Cas Schaap

on the clinical validity of the maslach burnout inventory and the burnout measure

Abstract Current knowledge about burnout suffers from a healthy worker bias since only working - and thus relatively healthy - employees have been investigated. The main objective of this study is to examine - for the first time among employees who sought psychological treatment - the validity of the two most widely used burnout instruments; the Maslach Burnout Inventory (MBI) and the Burnout Measure (BM). Two groups were distinguished: a “burned out” group (n = 71) that suffers from work-related neurasthenia (according to ICD-10 criteria), and a “non-burned out” group (n = 68). Results show that: (1) the validity of the three-factor structure of the MBI and the BM is confirmed; (2) burnout can partly be differentiated from other mental syndromes (e.g., anxiety and depression); and (3) two MBI-scales (Emotional Exhaustion and Depersonalization) and one BM-scale (Exhaustion) are able to discriminate between burned out and non-burned out employees. The practical implications of these results are discussed.

The Impact of Interpersonal Patient and Therapist Behavior on Outcome in Cognitive-Behavior Therapy A Review of Empirical Studies

Empirical studies are reviewed, the aim being to investigate characteristics of the therapeutic relationship in cognitive-behavior therapy (CBT) and to identify therapist or patient interpersonal behavior that affects treatment outcome. CBT is characterized by a more active and directive stance on the part of the therapists and higher levels of emotional support than are found in insight-oriented psychotherapies. Therapists express high levels of empathy and unconditional positive regard, similar to those expressed by insight-oriented psychotherapists. Two clusters of interpersonal behavior have been identified that are clearly associated with CBT outcome: (a) the Rogerian therapist variables—empathy, nonpossessive warmth, positive regard, and genuineness; and (b) therapeutic alliance. There is some evidence for the impact on outcome of three additional clusters of patient behavior: (a) the patients’ perception of the therapist as being selfconfident, skillful, and active; (b) the patients’ openness to discuss their problems; and (c) the patients’pretreatment predisposition to change and to accept psychological treatment as a means of achieving this. It is further concluded that relationship factors in general have a consistent but moderate impact on CBT outcome.

Prognostic factors in the behavioral treatment of panic disorder with and without agoraphobia

Pretreatment and early treatment variables were evaluated as predictors of outcome for the behavioral treatment of panic disorder (PD) with and without agoraphobia. The following variables were examined: severity of agoraphobic complaints, catastrophic agoraphobic cognitions, level of depression, quality of the therapeutic relationship, motivation for treatment, personality psychopathology, and marital dissatisfaction. Sixty patients, diagnosed with PD, received a standardized exposure-based behavioral treatment program. Severity of agoraphobiccomplaints, level of depression, motivation for treatment, personality psychopathology, and catastrophic agoraphobic cognitions were related to treatment outcome, whereas the quality of the therapeutic relationship and marital dissatisfaction were not. Catastrophic agoraphobic cognitions were the strongest predictor of poorer outcome. Patients frequently distressed by maladaptive cognitions tended to improve less with an exposure-based treatment program. Based on several predictors taken together, 75% to 85% of the patients were correctly classified as treatment failures or treatment successes. A decision model based on multiple prognostic variables may lead to a reliable screening method of PD patients who are unlikely to improve. Treatment programs can then be adapted for these patients.

The prevention of relationship distress for couples at risk: A controlled evaluation with nine-month and two-year follow-ups

A preventive intervention was randomly offered to a group of 67 non- to mildly distressed couples who participated in a larger study on relationships. At the 9-month follow-up, couples in which one partner experienced parental divorce demonstrated a significant increase in problem intensity and a trend toward decreased problem solving ability and relational efficacy, whereas couples from intact families of origin showed the opposite. At the 2-year follow-up, no significant differences were found between the two groups. At both follow-ups, participation in the preventive intervention did not appear to have a protective influence on decline in relationship functioning for persons whose parents divorced and their partners.

