Marcel E. Pieterse

Acceptance and commitment therapy as guided selfhelp for psychological distress and positive mental health: a randomized controlled trial

BACKGROUND In order to reduce the high prevalence of depression, early interventions for people at risk of depression are warranted. This study evaluated the effectiveness of an early guided self-help programme based on acceptance and commitment therapy (ACT) for reducing depressive symptomatology. METHOD Participants with mild to moderate depressive symptomatology were recruited from the general population and randomized to the self-help programme with extensive email support (n=125), the self-help programme with minimal email support (n=125) or to a waiting list control group (n=126). Participants completed measures before and after the intervention to assess depression, anxiety, fatigue, experiential avoidance, positive mental health and mindfulness. Participants in the experimental conditions also completed these measures at a 3-month follow-up. RESULTS In the experimental conditions significant reductions in depression, anxiety, fatigue, experiential avoidance and improvements in positive mental health and mindfulness were found, compared with the waiting list condition (effect sizes Cohens d=0.51-1.00). These effects were sustained at the 3-month follow-up. There were no significant differences between the experimental conditions on the outcome measures. CONCLUSIONS The ACT-based self-help programme with minimal email support is effective for people with mild to moderate depressive symptomatology.

Efficacy of an early intervention based on acceptance and commitment therapy for adults with depressive symptomatology: Evaluation in a randomized controlled trial

OBJECTIVE The current study examined the efficacy of an early intervention based on acceptance and commitment therapy (ACT) for depressive symptomatology. The ACT intervention is aimed at increasing the acceptance of negative thoughts and emotions and living a mindful and value-based life. METHOD Adults with mild to moderate depressive symptomatology were randomly assigned to the ACT intervention (n=49) or to a waiting list (n=44). The mean age of the participants was 49 years. The majority of the participants was female and of Dutch origin. All the participants completed measures before and after the intervention, as well as three months later at follow-up to assess depression (CES-D), anxiety (HADS-A), fatigue (CIS), alcohol use and acceptance (AAQ-II). RESULTS The ACT intervention led to statistically significant reduction in depressive symptomatology (Cohens d=.60). These reductions were maintained at the three-month follow-up. Also significant reductions in anxiety and fatigue were observed. Moreover, mediational analysis showed that the improvement of acceptance during the intervention mediated the effects of the intervention on depressive symptomatology at follow-up. CONCLUSION These findings suggest that an early intervention based on ACT, aimed at increasing acceptance, is effective in reducing depressive symptomatology.

Stress-reducing effects of indoor plants in the built healthcare environment: the mediating role of perceived attractiveness.

OBJECTIVE Natural elements in the built healthcare environment have shown to hold potential stress-reducing properties. In order to shed light on the underlying mechanism of stress-reducing effects of nature, the present study investigates whether the stress-reducing effects of indoor plants occur because such an environment is perceived as being more attractive. METHOD A single-factor between-subjects experimental design (nature: indoor plants vs. no plants) was used in which participants (n=77) were presented with a scenario describing hospitalization with a possible legionella diagnosis. The study was conducted from March to May 2007 in the Netherlands. Subsequently, they were exposed to a photo of a hospital room. In this room were either indoor plants, or there was a painting of an urban environment on the wall. Afterwards, perceived stress and the perceived attractiveness of the hospital room were measured. RESULTS Participants exposed to the hospital room with indoor plants reported less stress than those in the control condition. Mediation analysis confirmed that indoor plants in a hospital room reduce feelings of stress through the perceived attractiveness of the room. CONCLUSION This study confirms the stress-reducing properties of natural elements in the built healthcare environment. It also sheds light on the underlying mechanism causing this stress-reduction.

The Prevalence of Problematic Video Gamers in The Netherlands

This study surveyed Dutch adolescents and adults about their video gaming behavior to assess the prevalence of problematic gaming. A representative national panel of 902 respondents aged 14 to 81 took part in the study. The results show that gaming in general is a wide-spread and popular activity among the Dutch population. Browser games (small games played via the internet) and offline casual games (e.g., offline card games) were reported as most popular type of game. Online games (e.g., massively multiplayer online role-playing games) are played by a relatively small part of the respondents, yet considerably more time is spent on these online games than on browser games, offline casual games, and offline games (e.g., offline racing games). The prevalence of problematic gaming in the total sample is 1.3 percent. Among adolescents and young adults problematic gaming occurs in 3.3 percent of cases. Particularly male adolescents seem to be more vulnerable to developing problematic gaming habits.

