Colin van der Heiden

Randomized controlled trial on the effectiveness of metacognitive therapy and intolerance-of-uncertainty therapy for generalized anxiety disorder

This randomized controlled trial compared the effectiveness of metacognitive therapy (MCT) and intolerance-of-uncertainty therapy (IUT) for generalized anxiety disorder (GAD) in an outpatient context. Patients with GAD (N = 126) consecutively referred to an outpatient treatment center for anxiety disorder were randomly allocated to MCT, IUT, or a delayed treatment (DT) condition. Patients were treated individually for up to 14 sessions. Assessments were conducted before treatment (pretreatment), after the last treatment session (posttreatment), and six months after treatment had ended (follow-up). At posttreatment and follow-up assessments, substantial improvements were observed in both treatment conditions across all outcome variables. Both MCT and IUT, but not DT, produced significant reductions in GAD-specific symptoms with large effect sizes (ranging between 0.94 and 2.39) and high proportions of clinically significant change (ranging between 77% and 95%) on various outcome measures, and the vast majority of the patients (i.e., 91% in the MCT group, and 80% in the IUT group) no longer fulfilled the diagnostic criteria for GAD. Results further indicate that MCT produced better results than IUT. This was evident on most outcome measures, and also reflected in effect sizes and degree of clinical response and recovery.

A hierarchical model for the relationships between general and specific vulnerability factors and symptom levels of generalized anxiety disorder

The present study examined a hierarchical model for the relationships between general and specific vulnerability factors and symptom manifestations of generalized anxiety disorder (GAD). A clinical sample of patients with GAD (N=137) completed a set of self-report questionnaires for measuring neuroticism, extraversion, intolerance of uncertainty, metacognitive beliefs, and symptoms of generalized anxiety (i.e., worry) and depression. A bootstrapping analysis yielded support for a model in which the relation between the general vulnerability factor of neuroticism and symptoms of GAD were mediated by the specific vulnerability factors of intolerance of uncertainty and negative metacognitions. Implications for the classification and treatment of GAD are discussed.

Psychometric properties of a Dutch version of the Intolerance of Uncertainty Scale

Intolerance of uncertainty (IU) is thought to play a key role in the development and maintenance of worry and generalised anxiety disorder (GAD). The present study investigated the psychometric properties of the Dutch translation of the Intolerance of Uncertainty Scale (IUS), the most frequently employed scale for measuring IU. The factor analysis of the IUS pointed in the direction of a one-factor solution. Furthermore, the Dutch IUS portrayed excellent internal consistency and test-retest reliability. Tests of construct validity showed that the Dutch IUS correlated significantly more strongly with worry than with depression. The regression analysis demonstrated that IU contributed significantly to worry, after controlling for demographic variables and levels of anxiety and depression. In addition, it was demonstrated that the IUS successfully discriminated between patients with GAD and other anxiety disorders, and non-clinical participants. Overall, it seems safe to conclude that the Dutch IUS is a reliable and valid scale for assessing IU. (Netherlands Journal of Psychology, 62, 91-97.)

Normative data for the Dutch version of the Penn State Worry Questionnaire.

Worry is a common symptom in various psychiatric problems and the key symptom of generalised anxiety disorder (GAD). The Penn State Worry Questionnaire (PSWQ) is the most widely used self-report scale for measuring worry. The present study provides normative data for the Dutch version of the PSWQ for a large community sample and a clinically referred sample of patients with GAD. Norms are not only provided for the original 16-item version, but also for an abbreviated 11-item version, which only consists of the positively worded items and has been shown to be a promising alternative to the full-length version. The percentile scores obtained for the community sample and the clinical GAD sample did not show much overlap, and this appeared true for the full-length as well as the abbreviated version of the PSWQ. These normative data seem suitable for differentiating between normal and abnormal manifestations of worrying and for evaluating the efficacy of treatments for GAD. (Netherlands Journal of Psychology, 65, 69-75.)

Imagery rescripting as a stand-alone treatment for patients with social phobia: a case series.

