Mental health problems among children and youths are common and have numerous negative consequences for young people and their social network. Therewith, these problems pose a social issue. GPs... Show moreMental health problems among children and youths are common and have numerous negative consequences for young people and their social network. Therewith, these problems pose a social issue. GPs play an important role in early detection and management of these problems. Insight into their clinical decision- making and, as a result, way of working would be helpful to develop methods for providing children and youths with the help they need. Previous literature suggest many doctors(-to-be), of whom some are or will become GPs, have (lived) experience related to mental health problems themselves. Previous studies also suggest having (lived) experience influences GPs’ clinical decision-making, and consequently their way of working. It would have clinical benefits for GPs and patients to explore this process. This thesis is constructed of four different articles, each contributing to answering the main question: ‘How do GPs decide on child and youth mental health problems and what is the influence of their(lived) experience regarding these problems on this decision?’ Article 1: How do GPs make decisions regarding mental health problems in children and youths? For answering this subquestion, a mixed methods design was used: interviews among 14 and an online survey among 15 GPs. GPs were asked about their clinical decision-making process on children and youths with mental health problems using three vignettes describing children and youths with mental health problems representative of clinical practice. The findings suggest GPs differ with regards to their decision- making regarding child and youth mental health problems, and that their decision-making is influenced by factors related to 1) the GP, for example if the GP approaches the problem somatically or psychosocially, if the GP considers themself competent enough to solve the problem with regards to their interest in and knowledge about youth mental health care, 2) the child and its social context, for example if the child or youth has psychiatric (co)morbidity, if the problem is likely to solve itself and if the problem could be assessed as being complex and 3) the GPs’ collaboration with other youth care providers, for example if GPs have existing collaboration agreements with these youth care providers and how they view their collaboration. Article 2: Can GPs’ decisions on child and youth mental health problems be supported by means of a decision-support method?For answering this subquestion, a literature search was conducted to retrieve studies that involved clinical decision support methods for GPs’ clinical decision-making related to mental health problems among children and youths. This systematic review yielded 25 studies on 18 clinical decision-support methods, divided into computer-based methods (such as MyGRaCE), telecommunication methods (such as CAP PC) and methods with a combination of components related to computer-based methods and telecommunication methods (such as Collaborative care for depression intervention). The article provides insight into (possible) beneficial clinical implications of clinical decision-support methods. These methods could give more insight into possible mental health problems, they could provide structured information which can be used by the GP and/or parents during their next consultation with the child or youth, and they could also decrease time and costs spent by the primary care practice and the GP. There are also less beneficial clinical implications, such as an inability for some computer-based methods to be used in emergency situations, when time is short, problems for children and youths when using computer-based methods because of their mental status, and impediment to discuss certain topics freely because the decision-support method gives too much direction to the consultation. The article describes certain considerations for GPs when choosing a decision-support method, which may indirectly have a positive impact on the implementation of such methods into general practice. For example, the GP can take into account their way of working, user flexibility of the method for the GP, the child/youth and their parent(s) with regards to understandability and ease of use, if the GP already uses a clinical decision-support method, if the GP already has collaboration agreements with youth care providers, as well as their own attitude and knowledge regarding mental health problems among children and youths.Article 3: Do doctors-to-be, among whom future GPs, have (lived) experience regarding mental health problems? Study focused on preclinical medical students.For answering this subquestion, self-report questionnaires were sent to 1311 preclinical medical students of Leiden University Medical Center to measure burnout-, depression- and anxiety-related symptoms. The article concludes that symptoms related to mental health problems are common among preclinical medical students. Burnout-related symptoms were found in 46%, depression-related symptoms in 27% and anxiety- related symptoms in 29% of preclinical medical students. Burnout-related symptoms among preclinical medical students were correlated with a sleep duration of less than 6 hours per night, low happiness and a high need for recovery after a day of study. Depression- and anxiety-related symptoms were mainly correlated with low optimism, low happiness, and a high need for recovery after a day of study. These findings suggest preclinical medical