Does Experiential Avoidance Mediate the Effects of Maladaptive Coping Styles on Psychopathology and Mental Health

Experiential avoidance (EA) is considered a risk factor for psychopathology.This study explores whether EA mediates the relationship between maladaptive coping styles (palliative, avoidance, and passive coping) and psychopathology and positive mental health. A total of 93 adults with mild to moderate psychological distress completed measures assessing coping styles, psychopathology (depression, anxiety, and alcohol use), and mental health (emotional, psychological, and social well-being). Results showed that EA mediated the effects of passive coping on both increased anxiety and depression and decreased emotional and psychological well-being. These results suggest that a person who is prone to use EA or has learned EA in stressful situations has a higher risk of developing psychopathology and lower mental health.This indicates that early interventions that aim at people with high levels of EA are highly relevant.

A cognitive-behavioral model of problematic online gaming in adolescents aged 12-22years

The aim of this study was to apply the cognitive behavioral model of problematic Internet use to the context of online game use to obtain a better understanding of problematic use of online games and its negative consequences. In total, 597 online game playing adolescents aged 12-22years participated in this study. Results showed that the cognitive behavioral model of problematic Internet use can also be used in the context of online game use. More specifically, preference for online social interaction, mood regulation and deficient self-regulation appeared to play an important role in predicting negative outcomes from problematic online game use. Together, these cognitions and behaviors explained 79% of the variance of negative outcomes scores. These findings can be used to develop strategies that aim at reducing problematic online game behavior and its negative consequences.

Cost-effectiveness of an Intensive Smoking Cessation Intervention for COPD Outpatients

INTRODUCTION To determine the cost-effectiveness of a high-intensity smoking cessation program (SmokeStop Therapy; SST) versus a medium-intensity treatment (Minimal Intervention Strategy for Lung patients [LMIS]) for chronic obstructive pulmonary disease outpatients. METHODS The cost-effectiveness analysis was based on a randomized controlled trial investigating the effectiveness of the SST compared with the LMIS with 12-month follow-up. The primary outcome measure was the cotinine-validated continuous abstinence rate based on intention to treat. A health care perspective was adopted, with outcomes assessed in terms of (incremental) additional quitters gained, exacerbations prevented, and hospital days prevented. Health care resource use, associated with smoking cessation, was collected at baseline and 12 months after the start of the interventions. Monte Carlo simulations were performed to evaluate the robustness of the results. RESULTS The average patient receiving SST generated €581 in health care costs, including the costs of the smoking cessation program, versus €595 in the LMIS. The SST is also associated with a lower average number of exacerbations (0.38 vs. 0.60) and hospital days (0.39 vs. 1) per patient and a higher number of quitters (20 vs. 9) at lower total costs. This leads to a dominance of the SST compared with the LMIS. CONCLUSIONS The high-intensive SST is more cost-effective than the medium-intensive LMIS after 1 year. This is associated with cost savings per additional quitter, prevented exacerbations, and hospital days at lower or equal costs.

The St George's Respiratory Questionnaire revisited : A psychometric evaluation

PurposeThe St George’s Respiratory Questionnaire (SGRQ) has clearly acquired the status of legacy questionnaire for measuring health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). The main aim of this study was to assess the underlying dimensionality of the SGRQ and to investigate the added value of the empirical weights used to calculate total scores.MethodsThe official Dutch translation of the SGRQ was completed by 444 COPD patients participating in two clinical studies. These data were used for secondary data analysis in this study. Three complementary statistical methods were used to assess dimensionality: Mokken scale analysis (MSA), parametric multidimensional item response theory (IRT) and bifactor analysis. Additionally, the original SGRQ weighting procedure was compared to IRT-based weighting.ResultsThe results of the MSA and multidimensional item response theory (MIRT) pointed toward a unidimensional structure. The bifactor analyses indicated that there was a strong general factor, but the group factors did have additional value. Nineteen items performed poorly in the MSA, MIRT analysis or both. Shortening the scale from 50 to 31 items did not negatively impact measurement precision. SGRQ total score and IRT-derived scores correlated strongly, 0.90 for the one-parameter model and 0.99 for the two-parameter model.ConclusionThe SGRQ contains some multidimensionality, but an abbreviated version can be used as a unidimensional tool in patients with COPD. Subscale scores should be used with care. SGRQ total scores correlated highly with IRT-based scores, and thus, the weighting methods may be used interchangeably to calculate total scores.

