Psychological Factors Linked to Intimate Partner Violence and Childhood Maltreatment: On Dissociation as a Possible Bridge Symptom.

Intimate partner violence (IPV) is a serious health concern, occurring worldwide in various forms and settings. Over the past years, multiple sources reported an increase of IPV globally, partly related to COVID-19 restrictions. Childhood maltreatment enhances the risk of IPV, possibly via alterations in emotion regulation, attachment, maladaptive core beliefs, dissociation, and psychopathological symptoms. However, studies investigating these associations simultaneously are still needed. This study aimed to investigate association between IPV, childhood maltreatment severity, maladaptive schemata (mistrust, alienation, enmeshment), attachment anxiety, social support, emotion regulation, dissociation, posttraumatic stress disorder (PTSD), and borderline personality disorder (BPD) symptoms. We further explored the complex interplay of all factors, accounting for their shared associations. An anonymous online survey was posted on international online platforms for people experiencing domestic violence and on research platforms. Regression analyses and graph-theoretical network analysis were used to explore associations between all variables. N = 434 participants (40% in treatment) completed the survey. IPV perpetration and victimization were highly correlated. Both were significantly associated with childhood maltreatment severity, early maladaptive schemata, dissociation, BPD features, and PTSD symptoms. When including all variables in one model, IPV was associated with dissociation, which indirectly linked it to childhood maltreatment experiences, PTSD symptoms, withdrawal, and self-blame. Our findings suggest that IPV perpetration and victimization often co-occur. Dissociation may be an important bridge symptom, linking IPV to childhood maltreatment experiences, PTSD symptoms, and maladaptive coping. Prospective studies are needed to corroborate these findings and to establish psychological mechanisms underlying IPV.

Long-Term Effectiveness of an Online Self-help Intervention for People with HIV and Depressive Symptoms.

The aim of this study was to investigate the long-term effectiveness (3-4 years later) of an online intervention that was previously found to effectively reduce depressive symptoms in people with HIV on the short term. Participants were people with HIV who had participated in the large RCT on the short-term effectiveness of the guided online intervention. The primary outcome measure was depressive symptoms [Patient Health Questionnaire-9 (PHQ-9)] and the secondary outcome measure was anxiety symptoms [Generalized Anxiety Disorder-2 (GAD-2) scale]. Forty-seven participants completed the long-term follow-up. PHQ-9 scores, previously found to have been significantly reduced on the short term, remained low on the long term. GAD-2 scores did not decrease significantly on the short term, however, on the long term, a significant decrease was found. The intervention may not only be effective in lowering depressive symptoms on the short term but also retain the results on the long term.Trial registration International Clinical Trials Registry Platform, NL8448, March 3, 2020.

Academic stress, mindfulness-related skills and mental health in international university students.

This study investigated the relationships between academic stress, mindfulness-related constructs (ie, mindfulness, self-compassion and psychological flexibility) and anxiety and depressive symptoms in a sample of 190 international university students. Participants filled in an online questionnaire. Multiple Regression Analyses showed that anxiety and depressive symptoms were significantly related to higher levels of perceived academic stress, and to lower levels of acting with (mindful) awareness, lower self-compassion and lower psychological flexibility. None of the mindfulness-related constructs was found to moderate the relationship between perceived academic stress and anxiety and depressive symptoms. The results provide possible targets for mental health interventions in international university students. Especially the training of mindfulness-related skills could be a promising path.

Cost-effectiveness and cost-utility of an Acceptance and Commitment Therapy intervention vs. a Cognitive Behavioral Therapy intervention for older adults with anxiety symptoms: A randomized controlled trial.

