This thesis summarizes a PhD research project, in which we successfully developed and tested a smartphone-based version of the AAT. We used the mobile AAT to show that approach-avoidance tendencies... Show moreThis thesis summarizes a PhD research project, in which we successfully developed and tested a smartphone-based version of the AAT. We used the mobile AAT to show that approach-avoidance tendencies can undergo substantial state-like changes. We further demonstrate how these changes can be systematically related to other state-variables and how important health-related outcomes such as overweight and obesity, can be explained by disruptions of these dynamics. Our findings have broad implications for approach-avoidance research and task-based research in general, as they reveal how smartphones can be used to get insights into the dynamic nature of task outcomes and how (disruptions of) these dynamics can have important real-life consequences. Show less
Two types of financial incentives can help improve healthy lifestyles: carrots (a reward where one can gain something) and sticks (a deposit contract where one can lose something). In a deposit... Show moreTwo types of financial incentives can help improve healthy lifestyles: carrots (a reward where one can gain something) and sticks (a deposit contract where one can lose something). In a deposit contract, participants deposit own money and can lose or earn it back depending on lifestyle changes. We studied the potential of deposit contracts to stimulate a healthy lifestyle.A smartphone app was developed together with the Swiss university ETH Zurich to conduct experimental research into the effects of deposit contracts. In addition, we collaborated with the American company WayBetter to observe the effects of commercially available deposit contracts. Finally, the opinion of people with cardiovascular disease and healthcare professionals regarding financial incentives and deposit contracts for lifestyle change was investigated.The results show that deposit contracts can have strong effects on exercise behavior (daily step counts) in the short term. The results also show that voluntary participation in deposit contracts is limited, but can be increased by doubling the amount deposited and by allowing participants to determine the amount themselves. Finally, healthcare providers think it is a good idea to use financial incentives, but people with cardiovascular disease themselves are skeptical about the use of deposit contracts. Show less
Despite decades of research from psychology, anthropology, biology and economics, how social preferences arise and vary across contexts remains an open question. In three empirical chapters, this... Show moreDespite decades of research from psychology, anthropology, biology and economics, how social preferences arise and vary across contexts remains an open question. In three empirical chapters, this dissertation addresses this gap using a variety of economic games and neuroimaging techniques that allow for a tractable modeling of cooperation and competition. Overall, findings suggest that while social preferences are linked to neural structure, they can also adapt to environmental factors as well as beliefs about interaction partners. This doctoral thesis shows that interacting with ingroup or outgroup members, taking decisions publicly or privately, and knowing whether we may interact with others again affect our cooperative behavior. These results highlight the importance of understanding how prosociality may be altered and lay the foundations for policy makers to further those social environments that encourage prosocial behavior. Show less
By monitoring ongoing actions and performance outcomes, we are able to detect errors or mismatches between our intentions or predictions. Disturbances in such performance-monitoring processes may... Show moreBy monitoring ongoing actions and performance outcomes, we are able to detect errors or mismatches between our intentions or predictions. Disturbances in such performance-monitoring processes may importantly contribute to impaired adaptive behavior in clinical disorders, such as excessively impulsive behavior in externalizing disorders or excessively rigid or careful behavior in anxiety- and obsessive-compulsive disorders. In daily life, performance monitoring often takes place in a social context, where our actions have consequences not only for ourselves, but also for others. The investigation of (alterations in) such (pro)social performance-monitoring processes may help explain functional and social impairments across a wide range of clinical disorders. In this dissertation, we used various neuroimaging paradigms to examine subclinical and neurochemical influences on performance monitoring when errors had consequences for oneself or others. The studies in this dissertation indicate that neural performance-monitoring correlates are modulated by social, subclinical, and neurochemical factors, including social (responsibility) context, obsessive-compulsive symptoms, ovarian hormones, and pharmacological manipulations of dopamine and oxytocin. These findings have implications for the potential and utility of error-related brain activity as a clinical biomarker or endophenotype, our insight into social symptoms and impairments in obsessive-compulsive disorder, and for our understanding of the neurochemical mechanisms underlying performance monitoring. Show less
In my study I looked for a plausible cognitive theoretical framework for conforming behavior. The Theory of Event Coding (TEC) was the cognitive theory that offered a good basis for building this... Show moreIn my study I looked for a plausible cognitive theoretical framework for conforming behavior. The Theory of Event Coding (TEC) was the cognitive theory that offered a good basis for building this framework. I conducted an experiment using an existing study design adopted from previous studies of conformity adding a non-social condition where participants were confronted not with what they thought were other students’ choices but with random computer choices. According to TEC, a simple confrontation with an alternative behavior would affect reproduction of your own behavior at a later stage. The study results supported my theory. Unfortunately, the results were possibly influenced by Regression to the Mean. So I changed the study design to eliminate the issue. Also I wanted to see if and how conformity was affected by culture: collectivistic versus individualistic. This study was conducted partially in the lab (in the Netherlands and China) and partially online (in the USA and India). The results confirmed my initial hypothesis: the conformity effect did not differ across all experimental groups irrespective of the country or condition suggesting that people are sensitive to intervening events, but the social nature of these intervening events is irrelevant. Show less