Patient-therapist interaction in the behavioral treatment of panic disorder with agoraphobia

Although effective behavioral techniques have been developed, what aspects of the patient-therapist interaction affect treatment outcome remain largely unknown. This study hypothesized that the interaction between patient and therapist develops over several phases. Further, the association between behavior modes and treatment outcome was expected to alter as that interaction developed. Thirty patients diagnosed with panic disorder with agoraphobia were treated with a standardized behavioral treatment program of 12 sessions. The interpersonal verbal therapist and patient behavior modes were studied at Sessions 1, 3, and 10, using an observational instrument. It was found that behavior modes change over the course of treatment, in line with predictions derived from social-psychological models. The hypothesis that establishing a therapeutic relationship requires an empathic and nondirective stance by the therapist in Session 1 was pardy confirmed.

Do patients suffering from obsessions alone differ from other obsessive-compulsives?

The aim of this study was to determine whether a group of 48 patients with obsessions and compulsions differed from a group of 26 patients with obsessions alone, on the basis of demographic variables, variables relating to obsessive-compulsive neurosis, psychological variables and treatment outcome. It was found that they differed significantly in the following areas: marital status, level of education, age at onset of complaints, psychoactive medication taken when admitted for treatment, severity of obsessive-compulsive complaints, depression and intelligence. No difference was found as far as treatment outcome was concerned. Patients suffering from obsessions alone, would appear to form a distinct sub-group within the group of obsessive-compulsive patients as a whole.

The Therapeutic Relationship in the Behavioural Treatment of Anxiety Disorders

The present study investigates the prediction of treatment outcome in the early stages of therapy by examining the quality of the therapeutic relationship. Furthering our understanding of the critical relationship variables may be useful for intervening in unsuccessful treatment outcomes. Two self-report instruments are used to assess the client-therapist interaction: the EPIN and the TCRS. Results show the clients assessment of the quality of the therapeutic relationship, as assessed with the EPIN, is related to treatment outcome. None of the subscales of the TCRS showed significant correlations. We conclude that in the early stage of treatment, the establishment of an accepting, empathic and supportive relationship with the client (as perceived by the client), is important for the progress of directive behaviour therapy.

Blood pressure response during verbal interaction: Review and prospect

Blood pressure changes during verbal interaction have typically been measured by noninvasive devices, at regular intervals of 1 to 5 minutes, in hypertensive as well as in normotensive subjects. In early studies the role of content variables was emphasized together with that of the emotions of anger and anxiety. Later the focus was on transactional involvement as one of the main causes of blood pressure changes. Two categories of independent variables that have received recent attention are the act of speaking itself and individual difference variables such as the Type A behavior pattern, which is characterized by a competitive, aggressive and impatient style of living. The discontinuous and momentary nature of most measurement techniques poses serious limitations to the study of fast fluctuating physiological changes during verbal episodes. In this regard, the recent advent of a noninvasive device for the continuous measurement of blood pressure could give a new impetus to the experimental clinical investigation of blood pressure changes during verbal communication.

Ervaringen met de ambulante behandeling van gecompliceerde patiënten met een dwangneurose

SamenvattingPatiënten met een dwangneurose worden nogal eens uit wanhoop klinisch behandeld. In dit artikel worden drie casus beschreven van dergelijke patiënten die ambulant zijn behandeld. Twee van deze drie patiënten waren bijna klachtenvrij na 60–80 (soms dubbele) zittingen over een periode van ongeveer twee jaar. De derde patiënt vertoonde een significante verbetering in een vergelijkbare periode. Beschreven worden de kenmerken van dergelijke behandelingen en de noodzakelijke therapeutische maatregelen met name in de relationele en motiverende sfeer als in de sfeer van de combinatie van psychofarmaca met psychologische interventies.

The immediate effects of exposure versus response prevention in the treatment of obsessive-compulsive disorder

Several empirical studies suggest that exposure in vivo and response prevention have a differential treatment effect on the complaints presented by patients with Obsessive-Compulsive Disorder (OCD). In the present study it was hypothesized that exposure in vivo would result in a greater decrease of obsessional fear, whereas response prevention would result in a greater decrease of rituals. Forty patients, diagnosed with OCD, participated in the study. Half of the patients received exposure in vivo alone, followed by response prevention alone, and half received response prevention alone, followed by exposure in vivo alone. No differential treatment effects between exposure in vivo alone and response prevention alone could be found, although ritualistic behaviour was less strongly affected by exposure in vivo following response prevention.