BACKGROUND: A previous randomized controlled trial in older adults with anxiety symptoms found no differences between a brief blended Acceptance and Commitment Therapy (ACT) intervention and brief face-to-face Cognitive Behavior Therapy (CBT) regarding anxiety symptom severity at posttreatment and 12-month follow-up. A health-economic evaluation comparing these interventions has not yet been conducted. OBJECTIVE: This study examined the one-year cost-effectiveness and cost-utility of blended ACT compared to face-to-face CBT for older adults with anxiety symptoms. METHODS: The economic evaluation was embedded in a randomized controlled trial comparing blended ACT to CBT in 314 older adults with mild to moderately severe anxiety symptoms. Data were collected at baseline and 3, 6 and 12 months post baseline. For the cost-effectiveness analysis, treatment response was defined as a reliable improvement in anxiety symptom severity (measured with the Generalized Anxiety Disorder-7) between baseline and 12-month follow-up. To assess cost-utility, quality-adjusted life years (QALYs) were computed using EuroQol-5 Dimensions-5 Levels-5 utility scores. Analyses took the societal perspective, including both healthcare costs and productivity costs. Incremental cost-effectiveness ratios were calculated using 2500 bootstraps of seemingly unrelated regression equations of costs and effects. Sensitivity analyses were performed to assess the robustness of the findings. RESULTS: Differences between the blended ACT group and CBT group in treatment response and QALYs were statistically insignificant and clinically irrelevant. The ACT intervention was associated with an average per-participant cost reduction of €466 ($593) compared to CBT, which resulted from lower productivity costs in the blended ACT group. From a healthcare perspective, the ACT intervention was associated with higher costs (by €71 ($90)) than CBT. CONCLUSIONS: The results do not indicate that from a health-economic perspective blended ACT should be preferred over CBT in the treatment of older adults with anxiety symptoms. The findings support a model of shared decision making, where clinicians and patients collaboratively decide on the preferred intervention, based on ethical-medical, practical and personal considerations. TRIAL REGISTRATION: Netherlands Trial Register: TRIAL NL6131 (NTR6270); https://www.trialregister.nl/trial/6131.

Blended Acceptance and Commitment Therapy Versus Face-to-face Cognitive Behavioral Therapy for Older Adults With Anxiety Symptoms in Primary Care: Pragmatic Single-blind Cluster Randomized Trial.

BACKGROUND: Anxiety symptoms in older adults are prevalent and disabling but often go untreated. Most trials on psychological interventions for anxiety in later life have examined the effectiveness of face-to-face cognitive behavioral therapy (CBT). To bridge the current treatment gap, other treatment approaches and delivery formats should also be evaluated. OBJECTIVE: This study is the first to examine the effectiveness of a brief blended acceptance and commitment therapy (ACT) intervention for older adults with anxiety symptoms, compared with a face-to-face CBT intervention. METHODS: Adults aged between 55-75 years (n=314) with mild to moderately severe anxiety symptoms were recruited from general practices and cluster randomized to either blended ACT or face-to-face CBT. Assessments were performed at baseline (T0), posttreatment (T1), and at 6- and 12-month follow-ups (T2 and T3, respectively). The primary outcome was anxiety symptom severity (Generalized Anxiety Disorder-7). Secondary outcomes were positive mental health, depression symptom severity, functional impairment, presence of Diagnostic and Statistical Manual of Mental Disorders V anxiety disorders, and treatment satisfaction. RESULTS: Conditions did not differ significantly regarding changes in anxiety symptom severity during the study period (T0-T1: B=.18, P=.73; T1-T2: B=-.63, P=.26; T1-T3: B=-.33, P=.59). Large reductions in anxiety symptom severity (Cohen d≥0.96) were found in both conditions post treatment, and these were maintained at the 12-month follow-up. The rates of clinically significant changes in anxiety symptoms were also not different for the blended ACT group and CBT group (χ21=0.2, P=.68). Regarding secondary outcomes, long-term effects on positive mental health were significantly stronger in the blended ACT group (B=.27, P=.03, Cohen d=0.29), and treatment satisfaction was significantly higher for blended ACT than CBT (B=3.19, P<.001, Cohen d=0.78). No other differences between the conditions were observed in the secondary outcomes. CONCLUSIONS: The results show that blended ACT is a valuable treatment alternative to CBT for anxiety in later life. TRIAL REGISTRATION: Netherlands Trial Register TRIAL NL6131 (NTR6270); https://www.trialregister.nl/trial/6131.

Prevalence of anxiety disorders and subthreshold anxiety throughout later life: Systematic review and meta-analysis.

