This thesis examines questions related to the prevalence of anxiety symptomatology and disorders in older adults, and compares two brief low-threshold psychological interventions (blended... Show moreThis thesis examines questions related to the prevalence of anxiety symptomatology and disorders in older adults, and compares two brief low-threshold psychological interventions (blended Acceptance and Commitment Therapy versus face-to-face Cognitive Behavioral Therapy) for older adults with anxiety symptoms in primary care. Show less
This thesis aimed to lay the foundation for a new set of Dutch mental health instruments to measure depression and anxiety in an efficient, reliable, valid, and responsive manner. More specifically... Show moreThis thesis aimed to lay the foundation for a new set of Dutch mental health instruments to measure depression and anxiety in an efficient, reliable, valid, and responsive manner. More specifically, the Dutch-Flemish PROMIS adult v1.0 item banks for Depression and Anxiety were psychometrically evaluated for computerized adaptive test (CAT) administration in the Dutch clinical and general population. CAT is a modern methodology that can be used to develop instruments that measure both efficiently and reliably as only the most appropriate questions are administered, and assessment terminates as soon as sufficient reliability is achieved. For the PROMIS CAT instruments, this was demonstrated in the thesis: measuring depression and anxiety in Dutch persons was highly efficient and reliable. Moreover, the CAT instruments were shown to measure depression and anxiety sufficiently responsive and valid as well. This even includes longitudinal validity, which has barely been studied for other Dutch mental health instruments. Overall, it was concluded that the new instruments are an improvement over available instruments. Therefore, using the PROMIS CAT instruments in clinical practice may lead to more efficient and reliable measurement that supports professionals and patients in evaluating patients' treatment. Show less
This dissertation describes the findings of six studies on mental health problems in the family context, specifically focusing on the associations with the parent-child relationship, parenting... Show moreThis dissertation describes the findings of six studies on mental health problems in the family context, specifically focusing on the associations with the parent-child relationship, parenting behaviors and experiences of childhood maltreatment. The aim is to better understand the risk factors, development and transmission of common psychological problems in order to contribute to prevention and treatment strategies for common psychological problems such as anxiety and depression.Overall, the findings underline the importance of the family context in the development and levels of mental health problems. In addition to the impact of one's own negative parenting experiences, including lack of warmth and experiences of emotional or physical abuse, negative parenting experiences of one's siblings are also associated with elevated anxiety and depressive symptom levels.We also found that externalizing problems of fathers and children have a negative impact on the parent-child interactions. In addition, we found that children with behavioral problems during early adolescence experience harsher parental discipline, even three years later.In the current treatment guidelines for common mental disorders, most therapies focus on the individual. An (additional) systemic approach and considering past and present family relationships in therapy, can be of additional value. For example, supporting families with interventions to improve the parent-child relationship can be helpful in the short and long term. Moreover, (early) treatment of psychological and behavioral problems of the parent or child might be beneficial for all family members. Show less
It is common in life to not perform at the very top of our cognitive abilities. This phenomenon usually exacerbates when we are under high levels of stress and in people with psychiatric disorders.... Show moreIt is common in life to not perform at the very top of our cognitive abilities. This phenomenon usually exacerbates when we are under high levels of stress and in people with psychiatric disorders. Attention to negative information is considered to play a crucial role in the development and maintenance of these disorders, especially anxiety-related disorders. Attention to negative information is not necessarily bad as it is an evolutionary function to protect us from dangerous situations. However, it can be destructive when it occurs constantly or when we need to focus on an important task. There are many situations where we have to perform difficult cognitive tasks and we worry about our performance or other people’s evaluation. Trait cognitive control, the ability to control attention and maintain a goal-relevant behaviour, is suggested to play a key role in the relationships between anxiety/stress, attention to negative information, and cognitive performance. Yet, the evidence is limited and further investigation is needed. In the current thesis, the relations between anxiety/stress, attention to emotional information, and cognitive performance will be investigated in a multidisciplinary approach, synthesizing clinical and cognitive factors and neurobiological underpinnings, while focusing on the role of trait cognitive control. Show less
The ratio between frontal resting state EEG power in the theta and beta frequency bands (theta/beta ratio, TBR) was first associated with attention deficit hyperactivity disorder (ADHD) and later... Show moreThe ratio between frontal resting state EEG power in the theta and beta frequency bands (theta/beta ratio, TBR) was first associated with attention deficit hyperactivity disorder (ADHD) and later linked to various psychological functions and cognitive/emotional processes that rely on executive cognitive control. The aim of this thesis was to further investigate TBR as a potentially useful marker for executive/attentional control, particularly when studying threat selective attention and uncontrolled thoughts. It was found that high TBR was associated with more attention to mild than high threat and low threat-interference in visual-spatial tasks containing emotional information. TBR was also negatively related to self-reported attentional control. Frontal TBR was moreover significantly higher during uncontrolled thought compared to controlled thought and this effect was also found for functional connectivity of the ‘executive control network’, which was also correlated to the controlled versus uncontrolled thought effect on TBR. However, no evidence was found to suggest that TBR can be manipulated using Neurofeedback training. These findings provide clear indications of the neuropsychological functional nature of TBR and further support the notion that TBR reflects connectivity in brain networks involved in executive control processes. Show less
