[Wellbeing and personality pathology in inpatient schematherapy]. / Welbevinden en persoonlijkheidsproblematiek in klinische schematherapie.

BACKGROUND: In treatment of personality disorders, wellbeing is complementary to a focus on reducing symptoms. It is known that symptoms are being reduced and relate to the development of characteristics of personality pathology (schemamodes). AIM: To answer the questions: how does wellbeing develop and how is this development related to the development of schemamodes? METHOD: A naturalistic, prospective, within subjects design was used in the Boerhaven Clinic of Mediant. Respondents received inpatient schema therapy with a focus on symptom reduction as well as increasing functional schema modes and wellbeing. A mixed model analysis was used to assess changes in wellbeing and schema modes at 0, 6, 12 and 18 months. RESULTS: Wellbeing increased significantly during treatment, but declined somewhat at follow-up. A connection was found between increases in wellbeing and increases in functional schema modes and decreases in coping modes. CONCLUSION: Symptoms and wellbeing develop in a different way during and after inpatient schema therapy and they have different relationships with schema modes. A positive psychological approach is recommended besides treatment of symptoms.

[Digital psychiatry]. / Digitale psychiatrie.

BACKGROUND: The digitization of society has an increasing impact on healthcare in general and, therefore, also on psychiatry.
AIM: To provide an overview of digital developments and their influence on the design of future professional psychiatric care.
METHOD: With the help of examples from literature, show how digitization will influence diagnostic procedures as well as psychiatric treatment.
RESULTS: Digitization will have a major impact on psychiatric diagnostics and treatment. For example, psychiatric diagnostics will be strengthened by continuous monitoring of behaviour with digital wearables and the collection of large amounts of personal data. How we deal with these new sources of information needs to be developed in everyday practice. Psychiatric treatments with E-health, online therapies, apps and virtual reality are being developed rapidly. There is increasing evidence concerning the efficacy of these treatments in a variety of patient groups.
CONCLUSION: The digital revolution in psychiatric health services has just begun. To maximise the benefits of digitization for psychiatry, it is necessary to connect technological possibilities with well-founded scientific knowledge, professional expertise, expectations and needs of patients, and clear legal instructions.

Both positive mental health and psychopathology should be monitored in psychotherapy: Confirmation for the dual-factor model in acceptance and commitment therapy.

The dual-factor model of mental health suggests that enhancing positive mental health and alleviating psychopathology do not automatically go hand-in-hand. This study investigates the relationship between the effectiveness on depression/anxiety symptoms and positive mental health of Acceptance and Commitment Therapy (ACT). It draws on RCT data (n = 250) of a self-help ACT. Patients' depression/anxiety symptoms and positive mental health were completed at baseline, at post-intervention after nine weeks, and at follow-up after five months. Percentage of unique variance of depression/anxiety symptoms explained by positive mental health (and vice versa), and the degree of classificatory agreement between improvements in positive mental health and depression/anxiety, were examined using regression analysis and Reliable Change Index (RCI). Positive mental health, i.e. baseline and change, explained 15% and 12% of the variance in follow-up depression and anxiety symptoms, beyond the 7% and 9% that was explained by baseline levels of depression and anxiety. Depression and anxiety symptoms, i.e., baseline and change, explained 10% and 9% of the variance in follow-up positive mental health, on top of the 35% that was explained by baseline levels of positive mental health. Cross-classification of the Reliable Changes showed that 64% of the participants that improved during the ACT-intervention, improved on either depression symptoms or positive mental health, and 72% of the participants improved on either anxiety symptoms or positive mental health. The findings support the dual-factor model and suggest that it is important to systematically implement measures of both psychopathology and positive mental health in mental health care and therapy evaluations.

Mental health among living kidney donors: a prospective comparison with matched controls from the general population.

The impact of living kidney donation on donors' mental health has not been sufficiently nor comprehensively studied. Earlier studies demonstrated that mental health did not change in the majority of donors, however they often lacked a suitable control group and/or had other methodological limitations. Consequently, it remains unclear whether changes in mental health found among a minority of donors reflect normal fluctuations. In this study we matched 135 donors with individuals from the general Dutch population on gender and baseline mental health and compared changes in mental health over time. Mental health was measured using the Brief Symptom Inventory and Mental Health Continuum Short Form. Primary analyses compared baseline and 6 months follow-up. Secondary analyses compared baseline and 9 (controls) or 15 months (donors) follow-up. Primary multilevel regression analyses showed that there was no change in psychological complaints (p = 0.20) and wellbeing (p = 0.10) over time and donors and controls did not differ from one another in changes in psychological complaints (p = 0.48) and wellbeing (p = 0.85). Secondary analyses also revealed no difference in changes between the groups. We concluded that changes in mental health in the short term after donation do not significantly differ from normal fluctuations found in the Dutch general population.