This systematic review and meta-analysis compared prevalence rates for subthreshold anxiety and anxiety disorders in adults aged 55+ and examined if these rates were associated with age. A systematic search and screening procedure resulted in 46 included articles. First, prevalence rates for subthreshold anxiety and anxiety disorders were statistically compared. Subthreshold panic, generalized anxiety and specific phobia were significantly more prevalent than the corresponding clinical disorders. In general, subthreshold anxiety appeared to be at least similarly prevalent to anxiety disorders, although firm conclusions are precluded due to the small number of samples that could be included in the analyses and the large heterogeneity between the reported prevalence rates. Second, using subgroup analyses, pooled prevalence rates for four age groups of older adults (55-64, 65-74, 75-84, 85+) were compared. For specific phobia, the 75-84 and 85+ groups had significantly lower prevalence rates than the 55-64 and 65-74 groups. Posttraumatic stress disorder was significantly more prevalent in the 55-64 group than in the other age groups, and lowest in the 85+ group. No other significant differences between age groups were found. The association between later life subthreshold anxiety and age could not be examined due to a lack of reported information. The main limitation of this study is the small number of samples in the analyses, which limits their power and generalizability. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Intervention targets for people living with HIV and depressive symptoms in Botswana.

Background: The prevalence of HIV in Botswana is high. Many people living with HIV (PLWH) suffer from depressive symptoms and have inadequate coping skills. Most PLWH do not receive adequate psychological treatment. Empirically based interventions for PLWH with depressive symptoms in Botswana should be developed, with a focus on improving coping skills. The present study was a first step towards this goal, by trying to identify targets for intervention. The study aimed to provide prevalence rates of depression among PLWH in Botswana, to assess their mental health treatment needs and wishes as expressed by themselves, and to study the relationships between cognitive and behavioural coping strategies and depressive symptoms.Method: A cross-sectional study was conducted. The sample consisted of 291 participants (73% female) from 8 HIV treatment centres from Botswana. Participants completed standardized questionnaires on depressive symptoms (CES-D) and coping skills (CERQ, BERQ). They also answered questions regarding their mental health care needs and wishes.Results: In total 43.4% of participants reported clinically significant depressive symptoms. The majority of participants indicated that they needed help with the following topics: feelings of depression, physical tension, finding new goals and coping with HIV. In addition, they indicated preferring a self-help programme in booklet format. Multiple regression analyses showed that the following coping strategies had significant relationships with depressive symptoms: rumination, catastrophising, withdrawal, positive refocusing and refocus on planning (the latter two negatively).Conclusion: Almost half of the PLWH reported depressive symptoms that were clinically significant. The findings suggested that an intervention for PLWH with depressive symptoms in Botswana should preferably be a self-help programme presented in booklet format. With regard to content, the results confirmed that the intervention should focus on specific coping skills. In addition, elements like goal finding and strategies to reduce physical tension should be added.

Psychosocial interventions enhance HIV medication adherence: A systematic review and meta-analysis.

About 40 per cent of people living with HIV do not sufficiently adhere to their medication regimen, which adversely affects their health. The current meta-analysis investigated the effect of psychosocial interventions on medication adherence in people living with HIV. Databases were systematically searched, resulting in 43 included randomized controlled trials. Study and intervention characteristics were investigated as moderators. The overall effect size indicates a small to moderate positive effect (Hedges' g = 0.37) of psychosocial interventions on medication adherence in people living with HIV. No evidence for publication bias was found. This meta-analysis study concludes that various psychosocial interventions can improve medication adherence and thereby the health of people living with HIV.

Moderators of the effect of guided online self-help for people with HIV and depressive symptoms.

The goal of the study was to investigate moderators of intervention effect of a guided Internet-based self-help cognitive behavioral intervention for people with HIV and depressive symptoms. This study was part of a randomized controlled trial where the intervention was found to be effective in reducing depressive symptoms, compared to an attention-only control group. Demographic characteristics (e.g., age), HIV characteristics (e.g., duration of HIV), and psychological characteristics (e.g., coping self-efficacy) were investigated as potential moderators of intervention effect. In 2015, 188 people with HIV and depressive symptoms were included in the study: 97 were randomized to the intervention group and 91 to the control group. Two moderators of intervention effect were found: coping self-efficacy and baseline depression severity. Participants with low coping self-efficacy and baseline depression severity improved more in the intervention group than in the control group, and participants with high coping self-efficacy and baseline depression severity improved in both groups. The results indicate that the intervention may be provided to all people with HIV and depressive symptoms. It may be especially important for people with HIV and low coping self-efficacy to start with the intervention since they show less improvement in the control group with only attention. Trial registration: Nederlands Trialregister NTR5407, September 11, 2015.

