Yvonne Stikkelbroek

Internet and Computer-Based Cognitive Behavioral Therapy for Anxiety and Depression in Youth: A Meta-Analysis of Randomized Controlled Outcome Trials

Background Anxiety and depression in children and adolescents are undertreated. Computer- and Internet-based cognitive behavioral treatments (cCBT) may be an attractive treatment alternative to regular face-to-face treatment.This meta-analysis aims to evaluate whether cCBT is effective for treating symptoms of anxiety and depression in youth. Methods and Findings We conducted systematic searches in bibliographical databases (Pubmed, Cochrane controlled trial register, PsychInfo) up to December 4, 2013. Only randomized controlled trials in which a computer-, Internet- or mobile-based cognitive behavioral intervention targeting either depression, anxiety or both in children or adolescents up to the age of 25 were compared to a control condition were selected. We employed a random-effects pooling model in overall effect analyses and a mixed effect model for sub-group analyses. Searches resulted in identifying 13 randomized trials, including 796 children and adolescents that met inclusion criteria. Seven studies were directed at treating anxiety, four studies at depression, and two were of a transdiagnostic nature, targeting both anxiety and depression. The overall mean effect size (Hedges’ g) of cCBT on symptoms of anxiety or depression at post-test was g=0.72 (95% CI:0.55-0.90, numbers needed to be treated (NNT)=2.56). Heterogeneity was low (I²=20.14%, 95% CI: 0-58%). The superiority of cCBT over controls was evident for interventions targeting anxiety (g=0.68; 95% CI: 0.45-0.92; p < .001; NNT=2.70) and for interventions targeting depression (g=0.76; 95% CI: 0.41-0.12; p < .001; NNT=2.44) as well as for transdiagnostic interventions (g=0.94; 95% CI: 0.23-2.66; p < .001; NNT=2.60). Conclusions Results provide evidence for the efficacy of cCBT in the treatment of anxiety and depressive symptoms in youth. Hence, such interventions may be a promising treatment alternative when evidence based face-to-face treatment is not feasible. Future studies should examine long-term effects of treatments and should focus on obtaining patient-level data from existing studies, to perform an individual patient data meta-analysis.

The Disease Burden of Childhood Adversities in Adults: A Population-Based Study.

OBJECTIVES There is much evidence showing that childhood adversities have considerable effects on the mental and physical health of adults. It could be assumed therefore, that the disease burden of childhood adversities is high. It has not yet been examined, however, whether this is true. METHOD We used data of a large representative sample (N=7,076) of the general population in the Netherlands. We calculated the disability weight (DW) for each respondent. The DW is a weight factor that reflects the severity of a disease or condition on a scale from 0 (perfect health) to 1 (equivalent to death). We used an algorithm based on the SF-6D to estimate DW. Because the DW indicates the proportion of a healthy life year that is reduced by the specific health state of the individual, it also possible to calculate the total number of years lost due to disability (YLD) in the population. We calculated the years lived with disability (YLD) for 9 different childhood adversities (in the areas of parental psychopathology; abuse and neglect; major life events), as well as for major categories of mental disorders and general medical disorders. RESULTS All 9 adversities resulted in a significantly increased DW, except death of a parent before the age of 16. Adversities in the category of abuse and neglect are associated with the highest DWs (0.057), followed by parental psychopathology (0.031) and life events during childhood (0.012). All adversities (46.4% of the population reports one or more adversity) are associated with 20.7 YLD/1,000, which is more than all mental disorders together (12.9 YLD/1,000). The category of abuse/neglect has the highest YLD/1,000 (15.8), which is also higher than all mental disorders together. Adjustment for the presence of mental and general medical disorders resulted in comparable outcomes. CONCLUSIONS Childhood adversities are more important from a public health point of view than all common mental disorders together, and should be a priority for public health interventions.

Parental death during childhood and psychopathology in adulthood

We examined the association between parental death during childhood and lifetime and 12-month psychopathology, age of onset, incidence of mental health problems, use of mental health services during adulthood and functional limitations during adulthood. We conducted a longitudinal, population-based epidemiological study in adults aged 18-64 years (N=7076). Mental disorders were assessed with a standardized diagnostic interview (Composite International Diagnostic Interview (CIDI)). Few indications were found that there was a significant increase in mental disorders in adulthood among people who had lost a parent before the age of 16 (N=541). Parental death was not associated with mental disorders (12 months; lifetime), age of onset, incidence of mental disorders, functional limitations or use of mental health services. The majority of children overcome the loss of a parent during childhood without experiencing increased mental health problems, reduced functional limitations or a greater need for mental health services during adulthood.