Life review in groups? An explorative analysis of social processes that facilitate or hinder the effectiveness of life review.

OBJECTIVES: Life review can be implemented within a group as well as on an individual level. There have been few discussions about which the format is most effective. This study investigates the social aspects of a life-review group intervention from the perspective of the client within the context of a large, randomized controlled trial. METHOD: This was an exploratory study using a qualitative methodology. We conducted semi-structured interviews to explore how participants felt about the benefits and barriers of receiving life review in a group. Transcripts of the interviews were analyzed using inductive analysis. RESULTS: The social processes of life review in a group included experiencing a sense of belonging, feeling accepted, finding good company, disclosing oneself, learning to express oneself, finding recognition, realizing that others have problems too, being more successful at coping than others, learning from others, and being able to help others. Negative processes were less often mentioned and included having difficulties with sharing in a group, finding no recognition, and anxiety caused by the prospect of finding no recognition. These social processes can be divided into three categories: first, having a good atmosphere in the group; second, disclosure to peers; and third, relating to others. CONCLUSION: Our results reveal a variety of social processes that may facilitate the effects of life-review therapy. Future research, however, is needed to further examine the importance of these social processes and their effects on depression.

Life review therapy for older adults with moderate depressive symptomatology: a pragmatic randomized controlled trial.

BACKGROUND. Although there is substantial evidence for the efficacy of life review therapy as an early treatment of depression in later life, its effectiveness in natural settings has not been studied. The present study evaluates an intervention based on life review and narrative therapy in a large multi-site, pragmatic randomized controlled trial(RCT). METHOD. Life review therapy was compared with care as usual. The primary outcome was depressive symptoms;secondary outcomes were anxiety symptoms, positive mental health, quality of life, and current major depressive episode (MDE). To identify groups for whom the intervention was particularly effective, moderator analyses were carried out (on sociodemographic variables, personality traits, reminiscence functions, clinically relevant depressive and anxiety symptoms, and past MDEs). RESULTS. Compared with care as usual (n=102), life review therapy (n=100) was effective in reducing depressive symptoms, at post-treatment (d=0.60, B= -5.3, p<0.001), at 3-month follow-up (d=0.50, B= -5.0, p<0.001) and for the intervention also at 9-month follow-up (t=5.7, p<0.001). The likelihood of a clinically significant change in depressive symptoms was significantly higher [odds ratio (OR) 3.77, p<0.001 at post-treatment ; OR 3.76, p<0.001 at the 3-month follow-up]. Small significant effects were found for symptoms of anxiety and positive mental health.Moderator analyses showed only two significant moderators, the personality trait of extraversion and the reminiscence function of boredom reduction. CONCLUSIONS. This study shows the effectiveness of life review therapy as an early intervention for depression in an ecologically valid context, supporting its applicability to a broad target group. The intervention is also effective in reducing anxiety symptoms and strengthening positive mental health.

[Reminiscence and mental health, empirical underpinning of interventions]. / Reminiscentie en geestelijke gezondheid: empirische onderbouwing van interventies.

The relation between functions of reminiscence and mental health has been studied elaborately in older adults. In this paper a review of this research is first presented. Eight functions are distinguished: bitterness revival, boredom reduction, identity, problem solving, maintaining intimacy, preparing for death, teaching/informing and conversation. Some functions such as bitterness revival are used more often by people with depression or anxiety. Other functions such as identity are used less often by people with psychological distress. A model based on these research findings is discussed. Three types of interventions are distinguished: reminiscence, life-review and life-review therapy. Life-review therapy is an evidence based treatment of depression in older adults. In the last part of the paper three effective Dutch interventions are discussed: Op zoek naar zin (Searching for meaning), Dierbare Herinneringen (Dear Memories) and De verhalen die we leven (The stories we live by).

[Effects of recollecting autobiographical memories on the emotional well-being of older adults]. / Effecten van het ophalen van autobiografische herinneringen op emotioneel welbevinden bij ouderen.

This experiment examined the effect of different ways of recollecting autobiographical memories on emotional well-being. Participants between 65 and 80 years old (N = 70) were instructed to write about a memory from their life when they were 15 to 30 years old. They were asked to do this in a narrative way about a positive memory, in a narrative way about a negative memory or in an interpretative way about a negative memory. We also examined whether spontaneous reminiscence types in everyday life moderate the effects of the experimental manipulation on emotional well-being. Narrating positive memories is more favourable for negative affect than narrating or interpreting negative memories. There is no moderating role for everyday reminiscence types, even though these are related to emotional well-being. Manipulated and spontaneous reminiscence are therefore different. This is a favourable finding for reminiscence interventions, because they can stimulate positive memories, no matter how older people are used to memorize their past.