students are at risk to develop mental health problems, which can inspire universities to come up with preventive interventions.Article 4: Do doctors-to-be, among whom future GPs, have (lived) experience regarding mental health problems? Study focused on medical interns.For answering this subquestion, self-report questionnaires were sent to 709 medical interns of the same institution mentioned in article 3 to measure burnout-related symptoms. Burnout-related symptoms were found in 30% of medical interns. Burnout-related symptoms among medical interns were related to low dedication with regards to work, a high work pace and quantity, a high need for recovery after a day of work and low optimism. These correlates could be used to prevent mental health problems among medical interns by making adjustments to the medical curriculum. The articles of this thesis suggest GPs’ decision-making on mental health problems in children and youths is multifactorial and consists of objective and subjective components. Furthermore, decision-making seems to differ between GPs, which may be an explanation why there are a variety of clinical decision support methods. Some clinical decision support methods have been implemented in the context of research into general practice, like MyGRaCE, CHICA, Mobiletype, Youth StepCare, consultation-liason method(between GPs and psychiatrists), telepsychiatry consultation practice and the MC3 Program. A clinical implication is GPs can choose a decision-support method which match their personal style of clinical decision-making. However, the validity, trustworthiness and usability of available methods need to be further explored. A clinical implication with regards to medical students’ mental health comprises universities provide accessible proactive mental support to preclinical medical interns and medical interns, because many do not seek help themselves. Furthermore, universities could stimulate a stigma-reducing educational environment, for example in collaboration with the department of (Child- and Adolescent) Psychiatry. Therefore, medical students could be equipped with effective strategies to cope with mental health problems. Also, they might be made aware of their vulnerability, so that they may know their subjectivity and use their personal experiences in practice. The results of this thesis invite more (longitudinal) research on the diagnostic precision, predictive value and cost-efficiency of clinical decision-support methods. Furthermore, more research is needed on the prevalence of mental health problems among graduated doctors, like GPs, and possible effects of these problems on their way of working, their decision-making and their contacts with patients. Strengths of this thesis include exploration of a relatively unknown research area, namely GPs’ clinical decision-making regarding mental health problems among children and youths. Therefore, this thesis used multiple research methodologies and it used a practical scope. This thesis also contains several limitations, such as inclusion of a small GP population, as well as self-selection bias in the studies on preclinical medical students, medical interns and GPs. Finally, interpretation of the results of this thesis was impeded because the research has been conducted in one university, because cause and effect of results could not always be disentangled and because of low statistical power. Because having mental health problems may influence GPs’ clinical decision-making, one could explore how (future) doctors work, study and relax. Therefore, it is recommended to strive for educating balanced doctors: persons who, in collaboration with their colleagues, are – through reflection – aware of their needs and wants between professional boundaries. Show less
The history of the Central African Republic (CAR) has been one of persistent violence, despite internal and external attempts to break the cycle of misfortune in the country. A number of factors... Show moreThe history of the Central African Republic (CAR) has been one of persistent violence, despite internal and external attempts to break the cycle of misfortune in the country. A number of factors are cited as determinants or amplifiers to explain this ever-renewed cycle of violence in the country, including a disastrous colonial legacy, poor governance, an abundance of natural resources in an uncontrolled territory, greed for power, the collapse of the state, or a combination of all or some of these non-exhaustive factors. However, over and above these not insignificant factors, we need to reconsider the weight of history and the role of young people as constants in the recurrent conflict in the Central African Republic. To explain the durability of this context of instability inscribed in a continuum, we propose the concept of the political arena, a situation of confrontation built up over the course of history, and within which a large number of young people are growing up with a limited agency. We conclude that young people in the CAR have ultimately become a usable resource, having been exploited in the same way as natural resources since pre-colonial and colonial times. Hence the reproduction and/or continuation of violent and recurrent conflicts in the Central African Republic. Show less
