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Biomedical subjects

Philip Spinhoven

Publications and source records attributed to Philip Spinhoven.

At least 37 records · Page 2Linked to original sources
PubMed2005

The impact of early trauma and recent life-events on symptom severity in patients with conversion disorder.

Although the presence of psychological stress factors in the evolution of conversion symptoms forms an important criterion for the DSM-IV diagnosis of conversion disorder, little is known about the nature and timing of these stress factors. Fifty-four patients with conversion disorder and 50 control patients with an affective disorder were screened for life events experienced in the year before the symptom onset. Conversion patients did not differ from control patients in the number or severity of life events, but showed a significant relation between the recent life events and the severity of conversion symptoms. Especially life events with respect to work and relationships contributed to this effect. These results remained when controlling for the previously found effects of childhood traumatization on the severity of conversion symptoms. The findings imply that conversion symptoms may be elicited by a complex of early and later negative life events and that traditional unifactorial trauma-theories of conversion disorder should be replaced by multifactorial stress models.

Adult↗
PubMed2005

Acute tryptophan depletion as a model of depressive relapse: behavioural specificity and ethical considerations.

BACKGROUND: Acute tryptophan depletion transiently induces symptoms in those with remitted depression. The behavioural specificity is uncertain, however. Recently, symptom provocation studies have become controversial, particularly in the USA. AIMS: To assess the specificity of acute tryptophan depletion. To investigate systematically the subjective experiences of those taking part in a symptom provocation study. METHOD: Twenty individuals with remitted depression underwent acute tryptophan depletion in a double-blind, crossover trial. Psychiatric symptoms and self-schemata relevant to depression were assessed. The quality of the informed consent procedure and subjective experiences were also evaluated. RESULTS: Acute tryptophan depletion induced a specific depressive response. The effects were more pronounced in females than in males. Participants were quite satisfied with the informed consent procedure. They had understood that this was a fundamental research project and personal benefits were not expected. However, some participants still found it a positive experience. CONCLUSIONS: Acute tryptophan depletion is a suitable model of vulnerability to depression, from both a scientific and an ethical perspective.

Amino Acids↗
PubMed2004

Catastrophizing and internal pain control as mediators of outcome in the multidisciplinary treatment of chronic low back pain.

The aim of the present study was to examine (a) whether a cognitive-behavioral treatment (differentially) affects pain coping and cognition; and (b) whether changes in pain coping and cognition during treatment mediate treatment outcome. Participants in this randomized clinical trial were 148 patients with chronic low back pain attending a multidisciplinary treatment program consisting of operant-behavioral treatment plus cognitive coping skills training (N = 59) or group discussion (N = 58) or allocated to a waiting list control condition (N = 31). Patients improved with respect to level of depression, pain behavior and activity tolerance at posttreatment and 12-month follow-up. Treatment also resulted in a short- and long-term decrease in catastrophizing and an enhancement of internal pain control. Changes in catastrophizing and to a lesser degree in internal pain control mediated the reduction in level of depression and pain behavior following treatment. The use of behavioral and cognitive interventions aimed at decreasing catastrophizing thoughts about the consequences of pain and promoting internal expectations of pain control possibly constitute an important avenue of change irrespective of the type of treatment.

Adaptation, Psychological↗
PubMed2004

The effects of failing to control pain: an experimental investigation.

Chronic pain patients are often confronted with repeated failure to achieve pain relief. The aim of this study was to experimentally investigate the effects of repeated failing attempts to control pain on pain impact (pain intensity, emotional and physiological responses). Perceived control over an electrocutaneous pain stimulus was manipulated between subjects by success or failure feedback on a task by which control over pain could be acquired. In addition, success or failure at the task was manipulated without suggesting a possibility to control pain. It was hypothesized that successful control would lead to lowest pain impact, whereas failure to control pain would lead to even higher pain impact than absent control. Furthermore, it was hypothesized that failure feedback would increase pain impact when compared to success feedback. Results indicated that repeated failure to control pain increased anger and heart rate responses compared to the other conditions, but not pain intensity. It is concluded that persistent efforts to control pain in the face of failure may lead to the maintenance or exacerbation of physiological and emotional responses.

Adaptation, Psychological↗
PubMed2004

Psychometric properties of the Dutch version of the Washington Psychosocial Seizure Inventory.

