Chris Hinnen

Do patients trust their physician? The role of attachment style in the patient-physician relationship within one year after a cancer diagnosis.

Abstract Background. The degree of trust in and satisfaction with the physician has been shown to have important implications for treatment outcomes. This study aims to examine individual differences in patients’ trust, satisfaction and general distress from an attachment theoretical perspective. Material and methods. One hundred and thirty recently diagnosed cancer patients of three medical hospitals were extensively interviewed by trained psychologists to assess attachment style. Patients completed standardized questionnaires three and nine months after diagnosis to assess trust, satisfaction and distress. t-tests and repeated measures ANOVAs were used to examine differences between securely and insecurely attached patients and changes over time. A mediation model based on a bootstrapping method was used to examine whether trust mediated between attachment and satisfaction, and attachment and distress. Results. Insecurely attached patients (N = 45, 35%) reported less trust in and satisfaction with their physician, and reported more general distress than securely attached patients three and nine months after diagnosis (p < 0.05). Trust and distress levels did not change over time. Trust mediated between attachment and satisfaction, but not between attachment and distress. Conclusion. Insecurely attached patients trusted their physician less than securely attached patients, and in turn were less satisfied with their physician. Their higher levels of general distress were not related to their lower levels of trust. Attachment theory provides a framework to interpret differences in patients’ trust, satisfaction and distress, and may help physicians respond in such a way that their patients feel secure, which in turn is expected to result in better health outcomes.

Partner support and distress in women with breast cancer: The role of patients’ awareness of support and level of mastery

The aim of the present study was to investigate the associations between partners’ ways of providing support (both active engagement and protective buffering) and distress in women with breast cancer as a function of patients’ awareness of the support received and their sense of mastery. These associations were investigated both cross-sectionally and longitudinally (i.e. changes in distress over time). At 3 months (T1) after diagnosis, women with breast cancer and their partners (n = 82 couples) were assessed regarding partners’ supportive behaviour. Women also indicated their sense of mastery. At both 3 and 9 months (T2) after diagnosis, women reported their level of distress. Cross-sectional as well as longitudinal analyses showed that active engagement was unrelated to distress, regardless of patients’ awareness of the support received and their feelings of mastery. In contrast, perceived protective buffering was found to be associated with more concurrent distress (i.e. cross-sectionally). Moreover, protective buffering that was reported by partners but remained unnoticed by patients was associated with higher levels of concurrent distress, but only for patients who were low in mastery. Over time, protective buffering that remained unnoticed by patients was associated with more distress, regardless of womens sense of mastery.

The effectiveness of cognitive behavioral therapy on the quality of life of patients with inflammatory bowel disease: multi-center design and study protocol (KL!C- study)

BackgroundInflammatory Bowel Disease (IBD) patients report poorer quality of life (QoL) and more anxiety and depressive symptoms than controls from the general population. Cognitive behavioral therapy (CBT) is effective for anxiety and depression, but questionable in case of co-morbidity with IBD. Therefore, an adapted new CBT specifically designed for IBD patients was developed. The objective of this study is to evaluate the effectiveness of adapted CBT on QoL.Methods/designIBD patients with a poor level of mental QoL (score less than or equal to 23 on the mental health scale of SF-36) will be randomly assigned to the experimental (n = 40) or waiting-list control condition (n = 40). The experimental condition will then immediately start CBT. The waiting-list control condition will wait 3,5 months before CBT begins with pre- and post assessments. Both conditions will complete a baseline and follow-up assessment following CBT and a mid-treatment assessment. The primary outcome is IBD-specific QoL (IBDQ). Secondary outcomes are generic QoL (SF-36) and anxiety and depression complaints (HADS, CES-D). Additionally, we will examine the working mechanism of the psychological intervention by investigating the impact of the intervention on illness-related cognitions, attitudes, coping styles and their associations with outcome. Data will be analysed on an intention to treat (ITT) as well as treatment completer basis (greater than or equal to five sessions followed).DiscussionIf found effective, this IBD-specific CBT is a first step to enhance poor QoL in IBD patients and possibly, other gastroenterological diseases. By enhancing IBD patients’ QoL, we may also improve their mental and physical health, and lower unnecessary health care consumption.Trial registration numberNTR (TC = 1869)

Lower levels of trust in one's physician is associated with more distress over time in more anxiously attached individuals with cancer

OBJECTIVE In the present study, we investigated individual differences in the outcome of patient-physician trust when confronted with cancer from an attachment theoretical perspective. We expected that lower levels of trust are associated with more emotional distress and more physical limitations within the first 15 months after diagnosis, especially in those who score relatively high on attachment anxiety. No such association was expected for more avoidantly attached individuals. METHOD A group of 119 patients with different types of cancer (breast, cervical, intestinal and prostate) completed questionnaires concerning trust (short version of the Wake Forest Physician Trust Scale) and attachment (Experiences in Close Relationship scale Revised) at 3 months after diagnosis. Emotional distress (Hospital Anxiety and Depression Scale) and physical limitations (physical functioning subscales of the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire-C30) were assessed at 3, 9 and 15 months after diagnosis. To test the hypotheses, multiple hierarchical regression analyses were performed. RESULTS Lower levels of trust were associated with more emotional distress and more physical limitations at 3, 9 and 15 months after diagnosis in more anxiously attached patients, but not in less anxiously attached patients. DISCUSSION These results indicate an attachment-dependent effect of trust in ones physician. Explanations and clinical implications are discussed.