April 2015, Burundi. What started as peaceful demonstrations against another term of president Nkurunziza, quickly turned into violent confrontations between mostly young male civilians and... Show moreApril 2015, Burundi. What started as peaceful demonstrations against another term of president Nkurunziza, quickly turned into violent confrontations between mostly young male civilians and government forces. The demonstrations signalled the beginning of a new political crisis after a decade of peace. In this paper, we draw on eye-witness accounts of civilians to understand the escalation of violence. We argue that legacies of conflict informed the understanding and escalation of the violence. For instance, memories and skills learned by adults and older peers during the civil war were passed on to novices to organise protests and neighbourhood defence. Yet the legacies of conflict also juxtaposed with protesters’ ideals on ‘civil’ non-violent political dialogue. The ambivalence towards violence experienced and narrated by protesters and witnesses points to intergenerational change, but may also be understood as contradictions in how political dialogue and competition is generally envisioned in Burundi. Show less
Calhoun, L.M.; Mandal, M.; Onyango, B.; Waga, E.; McGuire, C.; Akker, T. van den; ... ; Speizer, I.S. 2023
BackgroundMany factors influence young women's choice of contraceptive methods and where to source them, yet less is known about whether one of these choices (method or source) is prioritized and... Show moreBackgroundMany factors influence young women's choice of contraceptive methods and where to source them, yet less is known about whether one of these choices (method or source) is prioritized and the relationship between these choices. This study qualitatively explored decision-making around contraceptive method and source choice among young women in Kenya.MethodsIn August-September 2019, 30 in-depth interviews were conducted with women ages 18-24 who had used two or more contraceptive methods and resided in three counties: Nairobi, Mombasa or Migori. Participants were recruited from public and private health facilities and pharmacies. Interview guides captured information about decision-making processes for each contraceptive method the respondent had ever used. Responses were audio-recorded, transcribed, translated into English, coded, and analyzed thematically.ResultsThe majority of respondents knew which method they wanted to use prior to seeking it from a source. This was true for all types of methods that women ever used. Of the small number of respondents who selected their source first, most were in the post-partum period or experiencing side effects and sought counseling at a source before choosing a method.ConclusionsThis study highlights the importance of providing young women with high quality counseling that provides full information about contraceptive options and addresses that young women's needs vary along the reproductive health continuum of care. This will ensure that young women have information to inform future contraceptive decision-making prior to seeking care. Show less
Beer, C.R.M. de; Domburgh, L. van; Vermeiren, R.R.J.M.; Vreugd, M. de; Nooteboom, L.A. 2023
The involvement of youth peer workers (YPSWs) in child and adolescent mental health services (CAMHS) stimulates hope, destigmatization, and more culturally and developmentally appropriate support.... Show moreThe involvement of youth peer workers (YPSWs) in child and adolescent mental health services (CAMHS) stimulates hope, destigmatization, and more culturally and developmentally appropriate support. Nevertheless, the collaboration between YPSWs and non-peer colleagues remains challenging, as it requires services to embed a new type of expert into practice. To stimulate the involvement of YPSWs in practice, this study reports on 27 semi-structured interviews with YPSWs and non-peer colleagues to provide insight into the barriers and facilitators in the collaboration process. The study took place in the Netherlands. A total of 10 interviews with YPSWs, and 17 interviews with non-peer colleagues in different healthcare occupations in CAMHS were conducted. Overall, the participants perceived relatively more barriers compared to facilitators in the collaboration process. Barriers to operate efficiently with YPSWs in multidisciplinary teams included: condescending attitudes and professional stigma towards YPSWs; concerns for YPSW boundaries; bureaucratic and clinical language usage by non-peer colleagues; conflicts due to different sets of expertise; and, lack of role clarity and guidelines for YPSWs. To improve the partnership between YPSWs and non-peer colleagues, participants described the importance of supervision and monitoring of YPSW activities. Moreover, participants also stressed the need for clear guidelines, and introduction and evaluation sessions to facilitate the collaboration process. While YPSWs seem to be an asset to CAMHS, there are a number of barriers to overcome. To overcome these barriers, organizational commitment, supervision (especially from peer colleagues), flexibility by non-peer colleagues, training non-peer staff to support YPSWs, and consistent evaluation of the implementation of YPSWs in services is recommended. Show less
Bansema, C.H.; Vermeiren, R.R.J.M.; Soet, R. de; Ewijk, H. van; Nijland, L.; Nooteboom, L.A. 2023