In the realm of cognitive science, the quest to understand cognitive control has persisted for decades. Traditional notions of cognitive control have focused on inhibition through the prefrontal... Show moreIn the realm of cognitive science, the quest to understand cognitive control has persisted for decades. Traditional notions of cognitive control have focused on inhibition through the prefrontal cortex, but this dissertation challenges that perspective with a more comprehensive framework: The Metacontrol State Model (MSM). The MSM proposes that cognitive control emerges from the interplay between two opposing systems – one promoting flexibility and the other promoting persistence. These systems interact to shape our cognitive processing styles, thereby influencing our ability to effectively regulate our actions. This dissertation explores questions such as why individuals exhibit differences in cognitive control capacity and how state-related changes and trait-related predispositions impact cognitive control function. The overarching goal of this dissertation is to empirically test the MSM model and shed light on the factors that influence cognitive control. Through a series of experiments, it seeks to understand how altered states of consciousness, achieved through meditation techniques or serotonergic psychedelics, affect the balance between intentional and habitual processes. Additionally, it examines the extent to which individual trait biases serve as trans-diagnostic markers in various psychopathologies. This work comprises a literature review and six empirical articles. By integrating theory and empirical research, this dissertation takes us on a journey into the intricate world of cognitive control, shaping our understanding of how it influences our lives. Show less
Gerritsen, R.J.S.; Band, G.P.H.; Lafeber, J.; van den Beukel, N.; van Voskuilen, B.; Hoogland, R. 2023
Social anxiety is anxiety about negative evaluation and rejection by others. Social anxiety has been long related to reduced eye contact, this feature is seen as a casual and a maintaining factor... Show moreSocial anxiety is anxiety about negative evaluation and rejection by others. Social anxiety has been long related to reduced eye contact, this feature is seen as a casual and a maintaining factor of social anxiety disorder. However, related empirical findings were equivocal. The dissertation sought to address three key questions: (1) Whether social anxiety is featured by gaze avoidance. (2) Under which conditions socially anxious individuals display gaze avoidance. (3) To what extent subjective experience of gaze avoidance corresponds with actual gaze behavior. Using the combination of naturalistic social settings and wearable eye-trackers, the dissertation provides evidence for the relationship between social anxiety and gaze avoidance particularly in naturalistic social situation, and further reveals that the relationship depends on severity of social anxiety symptoms, type of social situation and age group. Besides, gaze anxiety is moderately associated with actual gaze avoidance. Altogether, the dissertation sheds light on the nature of gaze behavior adopted by socially anxious individuals in naturalistic social interactions. Show less
For people with chronic kidney disease (CKD), adhering to a range of self-management tasks—such as healthy eating, frequent physical activity, and non-smoking—is crucial. However, changing health... Show moreFor people with chronic kidney disease (CKD), adhering to a range of self-management tasks—such as healthy eating, frequent physical activity, and non-smoking—is crucial. However, changing health behaviors is difficult. To support patients in doing so, an eHealth care pathway was developed and evaluated. The results provide different insights into patients' priorities and care needs. Many individuals with CKD experience problems in self-management, which can be hindered by many different barriers of which a common one is psychological distress. Therefore, personalized interventions are needed with screening and treatment of both psychological distress and suboptimal self-management, tailored to the specific barriers and needs of the individual patient. The E-GOAL eHealth care pathway is an example of such a personalized intervention, combining cognitive behavioral therapy with self-management support. Patients were enthusiastic about the eHealth care pathway. However, in a randomized study, the intervention was not effective in reducing psychological distress compared with regular care only. Patients did experience improvements in areas of functioning and self-management that they prioritized themselves. These mixed results show that interventions could be implemented that are person-tailored, with personalized outcomes that reflect individually meaningful treatment goals and improvements for every patient. Show less
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