Adolescent depression and negative life events, the mediating role of cognitive emotion regulation

Background Depression during adolescence is a serious mental health problem. Difficulties in regulating evoked emotions after stressful life events are considered to lead to depression. This study examined if depressive symptoms were mediated by various cognitive emotion regulation strategies after stressful life events, more specifically, the loss of a loved one, health threats or relational challenges. Methods We used a sample of 398 adolescents (Mage = 16.94, SD = 2.90), including 52 depressed outpatients, who all reported stressful life event(s). Path analyses in Mplus were used to test mediation, for the whole sample as well as separately for participants scoring high versus low on depression, using multigroup analyses. Results Health threats and relational challenging stressful life events were associated with depressive symptoms, while loss was not. More frequent use of maladaptive strategies was related to more depressive symptoms. More frequent use of adaptive strategies was related to less depressive symptoms. Specific life events were associated with specific emotion regulation strategies. The relationship between challenging, stressful life events and depressive symptoms in the whole group was mediated by maladaptive strategies (self-blame, catastrophizing and rumination). No mediation effect was found for adaptive strategies. Conclusion The association between relational challenging, stressful life events and depressive symptoms was mediated by maladaptive, cognitive emotion regulation strategies.

Rouw en verliesverwerking door jeugdigen

SamenvattingHet verlies van een dierbare is een ontwrichtende gebeurtenis. Desondanks is nog nauwelijks onderzoek gedaan naar verliesverwerking door jeugdigen. Bij volwassenen is er overtuigende evidentie voor het bestaan van gecompliceerde rouw; het heeft een eigen fenomenologie en is te onderscheiden van depressie en posttraumatische stress-stoornis. Voorts is aangetoond dat specifieke cognitief gedragstherapeutische interventies effectief zijn in de behandeling van rouwproblematiek. Op basis van de huidige inzichten is het waarschijnlijk dat gecompliceerde rouw als aparte stoornis in de dsm-v wordt opgenomen. Onderzoek naar gecompliceerde rouw bij jeugdigen is nodig om de opgelopen achterstand in te halen.

Complicaties bij behandeling van depressieve adolescenten met cognitieve gedragstherapie

SamenvattingHet toepassen van evidence-based behandelprotocollen zoals cognitieve gedragstherapie (CGT) en interpersoonlijke therapie (IPT) staat meer en meer op de voorgrond bij de behandeling van depressieve adolescenten. Bij de uitvoering van een behandelprotocol stuit de behandelaar op vele complicaties, waaronder comorbiditeit (angstklachten, leerproblemen, gedragsproblemen en ADHD) en geringe medewerking van de adolescent. Het uitvoeren van het behandelprotocol wordt daardoor belemmerd. De therapeut ervaart een grote spanning tussen het behandelprotocol en de klinische realiteit. Hoe kan behandeling met CGT worden afgestemd op de problematiek en de mogelijkheden van de individuele adolescent?Door de invoering van diagnose-behandelcombinaties (dbc’s) komt het accent te liggen op het gebruik van specifieke behandelprotocollen en de daarin toegepaste therapeutische technieken. Zo kan de misvatting ontstaan dat de therapeutische alliantie van ondergeschikt belang is.In dit artikel wordt een aanzet gegeven om een antwoord te geven op de vraag: ‘Hoe kan de therapeut de therapeutische alliantie bevorderen en rekening houden met de behoeften van de individuele adolescent?’

Correction: Adolescent Depression and Negative Life Events, the Mediating Role of Cognitive Emotion Regulation

[This corrects the article DOI: 10.1371/journal.pone.0161062.].

Reactie op voorlichting over borderline

In de rubriek ‘Voorlichting’ van PsychoPraxis wordt regelmatig bepaalde psychiatrische problematiek in een notendop beschreven. In het septembernummer 2008 was het onderwerp de borderline persoonlijkheidsstoornis. Op effciente wijze wordt veel kennis verschaft over de borderlineproblematiek en de mogelijkheden voor behandeling. Ook wordt er aandacht besteed aan de sociale omgeving van clienten. Zo worden er tips gegeven over hoe je kunt omgaan met iemand met een borderlinestoornis; o.a. wees geinformeerd, hou vol en bewaar geduld, maak goede afspraken, denk ook aan uw eigen leven, en aan uw eigen gezin. Behalve de tip ‘denk aan uw gezin’ wordt er echter niet ingegaan op de wijze waarop de gevolgen voor de kinderen van wie de ouder een border-linestoornis heeft zoveel mogelijk beperkt kunnen worden. Een omissie, gezien de impact van een psychiatrische stoornis, en de borderlinestoornis in het bijzonder, op het gezinsleven en de opvoeding en daarmee op de ontwikkeling van kinderen. Er is niet veel voorstellingsvermogen voor nodig om te bedenken wat de consequenties zijn voor een kind dat opgroeit ‘in een wereld van uitersten’ en dus ‘geduldig’ met zijn ouder om moet gaan.

Dyslexie nader bekeken

1 Welkom 2 Uitleg over de training 3 Watis wel waaren watis niet waar over dyslexie? 4 Tips & trucs 5 Klus

Omgaan met spanning

1 Bijpraten 2 Terugblikopdeklus 3 Oefeningen/Informatie 4 Tips&trucs 5 Klus