyses are not wholly contingent on the researcher performing them. METHODS To evaluate this, we crowdsourced the analysis of one individual patient's ESM data to 12 prominent research teams, asking them what symptom(s) they would advise the treating clinician to target in subsequent treatment. RESULTS Variation was evident at different stages of the analysis, from preprocessing steps (e.g., variable selection, clustering, handling of missing data) to the type of statistics and rationale for selecting targets. Most teams did include a type of vector autoregressive model, examining relations between symptoms over time. Although most teams were confident their selected targets would provide useful information to the clinician, not one recommendation was similar: both the number (0-16) and nature of selected targets varied widely. CONCLUSION This study makes transparent that the selection of treatment targets based on personalized models using ESM data is currently highly conditional on subjective analytical choices and highlights key conceptual and methodological issues that need to be addressed in moving towards clinical implementation.
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Affiliation(s)
- Jojanneke A Bastiaansen
- Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands; Department of Education and Research, Friesland Mental Health Care Services, Leeuwarden, the Netherlands
| | - Yoram K Kunkels
- Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
| | - Frank J Blaauw
- Department of Psychology, University of Groningen, Groningen, the Netherlands; Distributed Systems group, Faculty of Science and Engineering, University of Groningen, Groningen, the Netherlands
| | - Steven M Boker
- Department of Psychology, University of Virginia, Charlottesville, USA
| | - Eva Ceulemans
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Meng Chen
- Department of Human Development and Family Studies, Pennsylvania State University, State College, USA
| | - Sy-Miin Chow
- Department of Human Development and Family Studies, Pennsylvania State University, State College, USA
| | - Peter de Jonge
- Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands; Department of Psychology, University of Groningen, Groningen, the Netherlands
| | - Ando C Emerencia
- Department of Psychology, University of Groningen, Groningen, the Netherlands
| | - Sacha Epskamp
- Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Aaron J Fisher
- Department of Psychology, University of California Berkeley, Berkeley, USA
| | - Ellen L Hamaker
- Department of Methodology and Statistics, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands
| | - Peter Kuppens
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Wolfgang Lutz
- Department of Psychology, University of Trier, Trier, Germany
| | - M Joseph Meyer
- Department of Psychology, University of Virginia, Charlottesville, USA
| | - Robert Moulder
- Department of Psychology, University of Virginia, Charlottesville, USA
| | - Zita Oravecz
- Department of Human Development and Family Studies, Pennsylvania State University, State College, USA
| | - Harriëtte Riese
- Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
| | - Julian Rubel
- Department of Psychology, Justus-Liebig-University Giessen, Germany
| | - Oisín Ryan
- Department of Methodology and Statistics, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands
| | - Michelle N Servaas
- Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
| | - Gustav Sjobeck
- Department of Psychology, University of Virginia, Charlottesville, USA
| | - Evelien Snippe
- Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
| | - Timothy J Trull
- Department of Psychological Sciences, University of Missouri, Columbia, USA
| | - Wolfgang Tschacher
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Date C van der Veen
- Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
| | - Marieke Wichers
- Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
| | - Phillip K Wood
- Department of Psychological Sciences, University of Missouri, Columbia, USA
| | - William C Woods
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA
| | - Aidan G C Wright
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA
| | - Casper J Albers
- Department of Psychology, University of Groningen, Groningen, the Netherlands
| | - Laura F Bringmann
- Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands; Department of Psychology, University of Groningen, Groningen, the Netherlands.
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18
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Geraets CNW, Snippe E, van Beilen M, Pot-Kolder RMCA, Wichers M, van der Gaag M, Veling W. Virtual reality based cognitive behavioral therapy for paranoia: Effects on mental states and the dynamics among them. Schizophr Res 2020; 222:227-234. [PMID: 32527676 DOI: 10.1016/j.schres.2020.05.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/06/2019] [Revised: 03/31/2020] [Accepted: 05/18/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Negative affective processes may contribute to maintenance of paranoia in patients with psychosis, and vice versa. Successful treatment may break these pathological symptom networks. This study examined whether treatment with virtual reality based cognitive behavioral therapy (VR-CBT) for paranoia influences momentary affective states, and whether VR-CBT changes the adverse interplay between affective states and paranoia. METHODS Patients with a psychotic disorder (n = 91) were randomized to 16-session VR-CBT or treatment as usual (TAU). With the experience sampling method (structured diary technique) mental states were assessed for 6-10 days at baseline, posttreatment and 6-month follow-up. Multilevel analysis were performed to establish treatment effects and time-lagged associations between mental states, that were visualized with networks of mental states. RESULTS Average levels of paranoia (feeling suspicious [b = -032., p = .04], disliked [b = -49., p < .01] and hurt [b = -0.52, p < .01]) and negative affect (anxious [b = -0.37, p = .01], down [b = -0.33, p = .04] and insecure [b = -0.17, p = .03) improved more after VR-CBT than TAU, but positive affect did not. Baseline mental state networks had few significant connections, with most stable connections being autocorrelations of mental states. The interplay between affective states and paranoia did not change in response to treatment. A trend reduction in average intranode connections (autocorrelations) was found after VR-CBT (b = -0.07, p = .08), indicating that mental states reinforce themselves less after treatment. CONCLUSIONS VR-CBT reduced paranoid symptoms and lowered levels of negative affect in daily life, but did not affect the extent to which mental states influenced each other. Findings do suggest that as a result of treatment mental states regain flexibility.
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Affiliation(s)
- Chris N W Geraets
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, the Netherlands.
| | - Evelien Snippe
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), the Netherlands
| | - Marije van Beilen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, the Netherlands
| | - Roos M C A Pot-Kolder
- Parnassia Psychiatric Institute, The Hague, the Netherlands; VU University and Amsterdam Public Mental Health research institute, Department of Clinical Psychology, Amsterdam, the Netherlands
| | - Marieke Wichers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), the Netherlands
| | - Mark van der Gaag
- Parnassia Psychiatric Institute, The Hague, the Netherlands; VU University and Amsterdam Public Mental Health research institute, Department of Clinical Psychology, Amsterdam, the Netherlands
| | - Wim Veling
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, the Netherlands; Parnassia Psychiatric Institute, The Hague, the Netherlands; Maastricht University, Department of Psychiatry and Neuropsychology, Maastricht, the Netherlands
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19
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Ghafoerkhan RS, van Heemstra HE, Scholte WF, van der Kolk JRJ, ter Heide JJF, de la Rie SM, Verhaak LM, Snippe E, Boelen PA. Feasibility and predictors of change of narrative exposure therapy for displaced populations: a repeated measures design. Pilot Feasibility Stud 2020; 6:69. [PMID: 32477587 PMCID: PMC7243314 DOI: 10.1186/s40814-020-00613-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/04/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Displaced victims of interpersonal violence, such as refugees, asylum seekers, and victims of sexual exploitation, are growing in numbers and are often suffering from a post-traumatic stress disorder (PTSD). At the same time, these victims are known to benefit less from trauma-focused therapy (TFT) and to be less compliant to treatment. The objective of this paper is to describe the rationale and research protocol of an ongoing trial that aims to evaluate different variables that might influence the feasibility of TFT for the study population. Specifically, perceived daily stress, emotion regulation, and mood are investigated as predictors of change in PTSD symptoms during a trauma-focused therapy (narrative exposure therapy (NET)). The feasibility of administering measures tapping these constructs repeatedly during treatment will also be evaluated. METHODS/DESIGN Using an observational treatment design, 80 displaced victims of interpersonal violence will be measured before, during, and after partaking in NET. Several questionnaires tapping PTSD plus the aforementioned possible predictors of PTSD change will be administered: Post-traumatic Stress Disorder Checklist-5, Perceived Stress Scale, Difficulties in Emotion Regulation Scale-18 (pre-test, post-test, and follow-up),subscale impulsivity of the Difficulties in Emotion Regulation Scale-18, Perceived Stress Scale short version, Primary Care Post-traumatic Stress Disorder and a single Mood item (each session). Multilevel modelling will be used to examine the relation between the possible predictors and treatment outcome. DISCUSSION The present study is the first to examine the interplay of facilitating and interfering factors possibly impacting treatment feasibility and effectiveness in displaced victims of interpersonal violence with PTSD receiving NET, using repeated measures. The current study can help to improve future treatment based on individual characteristics. TRIAL REGISTRATION Netherlands Trial Register: NTR7353, retrospectively registered. Date of registration: July 11, 2018.
