Richard Van Dyck

Dissociative experiences and trauma in eating disorders

This study explores the relationship between traumatic experiences and dissociative phenomena in a large group of eating disorder patients (N = 98). Traumatic experiences were assessed by means of a self-report questionnaire and a clinical interview; dissociative experiences were assessed with the newly developed self-reporting Dissociation Questionnaire (DIS-Q). About 25% of the patients reported to have experienced traumatic events in their personal life and this subgroup had significantly higher scores on the DIS-Q, compared with normal control subjects. About 12% of our patient sample mentioned dissociative experiences to a degree as high as in a group of patients with dissociative disorders. Amnesia turned out to be the most specific characteristic in trauma-induced dissociation. These data suggest that trauma-induced dissociative experiences may play an important role in the development of a subgroup of patients with an eating disorder.

Origin of the Comorbidity of Anxiety Disorders and Alcohol Dependence: Findings of a General Population Study

A representative general population sample (n = 7,076) was used to study retrospectively and prospectively the nature of the relationship between co-morbid alcohol dependence and anxiety disorders. Four different models were tested: (1) anxiety disorders increase the risk of alcohol dependence; (2) alcohol dependence increases the risk of anxiety disorders; (3) family history or childhood traumatisation increase the risk of both alcohol dependence and anxiety disorders, and (4) comorbid conditions are a separate psychopathological entity. The data show that alcohol dependence does not precede the onset of anxiety disorders, that anxiety disorders do precede the onset of alcohol dependence, that family history is not very likely to be the third factor explaining the elevated comorbidity, and that in women childhood trauma might be partially responsible for the association between both disorders. The data are inconsistent with regard to comorbidity as a distinct psychopathological entity. These findings are of great importance for treatment planning in patients with alcohol dependence and comorbid anxiety disorders.

The inpatient treatment of patients suffering from (motor) conversion symptoms : A description of eight cases

This article presents a preliminary study that used two controlled randomized trials to study the effect of hypnosis in the treatment of eight patients with (motor) conversion symptoms. Controlled research into the treatment of conversion symptoms is scarce and can often be criticized on methodological grounds. It would appear, however, that both the use of suggestive and behavioral therapeutic techniques and eclectic treatment programs yield good results in the treatment of conversion symptoms. The results of the study suggest that comprehensive clinical treatment including hypnosis has enough promise to be studied in clinical trials. In the interpretation of the results, special attention is given to primary diagnosis, duration of complaints, traumatic experiences in childhood, dissociative capacity, and hypnotizability.

Dissociative and Hypnotic Experiences in Eating Disorder Patients: An Exploratory Study

Hypnotizability, subjective experiences during hypnotizability assessment, and dissociation were studied in 53 eating disorder patients in order to explore the relationship between these phenomena. Dissociation was measured with a newly developed self-reporting Dissociation-Questionnaire (DIS-Q), level of hypnotizability was assessed with the Stanford Hypnotic Clinical Scale (SHCS), subjective experiences during hypnosis with the Dutch Phenomenology of Consciousness Inventory (DPCI), and the Dutch Resistance to Hypnosis Scale (DRHS). Compared with normals, eating disorder patients scored significantly higher on the DIS-Q and SHCS. Compared with restricting anorexics, anorexics of the mixed type as well as bulimics report higher scores on both the DIS-Q and SHCS, but a significant difference was found only for the DIS-Q subscale loss of control. Although positive correlations between the DIS-Q and SHCS were found, the magnitude of the correlations shows that both instruments probably are measuring different constructs. Some implications of these findings are discussed.

Personality pathology and cognitive-behavioral treatment of fear of flying

Studies have been inconclusive about the influence of personality pathology on treatment outcome in anxiety disorders. In general, it has been presumed that treatment outcome is negatively influenced by the presence of personality pathology. This is a study of the prevalence of personality pathology among persons who were seeking help for fear of flying. Moreover, the effects of personality pathology on the results of a multimodal, standardized, cognitive-behavioral fear of flying treatment program employed by an agency that specializes in treating people with fear of flying were studied. Personality pathology was determined with a self-report questionnaire, which provides ICD-10 diagnoses of personality disorders and dimensional severity scores for personality pathology. Treatment outcome was assessed with three different fear of flying questionnaires. Based on clinical judgment after individual-case conceptualization, participants (N=922) were assigned to a particular treatment for fear of flying. Self-report data for fear of flying were collected at pretreatment and at 3, 6 and 12-month follow-ups in 659 participants who followed the 2-day treatment program. Moreover, the number of flights made in the year following treatment was determined.The results of this study showed that participants with personality pathology, mainly from cluster C (anxiety), report greater fear of flying before treatment than participants without personality pathology. After treatment fear of flying was significantly reduced. Presence of personality pathology was not predictive of the number of flights after treatment and scores on the VAFAS scale at short or long term. Only on two questionnaires for fear of flying collected at short-term participants with personality pathology obtained significantly higher scores, although the size of the differences was relatively small. It was concluded that participants with personality pathology also benefited from fear of flying treatment and that the presence of personality pathology although cannot be regarded as a contra indication for a standardized, cognitive-behavioral group treatment.

