H. van Middendorp

Emotion processing and regulation in women with morbid obesity who apply for bariatric surgery

Emotional eating, the tendency to eat when experiencing negative affect, is prevalent in morbid obesity and may indicate that ways to deal with emotions are disturbed. Our aim was to compare emotion processing and regulation between 102 women with morbid obesity who apply for bariatric surgery and 102 women from the general population (control group) and to examine in the group with morbid obesity the association of emotion processing and regulation with emotional eating. The group with morbid obesity reported higher scores on difficulty identifying feelings (alexithymia, p = 0.002) and suppression of emotions (p = 0.003) than the control group. In the women with morbid obesity, more negative affect and a higher difficulty identifying feelings were correlated with more emotional eating (r = 0.36 and r = 0.35, p < 0.001). Our study suggests that negative emotions and unhealthy emotion processing may play a role in emotional eating, and it indicates the possible relevance of emotion processing and emotional regulation as initiating or perpetuating mechanisms in morbid obesity.

The Course and Predictors of Health‐Related Quality of Life in Living Kidney Donors: A Systematic Review and Meta‐Analysis

A better understanding of the course and risk factors for impaired long‐term health‐related quality of life (HRQoL; ie, physical, psychological, and social–relational functioning) after kidney donation might help clinicians improve the care of live kidney donors. This systematic review and meta‐analysis summarizes prospective studies about the course and predictors of HRQoL in living kidney donors. Studies indicate that shortly after donation, donors have lower HRQoL, with minor to moderate changes in psychological and social–relational functioning and major changes in physical functioning. At 3–12 months after donation, HRQoL returned to baseline or was slightly reduced, particularly for fatigue, but scores were still comparable to general population norms. Results were mainly robust across surgery techniques. A limited number of studies examined risk factors for impaired HRQoL, with low psychological functioning before donation as the most consistent predictor. Based on these results, clinicians can inform potential donors that, on average, kidney donors have high long‐term HRQoL; however, donors with low psychological functioning at baseline are those most at risk of impaired long‐term HRQoL. Future studies should focus on other potentially relevant predictors of postdonation HRQoL, including donor eligibility criteria and donor–recipient relationships, to optimize screening and interventions for donors at risk.

Gender Differences in Emotion Regulation and Relationships with Perceived Health in Patients with Rheumatoid Arthritis

ABSTRACT Emotion regulation has been associated with perceived health in rheumatoid arthritis, which is diagnosed three times more often in women than men. Our aim was to examine gender differences in styles of emotion regulation (ambiguity, control, orientation, and expression) and gender-specificity of the associations between emotion regulation and perceived health (psychological well-being, social functioning, physical functioning, and disease activity) in 244 female and 91 male patients with rheumatoid arthritis. Women reported more emotional orientation than men, but did not differ from men with regard to ambiguity, control, and expression. Structural equation modelling showed that relationships between emotion regulation and perceived health were more frequent and stronger for women than men. This held especially for the affective dimension of health, while associations were similar for both women and men with regard to social and physical functioning. Only for women, the association between ambiguity and disease activity was significant, which appeared to be mediated by affective functioning. The observations that women are more emotionally oriented than men and that emotion regulation is more interwoven with psychological health in women than men, support the usefulness of a gender-sensitive approach in research and health care of patients with rheumatoid arthritis.

The burden of common skin diseases assessed with the EQ5D: a European multicentre study in 13 countries

Generic instruments measuring health‐related quality of life (HRQoL), like EQ5D™, enable comparison of skin diseases with healthy populations and nondermatological medical conditions, as well as calculation of utility data.

Immune responses to stress in rheumatoid arthritis and psoriasis

OBJECTIVE Stress is one of the factors that may exacerbate the progression of chronic inflammatory diseases such as RA and psoriasis. We exploratively compared the effects of acute stress on levels of circulating cytokines involved in disease progression and/or the stress response in patients with RA, patients with psoriasis and healthy subjects. METHODS Patients with RA, patients with psoriasis and healthy controls underwent a standardized psychosocial stress test (Trier Social Stress Test). Levels of circulating cytokines (IL-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IFN-γ and TNF-α) were measured before and after the stress test. RESULTS The baseline levels of all cytokines, except IL-8, were significantly higher in patients with RA. After correction for baseline levels, patients with RA showed higher stress-induced levels of IL-1β and IL-2 than patients with psoriasis and healthy controls. CONCLUSION The results suggest that patients with RA have a different immune response to stress than patients with psoriasis or healthy controls. More needs to be learned about the complex interaction between stress, immune parameters and chronic inflammation.