Exploring Mediators of a Guided Web-Based Self-Help Intervention for People With HIV and Depressive Symptoms: Randomized Controlled Trial.

BACKGROUND: Cognitive behavioral therapy (CBT) is frequently used to treat depressive symptoms in people living with HIV. We developed an internet-based cognitive behavioral intervention for people with HIV and depressive symptoms, which was based on an effective self-help booklet. The Web-based intervention was previously found to be effective. OBJECTIVE: The objective of this study was to investigate potential mediators of the Web-based intervention. METHODS: This study was part of a randomized controlled trial, in which the intervention was compared with an attention-only waiting list control condition. Participants were 188 (97 in intervention group and 91 in control group) people with HIV and mild to moderate depressive symptoms recruited in HIV treatment centers in the Netherlands. A total of 22 participants (22/188, 11.7%) in the study were female and 166 (166/188, 88.3%) were male. The average age of the participants was 46.30 years (SD 10.63). The intervention comprised Web-based self-help CBT for 8 weeks, 1 to 2 hours a week, including minimal telephone support from a coach. The participants received Web-based questionnaires at pretest, 3 times during the intervention/or waiting period, and post intervention. The outcome was depressive symptoms. Factors tested as potential mediators were changes in behavioral activation, relaxation, the cognitive coping strategies catastrophizing and positive refocusing, goal re-engagement, and coping self-efficacy. RESULTS: Using multilevel structural equation modeling, changes in behavioral activation (P=.006) and goal re-engagement (P=.009) were found to be significant mediators of the intervention effect. The mediation effect seemed to occur between weeks 3 and 5 for behavioral activation and weeks 1 and 3 for goal re-engagement. Using (bivariate) autoregressive latent trajectory analysis, we found a return effect (from the dependent variable to the mediator) for goal re-engagement but not for behavioral activation, which suggested that the mediation effect of changes in behavioral activation was stronger than that in goal re-engagement. CONCLUSIONS: The results suggest that changes in behavioral activation and goal re-engagement may mediate the effect of the Web-based intervention for people with HIV and depressive symptoms. The results may lead to possible mechanisms of change of the intervention and improvement of therapy outcomes. TRIAL REGISTRATION: Netherlands Trial Register NTR5407; https://www.trialregister.nl/trial/5298.

A booklet self-help intervention to reduce depressive symptoms among people living with HIV in Botswana: study protocol for a randomized controlled trial.

BACKGROUND: The treatment of mental health issues among people living with HIV (PLH) in Botswana is yet to be addressed. A recent study revealed that depressive symptoms are highly prevalent in a sample of PLH in Botswana. Based on empirical findings of a study that investigated intervention targets for PLH in Botswana, a self-help program with coaching in booklet format in the Setswana and English languages was developed, composed of cognitive behavioral techniques, coping skills interventions, and goal adjustment training. We will investigate the program for effectiveness in the treatment of depressive symptoms among PLH. Additionally, we will investigate treatment moderators and mediators. This paper describes the study protocol. METHODS/DESIGN: A randomized controlled trial will be conducted to compare the booklet self-help program with coaching with an attention-only control condition, by including pre-test, post-test, and follow-up assessments. We aim to enroll 200 participants with mild to moderate depressive symptoms into the study. The self-help program contains the following main components: activation, relaxation, changing maladaptive cognitions, and the attainment of new personal goals. This content is covered over six lessons to be completed in a maximum of 8 weeks. It uses a combination of psycho-education, assignments, and exercises. The participants will work on the program 1-2 h every week for 6 weeks (maximum 8 weeks). Coaches will offer support and motivate the participants. For both groups, depressive symptoms and possible mediators will be measured three times during the intervention, and at pre-test, post-test, and follow-up. DISCUSSION: If the intervention is found to effectively treat depressive symptoms, it will be implemented and thus help improve the psychological health of PLH in Botswana. TRIAL REGISTRATION: Netherlands Trial Register, NTR7428 . Registered on 23 August 2018.

Cost-utility of a guided Internet-based intervention in comparison with attention only for people with HIV and depressive symptoms: A randomized controlled trial.