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Affiliation(s)
- Rina S. Ghafoerkhan
- ARQ National Psychotrauma Centre, Nienoord 5, 1112 XE Diemen, The Netherlands
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
| | - Henriette E. van Heemstra
- ARQ National Psychotrauma Centre, Nienoord 5, 1112 XE Diemen, The Netherlands
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
| | - Willem F. Scholte
- ARQ National Psychotrauma Centre, Nienoord 5, 1112 XE Diemen, The Netherlands
- Dept. of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Laguna Collective, Reigerstraat 16, 3816 AX Amersfoort, The Netherlands
| | - Joriene R. J. van der Kolk
- Laguna Collective, Reigerstraat 16, 3816 AX Amersfoort, The Netherlands
- Sinai Centrum, Arthur van Schendelstraat 800, 3511 ML Utrecht, The Netherlands
| | | | - Simone M. de la Rie
- ARQ National Psychotrauma Centre, Nienoord 5, 1112 XE Diemen, The Netherlands
| | - Linda M. Verhaak
- ARQ National Psychotrauma Centre, Nienoord 5, 1112 XE Diemen, The Netherlands
| | - Evelien Snippe
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Paul A. Boelen
- ARQ National Psychotrauma Centre, Nienoord 5, 1112 XE Diemen, The Netherlands
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
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20
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Helmich MA, Wichers M, Olthof M, Strunk G, Aas B, Aichhorn W, Schiepek G, Snippe E. Sudden gains in day-to-day change: Revealing nonlinear patterns of individual improvement in depression. J Consult Clin Psychol 2020; 88:119-127. [PMID: 31894994 DOI: 10.1037/ccp0000469] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We examined individual overall trajectories of change and the occurrence of sudden gains in daily self-rated problem severity and the relation of these patterns to treatment response. METHOD Mood disorder patients (N = 329, mean age = 44, 55% women) completed daily self-ratings about the severity of their complaints as a standard part of treatment, using the Therapy Process Questionnaire (TPQ). Per individual, the best-fitting defined (linear, log-linear, 1-step) trajectory was tested for significance: for change over time, and for specificity of the best-fitting trajectory. Two-hundred and three cases had ICD-10 Symptom Rating (ISR) depression scores posttreatment: a score ≤1 identified 114 treatment responders. Relation to response was examined for sudden gains and type of change trajectory. RESULTS 138 cases (42%) had a significant decrease in problem severity, of which 54 cases (16%) had a defined trajectory: 50 cases with one-step improvement, and 4 with a linear improvement in daily problem severity. Sudden gains occurred in 28% of the total sample, and within 58% of improvement patterns. Specifically, sudden gains occurred in 68% of significant 1-step trajectories and 25% of the linear cases. Sudden gains and nonspecific change trajectories were significantly more frequent for treatment responders. CONCLUSIONS At the day-level, patterns of improvement are nonlinear for most patients. Sudden gains occur within various forms of overall change and are associated with treatment response. Clinically relevant improvements in depression occur both gradually and abruptly, and this finding allows for the possibility that the remission process functions according to dynamical systems principles. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Marieke A Helmich
- University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen
| | - Marieke Wichers
- University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen
| | | | - Guido Strunk
- Centre for Complexity Sciences and Entrepreneurship Education, Technical University Dortmund
| | - Benjamin Aas
- Institute for Synergetics and Psychotherapy Research, University Hospital for Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University
| | - Wolfgang Aichhorn
- Institute for Synergetics and Psychotherapy Research, University Hospital for Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University
| | - Günter Schiepek
- Institute for Synergetics and Psychotherapy Research, University Hospital for Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University
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21
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Smit AC, Snippe E, Wichers M. Increasing Restlessness Signals Impending Increase in Depressive Symptoms More than 2 Months before It Happens in Individual Patients. Psychother Psychosom 2020; 88:249-251. [PMID: 31256155 DOI: 10.1159/000500594] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 04/24/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Arnout C Smit
- ICPE, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,
| | - Evelien Snippe
- ICPE, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marieke Wichers
- ICPE, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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22
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Bringmann LF, Elmer T, Epskamp S, Krause RW, Schoch D, Wichers M, Wigman JTW, Snippe E. What do centrality measures measure in psychological networks? J Abnorm Psychol 2019; 128:892-903. [PMID: 31318245 DOI: 10.13140/rg.2.2.25024.58884] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Centrality indices are a popular tool to analyze structural aspects of psychological networks. As centrality indices were originally developed in the context of social networks, it is unclear to what extent these indices are suitable in a psychological network context. In this article we critically examine several issues with the use of the most popular centrality indices in psychological networks: degree, betweenness, and closeness centrality. We show that problems with centrality indices discussed in the social network literature also apply to the psychological networks. Assumptions underlying centrality indices, such as presence of a flow and shortest paths, may not correspond with a general theory of how psychological variables relate to one another. Furthermore, the assumptions of node distinctiveness and node exchangeability may not hold in psychological networks. We conclude that, for psychological networks, betweenness and closeness centrality seem especially unsuitable as measures of node importance. We therefore suggest three ways forward: (a) using centrality measures that are tailored to the psychological network context, (b) reconsidering existing measures of importance used in statistical models underlying psychological networks, and (c) discarding the concept of node centrality entirely. Foremost, we argue that one has to make explicit what one means when one states that a node is central, and what assumptions the centrality measure of choice entails, to make sure that there is a match between the process under study and the centrality measure that is used. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Timon Elmer
- Department of Humanities, Social and Political Sciences
| | | | | | | | - Marieke Wichers
- Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE)
| | | | - Evelien Snippe
- Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE)
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23
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Bos FM, Snippe E, Bruggeman R, Wichers M, van der Krieke L. Insights of Patients and Clinicians on the Promise of the Experience Sampling Method for Psychiatric Care. Psychiatr Serv 2019; 70:983-991. [PMID: 31434558 DOI: 10.1176/appi.ps.201900050] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [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] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This qualitative study aimed to map the relevance of the experience sampling method (ESM) for psychiatric practice and identify barriers and facilitators for implementation, as perceived by patients and clinicians. METHODS Participants were 22 patients with various diagnoses and 21 clinicians (e.g., psychiatrists, psychologists) who participated in interviews or focus groups. Using Atlas.TI, the authors conducted qualitative thematic analysis to analyze the transcripts, resulting in four themes: applications, advantages, undesirable effects, and requirements for implementation of ESM in care. RESULTS Clinicians and patients believed ESM could be relevant in every phase of care to increase patients' awareness, insight, and self-management; personalize interventions; and alert patients to rising symptoms. Further, ESM was expected to improve the patient-clinician relationship; lead to objective, personalized, reliable and visual data; and increase efficiency of care. However, participants warned against high assessment burden and potential symptom worsening. CONCLUSIONS This study provides first evidence that the potential of ESM is recognized by both patients and clinicians. Key recommendations for optimal implementation of ESM in psychiatric care include flexible application of ESM, collaboration between patient and clinician, regular evaluation, awareness of negative reactivity, availability to patients with different psychiatric syndromes, and implementation by an interdisciplinary team of patients, clinicians, researchers, and information technology specialists.
