This dissertation aimed to contribute to the quality of foster care addressing three main objectives: The first objective was to investigate if existing parenting interventions are effective in... Show moreThis dissertation aimed to contribute to the quality of foster care addressing three main objectives: The first objective was to investigate if existing parenting interventions are effective in supporting/improving parenting and child outcomes in foster care using a meta-analytic approach. The second objective was to study the effectiveness of an adapted version of Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) for foster care, i.e., VIPP-FC. The implementation of VIPP-SD in different types of families and in childcare settings was first reviewed, with special attention to VIPP-FC. Subsequently, the study protocol of the randomized controlled trial (RCT) investigating the effectiveness of VIPP-FC was described. In addition, the results of this RCT regarding the effectiveness of VIPP-FC on parenting behavior and attitudes were presented. The third objective was to examine correlates of indiscriminate friendliness (IF) displayed by foster children. To answer this question, the relations of attachment security, parental sensitivity, and child inhibitory control with IF were examined using data collected during the pretest of the VIPP-FC RCT. Results are described and discussed in different chapters, and implications for clinical practice and recommendations for future research are additionally provided. Show less
We investigated the effects of two novel treatments for posttraumatic stress disorder (PTSD). The first treatment is Attentional Bias Modification (ABM). This treatment for anxiety disorders has... Show moreWe investigated the effects of two novel treatments for posttraumatic stress disorder (PTSD). The first treatment is Attentional Bias Modification (ABM). This treatment for anxiety disorders has become quite popular in a relatively short time and was featured in recent articles in the New York Times and The Economist. ABM is a brief, computerized treatment in which patients are trained to keep their attention away from the threatening stimuli from which they automatically attend. Since attentional bias (AB) is considered an important feature of PTSD, we tested ABM in a randomized controlled trial. ABM did not effect PTSD, nor did it change AB. We also investigated an individualized version of ABM in a case series and saw no therapeutic effects. Since the current popularity of ABM is based on smaller studies than our RCT, dissemination efforts may have to be reconsidered. Next, we explored the usefulness of a 8-week course of mindfulness-based cognitive therapy (MBCT) in a pilot study with patients with chronic PTSD. No adverse effects were observed and patients evaluated the course positively. About half of the patients who finished MBCT demonstrated positive clinical effects. However, considering the early dropout rate, different formats may have to be developed to increase its acceptability in this group. Show less
Background As maintenance of lifestyle change and risk factor modification following completion of cardiac rehabilitation (CR) has been shown to be notoriously difficult, we developed a brief self... Show moreBackground As maintenance of lifestyle change and risk factor modification following completion of cardiac rehabilitation (CR) has been shown to be notoriously difficult, we developed a brief self-regulation lifestyle program for post-CR patients. Design Randomized-controlled trial. Method Following completion of CR 210 patients were randomized to receive either a lifestyle maintenance program (n=112) or standard care (n=98). The program was based on self-regulation principles and consisted of a motivational interview, 7 group sessions and home assignments. Risk factors and health behaviors were assessed at baseline (end of CR), and 6 and 15 months thereafter. Results ANCOVAs showed a significant effect of the lifestyle program after 6 months on blood pressure, waist circumference and exercise behavior, only the latter of which remained significant at follow-up (15 months). Mediation analysis demonstrated that the treatment effect on exercise behavior could be explained by an effect on self-regulation skills. Furthermore, the lifestyle intervention program was associated with a 12% reduction in self-reported cardiac hospital admission rates. In addition, patients in the intervention group had significantly fewer uncontrolled risk factors as compared to the control group. However, there was only a long-term beneficial intervention effect on obesity and physical inactivity, but not on other individual risk factors (increased waist circumference, raised blood pressure, raised TC/HDLC-ratio and smoking). Conclusion This trial indicates that a relatively brief, theory-based lifestyle program is capable of inciting and maintaining improvements in exercise adherence. It is suggested that patients may need ongoing attention and guidance, for example in the form of (internet-based) booster sessions, as long-term consolidation of changes is arduous. Show less
Early interventions address concerns that an unacceptably large number of children are already, by four years of age, lacking in competencies fundamental to success in learning to read. Using a... Show moreEarly interventions address concerns that an unacceptably large number of children are already, by four years of age, lacking in competencies fundamental to success in learning to read. Using a randomized controlled trial, the studies presented in this thesis examined program features and children__s behavioral and genetic characteristics (e.g., regulatory skills and DRD4) that might be of influence on learning effects of an exemplary computer intervention program Living Letters. Our conclusions include three major points. First, computer-aided instruction can be a useful tool in early literacy education, even in kindergarten-age (chapter 2). Second, the efficiency depends on the presence of immediate and individualized oral feedback. Without feedback the target program is not a stronger stimulus for learning code-related skills than daily experiences with written language (chapter 3). Third, a large part of the children benefits from the computer intervention but not all children. Susceptible children outperform the rest with a program enriched with positive, responsive interactions; they suffer more from instruction without these vital elements. The less susceptible group benefits from all opportunities for learning without excelling in the most helpful condition (chapter 4). This susceptibility is associated with a genetic predisposition to dopamine-regulated reward- and attention-related mechanisms and may influence learning via executive attention (chapter 5). Show less
The thesis ‘Quality in home-based childcare: Impact and improvement’ consists of two studies. The general aim of the first study is to examine children’s stress levels and wellbeing, and the role... Show moreThe thesis ‘Quality in home-based childcare: Impact and improvement’ consists of two studies. The general aim of the first study is to examine children’s stress levels and wellbeing, and the role of caregiver stress and childcare quality. This first study is described in chapters 2, 3, and 4. Chapter 2 addresses the question whether children’s cortisol levels (and wellbeing) differ between contexts (childcare day or at home day) and setting (childcare homes and childcare centers), and associations with childcare quality are examined. Chapter 3 reports on caregivers’ cortisol levels (and perceived stress) between contexts (work day, non-work day) and setting (childcare homes and childcare centers). In addition, associations between caregiver stress and childcare quality are examined. Chapter 4 investigates associations between caregivers’ cortisol levels (and perceived stress) and children’s wellbeing and cortisol in home-based childcare. Also, children’s temperament is taken into account. In the second study, described in chapter 5, we test the effectiveness of the Video-feedback Intervention to promote Positive Parenting – Childcare (VIPP-CC) in enhancing childcare quality in home-based childcare. Show less
This thesis describes the outcomes of a randomized controlled trial of a Cognitive Behavioural Therapy (CBT) intervention for patients who engage in Deliberate Self-Harm (DSH). The CBT intervention... Show moreThis thesis describes the outcomes of a randomized controlled trial of a Cognitive Behavioural Therapy (CBT) intervention for patients who engage in Deliberate Self-Harm (DSH). The CBT intervention was designed to supplement usual care following an episode of DSH. The study involved 90 people (95% females), aged 15–35 years, who were randomly assigned to CBT in addition to treatment as usual (TAU) or to treatment as usual only. The main study hypothesis, that CBT in addition to TAU would be more effective in reducing repetition of DSH than TAU only, was supported. Furthermore, those who received CBT in addition to TAU were shown to have significantly greater reductions in depression, anxiety and suicidal cognitions, and significantly greater improvements in self-esteem and problem solving ability. It is reasonable to assume that these positive findings are attributable to the effect of the CBT, given the random assignment as well as the absence of between group differences with respect to demographics, DSH, history of DSH, psychopathology and use of health care services. It is encouraging that these results are found for people with recurrent and chronic DSH, with high risk of repetition, and with high levels of psychiatric co-morbidity. Show less