PURPOSE: The psychometric properties of the Dutch version of the Washington Psychosocial Seizure Inventory (WPSI) were investigated. METHODS: The dimensional structure, reliability, and validity of the WPSI scales were assessed in 218 patients with epilepsy. The association with relevant patient and epilepsy characteristics also was studied. RESULTS: An exploratory seven-factor principal components analysis was compared with a confirmatory factor analysis, and a loss of 3.36% of total variance was found. To increase the homogeneity of the scales, 30 items with low factor loadings or highest factor loading on the wrong clinical scale were excluded. This resulted in a higher amount of explained variance and improvement of the factor loadings of the remaining items. The reliability and validity of the WPSI scales was satisfactory to good. No clinically relevant associations were found between the WPSI scales and patient and epilepsy characteristics. CONCLUSIONS: The factor structure, reliability, and validity of the Dutch translation of the WPSI are good and comparable to the original English version of Dodrill. The results demonstrate that shortening the WPSI makes the inventory more reliable and the clinical scales less dependent on each other.

Adaptation, Psychological↗
PubMed2004

Trauma and dissociation in conversion disorder and chronic pelvic pain.

OBJECTIVE: The purpose of this study was to: a) assess the link between sexual and/or physical abuse and dissociation in conversion disorder and chronic pelvic pain patients; and b) assess whether this effect is independent of level of general psychopathology. METHOD: This report examines data from four separate samples. Fifty-two patients with chronic pelvic pain, 61 patients with non-epileptic seizures, and two samples of patients (102 and 54) with predominantly motor or sensory types of conversion disorder were studied. RESULTS: Using point-biserial correlations no compelling evidence for a consistent and positive association of sexual and/or physical abuse with dissociation was found. After statistically controlling for level of psychopathology using multiple regression analyses, in most of the cases the association of abuse with dissociation was no longer statistically significant. Only physical abuse predicted level of somatoform dissociation over and above level of psychopathology. CONCLUSION: In future clinical studies of dissociation in patients with conversion disorder and chronic pelvic pain more complex models may be needed with less exclusive reliance on historical antecedents such as childhood abuse and more emphasis on recent potentially traumatizing experiences or co-morbid psychiatric disorders.

Adult↗
PubMed2004

Associations among homesickness, anger, anxiety, and depression.

The study investigated the association of homesickness with the related concepts of anxiety, depression, and anger. Two conceptualizations of homesickness were used, one considering homesickness as a state, characterized by severe symptoms of a depressive episode, and the other one as a self-reported tendency to experience homesickness in times of separation from the familiar environment. The latter conceptualization can rather be considered as an enduring trait and does not specifically refer to actual feelings of depression. We compared these two conceptualizations of homesickness in a random sample from the Dutch population (n=485) by assessing their uni- and multivariate associations with anger, anxiety, depression, and anxiety-sensitivity. Both conceptualizations of homesickness were associated with anxiety and depression and with the externalization of anger. No association was found between internalization of anger or control over internalized and externalized anger for either conceptualization of homesickness. The pattern of multivariate associations between homesickness and its emotional correlates was similar for both conceptualizations, although homesickness as a state appeared to have a stronger association with depression, whereas the tendency to develop homesickness showed a particularly strong association with anxiety. It is concluded that homesickness can be considered as a mixed emotion of anxiety and depression ("Cothymia"), but that depression is more characteristic of homesickness as a state, whereas anxiety is more important if homesickness is conceptualized as an enduring tendency.

Adjustment Disorders↗
PubMed2003

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.

Adolescent↗
PubMed2003

A randomized controlled clinical trial of a hypnosis-based treatment for patients with conversion disorder, motor type.

This study tested whether a hypnosis-based intervention showed promise as a treatment for patients with conversion disorder, motor type. Forty-four outpatients with conversion disorder, motor type, or somatization disorder with motor conversion symptoms, were randomly assigned to a hypnosis or a waiting-list condition. The hypnosis-condition patients were more improved relative to baseline and the waiting-list controls. Improvement was evident on an observational index of behavioral symptoms associated with the motor conversion and on an interview measure of extent of motor disability. No effect was obtained on a nonspecific measure of broad psychopathology immediately posttreatment. At 6-month follow-up, improvement was maintained across the behavioral and interview measures. The effect size of hypnotizability as a predictor of treatment outcome was comparable to that found for other individual patient differences associated with psychotherapy outcome although non-significant. Hypnotizability scored above patient expectations as a predictor of treatment outcome.

Adolescent↗
PubMed2003

Testimony therapy: treatment method for traumatized victims of organized violence.