A small group of youth and emerging adults deals with severe and enduring mental health problems (SEMHP). Current mental health care struggles to recognize and treat this group timely and... Show moreA small group of youth and emerging adults deals with severe and enduring mental health problems (SEMHP). Current mental health care struggles to recognize and treat this group timely and adequately, leaving these youth between the cracks of the system. A first step to improve care for this group is to gain a deeper understanding of the characteristics of youth with SEMHP. Therefore, this study aimed at reviewing current literature about this target group and what is known so far about their characteristics. We included 39 studies with a focus on youth aged 12-25 years with SEMHP. After critical appraisal, a content analysis and in-depth thematic analysis were conducted. According to the included studies, youth with SEMHP were characterized by severe distress and recurrent comorbid mental health problems, with pervasive suicidality. Further, underlying trauma, family conflicts, peer rejection, deep feelings of hopelessness, and psychosocial malfunctioning characterized SEMHP. It was described that for youth with SEMHP a pervasive pattern of dysfunction in multiple domains is present leading to a detrimental impact. Subsequently, this pattern exerts a reciprocal influence on the mental health problems, causing a vicious circle further worsening SEMHP. Our findings emphasize the need for a holistic approach and to look beyond the traditional classification system in order to meet the needs of these youth with wide-ranging comorbid mental health problems. Show less
Benthem, P. van; Spijkerman, R.; Blanken, P.; Boon, A.; Vermeiren, R.; Hendriks, V. 2023
Introduction: We investigated the value of systematic client feedback in youth mental health and addiction care. In the present study, we examined whether a client feedback intervention would... Show moreIntroduction: We investigated the value of systematic client feedback in youth mental health and addiction care. In the present study, we examined whether a client feedback intervention would result in improved therapeutic alliance and treatment outcomes. Methods: Two hundred and four adolescents participated in the study using a - non-randomized - between-group A/B design. In the first study group, 127 patients were offered 4 months of treatment as usual (TAU), and in the second study group, 77 patients received the client feedback intervention as an add-on to TAU during 4 months. Results: Youths who received systematic client feedback in addition to TAU did not show better treatment outcomes or better alliance ratings after 4 months than youths receiving TAU only. Sensitivity analyses, in which we compared the more adherent patients of the second study group with patients receiving TAU, did not show significant beneficial effects of client feedback either. Also, the client feedback intervention did not result in lower rates of early treatment drop-out. Discussion/Conclusion: Our results cautiously suggest that client feedback does not have incremental effects on alliance and the treatment outcome for youth in mental health and addiction treatment. Moreover, our study highlights the challenges of implementing client feedback in clinical practice and the need for additional research addressing these challenges. Show less
Calhoun, L.M.; Mirzoyants, A.; Thuku, S.; Benova, L.; Delvaux, T.; Akker, T. van den; ... ; Speizer, I.S. 2022
Plain language summary In Kenya, about 15% of women age 15-19 have already had a birth and approximately one third of these women did not want to have a child at that time. Yet about 45% of... Show morePlain language summary In Kenya, about 15% of women age 15-19 have already had a birth and approximately one third of these women did not want to have a child at that time. Yet about 45% of sexually active women ages 15-24 report that they currently use family planning (FP). Among young people, friends and peers are an important influence on behaviors. This study focused on a representative sample from Kenya of female and male youth (ages 15-24) who ever had sex. Men and women were asked questions about use of FP, if they think their peers use FP and about characteristics such as age and education. The results showed that young women and men who believed their peers use FP were more likely to use FP themselves. Also, young men and women who believed that peers use FP were more likely to use condoms than not use any FP and more likely to use condoms than to use another modern method of FP. Young women who thought their peers use were more likely to use another modern method (not including condoms) than to be a nonuser of FP. Programs targeting young people should include information on a range of FP methods and aim to include groups of peers and encourage open discussion.Background Prior research has established that an individual's social environment may influence his or her reproductive behaviors, yet less is known about peer influence on contraceptive use among young people (ages 15-24). In Kenya, the site of this study, 15% of adolescents ages 15-19 have begun childbearing and 45% of sexually active young women report current use of a modern contraceptive method. This highlights the need to better understand what factors influence young people to use contraception. The objective of this study is to explore the relationship between the perception of peers' use of contraceptives and contraceptive use and method choice among young men and women in Kenya. Methods This study utilizes a nationally representative sample of women and men aged 15-24 years from the 2018 and 2019 cross sectional Shujaaz State of the Kenyan Youth annual surveys. Among the sample of sexually experienced young people (59%), multivariable multinomial logistic regression was used to explore the association between the perception of peers' use of contraceptives and the respondent's contraceptive method choice: non-user, condom use or use of any other modern method. Results are presented separately for young men and young women. Results Our results show that sexually experienced young men and women who perceive that their peers are using contraceptives are more likely to report current use of condoms compared to being a nonuser (RRR = 2.12, p < 0.001, RRR = 2.59, p < 0.001, respectively); they are also more likely to use condoms than another modern method of contraception (RRR = 2.13, p = 0.034, RRR = 1.71, p = 0.014, respectively). Young women are more likely to use another modern method (not including condoms) than be a nonuser when they perceive that their peers' use contraceptives (RRR = 1.51, p = 0.020). Conclusions The results of this study highlight the important role of peer influence on young people's contraceptive choices. These findings can be used to develop programs that encourage behavior change communication activities in Kenya that focus on normalizing use of a full range of contraceptive methods among peer groups of sexually experienced young people. Show less