The overarching goal of this dissertation was to investigate parenting processes in relation to affective well-being in families in the daily flow of life from different perspectives (i.e.,... Show moreThe overarching goal of this dissertation was to investigate parenting processes in relation to affective well-being in families in the daily flow of life from different perspectives (i.e., adolescent, mother, father), on different levels (i.e., objective, momentary, and daily), and in a clinical sample (families with an adolescent with a depression) in addition to community samples. Our findings underline the importance of daily parental warmth and criticism of mothers and fathers for adolescents’ well-being. In addition, we showed that adolescents, parents, and their perceptions of parenting influence each other and that becoming more attuned to each other’s intention and needs is essential. Importantly, we consistently demonstrated that not only the extent and direction of the dynamic processes between parenting and affect in daily life differs between, but also within persons and families. This stresses the need for research focusing on individual processes and combining quantitative with qualitative measures. The use of more idiographic approaches would not only enable gaining more insight into these differences between individuals, but also contribute to identifying parenting practices that work for almost all adolescents. This would facilitate the development of interventions combining universal parenting principles with suggestions for tailoring it to individual- or family-specific situations. Show less
This dissertation reveals that sound financial decisions are determined by multiple factors and are germane to both financial satisfaction and financial well-being. The most promising factors to... Show moreThis dissertation reveals that sound financial decisions are determined by multiple factors and are germane to both financial satisfaction and financial well-being. The most promising factors to increase financial satisfaction were financial confidence, future orientation, and perceived behavioural control, and the most promising factors to increase financial well-being were the combination of high objective and high subjective financial knowledge and financial self-efficacy. We also found two observations remarkable. First, not all financial behaviours that could be intuitively regarded as positive were immediately beneficial to financial satisfaction or financial well-being. For example, budgeting and making considered purchases could be unpleasant and, therefore, adversely affect financial well-being in the short term. Likewise, adjusting spending based on changing (financial) circumstances and keeping track of expenses could be painful and, hence, adversely impacted financial satisfaction in the short term. Second, not all control skills that could be expected to help people make sound financial decisions, actually do so. For instance, people with more spending self-control reported working less toward their financial goals. It is possible that these people are so focused on curbing purchase impulses, that they forget what they are doing it for, namely to create financial room to achieve their goals. 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
This PhD research dealt with neurobiological and behavioral aspects of pain. Previous research has demonstrated that pain sensitivity can be worsened as a result of learned negative expectations, a... Show moreThis PhD research dealt with neurobiological and behavioral aspects of pain. Previous research has demonstrated that pain sensitivity can be worsened as a result of learned negative expectations, a phenomenon termed nocebo hyperalgesia –a counterpart to placebo analgesia. This PhD dissertation describes neuroimaging and biobehavioral experimental studies as well as a review and a meta-analysis concerned with such learned effects on pain. The research adds to a growing literature that has been challenging antiquated understandings of pain as a bottom-up process. We conducted a series of biobehavioral studies to further our understanding of how bottom-up pain signaling can be influenced by top-down processing. We examined the types of experiences, such as receiving negative information or experiencing a negative effect first-hand, that may lead to stronger nocebo effects. Behavioral paradigms were used to model real-life pain experiences, through validated methods, novel learning manipulations, as well as a close examination of emotional correlates such as fear. Concurrently, innovative neuroscientific methods –including pharmacological manipulations– were used to examine the biobehavioral underpinnings of learned nocebo responses. Our findings add to the growing knowledgebase from the field of nocebo hyperalgesia, demonstrating that learning by experience can decisively influence the processing and perception of noxious stimuli. Show less
The current dissertation aims to assess the well-being of Emergency Department (ED) nurses and identify (combinations of) job factors related to this. Second, it aims to evaluate the overall... Show moreThe current dissertation aims to assess the well-being of Emergency Department (ED) nurses and identify (combinations of) job factors related to this. Second, it aims to evaluate the overall effectiveness and effective elements of an intervention implementation project conducted in multiple EDs in the Netherlands. Findings show a high prevalence of stress-related outcomes in ED nurses, but also high levels of work engagement and job satisfaction. Worktime demands and aggression/conflict situations have the strongest relationship with exhaustion, whilst work engagement is mostly related to developmental opportunities. Recovery during and outside of work can buffer the impact of patient-related stressful situations. According to a literature review, interventions can effectively prevent/reduce stress-related outcomes in nurses, with person-directed interventions reaching greater short-term effects. Little is known about their longevity and only a limited number of organization-directed studies exist. The current 2,5-year (mostly organization-directed) intervention project, led to improved working conditions but not (yet) to better well-being. Greater effects were found in hospitals with more fitting interventions and were employees felt more informed about and involved in the project. Psychosocial safety climate was positively related to communication, participation and the fit of actions to the risk factors, and as such provides a good starting point for a successful intervention project. Show less