The impact of non-response bias due to sampling in public health studies: A comparison of voluntary versus mandatory recruitment in a Dutch national survey on adolescent health

BackgroundIn public health monitoring of young people it is critical to understand the effects of selective non-response, in particular when a controversial topic is involved like substance abuse or sexual behaviour. Research that is dependent upon voluntary subject participation is particularly vulnerable to sampling bias. As respondents whose participation is hardest to elicit on a voluntary basis are also more likely to report risk behaviour, this potentially leads to underestimation of risk factor prevalence. Inviting adolescents to participate in a home-sent postal survey is a typical voluntary recruitment strategy with high non-response, as opposed to mandatory participation during school time. This study examines the extent to which prevalence estimates of adolescent health-related characteristics are biased due to different sampling methods, and whether this also biases within-subject analyses.MethodsCross-sectional datasets collected in 2011 in Twente and IJsselland, two similar and adjacent regions in the Netherlands, were used. In total, 9360 youngsters in a mandatory sample (Twente) and 1952 youngsters in a voluntary sample (IJsselland) participated in the study. To test whether the samples differed on health-related variables, we conducted both univariate and multivariable logistic regression analyses controlling for any demographic difference between the samples. Additional multivariable logistic regressions were conducted to examine moderating effects of sampling method on associations between health-related variables.ResultsAs expected, females, older individuals, as well as individuals with higher education levels, were over-represented in the voluntary sample, compared to the mandatory sample. Respondents in the voluntary sample tended to smoke less, consume less alcohol (ever, lifetime, and past four weeks), have better mental health, have better subjective health status, have more positive school experiences and have less sexual intercourse than respondents in the mandatory sample. No moderating effects were found for sampling method on associations between variables.ConclusionsThis is one of first studies to provide strong evidence that voluntary recruitment may lead to a strong non-response bias in health-related prevalence estimates in adolescents, as compared to mandatory recruitment. The resulting underestimation in prevalence of health behaviours and well-being measures appeared large, up to a four-fold lower proportion for self-reported alcohol consumption. Correlations between variables, though, appeared to be insensitive to sampling bias.

An early intervention to promote well-being and flourishing and reduce anxiety and depression: A randomized controlled trial

Background There is growing evidence that fostering mental well-being and flourishing might effectively prevent mental disorders. In this study, we examined whether a 9-week comprehensive positive self-help intervention with email support (TL-E) was effective in enhancing well-being and flourishing and decreasing anxiety and depressive symptoms in a non-clinical sample. Methods A total of 275 participants with low or moderate well-being (mean age = 48 years, 86% female) were randomly assigned to a TL-E (n = 137) or wait-list control group (WL; n = 138). Participants completed online self-reporting questionnaires at baseline and at 3, 6 and 12 months. Results Repeated measure analyses revealed significant more improvement on mental well-being (F = 42.00, p ≤ 0.001, d = 0.66, 95% CI = 0.42–0.90), anxiety (F = 21.65, p ≤ 0.001, d = 0.63, 95% CI = 0.39–0.87) and depression (F = 13.62, p ≤ 0.001, d = 0.43, 95% CI = 0.19–0.67) in the TL-E group versus the WL group. The proportion of flourishing in the TL-E group increased from 7 to 30% after 3 months (NNT = 5.46) and to 34% after 6 months (NNT = 5.25). All within group effects were maintained up to 12 months. We found no meaningful dose-response relationship for adherence, nor a clear moderator pattern. Limitations It is unknown whether results were influenced by the email support that accompanied the self-help intervention since TL-E was only compared to a wait-list condition. The generalizability of the findings is limited by the self-selected sample of mainly higher-educated women. Conclusion A guided positive self-help intervention might be considered as a new mental health promotion strategy because it has the potential to improve well-being up to the status of flourishing mental health, and to decrease anxiety and depressive symptomatology.