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Affiliation(s)
- Fionneke M Bos
- Rob Giel Research Center (Bos, Bruggeman, van der Krieke) and Interdisciplinary Center Psychopathology and Emotion Regulation (Bos, Snippe, Wichers, van der Krieke), Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Evelien Snippe
- Rob Giel Research Center (Bos, Bruggeman, van der Krieke) and Interdisciplinary Center Psychopathology and Emotion Regulation (Bos, Snippe, Wichers, van der Krieke), Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- Rob Giel Research Center (Bos, Bruggeman, van der Krieke) and Interdisciplinary Center Psychopathology and Emotion Regulation (Bos, Snippe, Wichers, van der Krieke), Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marieke Wichers
- Rob Giel Research Center (Bos, Bruggeman, van der Krieke) and Interdisciplinary Center Psychopathology and Emotion Regulation (Bos, Snippe, Wichers, van der Krieke), Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lian van der Krieke
- Rob Giel Research Center (Bos, Bruggeman, van der Krieke) and Interdisciplinary Center Psychopathology and Emotion Regulation (Bos, Snippe, Wichers, van der Krieke), Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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24
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Bringmann LF, Elmer T, Epskamp S, Krause RW, Schoch D, Wichers M, Wigman JTW, Snippe E. What do centrality measures measure in psychological networks? Journal of Abnormal Psychology 2019; 128:892-903. [DOI: 10.1037/abn0000446] [Citation(s) in RCA: 287] [Impact Index Per Article: 57.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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25
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Affiliation(s)
- Christopher J. May
- Department of Life Sciences Carroll University Waukesha Wisconsin
- Department of Social Sciences University College Groningen University of Groningen Groningen The Netherlands
| | - Brian D. Ostafin
- Department of Psychology University of Groningen Groningen The Netherlands
| | - Evelien Snippe
- Interdisciplinary Center for Psychopathology and Emotion Regulation University Medical Center of Groningen Groningen The Netherlands
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26
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Groen RN, Snippe E, Bringmann LF, Simons CJP, Hartmann JA, Bos EH, Wichers M. Capturing the risk of persisting depressive symptoms: A dynamic network investigation of patients' daily symptom experiences. Psychiatry Res 2019; 271:640-648. [PMID: 30791337 DOI: 10.1016/j.psychres.2018.12.054] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 01/17/2018] [Revised: 12/07/2018] [Accepted: 12/07/2018] [Indexed: 01/28/2023]
Abstract
What drives the large differences across patients in terms of treatment efficacy of major depressive disorder (MDD) is unclear. A network approach to psychopathology may help to reveal underlying mechanisms determining patients' capacity for recovery. We used daily diary MDD symptom data and six-month follow-up data on depression to examine how dynamic associations between symptoms relate to the future course of MDD. Daily experiences of depressive symptoms of 69 participants were assessed by means of the SCL-90-R depression subscale, three days a week for a period of six weeks, as part of a larger intervention study. Multilevel vector autoregressive modelling was used to estimate networks of dynamic symptom connections. Long-term outcome was determined by the percentage change in Hamilton Depression Rating Scale (HDRS) score between pre-intervention and six-month follow-up. For patients with more persisting symptoms, the symptom 'feeling everything is an effort' most strongly predicted other symptoms. The networks of the two groups did not significantly differ in overall connectivity. Findings suggest that future research should not solely focus on the presence or intensity of individual symptoms when predicting long-term outcomes, but should also examine the role of a specific symptom in the larger network of dynamic symptom-to-symptom interactions.
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Affiliation(s)
- Robin N Groen
- Interdisciplinary Center for Psychopathology and Emotion regulation (ICPE), Dept. of Psychiatry (UCP), University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands.
| | - Evelien Snippe
- Interdisciplinary Center for Psychopathology and Emotion regulation (ICPE), Dept. of Psychiatry (UCP), University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - Laura F Bringmann
- Heymans Institute, Department of Psychometrics and Statistics, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Claudia J P Simons
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands; GGzE, Institute for Mental Health Care Eindhoven and De Kempen, Eindhoven, The Netherlands
| | - Jessica A Hartmann
- Orygen, the National Centre of Excellence in Youth Mental Health, University of Melbourne, Australia
| | - Elisabeth H Bos
- Heymans Institute, Department of developmental Psychology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Marieke Wichers
- Interdisciplinary Center for Psychopathology and Emotion regulation (ICPE), Dept. of Psychiatry (UCP), University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
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27
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Jeronimus BF, Snippe E, Emerencia AC, de Jonge P, Bos EH. Acute stress responses after indirect exposure to the MH17 airplane crash. Br J Psychol 2018; 110:790-813. [PMID: 30450537 PMCID: PMC6900050 DOI: 10.1111/bjop.12358] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 02/28/2018] [Revised: 08/28/2018] [Indexed: 12/18/2022]
Abstract
People can experience disasters vicariously (indirectly) via conversation, social media, radio, and television, even when not directly involved in a disaster. This study examined whether vicarious exposure to the MH17-airplane crash in Ukraine, with 196 Dutch victims, elicited affective and somatic responses in Dutch adults about 2,600 km away, who happened to participate in an ongoing diary study. Participants (n = 141) filled out a diary three times a day for 30 days on their smartphones. Within-person changes in positive affect (PA) and negative affect (NA) and somatic symptoms after the crash were studied. Additionally, we tested whether between-person differences in response could be explained by age, baseline personality (NEO-FFI-3), and media exposure. The MH17 crash elicited a small within-person decrease in PA and an increase in NA and somatic symptoms. This response waned after 3 days and returned to baseline at day four. The decrease in PA was larger in more extraverted participants but smaller in those higher on neuroticism or conscientiousness. The NA response was smaller in elderly. Personality did not seem to moderate the NA and somatic response, and neither did media exposure. Dutch participants showed small acute somatic and affective responses up till 3 days to a disaster that they had not directly witnessed. Vicariously experienced disasters can thus elicit affective-visceral responses indicative of acute stress reactions. Personality and age explained some of the individual differences in this reaction.