Former political prisoners in Chile gave testimony of their traumatic experiences, which resulted in diminishing their posttraumatic symptoms. Based on this experience, testimony therapy has been developed and used in treatment of traumatized victims of war or other organized violence. This short-term therapy, as it applied in the treatment of traumatized asylum seekers and refugees in Centrum '45/De Vonk in the Netherlands, is described in this article. The therapy consists of 12 sessions in which patients tell their life stories, including the traumatic experiences. The narrative is reflected in a written document that, for example, can be read to family and friends, or be sent to a historical archive. This article discusses the preliminary research data on the effects of testimony therapy. Finally, hypotheses on the working mechanisms of testimony therapy are offered.

Chile↗
PubMed2002

Negative life events and depression in elderly persons: a meta-analysis.

In a meta-analysis of 25 studies, the relationship of both specific types of negative life events and the total number of experienced events to depression in old age was studied. Almost all negative life events appeared to have a modest but significant relationship with depression. The total number of negative life events and the total number of daily hassles appeared to have the strongest relationship with depression (respectively, combined r =.15, n = 5,037, and combined r =.41, n = 461), whereas sudden unexpected events were the only cluster of negative life events that seemed not to be related to depression scores (combined r =.05, n = 857). These findings suggest that providers and developers of intervention and prevention programs for elderly people should pay attention to the occurrence of negative life events. Special attention should be given to elderly people who have experienced an accumulation of stressful events and daily hassles, because they seem to be a group at greater risk.

Adaptation, Psychological↗
PubMed1996

Cognitive coping and appraisal processes in the treatment of chronic headaches.

The purpose of the present study was to investigate the active cognitive ingredients of change in psychological treatments for long-term chronic headache complaints. The primary questions this study addressed were: (1) Is a cognitive self-hypnosis training which explicitly attempts to change appraisal and cognitive coping processes more effective in producing these changes than a relaxation procedure, and (2) are changes in pain appraisal and cognitive coping related to changes in pain and adjustment in the short and long term? A total of 144 patients were assigned at random to a cognitive self-hypnosis (CSH) treatment or autogenic training (AT) with a duration of 7 weeks. Measures used were: Headache Index (HI), Symptom Checklist-90 (SCL-90), Coping Strategy Questionnaire (CSQ), Multidimensional Locus of Pain Control Questionnaire (MLPC) and treatment expectations. The results indicated that patients successfully changed their use of coping strategies and pain appraisals. Cognitive therapy was more effective than relaxation training in changing the use of cognitive coping strategies which were the direct targets of treatment. However, treatment effects were only related with changes in the use of coping strategies and appraisal processes to a limited extent and the mediational role of cognitive processes in pain reduction and better adjustment was inconclusive.

Adaptation, Psychological↗
PubMed1994

Autogenic training and cognitive self-hypnosis for the treatment of recurrent headaches in three different subject groups.

The aims of this study were to (a) investigate the efficacy of autogenic training (AT) and cognitive self-hypnosis training (CSH) for the treatment of chronic headaches in comparison with a waiting-list control (WLC) condition, (b) investigate the influence of subject recruitment on treatment outcome and (c) explore whether the level of hypnotizability is related to therapy outcome. Three different subjects groups (group 1, patients (n = 58) who were referred by a neurological outpatient clinic; group 2, members (n = 48) of the community who responded to an advertisement in a newspaper; and group 3, students (n = 40) who responded to an advertisement in a university newspaper) were allocated at random to a therapy or WLC condition. During treatment, there was a significant reduction in the Headache Index scores of the subjects in contrast with the controls. At post-treatment and follow-up almost no significant differences were observed between the 2 treatment conditions or the 3 referral sources regarding the Headache Index, psychological distress (SCL-90) scores and medication use. Follow-up measurements indicated that therapeutic improvement was maintained. In both treatment conditions, the high-hypnotizable subjects achieved a greater reduction in headache pain at post-treatment and follow-up than did the low-hypnotizable subjects. It is concluded that a relatively simple and highly structured relaxation technique for the treatment of chronic headache subjects may be preferable to more complex cognitive hypnotherapeutic procedures, irrespective of the source of recruitment. The level of hypnotic susceptibility seems to be a subject characteristic which is associated with a more favourable outcome in subjects treated with AT or CSH.

Adult↗
PubMed1991

Behavioral treatment of chronic low back pain. I. Relation of coping strategy use to outcome.