EnglishThe position of children under the Dutch East India Company (VOC) in Sri Lanka has been a hitherto fairly neglected subject in the historiography on the VOC. Recent studies have demonstrated... Show moreEnglishThe position of children under the Dutch East India Company (VOC) in Sri Lanka has been a hitherto fairly neglected subject in the historiography on the VOC. Recent studies have demonstrated the importance of focusing on children in colonial contexts during the nineteenth and twentieth centuries, especially when analysing political rationalities of colonial power and religion. While the VOC was an early modern mercantilist company, it sought to impose intellectual, moral and bodily discipline on the local population. The Company wanted to create subjects through education and the introduction of Protestant religion, explicitly targeting children. Why did an early modern mercantilist Company-state attempt to create loyal subjects? How was the Dutch Reformed Church involved in this process of subject-making in Sri Lanka, and what was the importance accorded to children? Using ordinances, visitation reports, minutes from church council meetings and school thombos (parish registers containing school data), I will show why children in eighteenth century Sri Lanka were targets of Dutch colonial subject-making.NederlandsDe positie van kinderen onder de Verenigde Oostindische Compagnie (VOC) in Sri Lanka is een tot nog toe weinig verkend perspectief in de historiografie over de VOC. Recente studies over kinderen in de negentiende- en twintigste-eeuwse koloniale context hebben laten zien dat dit een belangrijk uitgangspunt is voor het bestuderen van de politieke visies achter koloniale en religieuze machtsstructuren. Hoewel ze een vroegmoderne, commerciële compagnie was, wilde ook de VOC morele, intellectuele en lichamelijke discipline opleggen aan de lokale bevolking. Door het gebruik van educatie en het invoeren van de protestantse religie wilde de Compagnie hen omvormen tot loyale onderdanen, en zij richtte zich daarbij expliciet op kinderen. Waarom probeerde een vroegmoderne, mercantilistische Compagnie-staat haar bevolking door een proces van ‘subject-making’ aan zich te binden? Hoe was de Nederduits Gereformeerde Kerk betrokken in dit proces in Sri Lanka, en welke rol en welk belang werd hierin aan kinderen toebedeeld? Met behulp van visitatierapporten, minuten van de Kerkenraadvergadering en ‘school thombos’ (kerkelijke dorpsregisters die schooldata bevatten) laat ik zien waarom kinderen in het achttiende-eeuwse Sri Lanka het doelwit waren van een Nederlands, koloniaal disciplineringsbeleid. Show less
We investigated the potential role of first-session therapeutic alliance ratings to serve as an early marker of treatment outcome in youth mental health and addiction treatment. The present study... Show moreWe investigated the potential role of first-session therapeutic alliance ratings to serve as an early marker of treatment outcome in youth mental health and addiction treatment. The present study is among the first to incorporate both a youths' and a therapists' perspective of the therapeutic alliance in order to maximize predictive value of the alliance for treatment outcome. One hundred and twenty-seven adolescents participated in a multi-site prospective naturalistic clinical cohort study, with assessments at baseline and at 4 months post-baseline. Main outcome measure was favorable or unfavorable treatment outcome status at 4-month follow-up. Early therapeutic alliance had a medium and robust association with treatment outcome for youth' (b = 1.29) and therapist' (b = 1.12) perspectives and treatment setting. Based on the two alliance perspectives four subgroups were distinguished. Incorporating the alliance-ratings from both perspectives provided a stronger predictor of treatment outcome than using one perspective. Youth with a strong alliance according to both perspectives had an eightfold odds of favorable treatment outcome compared with youth with a weak alliance according to both perspectives. The association between therapeutic alliance and treatment outcome in youth mental health and addiction treatment may be substantially stronger than earlier assumed when both a youths' and therapists' perspective on alliance is considered. Show less
Stapersma, L.; Brink, G. van den; Ende, J. van der; Bodelier, A.G.; Wering, H.M. van; Hurkmans, P.C.W.M.; ... ; Utens, E.M.W.J. 2019