OBJECTIVE: The aim of this study was to evaluate the cost-utility of a guided Internet-based intervention for people living with HIV and depressive symptoms, compared to attention only (control condition). It was previously found that the intervention was effective in decreasing depressive symptoms, compared to the control group. METHODS: This economic evaluation was conducted alongside a randomized controlled trial. The control group received attention only and was put on a waiting list. Quality adjusted life years were calculated over six months. The study was conducted from a societal perspective and included intervention costs, healthcare costs, and non-healthcare costs. Participants completed a pretest, a post-test after two to three months, and a second post-test after six months. Cost-utility acceptability curves were constructed and two sensitivity analyses were conducted. RESULTS: No differences between the intervention and the control group were found in quality adjusted life years and total societal costs. The results indicate that the intervention is likely to be cost-effective, compared to attention only. The findings of the sensitivity analyses point in the same direction. CONCLUSION: More research with larger samples is necessary to confirm the findings. The outcomes of this study may inform policy makers to decide which interventions will be included in policies. The guided Internet intervention may improve psychological care for people living with HIV and depressive symptoms, against low costs. TRIAL REGISTRATION: Nederlands Trialregister NTR5407, September 11, 2015.

Cognitive and behavioral coping in people with Chronic fatigue syndrome: An exploratory study searching for intervention targets for depressive symptoms.

The aim of the study was to find relevant coping factors for the development of psychological interventions for people with chronic fatigue syndrome who suffer from depressive symptoms. A total of 30 adults with chronic fatigue syndrome filled in the Cognitive Emotion Regulation Questionnaire, the COPE and the Hospital Anxiety and Depression Scale. The findings suggested that cognitive coping strategies have a stronger influence than behavioral coping strategies on depressive symptoms. Especially, the cognitive coping strategies refocusing positive, positive reappraisal and catastrophizing were of importance. These findings suggest that these coping strategies should be part of psychological programs for people with chronic fatigue syndrome.

An Internet-based Acceptance and Commitment Therapy intervention for older adults with anxiety complaints: study protocol for a cluster randomized controlled trial.

BACKGROUND: Anxiety is among the most prevalent and disabling mental health problems in older adults. Few older adults with mild to moderately severe anxiety symptoms receive adequate interventions, putting them at risk for developing anxiety disorders, depression, and various somatic problems. Effective, low-threshold interventions should be developed. Blended care, in which a web-based intervention is combined with a limited amount of face-to-face contacts with a mental healthcare counselor at the general practice, is a promising option. The online self-help intervention "Living to the Full"-an Acceptance and Commitment Therapy (ACT) intervention-has been proven to reduce depression and anxiety in several patient groups, but has not yet been investigated in older adults. The aim of this study is to evaluate the (cost-)effectiveness of a blended form of "Living to the Full" in reducing anxiety symptoms in adults aged 55 to 75 years. Furthermore, moderators and mediators of the treatment effect are investigated. METHODS/DESIGN: The (cost-)effectiveness of the ACT intervention will be investigated in a cluster single-blind randomized controlled trial (RCT). The blended intervention will be compared to treatment-as-usual. Thirty-six mental health counselors working at general practices in the Netherlands will be randomized to deliver blended care or treatment as usual. A total of 240 participants (aged 55-75 years) with mild to moderately severe anxiety complaints (defined as a total score of 5-15 on the GAD-7) will be recruited. There are four measurements consisting of online questionnaires (primary outcome: GAD-7) and a telephone interview: before the start of the intervention; directly following the intervention (14 weeks after baseline); and six and twelve months after baseline. Possible mediator variables will be assessed multiple times basis during the intervention. DISCUSSION: This RCT will evaluate the effectiveness of a blended ACT intervention for older adults with anxiety symptoms. If the intervention is shown to be effective, it will be implemented, thereby improving the accessibility and quality of preventive interventions for older adults with anxiety problems. TRIAL REGISTRATION: Netherlands Trial Register, NTR6270 . Registered on 21 March 2017.

Guided internet-based intervention for people with HIV and depressive symptoms: a randomised controlled trial in the Netherlands.

