To ensure the continuity of care during the COVID-19 pandemic, clinicians in Child and Adolescent Psychiatry (CAP) were forced to immediately adapt in-person treatment into remote treatment. This... Show moreTo ensure the continuity of care during the COVID-19 pandemic, clinicians in Child and Adolescent Psychiatry (CAP) were forced to immediately adapt in-person treatment into remote treatment. This study aimed to examine the effects of pre-COVID-19 training in- and use of telepsychiatry on CAP clinicians' impressions of telepsychiatry during the first two weeks of the Dutch COVID-19 related lockdown, providing a first insight into the preparations necessary for the implementation and provision of telepsychiatry during emergency situations. All clinicians employed by five specialized CAP centres across the Netherlands were invited to fill in a questionnaire that was specifically developed to study CAP clinicians' impressions of telepsychiatry during the COVID-19 pandemic. A total of 1065 clinicians gave informed consent and participated in the study. A significant association was found between pre-COVID-19 training and/or use of telepsychiatry and CAP clinicians' impressions of telepsychiatry. By far, the most favourable impressions were reported by participants that were both trained and made use of telepsychiatry before the pandemic. Participants with either training or use separately reported only slightly more favourable impressions than participants without any previous training or use. The expertise required to provide telepsychiatry is not one-and-the-same as the expertise that is honed through face-to-face consultation. The findings of this study strongly suggest that, separately, both training and (clinical) practice fail to sufficiently support CAP clinicians in the implementation and provision of telepsychiatry. It is therefore recommended that training and (clinical) practice are provided in conjunction. Show less
Background: An important determinant of therapy outcome is the quality of the therapeutic relationship. This study evaluated the association between the client's assessment of first-session... Show moreBackground: An important determinant of therapy outcome is the quality of the therapeutic relationship. This study evaluated the association between the client's assessment of first-session therapeutic relationship (FSTR) and outcome in an intensive treatment for adolescents with personality disorders. Method: Patients (N = 92) were measured weekly during intensive group treatment. The therapeutic relationship was measured with the Child version of the Session Rating Scale (C-SRS) that was completed after each group therapy session by the patient. Outcome was measured with the Child version of the Outcome Rating Scale (C-ORS). Reliable change index (RCI) was calculated for the both instruments to determine significant changes in therapeutic relationship and outcome. Results: A good FRST gave twice as much chance of a significantly better outcome. Especially for those with moderate FSTR, establishing and maintaining a good working relationship during treatment could increase the chances of a good outcome considerably. In contrast, adolescents with low FSTR had little chance of positive outcome regardless of any improvement in the therapeutic relationship. Conclusion: Adolescents assessment of FRST is indicative of the chance of a good outcome. Show less
The aim of this study was to examine cognitive emotion regulation strategies (CERS) of help-seeking adolescents diagnosed with personality disorders. At pre-treatment, patients (N = 116) were found... Show moreThe aim of this study was to examine cognitive emotion regulation strategies (CERS) of help-seeking adolescents diagnosed with personality disorders. At pre-treatment, patients (N = 116) were found to use some maladaptive but also some adaptive CERS more often than adolescents from the general population. Less than 4% of these pre-treatment CERS predicted treatment outcome. In patients whose treatment outcome according to the Symptom Checklist-90 (SCL-90) showed significant improvement (N = 75), a reduction of maladaptive CERS and an increase of adaptive CERS occurred. Patients that were unchanged or deteriorated (N = 41) showed no significant changes in CERS. In conclusion, pre-treatment CERS are not predictive for treatment outcome in this sample of adolescents diagnosed with personality disorders. Even though patients who use more adaptive and less maladaptive CERS have fewer symptoms, the relationship between these CERS and symptoms in this group of severe patients remains unclear. Show less
Objective Dropout rates are a prominent problem in youth psychotherapy. An important determinant of dropouts is the quality of the therapeutic relationship. This study aimed to evaluate the... Show moreObjective Dropout rates are a prominent problem in youth psychotherapy. An important determinant of dropouts is the quality of the therapeutic relationship. This study aimed to evaluate the association between the therapeutic relationship and dropouts in an intensive mentalization-based treatment (MBT) for adolescents with personality disorders. Methods Patients (N = 105) included were either dropouts (N = 36) or completers (N = 69) of an intensive MBT. The therapeutic relationship was measured with the child version of the Session Rating Scale (C-SRS), which was completed by the patient after each group therapy session. For each patient, the treatment termination status (dropout or completer) was indicated by the treatment staff. The reliable change index (RCI) was calculated for the C-SRS to determine significant changes in the therapeutic relationship. Results While both groups started with similar scores on the C-SRS, the scores between dropouts and completers differed significantly at the end of the treatment period. On average, during therapy, an increase was seen in the scores of completers, and a decrease was seen in the scores of dropouts. While dropouts could not be predicted based on the C-SRS scores, a significant decrease (RCI) in C-SRS scores during the last two sessions occurred more often for dropouts than for completers. Conclusion Our findings show that to prevent dropouts, the patient's judgment of the quality of the therapeutic relationship should be monitored continuously, and decreases discussed with the patient and the group. Show less
Hauber, K.; Boon, A.; Kuipers, G.; Vermeiren, R. 2020
