Wim Chr. Kleijn

COGNITION, STUDY HABITS, TEST ANXIETY, AND ACADEMIC PERFORMANCE

The Study Management and Academic Results Test (SMART) was developed to measure study- and examination-related cognitions, time management, and study strategies. This questionnaire was used in three prospective studies, together with measures for optimism and test anxiety. In the first two studies, done among 253 first-year students enrolled in four different faculties, the highest significant correlations with academic performance were found for the SMART scales. In a replication study among first-year medical students (n = 156) at a different university, the same pattern of results was observed. A stepwise multiple regression analysis, with academic performance as a dependent variable, showed significant correlations only for the SMART Test Competence and Time Management (Multiple R = .61). Results give specific indications about the profile of successful students.

Health Problems Among Latin-American and Middle-Eastern Refugees in the Netherlands: Relations With Violence Exposure and Ongoing Sociopsychological Strain

In two studies (n = 480; n = 156), the health problems (somatic, psychological, and migration-related complaints) of refugees were examined, in relation to violence, demographic, and asylum variables (ongoing sociopsychological strain). High frequencies for torture events and a substantial number of medical complaints were reported, but few cases of diagnosable Posttraumatic Stress Disorder (PTSD) were identified (Study I: 6%; Study II: 11%). Not only reported violence, but also the current social situation contributed to the experiencing of ongoing health complaints. Refugees attributed their somatic and psychological complaints to illness (48%) and to torture (29%) and psychological complaints, in particular, to worries related to the postmigration situation (40%). Paying attention only to health complaints and to past violent experiences is too limited an approach in responding to the needs of refugees.

Dealing with man-made trauma: the relationship between coping style, posttraumatic stress, and quality of life in resettled, traumatized refugees in the Netherlands.

This study investigated the relationship between coping style, posttraumatic stress disorder (PTSD) symptoms, and quality of life in traumatized refugees (N = 335). Participants had resettled in the Netherlands on average 13 years prior and were referred to a Dutch clinic for the treatment of posttraumatic psychopathology resulting from persecution, war, and violence. The majority (85%) of the research sample met diagnostic criteria for PTSD. Path analysis suggested a model in which PTSD symptoms (β = -.61, p < .001), social support seeking (β = .12, p < .05), and emotion-focused coping (β = .13, p < .01) have a direct effect on quality of life. The role of avoidant and problem-focused coping could be interpreted in 2 ways. Either these coping styles are influenced by PTSD severity and have no effect on quality of life, or these coping styles influence PTSD severity and therefore have an indirect effect on quality of life. Intervention strategies aimed at modifying coping strategies and decreasing PTSD symptoms could be important in improving the quality of life of traumatized refugees.

When the war was over, little changed: women's posttraumatic suffering after the war in Mozambique

This article explores the psychosocial effects of womens prolonged exposure to civil war in the center of Mozambique. Using a combination of quantitative and qualitative methods, 91 women were assessed for posttraumatic stress symptoms and psychosocial indicators of ill health. The results indicate that for the majority of the women in this study, traumatic experiences are sequential processes. Their ill health ranges from symptoms of posttraumatic stress to episodes of spirit possession (gamba), affecting womens capacities to conceive and raise children, and marginalizing their social position. A careful analysis of the specific problems and needs of women in postwar contexts is recommended, along with a systematic examination of the effectiveness of the available resources that may play a role in boosting trauma recovery in this group of women.

Agricultural cycle and the prevalence of posttraumatic stress disorder: A longitudinal community study in postwar Mozambique

The influence of physical activity on the prevalence and remission of war-related mental disturbances has never been systematically evaluated. This study examined the influence of participation in the agricultural cycle on the posttraumatic stress disorder (PTSD) prevalence and correlated symptoms longitudinally in post civil war Mozambique. Prevalence rates were examined in the end and the outset of the agricultural cycle in a community population (N = 240). The agricultural cycle, which is characterized by fluctuations in physical activities, social connectedness, and the sense of purpose in life influences the PTSD prevalence and correlated symptoms. By studying the influence of the agricultural cycle on PTSD prevalence, severe PTSD cases that fail to respond to the agricultural cycle can be identified, and subsequently evaluated regarding the need for specialized care.