BACKGROUND: Many people living with HIV have depressive symptoms, but some individuals do not receive adequate treatment. We developed an online self-help intervention for people with HIV with depressive symptoms on the basis of previous research. The aim of this study was to investigate the effectiveness of the intervention on depressive symptoms in individuals with HIV. METHODS: In this randomised controlled trial, participants recruited from 23 HIV treatment centres in the Netherlands were eligible if they were aged 18 years and older, had been diagnosed with HIV at least 6 months before the study, and had mild to moderate depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score >4 and <20). Individuals also had to speak English or Dutch and have internet access and an email address. Participants were randomly assigned (1:1) to an internet-based intervention (Living positive with HIV) or an attention-only waiting-list control condition. Randomisation was done using random number tables, with permuted blocks of 12, stratified by treatment centre and sex. Participants, researchers, and coaches were not masked to group allocation. The primary outcome was depressive symptoms assessed with the PHQ-9 and the Center for Epidemiologic Studies Depression Scale (CES-D) at pretest, 8 weeks after baseline, and 3 months after completion of the intervention or control condition (post-test 2). The primary analysis was done by intention to treat. Between group effect size was assessed with Cohen's d. This trial is registered with the Netherlands Trial Registry, number NTR5407. FINDINGS: Between Feb 1, and Dec 31, 2015, we randomly assigned 188 participants to the intervention group (n=97) or the control group (n=91). Mean pretest PHQ-9 score was 11·74 (SD 2·49) in the intervention group and 11·11 (2·37) in the control group; at the post-test visits it was 6·73 (3·00) and 6·62 (3·03) in the intervention group and 8·60 (3·12) and 8·06 (3·17) in the control group. Mean pretest CES-D score was 24·91 (5·93) in the intervention group and 22·94 (6·48) in the control group; at the post-test visits it was 13·94 (6·39) and 15·71 (6·39) in the intervention group and 19·09 (7·05) and 18·43 (7·05) in the control group. The reduction in depressive symptoms was significantly larger in the intervention group than in the control group (d=-0·56 [95% CI -0·85 to -0·27] for PHQ-9 and -0·72 [-1·02 to -0·42] for CES-D at post-test 1; -0·46 [-0·75 to -0·17] for PHQ-9 and -0·47 [-0·76 to -0·18] for CES-D at post-test 2). No adverse events were reported. INTERPRETATION: This guided internet-based intervention might be effective for the treatment of depressive symptoms. Future research should focus on the effectiveness of online psychological interventions for people with HIV who have mental health problems in low-income and middle-income countries. FUNDING: Aids Fonds.

The Benefits of Psychosocial Interventions for Mental Health in People Living with HIV: A Systematic Review and Meta-analysis.

In this systematic review and meta-analysis we investigated the effectiveness of different psychosocial treatments for people living with HIV (PLWH) and mental health problems. Additionally, characteristics that may influence the effectiveness of a treatment (e.g., treatment duration) were studied. PubMed, PsycINFO and Embase were searched for randomized controlled trials on psychosocial interventions for PLWH. Depression, anxiety, quality of life, and psychological well-being were investigated as treatment outcome measures. Sixty-two studies were included in the meta-analysis. It was found that psychosocial interventions for PLWH had a small positive effect on mental health (g = 0.19, 95% CI [0.13, 0.25]). Furthermore, there was evidence for publication bias. Six characteristics influenced the effectiveness of a treatment for depression. For example, larger effects were found for studies with psychologists as treatment providers. To conclude, this systematic review and meta-analysis suggests that psychosocial interventions have a beneficial effect for PLWH with mental health problems.

Stress in Parents of a Child with Hemifacial Microsomia: The Role of Child Characteristics and Parental Coping Strategies.

OBJECTIVE: Examine stress levels of parents of children with hemifacial microsomia (HFM) and the relationship of parental stress to child characteristics and cognitive coping strategies. DESIGN: Prospective cross-sectional study. PARTICIPANTS AND SETTING: Parents with a child (age 3-19 years) with HFM (N = 31) were recruited through the Department of Orthodontics and the Craniofacial Center, Sophia-Erasmus Medical Center, Rotterdam, The Netherlands. Intervention and Outcome Measures: The adapted and shortened Dutch version of the parental stress index (NOSI-K) was used to measure parental stress, and the cognitive emotion-regulation questionnaire was used to measure cognitive coping strategies. Pearson correlations and a multiple regression analysis were performed. RESULTS: The hierarchical multiple regression analysis showed associations between increased parental stress and learning difficulties and use of acceptance as a coping strategy. This suggests that problems other than the characteristic visual appearance of the child's face in HFM have a greater influence on parental stress. CONCLUSIONS: Learning difficulties of the child with HFM and parental acceptance affect stress in parents with a child with HFM the most and are important in the search for a targeted tailoring of intervention for parents with high levels of parental stress.

