http://repub.eur.nl/res/aut/3059/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/20861/ 2009-01-01T00:00:00Z Abstract BACKGROUND: Standardised evaluation studies performed in the Netherlands in a large number of inpatient and day-treatment hospitals providing psychotherapy have shown significant symptomatic improvements in patients between the date of entry to the studies and follow-up after one year. However, the work situation of ex-patients hardly changed and a large number of patients were still receiving psychotherapy. AIM: To examine the effectiveness of a specifically designed course of re-integration training. METHOD: A group of 128 patients were assigned randomly either to a re-integration training course aimed at improved functioning at work and improved relationships, or to booster sessions. Outcome measures were symptom level, work status, absence from work, and further psychotherapy. results After two years the number of patients in paid employment remained the same (76%) in the re-integration training course and increased from 67 to 87% in the booster sessions. Attendance was significantly higher in the booster sessions than in the re-integration training. There were no differences in the other outcome measures. CONCLUSION: We conclude that re-integration training was no more effective than the booster sessions. Our hypothesis is that continuity of care (therapists plus programme) explains the favourable result of the booster sessions. http://repub.eur.nl/res/pub/9211/ 1999-01-01T00:00:00Z Presymptomatic DNA testing for autosomal dominant hereditary breast/ovarian cancer (HBOC) became an option after the identification of the BRCA1 and BRCA2 genes in 1994-1995. Healthy female mutation carriers have a high lifetime risk for breast cancer (56-87%) or ovarian cancer (10-60%) and may opt for intensive breast and ovary surveillance or prophylactic surgery (mastectomy/oophorectomy).We studied general and cancer related distress in 85 healthy women with a 25% or 50% risk of being carrier of a BRCA1/BRCA2 gene mutation and 66 partners in the six to eight week period between genetic counselling/blood sampling and disclosure of the test result. Questionnaire and interview data are analysed. Associations are explored between levels of distress and (1) expected consequences of being identified as a mutation carrier, (2) personality traits, (3) sociodemographic variables, and (4) experiences related to HBOC.Mean pre-test anxiety and depression levels in women at risk of being a carrier and partners were similar to those of a normal Dutch population. In about 25% of those at risk of being a carrier and 10% of the partners, increased to high levels of general and cancer related distress were found. Increased levels of distress were reported by women who (1) anticipated an increase in problems after an unfavourable test outcome, (2) considered prophylactic mastectomy if found to be mutation carrier, (3) had an unoptimistic personality, (4) tended to suppress their emotions, (5) were younger than 40 years, and (6) were more familiar with the serious consequences of HBOC. Recently obtained awareness of the genetic nature of cancer in the family was not predictive of distress.The majority of the women and their partners experienced a relatively calm period before the disclosure of the test result and seemed to postpone distressing thoughts until the week of disclosure of the result. The low distress levels may partly be explained by the use of strategies to minimise the emotional impact of a possibly unfavourable test outcome. However, a minority reported feeling very distressed. Several factors were found to be predictive for increased distress levels. http://repub.eur.nl/res/pub/10445/ 1990-09-21T00:00:00Z Rede, uitgesproken bij de aanvaarding van het ambt van Gewoon Hoogleraar in de Psychotherapie aan de Erasmus Universiteit Rotterdam, op vriojdag 21 september 1990. http://repub.eur.nl/res/pub/15228/ 1986-12-01T00:00:00Z Inpatient Multimodal Therapy (imt) is a residential treatment program, lasting a maximum of 36 weeks, for patients with severe neurotic symptoms. A group of 44 chronic obsessive-compulsive patients and a group of 40 chronic phobic patients were treated in order to assess the outcome and the process of treatment and to identify prognostic factors associated with the effect. At follow-up-on average, eight months after discharge-it was found that 60% had improved, 32% had remained the same, and 8% had deteriorated, indicating that, in general, the treatment was beneficial. That these effects were long-lasting is supported by the fact that, at follow-up, 78% of all patients were no longer receiving treatment, 18% were receiving outpatient or day treatment, and 4% were receiving inpatient treatment. Phobic patients appear to have gained more from the multimodal approach than did obsessive-compulsive patients, as indicated by the fact that the severity of symptoms decreased as they improved in rational thinking, assertiveness, and arousal. By contrast, obsessive-compulsive patients relapsed more than phobic patients did. This was attributed to the fact that the former gained less from the rational-emotive training, denied problems with assertiveness, and did not practice the acquired relaxation skills. It further appeared that a favorable outcome could be induced in patients who (1) expressed relatively mild symptoms in this otherwise severe group, (2) reported relatively few additional complaints, (3) could clearly indicate interpersonal problems, and (4) did not use psychotropic drugs. These prognostic factors are so widespread that not much weight can be ascribed to them. Yet they are useful for indication of imt until better predictors are found. http://repub.eur.nl/res/pub/31547/ 1981-06-05T00:00:00Z De gedragstherapeutische behandeling van dwangklachten verloopt soms voorspoedig. Vaak echter blijken dwangsymptomen zeer hardnekkig en wordt van de patiënt en van de therapeut veel creativiteit en doorzettingsvermogen gevraagd. In contacten met dwangpatiënten of supervisanden die dwangpatiënten gedragstherapeutisch behandelen, blijkt nogal eens dat veel gebruikte behandelingstechnieken tekortschieten. Het gaat dan bijvoorbeeld om responspreventie, flooding en denkstop {cf. Beech & Vaughan, 1978, Haaijman, 1977, Haaijman & Haaijman-van Breukelen; 1979, Marks, 1973, Rimm & Masters, 1974, Yates, 1970). Sommige auteurs {bijvoorbeeld Haaijman, 1977 en Haaijman & Haaijman-van Breukelen, 1979) maken echter duidelijk dat het praktisch en nuttig is deze gedragstherapeutische procedures aan te vullen met motiveringstechnieken, echtpaarbehandeling, psychodrama en zo meer. Bij een dergelijke praktische gerichtheid is het nut van verklaringsprincipes niet erg groot. Het hoeft dan ook geen verwondering te wekken dat wat uit de leertheorie bekend is over het ontstaan van dwanggedrag niet erg aansluit bij de therapeutische praktijk. Doorgaans lijkt de veronderstelling dat dwanggedrag een angstreducerende werking heeft voldoende grond te bieden voor het ontwerpen van een behandelingsplan. Dat niet altijd sprake is van angstreductie bij dwang is theoretisch misschien interessant, maar praktisch niet erg relevant. De idee dat verklaringsprincipes en erop gebaseerde behandelingsmethoden tekortschieten is echter onbevredigend. Het is immers mogelijk dat elke stap in de richting van een béter passende verklaring van het ontstaan van dwanggedrag ook tot verbetering van behandelingsprocedures kan leiden. De belangstelling naar de verklaring van het ontstaan van dwanggedrag is de drijfveer geweest voor het onderzoek waarover in dit proefschrift wordt gerapporteerd. Het uitgangspunt van het onderzoek is dat eenvoudige leerprincipes als klassieke en eperante conditionering niet goed verklaren hoe dwanggedrag ontstaat, noch wat precies het rituele van veel dwanggedrag bepaalt, waarom angst soms toeneemt bij het uitvoeren van dwanggedrag, en tenslotte waarom dwangpatiënten niet lijken te geloven dat het gedrag dat ze uitvoeren zinvol is