The aim of this study in a high-risk adolescent sample with personality disorders receiving intensive mentalisation-based treatment (MBT), was first, to examine deviations in insecure attachment... Show moreThe aim of this study in a high-risk adolescent sample with personality disorders receiving intensive mentalisation-based treatment (MBT), was first, to examine deviations in insecure attachment distribution of the normative pattern, and in borderline personality disorder and other personality disorders; second, to explore whether MBT alters attachment representations and whether these alterations are related to changes in psychological distress. A total of 60 adolescents were investigated pre-treatment for both categorical and continuous measures of the Adult Attachment Interview (AAI). Pre- and post-AAI (N = 33) data were compared with psychological distress measured by the Symptom Checklist-90. While the most disturbed category of insecure attachment, the "cannot classify" category, was overrepresented (46.7%) at pre-treatment, no differences were observed by type of personality disorder. At post-treatment, 48.5% of the participants showed positive change in the attachment representation, and their psychological distress lowered significantly (p = .002). The whole sample demonstrated change towards increased secure attachment (z = -2.85, p = .004). Attachment insecurity was found in all adolescent personality disorders which MBT seemed to be able to alter. However, as we included no control group, we cannot conclude that changes are due to the treatment itself. Show less
The aim of this study in a high-risk adolescent sample with personality disorders receiving intensive mentalisation-based treatment (MBT), was first, to examine deviations in insecure attachment... Show moreThe aim of this study in a high-risk adolescent sample with personality disorders receiving intensive mentalisation-based treatment (MBT), was first, to examine deviations in insecure attachment distribution of the normative pattern, and in borderline personality disorder and other personality disorders; second, to explore whether MBT alters attachment representations and whether these alterations are related to changes in psychological distress. A total of 60 adolescents were investigated pre-treatment for both categorical and continuous measures of the Adult Attachment Interview (AAI). Pre- and post-AAI (N = 33) data were compared with psychological distress measured by the Symptom Checklist-90. While the most disturbed category of insecure attachment, the “cannot classify“ category, was overrepresented (46.7%) at pre-treatment, no differences were observed by type of personality disorder. At post-treatment, 48.5% of the participants showed positive change in the attachment representation, and their psychological distress lowered significantly (p = .002). The whole sample demonstrated change towards increased secure attachment (z = −2.85, p = .004). Attachment insecurity was found in all adolescent personality disorders which MBT seemed to be able to alter. However, as we included no control group, we cannot conclude that changes are due to the treatment itself. Show less
Background: Emotional abuse and emotional neglect are related to impaired interpersonal functioning. One underlying mechanism could be a developmental delay in mentalizing, the ability to... Show moreBackground: Emotional abuse and emotional neglect are related to impaired interpersonal functioning. One underlying mechanism could be a developmental delay in mentalizing, the ability to understand other people's thoughts and emotions.Objective: This study investigates the neural correlates of mentalizing and the specific relationship with emotional abuse and neglect whilst taking into account the level of sexual abuse, physical abuse and physical neglect.Method: The RMET was performed in an fMRI scanner by 46 adolescents (Age: M = 18.70, SD = 1.46) who reported a large range of emotional abuse and/or emotional neglect. CM was measured using a self-report questionnaire (CTQ).Results: Neither severity of emotional abuse nor neglect related to RMET accuracy or reaction time. The severity of sexual abuse was related to an increased activation of the left IFG during mentalization even when controlled for psychopathology and other important covariates. This increased activation was only found in a group reporting both sexual abuse and emotional maltreatment and not when reporting isolated emotional abuse or neglect or no maltreatment. Functional connectivity analysis showed that activation in the left IFG was associated with increased activation in the right insula and right STG, indicating that the IFG activation occurs in a network relevant for mentalizing.Conclusions: Being sexually abused in the context of emotional abuse and neglect is related to an increase in activation of the left IFG, which may indicate a delayed development of mirroring other people's thoughts and emotions. Even though thoughts and emotions were correctly decoded from faces, the heightened activity of the left IFG could be an underlying mechanism for impaired interpersonal functioning when social situations are more complex or more related to maltreatment experiences. Show less
Children who have experienced chronic parental rejection and exclusion during childhood, as is the case in childhood emotional maltreatment, may become especially sensitive to social exclusion.... Show moreChildren who have experienced chronic parental rejection and exclusion during childhood, as is the case in childhood emotional maltreatment, may become especially sensitive to social exclusion. This study investigated the neural and emotional responses to social exclusion (with the Cyberball task) in young adults reporting childhood emotional maltreatment. Using functional magnetic resonance imaging, we investigated brain responses and self-reported distress to social exclusion in 46 young adult patients and healthy controls (mean age = 19.2 +/- 2.16) reporting low to extreme childhood emotional maltreatment. Consistent with prior studies, social exclusion was associated with activity in the ventral medial prefrontal cortex and posterior cingulate cortex. In addition, severity of childhood emotional maltreatment was positively associated with increased dorsal medial prefrontal cortex responsivity to social exclusion. The dorsal medial prefrontal cortex plays a crucial role in self-and other-referential processing, suggesting that the more individuals have been rejected and maltreated in childhood, the more self-and other-processing is elicited by social exclusion in adulthood. Negative self-referential thinking, in itself, enhances cognitive vulnerability for the development of psychiatric disorders. Therefore, our findings may underlie the emotional and behavioural difficulties that have been reported in adults reporting childhood emotional maltreatment. Show less