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Affiliation(s)
- Bertus F Jeronimus
- Department of Developmental Psychology, University of Groningen, The Netherlands.,Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University Medical Center Groningen (UMCG), University of Groningen, The Netherlands
| | - Evelien Snippe
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University Medical Center Groningen (UMCG), University of Groningen, The Netherlands.,Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, The Netherlands
| | - Ando C Emerencia
- Department of Developmental Psychology, University of Groningen, The Netherlands.,Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University Medical Center Groningen (UMCG), University of Groningen, The Netherlands
| | - Peter de Jonge
- Department of Developmental Psychology, University of Groningen, The Netherlands.,Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University Medical Center Groningen (UMCG), University of Groningen, The Netherlands
| | - Elisabeth H Bos
- Department of Developmental Psychology, University of Groningen, The Netherlands.,Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University Medical Center Groningen (UMCG), University of Groningen, The Netherlands
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28
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Ciere Y, Snippe E, Padberg M, Jacobs B, Visser A, Sanderman R, Fleer J. The role of state and trait positive affect and mindfulness in affective reactivity to pain in chronic migraine. Health Psychol 2018; 38:94-102. [PMID: 30372104 DOI: 10.1037/hea0000692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE High affective reactivity to pain (i.e., increased negative affect in response to pain) can have an adverse impact on the well-being of individuals with chronic pain. The present study examined the role of momentary and average positive affect and trait mindfulness in protecting against affective reactivity to chronic migraine-related pain. METHODS The sample included 61 adults with chronic migraine. Following the experience sampling method, participants completed smartphone-based assessments of momentary pain intensity (PI), positive affect (PA), and negative affect (NA) at nine random moments a day for 7 consecutive days. The Five-Facet Mindfulness Questionnaire was used to assess two dimensions of mindfulness: nonjudging and nonreactivity. RESULTS Momentary PA inversely predicted the strength of the concurrent but not the time-lagged associations between PI and NA. Average PA predicted neither the strength of the concurrent nor the time-lagged associations between PI and NA. Furthermore, the concurrent associations between PI and NA were weaker in individuals who reported higher "nonjudging" while "nonreactivity" did not significantly moderate these associations. CONCLUSIONS Results provide partial support for the dynamic model of affect in the context of chronic migraine. State PA seems to play a larger role in momentary affective reactivity to chronic migraine-related pain than trait PA. Results also suggest that the ability to take a nonjudgmental stance toward negative experiences may lower momentary affective reactivity to pain. These factors seem promising targets for interventions aimed at improving the well-being of individuals with chronic migraine. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Yvette Ciere
- Department of Health Psychology, University Medical Center Groningen, University of Groningen
| | - Evelien Snippe
- Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen
| | | | - Bram Jacobs
- Department of Neurology, University Medical Center Groningen, University of Groningen
| | - Annemieke Visser
- Department of Applied Health Research, University Medical Center Groningen
| | - Robbert Sanderman
- Department of Health Psychology, University Medical Center Groningen, University of Groningen
| | - Joke Fleer
- Department of Health Psychology, University Medical Center Groningen, University of Groningen
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29
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Snippe E, Schroevers MJ, Tovote KA, Sanderman R, Emmelkamp PMG, Fleer J. Explaining variability in therapist adherence and patient depressive symptom improvement: The role of therapist interpersonal skills and patient engagement. Clin Psychol Psychother 2018; 26:84-93. [PMID: 30199135 PMCID: PMC6585745 DOI: 10.1002/cpp.2332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/05/2018] [Accepted: 09/05/2018] [Indexed: 11/16/2022]
Abstract
Understanding why therapists deviate from a treatment manual is crucial to interpret the mixed findings on the adherence–outcome association. The current study aims to examine whether therapists' interpersonal behaviours and patients' active engagement predict treatment outcome and therapist adherence in cognitive behaviour therapy (CBT) and mindfulness‐based cognitive therapy (MBCT) for depressive symptoms. In addition, the study explores rater's explanations for therapist nonadherence at sessions in which therapist adherence was low. Study participants were 61 patients with diabetes and depressive symptoms who were randomized to either CBT or MBCT. Depressive symptoms were assessed by the Beck Depression Inventory‐II. Therapist adherence, therapist interpersonal skills (i.e., empathy, warmth, and involvement), patients' active engagement, and reasons for nonadherence were assessed by two independent raters (based on digital video recordings). Therapist adherence, therapists' interpersonal skills, and patients' active engagement did not predict posttreatment depressive symptom reduction. Patients' active engagement was positively associated with therapist adherence in CBT and in MBCT. This indicates that adherence may be hampered when patients are not actively engaged in treatment. Observed reasons for nonadherence mostly covered responses to patient's in‐session behaviour. The variety of reasons for therapist nonadherence might explain why therapist adherence was not associated with outcomes of CBT and MBCT.
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Affiliation(s)
- Evelien Snippe
- Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maya J Schroevers
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - K Annika Tovote
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robbert Sanderman
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Paul M G Emmelkamp
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.,HSK Group, Woerden, The Netherlands
| | - Joke Fleer
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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30
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van Roekel E, Heininga VE, Vrijen C, Snippe E, Oldehinkel AJ. Reciprocal associations between positive emotions and motivation in daily life: Network analyses in anhedonic individuals and healthy controls. ACTA ACUST UNITED AC 2018; 19:292-300. [PMID: 29672074 DOI: 10.1037/emo0000424] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Anhedonia reflects a dysfunction in the reward system, which can be manifested in an inability to enjoy pleasurable situations (i.e., lack of positive emotions), but also by a lack of motivation to engage in pleasurable activities (i.e., lack of motivation). Little is known about the interrelations between positive emotions and motivation in daily life, and whether these associations are altered in anhedonic individuals. In the present study, we used a network approach to explore the reciprocal, lagged associations between positive emotions and motivation in anhedonic individuals (N = 66) and controls (N = 68). Participants (aged between 18 and 24 years) filled out momentary assessments of affect 3 times per day for 30 consecutive days. Our results showed that (a) anhedonic individuals and controls had similar moment-to-moment transfer of positive emotions; (b) in the anhedonic network feeling cheerful was the node with the highest outstrength, both within this group and compared with the control group; (c) feeling relaxed had the highest outstrength in the control network, and (d) anhedonic individuals had stronger pathways from positive emotions to motivation than controls. Taken together, our findings suggest that low levels of positive emotions lead to decreased motivation in the anhedonic group, which could instigate a negative spiral of low pleasure and low motivation. On a more positive note, we showed that cheerfulness had the highest outstrength in the network of anhedonic participants. Hence, interventions may focus on increasing cheerfulness in anhedonic individuals, as this will likely have the greatest impact on other positive emotions and motivations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Eeske van Roekel
- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen
| | - Vera E Heininga
- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen
| | - Charlotte Vrijen
- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen
| | - Evelien Snippe
- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen
| | - Albertine J Oldehinkel
- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen
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Abstract
Despite the apparent benefits of being mindful, people are often not very mindful. There seem to be forces that drive people toward as well as away from mindfulness. These forces are conceptualised in terms of competition for scarce attentional resources. To explore these forces and to test this framework, an experience sampling study was performed among people with an explicit intention to be mindful and an ongoing practice to examine concurrent associations between state mindfulness and daily life experiences that may affect it. Participants (N = 29, 1012 observations) filled out questions on momentary experiences at semi-random intervals, five times a day, over a period of 7 to 10 days. Predictors of within-person variations in awareness of Present Moment Experience (PME) and non-reactivity to PME were examined using multilevel analyses. Participants were more aware of PME when they had an activated intention to be mindful and when they felt good, and not very busy or hurried, and were not involved in social interaction. They were more reactive to PME when they experienced unpleasant affect, and when they were hurried or tired. An activated intention to be mindful was also associated with an increased tendency to analyse PME. Experiencing threat was associated with increased reactivity, but not with decreased awareness. Our study generally supports the idea that competition for attention can be a fruitful framework to describe mechanisms behind being or not being mindful.