Unravelling the spirits' message: a study of help-seeking steps and explanatory models among patients suffering from spirit possession in Uganda

As in many cultures, also in Uganda spirit possession is a common idiom of distress associated with traumatic experiences. In the DSM-IV and -5, possession trance disorders can be classified as dissociative disorders. Dissociation in Western countries is associated with complicated, time-consuming and costly therapies. Patients with spirit possession in SW Uganda, however, often report partial or full recovery after treatment by traditional healers.The aim of this study is to explore how the development of symptoms concomitant help-seeking steps, and explanatory models (EM) eventually contributed to healing of patients with spirit possession in SW Uganda. Illness narratives of 119 patients with spirit possession referred by traditional healers were analysed using a mixed-method approach.Treatments of two-thirds of the patients were unsuccessful when first seeking help in the medical sector. Their initially physical symptoms subsequently developed into dissociative possession symptoms. After an average of two help-seeking steps, patients reached a healing place where 99% of them found satisfactory EM and effective healing. During healing sessions, possessing agents were summoned to identify themselves and underlying problems were addressed. Often-mentioned explanations were the following: neglect of rituals and of responsibilities towards relatives and inheritance, the call to become a healer, witchcraft, grief, and land conflicts.The results demonstrate that traditional healing processes of spirit possession can play a role in restoring connections with the supra-, inter-, intra-, and extra-human worlds. It does not always seem necessary to address individual traumatic experiences per se which is in line with other research in this field. The study leads to additional perspectives on treatment of trauma-related dissociation in Western countries and on developing effective mental health services in low -and middle-income countries.

Are symptoms of spirit possessed patients covered by the DSM-IV or DSM-5 criteria for possession trance disorder? A mixed-method explorative study in Uganda

Introduction and aimsAs in many cultures, spirit possession is a common idiom of distress in Uganda. The DSM-IV contains experimental research criteria for dissociative and possession trance disorder (DTD and PTD), which are under review for the DSM-5. In the current proposed categories of the DSM-5, PTD is subsumed under dissociative identity disorder (DID) and DTD under dissociative disorders not elsewhere classified. Evaluation of these criteria is currently urgently required. This study explores the match between local symptoms of spirit possession in Uganda and experimental research criteria for PTD in the DSM-IV and proposed criteria for DID in the DSM-5.MethodsA mixed-method approach was used combining qualitative and quantitative research methods. Local symptoms were explored of 119 spirit possessed patients, using illness narratives and a cultural dissociative symptoms’ checklist. Possible meaningful clusters of symptoms were inventoried through multiple correspondence analysis. Finally, local symptoms were compared with experimental criteria for PTD in the DSM-IV and proposed criteria for DID in the DSM-5.Results and conclusionIllness narratives revealed different phases of spirit possession, with passive-influence experiences preceding the actual possession states. Multiple correspondence analysis of symptoms revealed two dimensions: ‘passive’ and ‘active’ symptoms. Local symptoms, such as changes in consciousness, shaking movements, and talking in a voice attributed to spirits, match with DSM-IV-PTD and DSM-5-DID criteria. Passive-influence experiences, such as feeling influenced or held by powers from outside, strange dreams, and hearing voices, deserve to be more explicitly described in the proposed criteria for DID in the DSM-5. The suggested incorporation of PTD in DID in the DSM-5 and the envisioned separation of DTD and PTD in two distinctive categories have disputable aspects.

Therapist reactions in self-experienced difficult situations : an exploration

Abstract This article describes a qualitative study of 63 difficult therapeutic situations described by 26 therapists. The study was part of research on specific reactions of therapists to traumatized clients. The research questions for the current analyses focused on the categorization of difficult situations, of short-term therapist reactions, and the exploration of situation-specific reaction patterns. The therapeutic style of the therapist was also explored. Three types of difficult situations were found: ‘traumatic situations’, ‘interactional situations’ and ‘existential situations’. Therapist reactions were sorted in to 20 categories; 10 of them were part of a situation-specific pattern. The therapeutic style of therapists was defined by a first dimension reflecting a continuum of experiencing versus actively intervening and a second dimension of feeling responsible. The relevance for therapist self-reflection, supervision and training is to acknowledge the specific difficulties in different therape...

‘… en wij proberen te luisteren…’ : Reacties van therapeuten op traumatische ervaringen van hun patiënten ()

Psychotherapie met ernstig getraumatiseerde patiënten kan bij therapeuten leiden tot ‘traumatische tegenoverdracht’, ‘secundaire traumatisering’ en ‘verplaatste traumatisering’. In een kwalitatief/kwantitatief exploratief onderzoek werden deze effecten en het verband met ervaren emotionele belasting en burnout onderzocht bij traumatherapeuten (= 3) van een landelijk instituut voor de behandeling van slachtoffers van georganiseerd geweld. Traumatherapeuten bleken inderdaad gevolgen te ondervinden van de confrontatie met ernstig interpersoonlijk geweld. Dit lijken echter normale reacties, verwerkingsprocessen en accommodatie van cognitieve schemas en niet een per definitie voor de therapeut destructief proces.

Reactie op ‘Secundaire traumatisering en slaapstoornissen’ van Angeline Donk

SamenvattingHierbij willen wij Angeline Donk danken voor haar reactie op ons artikel ‘…en wij proberen te luisteren…’ in dit tijdschrift (Smith, Kleijn & Stevens, 2000). Haar reactie illustreert zowel het belang als de ingewikkeldheid van differentiële conceptualisering van het ‘complex aan gevolgen van de door indirecte blootstelling aan traumatische situaties veroorzaakte stress en de veranderingen op cognitief en emotioneel gebied’.