Tailored Therapist-Guided Internet-Based Cognitive Behavioral Treatment for Psoriasis: A Randomized Controlled Trial.

Objective: Patients with somatic conditions, such as psoriasis, frequently suffer from high burden of their disease in daily life and might benefit from internet-based cognitive behavioral therapy (ICBT) tailored to their adjustment problems. The aim of this multicenter randomized controlled trial was to examine the effects of therapist-guided, individually tailored ICBT in a clinical sample of patients with psoriasis. Methods: A total of 131 patients with psoriasis, who were screened for a psychological risk profile, were randomized to either care as usual (CAU, n = 66) or ICBT in addition to CAU (n = 65). Participants filled out standardized self-report questionnaires assessing physical and psychological functioning and impact on daily activities at baseline, posttreatment assessment, and 6-month follow-up. Results: In covariate-controlled linear mixed-model analyses, significantly larger improvements in ICBT compared to CAU were found in the primary outcomes physical functioning (p = 0.03, d = 0.36) and impact on daily activities (p = 0.04, d = 0.35), but not in psychological functioning (p = 0.32), up to 6 months after treatment compared to baseline. In explorative analyses, the working alliance measured at the beginning of ICBT treatment predicted improved physical (p = 0.02) and psychological (p < 0.001) outcomes. Conclusions: Results underline the promise of therapist-guided, individually tailored ICBT to improve physical functioning and reduce the impact of psoriasis on daily activities in patients with a psychological risk profile. Establishing a good therapeutic relationship early on may be an important factor that influences treatment outcomes in personalized ICBT interventions. Further research is needed to evaluate ICBT effectiveness in additional samples and to explore its underlying mechanisms.

The psychophysiological stress response in psoriasis and rheumatoid arthritis.

Psychosocial stress can be a risk factor for the maintenance and exacerbation of chronic inflammatory diseases, such as psoriasis and rheumatoid arthritis (RA).

Predictors of perceived stigmatization in patients with psoriasis

The physical appearance of psoriasis can be cosmetically disfiguring, resulting in a substantial social burden for patients. An important aspect of this burden is the experience of stigmatization. While stigmatization is known to be disabling and stressful for patients, little is known about its correlates, and effective interventions are lacking.

Implicit stigmatization-related biases in individuals with skin conditions and their significant others

OBJECTIVE Stigmatization is common in people with chronic skin conditions and may also affect their significant others (SOs). The fast and implicit processing of stigmatization-related stimuli has received little attention in these populations; however, such knowledge may offer indications for new treatment methods. This study aimed to investigate implicit processing of stigmatization-related stimuli in people with skin conditions and their SOs. METHOD A modified Stroop task and 2 approach-avoidance tasks were administered to participants with chronic skin conditions (alopecia: n = 50 and psoriasis: n = 50); their significant others (alopecia SOs: n = 47 and psoriasis SOs: n = 50); and controls (n = 50). The aim was to examine attentional and behavioral biases toward disease-related and social threat-related stigmatization stimuli. RESULTS An attentional bias to disease-related stimuli was found in participants with alopecia and their SOs, compared with controls (p < .001). This effect was not found for participants with psoriasis and their SOs. Increased behavioral avoidance of disgusted faces was found in participants with psoriasis and their SOs, compared with controls (p = .047). This effect was not found in participants with alopecia and their SOs. CONCLUSIONS These results provide support for the idea that individuals with skin conditions and their SOs are characterized by a stigmatization-related stimulus bias regarding implicit cognitive and behavioral reactions, in comparison to healthy individuals. Furthermore, preliminary results suggest that these processes may differ across skin conditions, with people with psoriasis being more affected by social reactions (i.e., disgusted faces) and people with alopecia by disease-related cues possibly related to internalized self-stigma. (PsycINFO Database Record

Expectations about the effectiveness of pain- and itch-relieving medication administered via different routes

Placebo effects on pain have been found to vary in size for different routes of medication administration (e.g. oral vs. injection). This has important implications for both clinical research and practice. To enhance our understanding of these differential placebo effects, research on the underlying expectations about multiple routes and symptoms other than pain is vital.