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Affiliation(s)
- Han Suelmann
- 1Faculteit Psychologie en Onderwijswetenschappen, Open Universiteit NL, Postbus 2960, 6401DL Heerlen, The Netherlands
| | - André Brouwers
- 1Faculteit Psychologie en Onderwijswetenschappen, Open Universiteit NL, Postbus 2960, 6401DL Heerlen, The Netherlands
| | - Evelien Snippe
- 2Interdisciplinary Center Psychopathology and Emotion regulation, Unversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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32
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Bos FM, Blaauw FJ, Snippe E, van der Krieke L, de Jonge P, Wichers M. Exploring the emotional dynamics of subclinically depressed individuals with and without anhedonia: An experience sampling study. J Affect Disord 2018; 228:186-193. [PMID: 29253685 DOI: 10.1016/j.jad.2017.12.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 07/26/2017] [Revised: 11/13/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Anhedonia has been linked to worse prognosis of depression. The present study aimed to construct personalized models to elucidate the emotional dynamics of subclinically depressed individuals with versus without symptoms of anhedonia. METHODS Matched subclinically depressed individuals with and without symptoms of anhedonia (N = 40) of the HowNutsAreTheDutch sample completed three experience sampling methodology assessments per day for 30 days. For each individual, the impact of physical activity, stress experience, and high/low arousal PA/NA on each other was estimated through automated impulse response function analysis (IRF). These individual IRF associations were combined to compare anhedonic versus non-anhedonic individuals. RESULTS Physical activity had low impact on affect in both groups. In non-anhedonic individuals, stress experience increased NA and decreased PA and physical activity more strongly. In anhedonic individuals, PA high arousal showed a diminished favorable impact on affect (increasing NA/stress experience, decreasing PA/physical activity). Finally, large heterogeneity in the personalized models of emotional dynamics were found. LIMITATIONS Stress experience was measured indirectly by assessing level of distress; the timeframe in between measurements was relatively long with 6h; and only information on one of the two hallmarks of anhedonia, loss of interest, was gathered. CONCLUSIONS Our results suggest different pathways of emotional dynamics underlie depressive symptomatology. Subclinically depressed individuals with anhedonic complaints are more strongly characterized by diminished favorable impact of PA high arousal and heightened NA reactivity, whereas subclinically depressed individuals without these anhedonic complaints seem more characterized by heightened stress reactivity. The automatically generated personalized models may offer patient-specific insights in emotional dynamics, which may show clinical relevance.
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Affiliation(s)
- F M Bos
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Rob Giel Research Center, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center, Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands.
| | - F J Blaauw
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center, Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands; Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands; Johann Bernoulli Institute for Mathematics and Computer Science (JBI), Distributed Systems Group, University of Groningen, Groningen, The Netherlands
| | - E Snippe
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center, Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands
| | - L van der Krieke
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Rob Giel Research Center, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center, Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands
| | - P de Jonge
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center, Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands; Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands
| | - M Wichers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center, Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands
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Booij SH, Snippe E, Jeronimus BF, Wichers M, Wigman JTW. Affective reactivity to daily life stress: Relationship to positive psychotic and depressive symptoms in a general population sample. J Affect Disord 2018; 225:474-481. [PMID: 28863300 DOI: 10.1016/j.jad.2017.08.051] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 03/20/2017] [Revised: 05/17/2017] [Accepted: 08/14/2017] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Increased affective reactivity to daily life stress has been found in individuals with psychosis and depression, and in those at risk for these conditions. Because depressive and psychotic symptoms often co-occur, increased affective reactivity in these disorders may be explained by the presence of depressive symptoms, psychotic symptoms, or both. Therefore, we examined whether affective reactivity to daily stress is related to positive psychotic symptoms, independently of depressive symptoms, and vice versa. METHODS We used data from an intensive sampling study in the general population (n = 411), with three measurements a day (t = 90). The following subjective stressors were assessed: appraisal of activities, appraisal of social interactions, and experienced physical discomfort. Affective reactivity was conceptualized as both the positive affect (PA) and negative affect (NA) response to these stressors. By means of mixed model analyses, it was examined whether affective reactivity was independently related to depressive and/or positive psychotic symptoms. RESULTS The PA response to activities and NA response to social interactions were negatively and positively related to depressive symptoms, respectively, independent of psychotic symptoms. In contrast, no (in)dependent association was found between positive psychotic symptoms and affective reactivity to any of the daily life stressors. These findings were confirmed in a subsample with increased symptoms. LIMITATIONS The prevalence of positive psychotic symptoms was relatively low in this general population sample. CONCLUSIONS Increased affect reactivity predicts depressive symptoms, but not positive psychotic symptoms. Affective reactivity may still facilitate the development of psychotic symptomatology via its impact on depressive symptoms.
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Affiliation(s)
- Sanne H Booij
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), The Netherlands; Mental Health Service (GGZ) Friesland, Leeuwarden, The Netherlands.
| | - Evelien Snippe
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), The Netherlands
| | - Bertus F Jeronimus
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), The Netherlands; University of Groningen, Department of Developmental Psychology, The Netherlands
| | - Marieke Wichers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), The Netherlands
| | - Johanna T W Wigman
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), The Netherlands; Mental Health Service (GGZ) Friesland, Leeuwarden, The Netherlands
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Bos FM, Snippe E, de Vos S, Hartmann JA, Simons CJ, van der Krieke L, de Jonge P, Wichers M. Can We Jump from Cross-Sectional to Dynamic Interpretations of Networks? Implications for the Network Perspective in Psychiatry. Psychother Psychosom 2017; 86:175-177. [PMID: 28490028 PMCID: PMC5516409 DOI: 10.1159/000453583] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 11/17/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Fionneke M. Bos
- University of Groningen, University Medical Center Groningen, Rob Giel Research Center, Groningen, The Netherlands,University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands,*Fionneke M. Bos, MSc, University of Groningen, University Medical Center Groningen, Rob Giel Research Center, PO Box 30.001, NL-9700 RB Groningen (The Netherlands), E-Mail
| | - Evelien Snippe
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands
| | - Stijn de Vos
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands
| | - Jessica A. Hartmann
- Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, The Netherlands,Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Claudia J.P. Simons
- Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, The Netherlands,GGzE, Institute of Mental Health Care Eindhoven and De Kempen, Eindhoven, The Netherlands
| | - Lian van der Krieke
- University of Groningen, University Medical Center Groningen, Rob Giel Research Center, Groningen, The Netherlands,University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands
| | - Peter de Jonge
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands,Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands
| | - Marieke Wichers
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands
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Snippe E, Viechtbauer W, Geschwind N, Klippel A, de Jonge P, Wichers M. The Impact of Treatments for Depression on the Dynamic Network Structure of Mental States: Two Randomized Controlled Trials. Sci Rep 2017; 7:46523. [PMID: 28425449 PMCID: PMC5397847 DOI: 10.1038/srep46523] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 03/22/2017] [Indexed: 02/01/2023] Open
Abstract
Evidence is growing that vulnerability to depression may be characterized by strong negative feedback loops between mental states. It is unknown whether such dynamics between mental states can be altered by treatment. This study examined whether treatment with imipramine or treatment with Mindfulness-Based Cognitive Therapy (MBCT) reduces the connectivity within dynamic networks of mental states in individuals with depressive symptoms. In the Imipramine trial, individuals diagnosed with major depression were randomized to imipramine treatment or placebo-pill treatment (n = 50). In the Mind-Maastricht trial, individuals with residual depressive symptoms were randomized to Mindfulness-Based Cognitive Therapy (MBCT) or to a waiting-list control condition (n = 119). Lagged associations among mental states, as assessed with the Experience Sampling Method (ESM), were estimated at baseline and post-intervention. The results show that few of the dynamic network connections changed significantly over time and few of the changes after MBCT and imipramine treatment differed significantly from the control groups. The decrease in average node connectivity after MBCT did not differ from the decrease observed in the waiting-list control group. Our findings suggest that imipramine treatment and MBCT do not greatly change the dynamic network structure of mental states, even though they do reduce depressive symptomatology.