The effects of integrative reminiscence on meaning in life: results of a quasi-experimental study.

OBJECTIVES: Finding meaning in life is often cited as an important outcome of reminiscence, but this theoretical claim has not been empirically tested until now. A new intervention combining integrative reminiscence and elements of narrative therapy was developed and the effects on meaning in life were studied. METHODS: A total of 106 older adults with depressive symptomatology participated in a quasi-experimental study with two parallel conditions: integrative reminiscence vs a waiting list control group. Measurements were taken before and after the intervention. RESULTS: A significant improvement in the overall meaning in life in the participants of the intervention was found, but these effects were not significant in comparison to a waiting-list control group. There is a specific effect of the intervention in that it results in a decline of negative evaluation of the self by the participants and an increase in positive evaluation of social relations. The program also results in more positive evaluation of the past as well as in less negative evaluation of the future. These findings are somewhat stronger for women than for men. CONCLUSION: Integrative reminiscence within a narrative therapeutic framework may be an effective intervention for enhancing meaning in life with depressed older adults. The intervention has to be developed further and should then be studied in a randomized controlled trial with a larger sample and with follow-up measurements.

[Competent and diverse. Portrayal of older adults in Dutch television commercials ten years later]. / Competent en veelzijdig. Representatie van ouderen in de ster-reclame tien jaar later.

The present study replicates our study of older adults' portrayal in Dutch television commercials conducted in 1993. The central question is whether older adults are being portrayed more visibly in Dutch television commercials and whether this portrayal has become more diverse compared to ten years ago. Based on a list of descriptions of all commercials broadcasted by public television channels in 2003 (N= 4767) 117 commercials featuring older adults were selected. By means of a quantitative content analysis it was examined whether and how older men and women are portrayed. It was concluded that although older adults are not more prevalent compared to ten years ago, their portrayal is more diverse with respect to their roles and the advertised products. Older adults were portrayed as more competent and less age-stereotypical in television commercials.

[Mutual stereotypes of younger and older adults and their relation with self-concept and self-esteem]. / Wederzijdse stereotypen van jongeren en ouderen en hun relatie met zelfbeeld en zelfwaardering.

In this study younger and older persons were compared with regard to their stereotypes about both age groups, their self-concept and self-esteem. We examined the relation between age and stereotypes about younger and older adults, the relation between stereotypes about one's own age group and self-concepts, and the relation between self-concepts and self-esteem. Stereotypes and self-concepts were measured on two dimensions, warmth and competence. Twenty-eight younger adults (16-25 years) and 26 older adults (65-85 years) participated in this study. Both age groups perceived younger persons as more competent than older persons and older persons as more warm than younger persons. Older persons rate themselves higher than their in-group on competence and warmth. Younger respondents did the same, but on warmth only. A rating of the own person as more competent than the stereotype of their own age group, is related to self-esteem for older persons. Distancing oneself from negative stereotypes about one's own age group is an important key in maintaining high levels of self-esteem, but only in old age.

[Personal attitude of individuality and attachment in the second half of life]. / Selbstvorstellungen über Individualität und Verbundenheit in der zweiten Lebenshälfte.

Across the whole life span individuality and communion are two central motivational orientations. These themes are scarcely studied in the second half of life. In this study the following questions are posed: which concerns are associated with individuality and communion in middle and late adulthood? How central are these themes? Do age groups in the second half of life differ with regard to the meaning and centrality of individuality and communion? In the German Aging Survey East- and West-Germans from 40 to 85 years of age (N = 2934) were asked to fill out a sentence completion questionnaire (SELE) which requires self-descriptions. These self-descriptions were coded in terms of the different meanings related to individuality and communion: 13 concerns were identified. Results showed that individuality and communion are about equally important topics for meaning-giving in the second half of life. The comparison of five age groups shows that both themes are significantly less central in self-descriptions of older groups. The particular concerns associated with individuality and communion also differ according to age. When results on centrality and particular concerns are examined on the basis of theories of successful aging and psychological well-being, it becomes evident that the ideas adults have of themselves do not correspond with certain features of these theories. An important implication is that current theories of successful aging and well-being overemphasize individuality at the expense of communion. Implications for methodology are pointed out in the discussion.

The personal experience of aging, individual resources, and subjective well-being.

The personal experience of aging, the resources relevant to it, and the consequences for subjective well-being were investigated in a sample of 4034 Germans aged 40 to 85. The data revealed 3 dimensions of aging experiences as particularly relevant: (a) physical decline, (b) continuous growth, and (c) social loss. Not only being younger but also having better subjective health, higher income, less loneliness, higher education, and greater hope were negatively associated with physical decline and social loss and positively associated with continuous growth. The number of children participants had played no role. All three dimensions of the aging experience were also found to be related to both positive and negative affect and, with the exception of physical decline, to life satisfaction.