BACKGROUND AND OBJECTIVES The majority of patients with social phobia reports experiencing negative images, usually linked to memories of earlier aversive social experiences. Several studies have indicated that such negative self-imagery appears to have a causal role in maintaining social phobia, which suggests that interventions aimed at dealing with these images could be beneficial in the treatment of social phobia. One potentially powerful approach is imagery rescripting (IR), a clinical intervention that focuses on changing the meaning and impact of unpleasant memories. In the treatment of social phobia IR was only used as part of a broader cognitive-behavioral treatment package. However, we propose that IR alone might also be an effective treatment for this anxiety disorder. The present study reports an initial evaluation of the application of IR as a stand-alone treatment for six adult outpatients presenting with social phobia. METHODS A single case series using an A-B replication across patients design was employed. Following a no-treatment baseline period, IR was delivered weekly and patients were followed up for 3 and 6 months. RESULTS For all patients, substantial reductions were obtained on all outcome measures at post-treatment, and gains were largely maintained at 6-months follow-up. LIMITATIONS The generalizability of the effects of IR for social phobia is limited by the small number of patients treated by only one therapist. CONCLUSIONS The results of this preliminary case series suggest that IR as a stand alone treatment is an apparently effective intervention in the treatment of patients with social phobia, and indicate that controlled evaluation of its efficacy might be worthwhile.

Factor structure of the Dutch version of the Penn State worry questionnaire

The Penn State Worry Questionnaire (PSWQ) is a 16-item self-report scale for measuring the excessiveness and uncontrollability of worry. The current study examined the factor structure of the PSWQ in (1) a large community sample (N = 455), and (2) a clinical sample of patients with generalized anxiety disorder (GAD; N = 102), the disorder for which worry is the key feature. Confirmatory factor analysis was employed to test three models: (1) a one-factor model in which all items loaded on one and the same dimension, (2) a two-factor model in which positively and negatively worded items loaded on two separate but correlated factors, and (3) a one-factor model, that included the reverse items as a method factor. In the community sample the one-factor/method factor model provided the best fit for the data. This was also true in the clinical GAD sample, but only after error covariances between a number of items were allowed to correlate.

Generalized anxiety disorder: Clinical presentation, diagnostic features, and guidelines for clinical practice

Generalized anxiety disorder (GAD) is a prevalent and disabling disorder characterised by persistent worrying, anxiety symptoms, and tension. General practitioners and mental healthcare professionals frequently misdiagnose the presenting symptoms. This article addresses the clinical presentation of GAD and provides guidelines for discriminating GAD from other disorders, based on theoretical considerations and clinical experience. Debate relating to the validity of the definition of GAD is discussed, and suggestions are made for improving the criteria for GAD, which may guide future versions of classification systems such as the Diagnostic and Statistical Manual.

Does cognitive behavioral therapy strengthen the effect of bariatric surgery for obesity? Design and methods of a randomized and controlled study

BACKGROUND (Extreme) obesity is a chronic harmful condition with high risk of medical comorbidities and negative social and emotional consequences. Bariatric surgery is an effective intervention for obesity, but approximately 20 to 30% of the patients experience adverse outcomes after surgery and there is a need for augmentation of current treatment strategies. This study examines the added value of pre-operative cognitive behavioral therapy (CBT) focused on modification of thoughts and behaviors in terms of eating behavior and physical exercise as well as preparation for surgery and postoperative life style. We hypothesize that pre-operative CBT will result in better weight loss maintenance, reduction of maladaptive eating behavior and better adherence to postoperative lifestyle on the long term as compared to bariatric surgery alone. METHODS One hundred and twenty eight patients that are on a waiting list for bariatric surgery are randomly assigned to the control or treatment condition. Patients in the treatment condition receive 10 sessions of CBT before surgery aimed at modifying dysfunctional eating habits and behaviors and developing more rational weight and body-related beliefs in order to enable long term maintenance of a healthier lifestyle after surgery. Weight loss, eating behavior, eating disorders, depression, quality of life and psychological distress are assessed before and after treatment, as well as 1, 3, and 5 year following surgery.

Cognitieve therapie Informatie voor cliënten

Cognities is een mooi woord voor gedachten. Cognitieve therapie gaat ervan uit dat psychische klachten (nare gevoelens, problematisch gedrag) het gevolg zijn van de gedachten die mensen hebben in een bepaalde situatie.

Piekerexposure bij obsessies

SamenvattingDat de obsessief-compulsieve stoornis redelijk goed behandelbaar is, mag inmiddels bekend verondersteld worden. Ingewikkelder lijkt de behandeling van dit klachtenbeeld als er sprake is van obsessieve gedachten, zonder dat er neutraliserende dwanghandelingen zijn. Over het algemeen wordt er in dergelijke gevallen gebruikgemaakt van vormen van exposure, waarbij de patiënt de gedachten moet oproepen dan wel ze moet laten komen, zonder te proberen ze weg te krijgen (zie bijvoorbeeld De Haan & Verbraak, 1993). In deze notitie wordt een casus beschreven, waarin een specifieke vorm van exposure aan obsessies werd toegepast: piekerexposure.