What are the evolutionary roots of emotions? To answer this cardinal question, I study emotions in animals that are evolutionarily close to us: the great apes. In this dissertation, I investigated... Show moreWhat are the evolutionary roots of emotions? To answer this cardinal question, I study emotions in animals that are evolutionarily close to us: the great apes. In this dissertation, I investigated how bonobos, orangutans, and humans perceive emotions by studying three markers of emotion perception: attention, spontaneous mimicry, and implicit associations. Using touchscreen tasks and eye-tracking, I found that bonobos and humans share attentional mechanisms for perceiving their social surroundings. In both species, attention was immediately directed to emotional signals of unfamiliar others (in bonobos) or familiar others (in humans). Bonobos and humans also looked longer at certain emotionally-laden scenes than emotionally-neutral scenes. Subsequently, I studied orangutans: the only apes leading a semi-solitary existence. I found that orangutans show spontaneous mimicry in the form of contagious yawning and self-scratching, contradicting the idea that mimicry only occurs in highly social species. Finally, I created and validated a pictorial version of the implicit association test: a task that can potentially help us uncover whether apes have implicit associations with emotions. The results in this dissertation indicate a common evolutionary origin for attentional mechanisms and mimicry in great apes, including humans, and highlight the importance of considering species-specific characteristics that drive emotion perception. Show less
Physical and sexual abuse during childhood can have long lasting consequences such as posttraumatic stress disorder (PTSD). Prolonged Exposure (PE) is an established and effective guideline... Show morePhysical and sexual abuse during childhood can have long lasting consequences such as posttraumatic stress disorder (PTSD). Prolonged Exposure (PE) is an established and effective guideline treatment for PTSD. Nevertheless, a considerable number of patients drop out from treatment or do not (completely) recover from PTSD during PE. It has been suggested that patients with PTSD resulting from childhood abuse are specifically at risk for suboptimal treatment outcomes. We carried out a randomized controlled trial with 149 patients with childhood abuse-related PTSD comparing PE with two innovations: intensified PE (iPE) and skills training in affective and interpersonal regulation followed by PE (STAIR+PE). We found that all treatments were safe and resulted in large improvements in PTSD symptoms. iPE and STAIR+PE did not improve treatment outcomes of PE, although iPE led to faster symptom improvements. Not all patients benefitted from the allocated treatment, but we found no contra-indications for the treatments. We found that a combination of patient characteristics was predictive of a larger effect size of PTSD symptom improvement in PE and iPE or STAIR+PE. We conclude that the three forms of exposure therapy were effective treatments for patients with childhood abuse-related PTSD. Show less
This thesis describes a dissimilarity-based classification tool, the δ-machine, which gives an alternative way of statistical modeling compared to the conventional ones that directly use predictor... Show moreThis thesis describes a dissimilarity-based classification tool, the δ-machine, which gives an alternative way of statistical modeling compared to the conventional ones that directly use predictor variables. We use the symbol δ, because it is commonly used as a symbol for dissimilarities in multidimensional scaling.In this thesis, we discuss the properties of the δ-machine, and extend the δ-machine from handling continuous predictor variables only to handle different types of predictor variables, including continuous, ordinal, nominal, and binary predictor variables via the two tailored dissimilarity functions. Furthermore, we study the classification performance of the δ-machine in high dimensional data. We propose a Majorization-Minimization algorithm to interpolate new data points coherently into previously constructed classical multidimensional scaling (CMDS) configurations, and use the proposed algorithm in the δ-machine in high dimensional data scenario, where CMDS is applied to reduce the original high dimensional predictor variables. In order to make predictions for new data points, therefore, needs to interpolate them into the constructed CMDS.The δ-machine shows promising predictive performance in general and is able to find informative exemplars/prototypes, which bring extra insights of data. The informative exemplars could be used in the further study. Show less
This thesis investigated the development of emotional functioning in 2-to-6-year-old children with and without autism. Whereas autistic children experienced more challenges in the emotional domain,... Show moreThis thesis investigated the development of emotional functioning in 2-to-6-year-old children with and without autism. Whereas autistic children experienced more challenges in the emotional domain, their emotional abilities improved with age, and developed in similar ways as observed in non-autistic children. On the one hand, this thesis showed that autistic children might deal with emotions in a different way, and they might experience various difficulties when communicating emotions with non-autistic people. One the other hand, it is important to note that the difficulties could be bidirectional. As stated by the “double empathy problem”, non-autistic people may experience the same difficulties when communicating with autistic people. This could be a meaningful direction for future research, investigating emotional communication as a two-way interaction rather than focusing only on how people with autism react to people without autism. Furthermore, this thesis showed that autistic children had the potential to learn and to develop in the emotional domain. Again, this points to the importance of investigating how to create an inclusive social environment, which is not only nurturing for children without autism, but can also benefit the development of children with autism and with other special needs. Show less