Ad de Jongh

A randomised comparison of cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR) in disasterexposed children

Background : Building on previous research with disaster-exposed children and adolescents, a randomised clinical trial was performed in the treatment of trauma-related symptoms. In the current study two active treatments were compared among children in a broad age range and from a wide diversity of ethnic populations. Objective : The primary aim was to compare the effectiveness and efficiency of Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitisation and Reprocessing (EMDR). Design : Children (n=52, aged 4–18) were randomly allocated to either CBT (n=26) or EMDR (n=26) in a disaster mental health after-care setting after an explosion of a fireworks factory. All children received up to four individual treatment sessions over a 4–8 week period along with up to four sessions of parent guidance. Blind assessment took place pre- and post-treatment and at 3 months follow-up on a variety of parent-rated and self-report measures of post-traumatic stress disorder symptomatology, depression, anxiety, and behaviour problems. Analyses of variance (general linear model repeated measures) were conducted on the intention-to-treat sample and the completers. Results : Both treatment approaches produced significant reductions on all measures and results were maintained at follow-up. Treatment gains of EMDR were reached in fewer sessions. Conclusion : Standardised CBT and EMDR interventions can significantly improve functioning of disaster-exposed children. For the abstract in other languages, please see Supplementary files under Reading Tools online

Disgust sensitivity, blood–injection–injury fear, and dental anxiety

The present studies evaluated whether high disgust sensitivity is associated with high levels of blood-injection-injury (BII) fear. The first study found no evidence for a connection between disgust sensitivity and BII fear in a sample of undergraduate students (N = 1.66). In contrast, the second study did find a significant correlation between disgust sensitivity and BII fear in a mixed sample of dental anxious patients and undergraduate students (N = 96), but the magnitude of this correlation was rather modest. The third study relied on a sample of patients with clinical dental phobia (N = 36). Although these patients displayed heightened disgust sensitivity scores, no significant associations were found between disgust sensitivity and BII fear or fainting. Taken together, the present data indicate that disgust sensitivity plays only a minor role in BII-related fears such as dental anxiety. Copyright (C) 1999 John Wiley & Sons, Ltd.

Victims' use of professional services in a Dutch sexual assault centre

Background Prior research endorsed the establishment of sexual assault centres in the Netherlands because of the potential benefit for victims’ mental recovery. In 2012, the first Dutch sexual assault centre was founded at the University Medical Center Utrecht. The aim of the centre is to provide 24/7 coordinated and integrated services (i.e., medical, forensic, and psychological) in one location. Objective The purpose of the present study was to describe demographic, background, and assault characteristics of victims seen at the centre within one week post-assault, and their use of post-assault services in order to improve current services. Method From January 2012 to September 2013, prospective data of 108 patients were collected. To describe the population included, frequency counts and proportions were generated for categorical variables. Results The mean age was 21.3 years (SD=9.8). Most victims were female (91.7%). A large proportion of victims reported background characteristics known to increase the risk for post-traumatic stress disorder (PTSD) and revictimisation such as prior sexual abuse (32.4%), pre-existing use of mental health services (45.4%), and not living with both biological parents (61.7%). Most patients (88.9%) consulted the centre within 72 hours post-assault. The uptake of services was high: 82.4% received emergency medical care, 61.7% underwent a forensic–medical exam, 34% reported to the police, and 82.4% utilised psychological services. Conclusion To prevent revictimisation and PTSD, current psychological services could be improved with immediate trauma-focused treatments. Current forensic services may be improved with the use of standard top to toe forensic–medical examinations for both children and adults.

Imposed and chosen monitoring and blunting strategies in the dental setting: Effects, self-efficacy, and coping preference

Abstract In the present study, 94 dental patients received either monitoring (i.e., paying attention) or blunting (i.e., distraction) coping instructions during treatment. Half of the patients were given the possibility of choice, whereas the other half were offered one of both strategies without choice. A majority of the patients (n=61) indicated that the intervention had resulted in a decrease of their anxiety. Some indications were found for the monitoring strategy to be more effective than the blunting strategy. More specifically, monitoring strategy subjects reported that they had experienced less distress during treatment than blunting strategy subjects. In agreement with this finding, self-efficacy ratings of monitoring strategy subjects were higher than those of blunting strategy subjects. Possibility of choice and coping preference had no substantial influence on effectiveness of the interventions.

Looking at threat-relevant stimuli: The role of anxiety and coping style

Abstract Results of numerous studies demonstrate that anxious subjects selectively attend to threat-related rather than to neutral stimuli. It has been argued that, as a result of this, anxious individuals more easily perceive and misattribute threatening stimuli in their environment, thereby creating a vicious circle of attention and anxiety. The evidence for this anxiety-linked attentional bias, however, is largely based on studies using subliminal or dichotic presentation of verbal stimuli. The present study sought to replicate these results by examining the relationship between anxiety and visual attention during prolonged exposure to threat-relevant (pictures of situations in a dental practice) and neutral (pictures of situations at a hairdresser salon) material with 45 women. No significant relationship emerged between dental trait anxiety and duration subjects directed gaze to the threat-relevant pictures. Neither self-reported state anxiety nor habitual coping style appeared to be significantly related to duration of visual attention for the threat-relevant pictures. Hence, no evidence was found supporting the hypothesis that high anxiety leads to a bias in attention towards emotionally threatening information. It is suggested that hypervigilance occurs in the early stages of the appraisal process.