The clinical relevance of strategies to cope with pain was assessed by means of the Coping Strategy Questionnaire (CSQ). This was presented to a sample of 53 low back pain patients in The Netherlands, who had agreed to participate in a treatment outcome study of a group program consisting of education about pain and a training in relaxation and imaginative pain coping strategies. A baseline period of 10 weeks was followed by 10 weekly therapy sessions. At posttreatment, improvement in measurements of reported pain intensity and behavioral and emotional adjustment to pain correlated significantly with (changes in) coping strategy use. However, at the 6-month follow-up, only pain reduction appeared to be significantly related to pretreatment-follow-up changes on CSQ scores for Perceived Control. It is concluded that a judgment about one's capability to control pain may be as important as the specific pain coping strategies used.

Adaptation, Psychological↗
PubMed1989

Pain coping strategies in a Dutch population of chronic low back pain patients.

The use of strategies for coping with chronic pain was assessed by means of the Coping Strategy Questionnaire (CSQ) in a Dutch sample of 108 chronic low back pain (LBP) patients referred for behavioral treatment. The 3 factors of the CSQ were related to measurements of behavioral and emotional adjustment to LBP above and beyond the effects of demographic and medical status variables. Especially patients high on the factor Helplessness reported higher levels of pain, functional impairment, anxiety, depression and psychoneuroticism, while patients high on the factor Perceived Control reported lower levels of pain, functional impairment and also manifested a higher level of uptime. The causal role of coping strategies in adjustment to pain, the selectivity of focusing on LBP patients selected through referral and implications for pain management are discussed.

Adaptation, Psychological↗
PubMedDate not supplied

Predictors of fatigue in rescue workers and residents in the aftermath of an aviation disaster: a longitudinal study.

OBJECTIVES: Although medically unexplained physical symptoms such as fatigue are frequently observed after exposure to trauma, the vast majority of health outcomes studies in trauma and disaster research relates to the psychological and psychiatric problems met by victims. The objectives of this study were to investigate the prevalence of (persistent) fatigue in the aftermath of a disaster and to analyze the predictive value of sociodemographic and various health-related variables for fatigue among both rescue workers and residents. METHODS: A total of 1951 rescue workers and 753 residents involved in the Bijlmermeer aviation disaster participated in this study. Follow-up data were gathered in 70% of randomly selected rescue workers and 53% of the residents. Multiple regression analyses, multivariate logistic regression analyses, and crosslagged panel analyses examined sociodemographic variables and self-report measures for psychopathology, posttraumatic stress reactions, quality of life, somatosensory amplification, health anxiety, and tendency to be reassured by a physician as predictors of fatigue at baseline and fatigue from baseline to 13 to 28 months follow up. RESULTS: Elevated levels of fatigue are common after involvement in a disaster in rescue workers (20.6%) and residents (45.4%). Higher levels of psychopathology, lower quality of life, and the tendency to be less reassured were multivariate predictors of both elevated and persistent fatigue. Tendency to be reassured was the most important causal factor for fatigue. CONCLUSIONS: These results suggest that early identification, adequate reassurance, and treatment of individuals at risk may be worthwhile to prevent chronic fatigue.

Accidents, Aviation↗
PubMedDate not supplied

A randomised controlled clinical trial on the additional effect of hypnosis in a comprehensive treatment programme for in-patients with conversion disorder of the motor type.

BACKGROUND: The primary aim of this study was threefold: (1) to examine the additional effects of hypnosis aimed at symptom reduction, using symptom-oriented and expression- and insight-oriented techniques in a comprehensive clinical treatment programme for in-patients with a persistent conversion disorder of the motor type; (2) to assess whether the level of hypnotisability was predictive of treatment outcome, and (3) to explore the efficacy of the total clinical treatment programme. METHODS: The study population consisted of 45 in-patients between 18 and 65 years of age meeting the DSM-III-R criteria for conversion disorder of the motor type or somatisation disorder with motor conversion symptoms. A randomised controlled clinical trial was undertaken. The primary outcome measures were the Video Rating Scale for Motor Conversion Symptoms, the D(isabilities) code items from the International Classification of Impairments, Disabilities and Handicaps and the Symptom Checklist-90. Measures of the credibility of treatment and patient expectations of treatment outcome were used as manipulation checks. Hypnotisability was measured using the Stanford Hypnotic Clinical Scale. RESULTS: Significant treatment results for all outcome measures were found for the total sample. These effects proved to be clinically significant. The use of hypnosis had no additional effect on treatment outcome. Hypnotisability was not predictive of treatment outcome. CONCLUSION: A comprehensive treatment programme, either with or without hypnosis, can be worthwhile for patients with long-standing conversion symptoms.

Adolescent↗