Specificity of relations between adolescents' cognitive emotion regulation strategies and symptoms of depression and anxiety.

The aim of this study was to examine the extent to which cognitive emotion regulation strategies were "common or transdiagnostic correlates" of symptoms of depression and anxiety and/or "specific correlates" distinguishing one problem category from the other. The sample comprised 582 13- to 16-year-old secondary school students. Symptoms of depression and anxiety were measured by the SCL-90, and cognitive emotion regulation strategies were measured by the CERQ, in a cross-sectional design. Multivariate regression analyses were performed. Before controlling for comorbidity, the same cognitive emotion regulation strategies that were related to symptoms of depression were also related to symptoms of anxiety. However, after controlling for comorbid anxiety symptoms, rumination, self-blame (only girls), positive reappraisal, and positive refocusing (the latter two inversely) were uniquely (and significantly) associated with depression symptoms; and after controlling for comorbid depression symptoms, catastrophising and other-blame were uniquely related to anxiety symptoms. The results supported the cognitive content-specificity model, in which anxiety is supposed to be uniquely characterised by thoughts concerning the overestimation of threats and harm, and depression is supposed to be uniquely characterised by negative evaluations of self, and of past and future events.

Relationships Between Traumatic Life Events, Cognitive Emotion Regulation Strategies, and Somatic Complaints.

The aim of this study was to investigate the relationships between traumatic life events, specific cognitive emotion regulation strategies, and present somatic complaints. The sample consisted of 465 adults from the general population. The participants filled in online self-report questionnaires with regard to somatic complaints (SCL-90), cognitive emotion regulation strategies (CERQ) and traumatic life events. Multiple regression analysis was performed to study the relationships. The results showed that present somatic complaints were significantly related to the reporting of past negative events (such as loss and maltreatment) that still produce strong and negative feelings in the present. Somatic complaints were also significantly related to a more frequent use of maladaptive cognitive coping strategies, such as blaming oneself, ruminating, and catastrophizing about negative life events. Inquiring about unresolved traumatic memories and coping strategies can help guide a clinicians' approach to managing patients with somatic complaints that have no clear medical explanation.

An Internet-based self-help intervention for people with HIV and depressive symptoms: study protocol for a randomized controlled trial.

BACKGROUND: Many people living with HIV suffer from depressive symptoms. In a previous pilot study, self-help cognitive behavioral therapy (in booklet format) was found to be effective in treating depressive symptoms in people with HIV. We developed an online self-help program in Dutch and English (based on the booklet) for people with HIV and depressive symptoms. Besides the main question regarding the effectiveness of the program aimed at lowering depressive symptoms, sub-questions will focus on the moderators of treatment success (for which patients is the program especially beneficial?) and the mechanisms of change underlying the treatment outcome (which mediators affect the outcome of treatment?). In this paper, the protocol of the study will be described. METHODS/DESIGN: The effectiveness of the program will be investigated by comparing the intervention group with a waiting list-control group in a randomized controlled design, by including a pretest and three post-tests. The self-help program contains four main components: activation, relaxation, changing maladaptive cognitions, and goal attainment. Participants with mild to moderate depressive symptoms will work on the program for 6 to 10 weeks, during which a coach will provide motivational support by telephone once a week. Participants in the control condition will receive weekly minimal support from a coach for 8 weeks, and after the second post-test, they can gain access to the self-help program. Depressive symptoms and possible mediators (e.g., activation, cognitive coping, self-efficacy, and goal adjustment) will be assessed by self-report three times during the intervention/waiting period and at the pretest and first post-test. DISCUSSION: The proposed study aims to evaluate the effectiveness of an online self-help intervention for people with HIV and depressive symptoms. If the intervention is shown to be effective, the program will be implemented. Consequently, many patients with HIV could be reached, and their psychological care may be improved. TRIAL REGISTRATION: Netherlands Trial Register: NTR5407.