Comparison of eye movement desensitization and reprocessing therapy, cognitive behavioral writing therapy, and wait-list in pediatric posttraumatic stress disorder following single-incident trauma: a multicenter randomized clinical trial

BACKGROUNDnPractice guidelines for childhood posttraumatic stress disorder (PTSD) recommend trauma-focused psychotherapies, mainly cognitive behavioral therapy (CBT). Eye movement desensitization and reprocessing (EMDR) therapy is a brief trauma-focused, evidence-based treatment for PTSD in adults, but with few well-designed trials involving children and adolescents.nnnMETHODSnWe conducted a single-blind, randomized trial with three arms (nxa0=xa0103): EMDR (nxa0=xa043), Cognitive Behavior Writing Therapy (CBWT; nxa0=xa042), and wait-list (WL; nxa0=xa018). WL participants were randomly reallocated to CBWT or EMDR after 6xa0weeks; follow-ups were conducted at 3 and 12xa0months posttreatment. Participants were treatment-seeking youth (aged 8-18xa0years) with a DSM-IV diagnosis of PTSD (or subthreshold PTSD)xa0tied to a single trauma, who received up to six sessions of EMDR or CBWT lasting maximally 45xa0min each.nnnRESULTSnBoth treatments were well-tolerated and relative to WL yielded large, intent-to-treat effect sizes for the primary outcomes at posttreatment: PTSD symptoms (EMDR: dxa0=xa01.27; CBWT: dxa0=xa01.24). At posttreatment 92.5% of EMDR, and 90.2% of CBWT no longer met the diagnostic criteria for PTSD. All gains were maintained at follow-up. Compared to WL, small to large (range dxa0=xa00.39-1.03) intent-to-treat effect sizes were obtained at posttreatment for negative trauma-related appraisals, anxiety, depression, and behavior problems with these gains being maintained at follow-up. Gains were attained with significantly less therapist contact time for EMDR than CBWT (meanxa0=xa04.1xa0sessions/140xa0min vs. 5.4xa0sessions/227xa0min).nnnCONCLUSIONSnEMDR and CBWT are brief, trauma-focused treatments that yielded equally large remission rates for PTSD and reductions in the severity of PTSD and comorbid difficulties in children and adolescents seeking treatment for PTSD tied to a single event. Further trials of both treatments with PTSD tied to multiple traumas are warranted.

Treatment of a woman with emetophobia: a trauma focused approach

A disproportionate fear of vomiting, or emetophobia, is a chronic and disabling condition which is characterized by a tendency to avoid a wide array of situations or activities that might increase the risk of vomiting. Unlike many other subtypes of specific phobia, emetophobia is fairly difficult to treat. In fact, there are only a few published cases in the literature. This paper presents a case of a 46-year old woman with emetophobia in which a trauma-focused treatment approach was applied; that is, an approach particularly aimed at processing disturbing memories of a series of events which were considered to be causal in the etiology of her condition. Four therapy sessions of Eye Movement Desensitization and Reprocessing (EMDR) produced a lasting decrease in symptomatology. A 3-year follow up showed no indication of relapse.

Longitudinal changes in dental fear and coping behavior in children, adolescents, and young adults with cleft lip and/or cleft palate

Objective To determine changes in dental anxiety levels of cleft lip and/or palate (CL/P) children and to explore the role of coping strategies in the development of their dental anxiety. Design Prospective study. Setting Free University Medical Center Amsterdam. Patients A sample of CL/P children (at T1: n = 153, 4 to 18 years, 67 girls; at T2: n = 113, 7 to 21 years, 51 girls). Data were available at both time points for 102 children. Measures Dental anxiety and coping strategies were assessed at the start of the study (T1; mean age: 9.8 years, standard deviation 4.1) and 3 years later (T2; mean age: 13.4 years, standard deviation 3.8). These scores were compared to a normative group of Dutch children. Main Outcome Measure(s) The severity of dental anxiety was indexed using the Parental Version of the Dental Subscale of the Childrens Fear Survey Schedule. Dental coping strategies were assessed with the Dental Cope Questionnaire. Results Overall, dental anxiety decreased to a level equal to normative scores of Dutch children. However, 5% of the children became more anxious. At T2, children used significantly fewer coping strategies. Children whose level of dental anxiety increased significantly used more destructive coping strategies than children whose level of dental anxiety decreased significantly or remained stable. Conclusions Results suggest that dental anxiety levels of most CL/P children gradually decline over time. Whereas some coping strategies have the potential to be protective, more destructive coping strategies may put children at greater risk for developing and maintaining their dental anxiety.