Gastric bypass may promote weight loss in overweight partners

Introduction: Following bariatric surgery, patients are expected to implement diet and lifestyle changes that may be imitated by cohabitating family members. We hypothesize that cohabitating family members will lose weight and improve their eating behavior within 1 year after surgery. Methods: In this observational prospective study, family members of patients who had gastric bypass surgery (88 partners, 20 children ≥18 years old, and 25 children between 12 and 17 years old) were repeatedly assessed. Family members were asked to assess their weight and height before and 3, 6, and 12 months following bariatric surgery, and they filled out the Dutch Eating Behavior Questionnaire. Results: Between baseline and 1 year following surgery, 49 partners of patients who underwent gastric bypass surgery (66.2%) lost weight, 6 (8.1%) remained stable, and 19 (25.7%) gained weight. Body mass index of partners (P = .002), particularly of overweight partners (P < .001)—but not children—showed a small, significant decrease over time. No significant changes in eating behavior among partners or children were found. Conclusion: The study indicates that gastric bypass surgery may have a ripple effect, with body weight in partners of patients decreasing over time. However, there is considerable variation in the postoperative weight loss of partners.

COPING STYLE AS A MEDIATOR BETWEEN ATTACHMENT AND MENTAL AND PHYSICAL HEALTH IN PATIENTS SUFFERING FROM MORBID OBESITY

Objective: The presence of mental health problems and limitations in physical functioning is high in patients suffering from morbid obesity. The purpose of the current study was to examine the mediating role of coping style in the relationship between attachment representations and mental health and physical functioning in a morbidly obese population. Method: A total of 299 morbidly obese patients who were referred to the Slotervaart bariatric surgery unit in Amsterdam, the Netherlands, completed self-report questionnaires assessing adult attachment style (Experiences in Close Relationship—Revised Questionnaire), coping style (Utrecht Coping List), and patients physical functioning and mental health (Short Form-36). Results: Attachment anxiety (β = –.490, p < .001) and attachment avoidance (β = –.387, p < .001) were both found to be related to mental health. In addition, attachment anxiety was also found to be related to physical functioning (β = –.188, p < .001). Coping style partly mediated these associations. Conclusions: Findings suggest that coping mediates the association between attachment anxiety and attachment avoidance on the one hand and mental health and physical functioning in patients with morbid obesity on the other hand.

Attachment anxiety predicts poor adherence to dietary recommendations : an indirect effect on weight change 1 year after gastric bypass surgery

Are socioeconomic position, work stress, and work complexity associated to mobility after retirement?Abstracts from the ICBM 2014 Meetings from the ICBM 2014 MeetingIntroduction: Attitudinal ambivalence occurs when individuals endorse both positive and negative attitudes toward the same target object. Ambivalent attitudes are particularly relevant for addictive behaviours, as these behaviours may have both positive and negative evaluations associated with them. For example, drinking alcohol may make someone relaxed but can also produce feelings of nausea. Despite this, the majority of research focused on attitudes toward addictive behaviours assume that these attitudes are either positive or negative, not positive and negative. By assessing ambivalence toward addictive behaviours, a greater understanding of the nature of attitudes underlying these behaviours can be realised. Method: A total of 247 participants (M= 28.76 years) took part in this study. A measure of potential ambivalence, which asks participants to indicate their positive and negative evaluations on split semantic differential scales, was completed for five different health behaviours: drinking on a weekday and a weekend, exercising, increasing fruit and vegetable intake and smoking. Results: Attitudes toward alcohol consumption were found to be the most ambivalent. When examining drinking behaviour, a pattern emerged suggesting that the greater the quantity of alcohol consumed, the more ambivalent participants were toward drinking. Similar patterns were found for smoking. Conclusions: The results suggest that attitudinal ambivalence is an important aspect of addictive behaviours, as participants engaging in greater levels of these behaviours also reported higher levels of ambivalence. This indicates that individuals are aware of the positives and negatives of addictive behaviours but continue to perform them anyway.Salivary cortisol and alpha-amylase (sAA) that reflect hypothalamopituitary-adrenal axis (HPA-axis) activity and sympathetic activity within the autonomic nervous system (ANS) respectively, are bio ...Introduction: Previous research has developed an 11-item self-report measure assessing activation and pressure stress among adolescents. However, the biological correlates of this measure are uncle ...