This thesis aimed to investigate the neurobiological mechanisms of adolescent onset depression and anxiety disorders. A longitudinal fMRI study design was used that included both task related brain... Show moreThis thesis aimed to investigate the neurobiological mechanisms of adolescent onset depression and anxiety disorders. A longitudinal fMRI study design was used that included both task related brain activation and resting state functional connectivity. All participants were scanned three times in a six-month period. In between scan sessions the adolescents from the clinical group received treatment as usual. Adolescents from the control group were scanned within the same time interval but did not receive treatment. During a scan session several MRI parameters were collected including task based fMRI (emotional face processing task) and resting state fMRI. We also administered several questionnaires about derpession and anxiety symptomatology. It was demonstrated that adolescents with depressive and anxiety disorders show differentiating patterns of amygdala reactivity and connectivity compared to a healthy control group. Furthermore, using a dimensional approach and taking individual differences in self-reported depression and anxiety symptoms into account highlighted the role of self-reported anxiety symptoms in amygdala reactivity during emotional faces processing. These findings indicate that the amygdala indeed is an important region involved in emotional face processing and that focusing on this region can provide further insights in the development and persistence of depressive and anxiety disorders in adolescents. Show less
The present thesis concentrates on predictors and outcomes of occupational stress in emergency (ER-) nurses, working in in-hospital emergency wards, ambulance services and fast rescue teams. More... Show moreThe present thesis concentrates on predictors and outcomes of occupational stress in emergency (ER-) nurses, working in in-hospital emergency wards, ambulance services and fast rescue teams. More specifically, this thesis focuses on the relationships between (1) demographic factors, (2) exposure to traumatic events, (3) job characteristics, (4) organizational variables, (5) coping strategies and (5) goal orientation as potential determinants of (a) job satisfaction, (b) turnover intention, (c) burnout, (d) work engagement, (e) post-traumatic stress symptoms (f) fatigue and (g) other somatic complaints. The first part of this chapter gives an overview of the main results of the different studies, followed by an attempt to integrate all these results from a theoretical and methodological point of view, resulting in a set of practical recommendations and directions for future research Show less
School refusal is an attendance problem characterized by a young person’s difficulty in going to school, accompanied by emotional distress on the part of the young person and parental attempts to... Show moreSchool refusal is an attendance problem characterized by a young person’s difficulty in going to school, accompanied by emotional distress on the part of the young person and parental attempts to return the young person to regular school attendance. Prolonged absence from school has serious short- and long-term consequences for young people, their families, and schools. Therefore, effective treatment of school refusal is essential. Numerous treatment outcome studies provide evidence for the efficacy of cognitive-behavioural therapy (CBT) for school refusal. Previous research has however indicated that adolescent school refusers may be particularly disturbed and harder to treat. An existing treatment for school-refusing children and adolescents was modified to better account for the impact of developmental variables on engagement in treatment. The studies presented in this dissertation describe the preparation, implementation, and evaluation of the resulting developmentally-appropriate CBT for adolescent school refusal. The treatment was associated with increased school attendance, reduced emotional symptoms, and increased adolescent and parental self-efficacy. Exploratory analyses revealed that several developmental factors were related to treatment outcomes, namely clinician developmental appropriateness, insight, and autonomy. Recommendations for research and clinical practice are made on the basis of these findings, and on the methodological strengths and limitations of the current research. Show less
For a majority of people worries about upcoming stressful events are a common experience in daily life. The aim of this thesis was to examine the effects of common worries on somatic health. In... Show moreFor a majority of people worries about upcoming stressful events are a common experience in daily life. The aim of this thesis was to examine the effects of common worries on somatic health. In particular, the effects of worry on somatic health complaints, like headache and back pain, and on cardiac activity after stressful events were tested. Furthermore, the mechanisms by which worry was hypothesized to affect somatic health were investigated. The studies in this thesis add to the accumulating number of studies testing the perseverative cognition hypothesis stating that only perseverative cognitive representations of stressful events (worries) lead to prolonged stress-related physiological activity which, in turn, can lead to somatic disease. Taken together, the studies reported in this thesis provide evidence for the perseverative cognition hypothesis, that is, worry predicted adverse somatic health outcomes. In addition, the results of the studies presented in the second part of this thesis yielded several new and more specific hypotheses concerning the mechanisms behind the health effects of worry and the effects of worry on stress management therapies. All in all, evidence from real life and laboratory studies makes clear that worry might play a substantial role in somatic health. Show less
This thesis deals with emotional and social influences on childhood somatic complaints. Strong support is provided for the idea that negative affect contributes to the development of somatic... Show moreThis thesis deals with emotional and social influences on childhood somatic complaints. Strong support is provided for the idea that negative affect contributes to the development of somatic complaints in childhood. In addition, the studies described give information about the type and levels of negative affect associated with somatic complaints in childhood. When appraisal is characterized by the experience of little control over negative situations and emotions, this is likely to directly cause more feelings of negative affect and also to contribute to a more negative processing of emotions: children who feel little control evidently use more maladaptive emotion regulation strategies. This negative emotional processing further contributes to negative affect and subsequent somatic complaints. These relationships between negative affect and somatic complaints are even present at subclinical levels of emotional problems. With regard to social problems, it is found that they have an effect on somatic complaints that is fully mediated by aspects of children’s emotional functioning: self-perceived social problems indicate lower feelings of control and more maladaptive emotion regulation. Show less