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Affiliation(s)
- Evelien Snippe
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, the Netherlands
- Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Wolfgang Viechtbauer
- Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Nicole Geschwind
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Annelie Klippel
- Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Neuroscience, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Peter de Jonge
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, the Netherlands
- Developmental Psychology, University of Groningen, Groningen, the Netherlands
| | - Marieke Wichers
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, the Netherlands
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Snippe E, Jeronimus BF, aan het Rot M, Bos EH, de Jonge P, Wichers M. The Reciprocity of Prosocial Behavior and Positive Affect in Daily Life. J Pers 2017; 86:139-146. [DOI: 10.1111/jopy.12299] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Evelien Snippe
- University of Groningen, University Medical Center GroningenInterdisciplinary Center Psychopathology and Emotion Regulation (ICPE)
- School for Mental Health and NeuroscienceMaastricht University
| | - Bertus F. Jeronimus
- University of Groningen, University Medical Center GroningenInterdisciplinary Center Psychopathology and Emotion Regulation (ICPE)
- Developmental Psychology, Faculty of Behavioural and Social SciencesUniversity of Groningen
| | - Marije aan het Rot
- Department of Psychology and School of Behavioral and Cognitive NeurosciencesUniversity of Groningen
| | - Elisabeth H. Bos
- University of Groningen, University Medical Center GroningenInterdisciplinary Center Psychopathology and Emotion Regulation (ICPE)
- Developmental Psychology, Faculty of Behavioural and Social SciencesUniversity of Groningen
| | - Peter de Jonge
- University of Groningen, University Medical Center GroningenInterdisciplinary Center Psychopathology and Emotion Regulation (ICPE)
- Developmental Psychology, Faculty of Behavioural and Social SciencesUniversity of Groningen
| | - Marieke Wichers
- University of Groningen, University Medical Center GroningenInterdisciplinary Center Psychopathology and Emotion Regulation (ICPE)
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Snippe E, Dziak JJ, Lanza ST, Nyklíček I, Wichers M. The shape of change in perceived stress, negative affect, and stress sensitivity during mindfulness-based stress reduction. Mindfulness (N Y) 2017; 8:728-736. [PMID: 29057017 DOI: 10.1007/s12671-016-0650-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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] [Indexed: 11/30/2022]
Abstract
Both daily stress and the tendency to react to stress with heightened levels of negative affect (i.e., stress sensitivity) are important vulnerability factors for adverse mental health outcomes. Mindfulness-based stress reduction (MBSR) may help to reduce perceived daily stress and stress sensitivity. The purpose of this study was to examine how change in perceived stress, negative affect (NA), and the decoupling between perceived stress and NA evolved over the course of a MBSR program, without making any a priori assumptions on the shape of change. Seventy-one adults from the general population participating in MBSR provided daily diary assessments of perceived stress and NA during MBSR. The time-varying effect model (TVEM) indicated that perceived stress and NA decreased in a linear fashion rather than in a non-linear fashion, both as a function of time and as a function of the cumulative number of days of mindfulness practice. Both TVEM and multilevel growth modeling showed that the association between perceived stress and NA did not decrease over the course of MBSR. The findings support the hypothesis that MBSR reduces NA and also reduces the extent to which individuals perceive their days as stressful. Also, the results suggest that there is a dose-response relationship between the amount of mindfulness practice and reductions in daily stress and NA.
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Affiliation(s)
- Evelien Snippe
- Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - John J Dziak
- The Methodology Center, The Pennsylvania State University, State College (PA), the United States of America
| | - Stephanie T Lanza
- The Methodology Center, The Pennsylvania State University, State College (PA), the United States of America
| | - Ivan Nyklíček
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic disease (CoRPS), Tilburg University, Tilburg, the Netherlands
| | - Marieke Wichers
- Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Schroevers MJ, Tovote KA, Snippe E, Fleer J. Group and Individual Mindfulness-Based Cognitive Therapy (MBCT) Are Both Effective: a Pilot Randomized Controlled Trial in Depressed People with a Somatic Disease. Mindfulness (N Y) 2016; 7:1339-1346. [PMID: 27909465 PMCID: PMC5107193 DOI: 10.1007/s12671-016-0575-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Depressive symptoms are commonly reported by individuals suffering from a chronic medical condition. Mindfulness-based cognitive therapy (MBCT) has been shown to be an effective psychological intervention for reducing depressive symptoms in a range of populations. MBCT is traditionally given in a group format. The aim of the current pilot RCT was to examine the effects of group-based MBCT and individually based MBCT for reducing depressive symptoms in adults suffering from one or more somatic diseases. In this study, 56 people with a somatic condition and comorbid depressive symptoms (i.e., Beck Depression Inventory-II [BDI-II] ≥14) were randomized to group MBCT (n = 28) or individual MBCT (n = 28). Patients filled out questionnaires at three points in time (i.e., pre-intervention, post-intervention, 3 months follow-up). Primary outcome measure was severity of depressive symptoms. Anxiety and positive well-being as well as mindfulness and self-compassion were also assessed. We found significant improvements in all outcomes in those receiving group or individual MBCT, with no significant differences between the two conditions regarding these improvements. Although preliminary (given the pilot nature and lack of control group), results suggest that both group MBCT and individual MBCT are associated with improvements in psychological well-being and enhanced skills of mindfulness and self-compassion in individuals with a chronic somatic condition and comorbid depressive symptoms. Our findings merit future non-inferiority trials in larger samples to be able to draw more firm conclusions about the effectiveness of both formats of MBCT.