Assessing the clinical significance of outcome in agoraphobia research: A comparison of two approaches

We evaluated two methods for characterizing clinically significant change in agoraphobia treatment research: The method proposed by Jacobson and colleagues (1991) and an alternative method, in which the endstate functioning of patients (low, medium, or high) was assessed by several criteria relevant for panic disorder with agoraphobia. Whenever possible, statistically determined cutoff points were applied on these criteria. Comparison of the outcome revealed considerable consonance between both methods, although the Jacobson approach was somewhat more lenient in considering patients recovered. The reliable change index, an additional criterion proposed by Jacobson et al. in order to assess whether patients had experienced true change as a result of treatment, had little informational value: All patients who met the criterion of clinically meaningful change had reliably changed as well. Moreover, the reliable change index did not discriminate between patients with medium and low clinical endstatus.

The effectiveness of standardized versus individualized hypnotic suggestions: A brief communication

The results of a number of studies indicate that hypnotizability is a relatively stable trait that has some predictive value for therapy outcome. Some authors argue, however, that hypnotizability scores are artifacts of standardized test procedures, and that more people will benefit from hypnosis when a broader range of suggestions is used. The present study was designed to investigate the effectiveness of standardized versus individualized suggestions. In a crossover design, counterbalanced for order of presentation, 48 Ss were tested twice: once with the Stanford Hypnotic Clinical Scale: Adult (SHCS: Adult) of Morgan and J. R. Hilgard (1975) and once with an individualized equivalent of SHCS: Adult. The results of this comparison showed no significant differences between the 2 methods. The present study does not support the concept of hypnotizability scores as artifacts of standardized measurements.

Does hypnosis contribute to the care of burn patients? Review of the evidence.

In burn treatment, hypnosis has been used for the alleviation of pain, the prevention and treatment of anxiety and depression, and the acceleration of wound healing. The successful application of hypnosis decreases the extensive medication needed. Furthermore, it provides a tool to patients with which they may experience more control in situations that are often experienced as overwhelming. Notwithstanding these important applications and the very positive terms with which the results of studies are generally described, hypnosis has mostly been neglected as a tool to help burn patients. This article reviews the clinical and experimental evidence of the usefulness of hypnosis in the management of burns. Pain reduction and crisis intervention are promising applications. However, due to a lack of systematic and controlled research, more specific conclusions are precluded. In the controversial area of wound healing, claims for the effectiveness of hypnosis have been made on the basis of slim evidence and inconclusive studies. This hypothesis needs to be addressed in controlled experiments. In summary, systematic investigations are needed to confirm and supplement available clinical evidence. Recommendations for future research are given.

Goal attainment scaling: An idiosyncratic method to assess treatment effectiveness in agoraphobia

Goal attainment scaling (GAS) is an individually tailored way to measure treatment gains, using a highly standardized procedure. An advantage of the method is that it takes into account individual characteristics of the patients, and at the same time the data are suitable for quantitative analysis and comparable across patients. Despite the wide acceptance and use of the method in the evaluation of psychotherapy, data on its psychometric properties are rather scarce. In the current study, GAS was used as one of several outcome measures in a research project on the effectiveness of various treatments for panic disorder with agoraphobia. Guidelines for GAS are presented as well as data on the reliability and validity of the procedure. Results indicate that the procedure is reliable, valid, and sensitive to the improvement of patients during treatment. Comparison of GAS with standardized measures revealed considerable concordance, although the clinical end status of patients diverged somewhat dependent on the measure considered.

Depersonalization and derealization during panic and hypnosis in low and highly hypnotizable agoraphobics

The primary aim of the present study was to investigate the association between spontaneous experiences of depersonalization or derealization (D-D) during panic states and hypnosis in low and highly hypnotizable phobic individuals. Secondarily, the association among level of hypnotizability, capacity for imaginative involvement, and severity of phobic complaints was also assessed. Sixty-four patients with panic disorder with agoraphobia according to the DSM-III-R (American Psychiatric Association, 1987) criteria participated in the study. Proneness to experience D-D during hypnosis was positively related to hypnotizability, but only for agoraphobic patients who had already experienced these perceptual distortions during panic episodes. Correlations of level of hypnotizability and capacity for imaginative involvement with severity of agoraphobic complaints were not significant. These findings suggest that hypnotizability may be a mediating variable between two different, although phenotypically similar, perceptual distortions experienced during panic states and hypnosis. Implications for both theory and clinical practice are discussed.