In the current study two meta-analyses are performed on longitudinal studies on peer victimization and self-esteem. The goal of these meta-analyses was to analyze whether a low self-esteem predicts... Show moreIn the current study two meta-analyses are performed on longitudinal studies on peer victimization and self-esteem. The goal of these meta-analyses was to analyze whether a low self-esteem predicts future peer victimization, or whether peer victimization predicts future low self-esteem. The databases PsycINFO, MEDLINE, and ERIC were searched for relevant literature. Two authors independently went through the retrieved articles and found four doctoral dissertations and 14 peer reviewed articles eligible for inclusion in the meta-analysis. Articles were independently coded by two authors, with good interrater agreement. A total of 16,230 youth were included in the meta-analysis on peer victimization and self-esteem, and a total of 16,394 youth were included in the meta-analysis on self-esteem and peer victimization. Significant prospective pathways were found from peer victimization to self-esteem, and from self-esteem to peer victimization, which suggests that peer victimization and self-esteem are related in a transactional manner. Analyses suggested a negligible role of publication bias in the obtained results. Moderator analyses revealed that effect sizes were smaller for studies that used peer reports, and for studies that considered longer time-spans. The results of the current study suggest that peer victimization could have long lasting negative effects on self-esteem, but also point out that children may become victims because of low self-esteem. Show less
Africa is at the lower end of internet use, but Facebook connectivity is rapidly increasing, linking diaspora and local people in mainly urban regions in Africa. A survey conducted in N’Djaména... Show moreAfrica is at the lower end of internet use, but Facebook connectivity is rapidly increasing, linking diaspora and local people in mainly urban regions in Africa. A survey conducted in N’Djaména revealed that 1 in 10 people uses Facebook, which is an important platform for these connected Chadians to express feelings, write thoughts, and create networks (i.e., to create a social life). In countries where daily conflict, oppression, insecurity, and mistrust pervade social life, posts and messages engage with these circumstances in a certain dialogue, which can be understood as an expression of duress. This article follows three Facebook users from both the diaspora and N’Djaména, and I position their Facebook expressions and actions in the context of their personal lives in contemporary Chadian political and connectivity history. Facebook appears to be an escape route from the reality of duress, and a form of practical action coupled with political agency. Show less
Schawo, S.; Bouwmans, C.; Schee, E. van der; Hendriks, V.; Brouwer, W.; Hakkaart, L. 2017
The study at hand focuses on the control of sex and youngsters through the response by authorities most notably from within criminal justice. This dissertation consists of five articles and a... Show moreThe study at hand focuses on the control of sex and youngsters through the response by authorities most notably from within criminal justice. This dissertation consists of five articles and a concluding chapter. The emphasis of this study is on the societal interests as protected by the authorities. This approach provides a useful complement to more conventional research on sexual abuse and sexual transgression. In a lot of studies the behavior of individuals receives most attention and not the response by authorities, which can be indicative of the way authorities envision the organization of society. It is this organization through the control of youth and sex that sets this study apart from other studies. Show less
The main purpose of this dissertation was to highlight and address seven challenges related to the measurement of youth cognition, understanding the role of cognitive constructs in anxiety and... Show moreThe main purpose of this dissertation was to highlight and address seven challenges related to the measurement of youth cognition, understanding the role of cognitive constructs in anxiety and school refusal, and the examination of cognitive mediators of cognitive-behavioural treatment outcomes. The studies presented in this dissertation contributed to the empirically valid assessment of constructs of cognitive processing in youth which were until now only present in cognitive theories of Aron Beck. Now, constructs of cognitive processing coming from the cognitive theories of depression and anxiety of Beck and colleagues can be assessed in youth using one single measure. Further, cognitive dimensions of cognitive products and cognitive processes from Beck and colleagues cognitive theories of emotional disorders were found to be important in the etiology of school refusal. The belief that positive treatment outcomes can be achieved through changes in cognition received support. Using innovative statistical approaches to mediation, it was found that enhanced levels of self-efficacy following cognitive-behavioural treatment for school refusal were associated with increased levels of school attendance and decreased levels of school fear. Show less
This thesis deals with the negative perceptions of socially anxious youth in three different cognitive domains: (a) interpretation of ambiguous social situations, (b) self-evaluation of social... Show moreThis thesis deals with the negative perceptions of socially anxious youth in three different cognitive domains: (a) interpretation of ambiguous social situations, (b) self-evaluation of social skills and nervous behaviors, and (c) perception of physical arousal during social situations. It also addresses the issue of whether socially anxious youth's negative cognitions are justified as based on objective sources of information, such as independent observers, same age peers and actual physical responding. Show less