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Affiliation(s)
- Maya J Schroevers
- Department of Health Sciences, Health Psychology section, University of Groningen, University Medical Center Groningen, FA 12, Ant Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - K Annika Tovote
- Department of Health Sciences, Health Psychology section, University of Groningen, University Medical Center Groningen, FA 12, Ant Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Evelien Snippe
- Department of Health Sciences, Health Psychology section, University of Groningen, University Medical Center Groningen, FA 12, Ant Deusinglaan 1, 9713 AV Groningen, The Netherlands ; Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joke Fleer
- Department of Health Sciences, Health Psychology section, University of Groningen, University Medical Center Groningen, FA 12, Ant Deusinglaan 1, 9713 AV Groningen, The Netherlands
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Krieke LVD, Jeronimus BF, Blaauw FJ, Wanders RB, Emerencia AC, Schenk HM, Vos SD, Snippe E, Wichers M, Wigman JT, Bos EH, Wardenaar KJ, Jonge PD. HowNutsAreTheDutch (HoeGekIsNL): A crowdsourcing study of mental symptoms and strengths. Int J Methods Psychiatr Res 2016; 25:123-44. [PMID: 26395198 PMCID: PMC6877205 DOI: 10.1002/mpr.1495] [Citation(s) in RCA: 56] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/10/2015] [Accepted: 08/17/2015] [Indexed: 12/28/2022] Open
Abstract
HowNutsAreTheDutch (Dutch: HoeGekIsNL) is a national crowdsourcing study designed to investigate multiple continuous mental health dimensions in a sample from the general population (n = 12,503). Its main objective is to create an empirically based representation of mental strengths and vulnerabilities, accounting for (i) dimensionality and heterogeneity, (ii) interactivity between symptoms and strengths, and (iii) intra-individual variability. To do so, HowNutsAreTheDutch (HND) makes use of an internet platform that allows participants to (a) compare themselves to other participants via cross-sectional questionnaires and (b) to monitor themselves three times a day for 30 days with an intensive longitudinal diary study via their smartphone. These data enable for personalized feedback to participants, a study of profiles of mental strengths and weaknesses, and zooming into the fine-grained level of dynamic relationships between variables over time. Measuring both psychiatric symptomatology and mental strengths and resources enables for an investigation of their interactions, which may underlie the wide variety of observed mental states in the population. The present paper describes the applied methods and technology, and presents the sample characteristics. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lian Van Der Krieke
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
| | - Bertus F. Jeronimus
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
| | - Frank J. Blaauw
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
- University of GroningenJohann Bernoulli Institute for Mathematics and Computer Science, Distributed Systems GroupGroningenThe Netherlands
| | - Rob B.K. Wanders
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
| | - Ando C. Emerencia
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
| | - Hendrika M. Schenk
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
| | - Stijn De Vos
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
| | - Evelien Snippe
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
| | - Marieke Wichers
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
| | - Johanna T.W. Wigman
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
| | - Elisabeth H. Bos
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
| | - Klaas J. Wardenaar
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
| | - Peter De Jonge
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
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Snippe E, Fleer J, Tovote KA, Sanderman R, Emmelkamp PMG, Schroevers MJ. The Therapeutic Alliance Predicts Outcomes of Cognitive Behavior Therapy but Not of Mindfulness-Based Cognitive Therapy for Depressive Symptoms. Psychother Psychosom 2016; 84:314-5. [PMID: 26278928 DOI: 10.1159/000379755] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 02/06/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Evelien Snippe
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Bos EH, Snippe E, de Jonge P, Jeronimus BF. Preserving Subjective Wellbeing in the Face of Psychopathology: Buffering Effects of Personal Strengths and Resources. PLoS One 2016; 11:e0150867. [PMID: 26963923 PMCID: PMC4786317 DOI: 10.1371/journal.pone.0150867] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 02/04/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Many studies on resilience have shown that people can succeed in preserving mental health after a traumatic event. Less is known about whether and how people can preserve subjective wellbeing in the presence of psychopathology. We examined to what extent psychopathology can co-exist with acceptable levels of subjective wellbeing and which personal strengths and resources moderate the association between psychopathology and wellbeing. METHODS Questionnaire data on wellbeing (Manchester Short Assessment of Quality of Life/Happiness Index), psychological symptoms (Depression Anxiety Stress Scales), and personal strengths and resources (humor, Humor Style questionnaire; empathy, Empathy Quotient questionnaire; social company; religion; daytime activities, Living situation questionnaire) were collected in a population-based internet study (HowNutsAreTheDutch; N = 12,503). Data of the subset of participants who completed the above questionnaires (n = 2411) were used for the present study. Regression analyses were performed to predict wellbeing from symptoms, resources, and their interactions. RESULTS Satisfactory levels of wellbeing (happiness score 6 or higher) were found in a substantial proportion of the participants with psychological symptoms (58% and 30% of those with moderate and severe symptom levels, respectively). The association between symptoms and wellbeing was large and negative (-0.67, P < .001), but less so in persons with high levels of self-defeating humor and in those with a partner and/or pet. Several of the personal strengths and resources had a positive main effect on wellbeing, especially self-enhancing humor, having a partner, and daytime activities. CONCLUSIONS Cultivating personal strengths and resources, like humor, social/animal company, and daily occupations, may help people preserve acceptable levels of wellbeing despite the presence of symptoms of depression, anxiety, and stress.
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Affiliation(s)
- Elisabeth H. Bos
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
- * E-mail:
| | - Evelien Snippe
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
| | - Peter de Jonge
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
| | - Bertus F. Jeronimus
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
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Snippe E, Simons CJP, Hartmann JA, Menne-Lothmann C, Kramer I, Booij SH, Viechtbauer W, Delespaul P, Myin-Germeys I, Wichers M. Change in daily life behaviors and depression: Within-person and between-person associations. Health Psychol 2015; 35:433-41. [PMID: 26690641 DOI: 10.1037/hea0000312] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study examined associations between daily physical, sedentary, social, and leisure behaviors and depressive symptoms (a) at a macrolevel, over the course of an Experience Sampling (ESM) self-monitoring intervention, and (b) at a microlevel, by examining daily within-person associations. Second, we examined the effects of the ESM self-monitoring intervention on these daily life behaviors. METHODS Individuals with a diagnosis of depression (N = 102) receiving pharmacological treatment were randomized to 1 of 2 six-week ESM intervention conditions or a control condition. Physical, sedentary, social, and leisure behaviors as well as depressive symptoms were assessed prospectively in every-day life at baseline, postintervention, and during the ESM interventions. RESULTS Change in physical activity and talking from baseline to postintervention was associated with change in depressive symptoms from baseline to postintervention. Within-person daily fluctuations in talking, physical activity, doing nothing/resting, and being alone predicted end-of-day depressive symptoms over and above depressive symptoms at the previous day. The ESM interventions contributed to change in talking, doing nothing/resting, and being alone over time in comparison with the control group. The analyses revealed individual differences in the amount of behavioral change over time and in the within-subject associations between daily behaviors and depressive symptoms. CONCLUSIONS The findings suggest that physical, sedentary, and social behaviors have affective implications for daily mental health of individuals with depression. Self-monitoring using ESM may be a useful add-on tool to achieve behavioral change and to gain personalized insight in behaviors that improve daily depressive symptoms.
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Affiliation(s)
- Evelien Snippe
- Department of Psychiatry & Psychology, School for Mental Health and Neuroscience, Maastricht University
| | - Claudia J P Simons
- Department of Psychiatry & Psychology, School for Mental Health and Neuroscience, Maastricht University
| | - Jessica A Hartmann
- Orygen, the National Centre of Excellence in Youth Mental Health, University of Melbourne
| | - Claudia Menne-Lothmann
- Department of Psychiatry & Psychology, School for Mental Health and Neuroscience, Maastricht University
| | - Ingrid Kramer
- Department of Psychiatry & Psychology, School for Mental Health and Neuroscience, Maastricht University
| | - Sanne H Booij
- Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen
| | - Wolfgang Viechtbauer
- Department of Psychiatry & Psychology, School for Mental Health and Neuroscience, Maastricht University
| | - Philippe Delespaul
- Department of Psychiatry & Psychology, School for Mental Health and Neuroscience, Maastricht University
| | - Inez Myin-Germeys
- Department of Psychiatry & Psychology, School for Mental Health and Neuroscience, Maastricht University
| | - Marieke Wichers
- Department of Psychiatry & Psychology, School for Mental Health and Neuroscience, Maastricht University
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Tovote KA, Schroevers MJ, Snippe E, Sanderman R, Links TP, Emmelkamp PMG, Fleer J. Long-term effects of individual mindfulness-based cognitive therapy and cognitive behavior therapy for depressive symptoms in patients with diabetes: a randomized trial. Psychother Psychosom 2015; 84:186-7. [PMID: 25832365 DOI: 10.1159/000375453] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 01/18/2015] [Indexed: 11/19/2022]
Affiliation(s)
- K Annika Tovote
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Ciere Y, Jaarsma D, Visser A, Sanderman R, Snippe E, Fleer J. Studying learning in the healthcare setting: the potential of quantitative diary methods. Perspect Med Educ 2015; 4:203-207. [PMID: 26183248 PMCID: PMC4530538 DOI: 10.1007/s40037-015-0199-3] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Quantitative diary methods are longitudinal approaches that involve the repeated measurement of aspects of peoples' experience of daily life. In this article, we outline the main characteristics and applications of quantitative diary methods and discuss how their use may further research in the field of medical education. Quantitative diary methods offer several methodological advantages, such as measuring aspects of learning with great detail, accuracy and authenticity. Moreover, they enable researchers to study how and under which conditions learning in the health care setting occurs and in which way learning can be promoted. Hence, quantitative diary methods may contribute to theory development and the optimization of teaching methods in medical education.
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Affiliation(s)
- Yvette Ciere
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, FA12, PO Box 196, 9700 AD, Groningen, The Netherlands
| | - Debbie Jaarsma
- Center for Education Development and Research in Health Professions, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Annemieke Visser
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, FA12, PO Box 196, 9700 AD, Groningen, The Netherlands
| | - Robbert Sanderman
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, FA12, PO Box 196, 9700 AD, Groningen, The Netherlands
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Evelien Snippe
- Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Joke Fleer
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, FA12, PO Box 196, 9700 AD, Groningen, The Netherlands.
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Snippe E, Nyklíček I, Schroevers MJ, Bos EH. The temporal order of change in daily mindfulness and affect during mindfulness-based stress reduction. J Couns Psychol 2015; 62:106-14. [PMID: 25621590 DOI: 10.1037/cou0000057] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Increases in mindfulness are assumed to lead to improvements in psychological well-being during mindfulness-based treatments. However, the temporal order of this association has received little attention. This intensive longitudinal study examines whether within-person changes in mindfulness precede or follow changes in negative affect (NA) and positive affect (PA) during a mindfulness based stress reduction (MBSR) program. This study also examines interindividual differences in the association between mindfulness and affect and possible predictors of these differences. Mindfulness, NA, and PA were assessed on a daily basis in 83 individuals from the general population who participated in an MBSR program. Multilevel autoregressive models were used to investigate the temporal order of changes in mindfulness and affect. Day-to-day changes in mindfulness predicted subsequent day-to-day changes in both NA and PA, but reverse associations did not emerge. Thus, changes in mindfulness seem to precede rather than to follow changes in affect during MBSR. The magnitude of the effects differed substantially between individuals, showing that the strength of the relationship between mindfulness and affect is not the same for all participants. These between-subjects differences could not be explained by gender, age, level of education, average level of mindfulness home practice, or baseline levels of mindfulness and affect. Mindfulness home practice during the day did predict subsequent increases in mindfulness. The findings suggest that increasing mindfulness on a daily basis can be a beneficial means to improve daily psychological well-being.
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Affiliation(s)
- Evelien Snippe
- Department of Health Psychology, University of Groningen, University Medical Center Groningen
| | - Ivan Nyklíček
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic disease (CoRPS), Tilburg University
| | - Maya J Schroevers
- Department of Health Psychology, University of Groningen, University Medical Center Groningen
| | - Elisabeth H Bos
- Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen
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Tovote KA, Fleer J, Snippe E, Peeters ACTM, Emmelkamp PMG, Sanderman R, Links TP, Schroevers MJ. Individual mindfulness-based cognitive therapy and cognitive behavior therapy for treating depressive symptoms in patients with diabetes: results of a randomized controlled trial. Diabetes Care 2014; 37:2427-34. [PMID: 24898301 DOI: 10.2337/dc13-2918] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [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: 02/03/2023]
Abstract
OBJECTIVE Depression is a common comorbidity of diabetes, undesirably affecting patients' physical and mental functioning. Psychological interventions are effective treatments for depression in the general population as well as in patients with a chronic disease. The aim of this study was to assess the efficacy of individual mindfulness-based cognitive therapy (MBCT) and individual cognitive behavior therapy (CBT) in comparison with a waiting-list control condition for treating depressive symptoms in adults with type 1 or type 2 diabetes. RESEARCH DESIGN AND METHODS In this randomized controlled trial, 94 outpatients with diabetes and comorbid depressive symptoms (i.e., Beck Depression Inventory-II [BDI-II] ≥14) were randomized to MBCT (n = 31), CBT (n = 32), or waiting list (n = 31). All participants completed written questionnaires and interviews at pre- and postmeasurement (3 months later). Primary outcome measure was severity of depressive symptoms (BDI-II and Toronto Hamilton Depression Rating Scale). Anxiety (Generalized Anxiety Disorder 7), well-being (Well-Being Index), diabetes-related distress (Problem Areas In Diabetes), and HbA1c levels were assessed as secondary outcomes. RESULTS Results showed that participants receiving MBCT and CBT reported significantly greater reductions in depressive symptoms compared with patients in the waiting-list control condition (respectively, P = 0.004 and P < 0.001; d = 0.80 and 1.00; clinically relevant improvement 26% and 29% vs. 4%). Both interventions also had significant positive effects on anxiety, well-being, and diabetes-related distress. No significant effect was found on HbA1c values. CONCLUSIONS Both individual MBCT and CBT are effective in improving a range of psychological symptoms in individuals with type 1 and type 2 diabetes.
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Affiliation(s)
- K Annika Tovote
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Joke Fleer
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Evelien Snippe
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Anita C T M Peeters
- Department of Internal Medicine, Hospital Rivierenland Tiel, Tiel, the Netherlands
| | - Paul M G Emmelkamp
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands The Center for Social and Humanities Research, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Robbert Sanderman
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands
| | - Thera P Links
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Maya J Schroevers
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Snippe E, Maters GA, Wempe JB, Hagedoorn M, Sanderman R. Discrepancies between patients' and partners' perceptions of unsupportive behavior in chronic obstructive pulmonary disease. J Fam Psychol 2012; 26:464-469. [PMID: 22545936 DOI: 10.1037/a0028333] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The literature on chronic diseases indicates that partner support, as perceived by patients, contributes to well-being of patients in either a positive or a negative way. Previous studies indicated that patients' and partners' perceptions of unsupportive partner behavior are only moderately related. Our aim was (1) to investigate whether discrepancies between patients' and partners' perceptions of two types of unsupportive partner behavior-overprotection and protective buffering-were associated with the level of distress reported by patients with chronic obstructive pulmonary disease (COPD) and (2) to evaluate whether the direction of the differences between patients' and partners' perceptions was associated with distress (i.e., whether patient distress was associated with greater patient or greater partner reports of unsupportive partner behavior). A cross-sectional study was performed using the data of a sample of 68 COPD patients and their spouses. Distress was assessed using the Hopkins Symptom Checklist-25. Patients' and partners' perceptions of unsupportive partner behavior were assessed with a questionnaire measuring overprotection and protective buffering. Distress was independently associated with patients' perceptions of protective buffering and discrepancies in spouses' perceptions of overprotection. Regarding the direction of the discrepancy, we found that greater partner reports of overprotection as compared with patient reports were related to more distress in COPD patients. Our study showed that patients' distress was associated not only with patients' perceptions, but also with discrepancies between patients' and partners' perceptions of unsupportive partner behavior.
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Affiliation(s)
- Evelien Snippe
- Health Psychology Section (FA12), Department of Health Sciences,University Medical Center Groningen, University of Groningen, A.Deusinglaan 1, 9713 AV Groningen, The Netherlands.
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