Background: Pain and anxiety after surgery are common and can lead to negative outcomes, including impaired immune function, slow wound healing, higher morbidity rates and chronic pain. Empathic...Show moreBackground: Pain and anxiety after surgery are common and can lead to negative outcomes, including impaired immune function, slow wound healing, higher morbidity rates and chronic pain. Empathic communication can generate a placebo effect in clinical settings. Studies show a relationship between warm and empathic communication and reduced anxiety, specifically in highly anxious patients. Empathic communication may be beneficial for those with high anxiety, in reducing pain as well as anxiety. Aim: This study aimed to understand the moderating effect of pre-operative anxiety of patients on the effect of empathic communication on post-operative pain and anxiety. Methods: The study used a 2x2, single-blind, randomised controlled trial. Nurses used an empathy manipulation in communication with participants, standard and enhanced conditions of empathy. Participants’ post-operative pain and anxiety were assessed using NRS and STAI-state. Preoperative anxiety was measured before the surgery in two questions. A regression analysis was used to see what effect the moderator pre- operative anxiety had on the relationship between empathy and pain. We used a Bonferroni correction on the outcome of pain ( p <.025). Results: Empathic clinical communication did not significantly predict post-operative pain scores in highly anxious participants (p = .64, p = .46, p = .25, p = .50, p = .52, p = .42). There was a curious result of an increase in pain on day 3 in the subgroup of highly anxious participants (p = 0.01), but none of the variables in the model were significant so we could not attribute this higher pain score to the empathic communication or subgroup of highly anxious patients. Pre-operative anxiety did moderate the effect of empathy on post-operative anxiety (p = .05, p = .02). Discussion: The results suggest that empathy may be a useful tool for reducing anxiety in highly anxious patients undergoing surgery. Further research is needed to understand the mechanisms by which empathy affects pain and anxiety in this context and identify potential strategies for optimising its impact on patient outcomes.Show less
Background Lower neuroticism and higher optimism have been shown to predict more positive treatment-specific expectancies and more favourable treatment outcomes. A recent proof-of-concept study...Show moreBackground Lower neuroticism and higher optimism have been shown to predict more positive treatment-specific expectancies and more favourable treatment outcomes. A recent proof-of-concept study demonstrated the favourable effect of Wim Hof Method training (breathing exercises, meditation, and cold exposure) on inflammation in patients with Axial Spondyloarthritis (AxSpa). Objective This proof-of-principle study examined the relationship between general outcome expectancies (neuroticism and optimism) and change in disease activity after Wim Hof Method training among AxSpa patients, and the mediating role of treatment-specific expectancies. Methods A within-subject design with correlational, regression, and mediation analyses was employed. Nineteen Dutch AxSpa patients (57.9% male) between 24 and 49 years old completed the 8-week Wim Hof Method training. Neuroticism, optimism, and expectancies regarding training were assessed at baseline, and a combination of subjective and objective disease activity was assessed immediately before and after the intervention period. Results No significant correlations between general outcome expectancies and change in disease activity were observed (r-values ≤ .187). Moderate sized but non-significant associations were observed between higher neuroticism and more positive specific outcome expectancies (r = .37), and between more positive specific outcome expectancies and larger declines in disease activity (r = -.36). Specific outcome expectancies did not significantly mediate the relationship between neuroticism and change in disease activity, 95% CIbootstrap [-0.45, 0.09] nor the relationship between optimism and change in disease activity 95% CIbootstrap [-0.19, 0.30]. Conclusion Findings cautiously suggest that AxSpa patients who expect the Wim Hof Method training to be relatively effective experience better treatment outcome. Contrary to previous findings, results suggest that patients with higher neuroticism expected greater treatment effectiveness. It could be hypothesized that patients who experience negative emotions more intensely are desperate for treatments to work, therefore attaching more hope onto interventions. Future research is warranted to consolidate findings. It may be worth including possibly confounding biopsychosocial variables and measures of specific negative emotions, thereby assessing whether they provide a better conceptualization of the real-life interplay between emotional predispositions, expectancies, and treatment effects among inflammatory diseases.Show less
The universal experience of pain is a burden to all. However, this burden is not experienced the same by everyone. How much pain is actually experienced is influenced by our expectancies and...Show moreThe universal experience of pain is a burden to all. However, this burden is not experienced the same by everyone. How much pain is actually experienced is influenced by our expectancies and interpretation of pain. In this experiment we set the expectations of pain through verbal suggestion and conditioning and investigated the predictive value of anxiety on the nocebo effect. We hypothesized that pain expectations induced through verbal suggestion and conditioning can lead to more pain experienced from the conditioned stimuli. Furthermore, we hypothesized that higher anxiety scores on the STAI-S is able to predict nocebo hyperalgesia. 70 participants (15 male, 54 female, 1 non-binary) were randomly allocated to either a control condition in which they received no verbal suggestions and conditioning or a nocebo condition in which the participants did receive verbal suggestions and conditioning. In this experiment, a significant nocebo effect was found using a repeated measures ANOVA (p= 0.001), confirming that as a result of verbal suggestion and conditioning, there is indeed a nocebo effect present. Unfortunately, no significant predictive value for anxiety on the nocebo scores was found using a simple regression analysis (p = 0.246). This indicates that anxiety does not affect the strength of the nocebo effect. These results further help us understand which mechanisms (and which not) underly the nocebo effect and affect how much pain is experienced. This knowledge can be used to improve therapy and clinical practice to diminish unnecessary pain experiences.Show less
Background Stigmatization can cause psychological problems and is commonly experienced by patients with chronic illnesses such as Parkinson’s disease and psoriasis. Little research about...Show moreBackground Stigmatization can cause psychological problems and is commonly experienced by patients with chronic illnesses such as Parkinson’s disease and psoriasis. Little research about stigmatization towards health conditions and their predictors in the general population has been conducted. Objectives This study aimed to investigate the levels of stigmatizing attitudes towards individuals with psoriasis, Parkinson's disease, and a common cold in comparison to healthy individuals. Additionally, the study aimed to identify potential predictors of stigmatizing attitudes, including gender, familiarity with the health condition, and perceived vulnerability to disease. Methods After showing 4 vignettes describing encounters with people with health conditions (Parkinson’s disease, psoriasis, common cold and healthy individual), questionnaires were administered to 164 participants in a cross-sectional 4 x 1 within subjects design. A one-way repeated measures MANOVA, multiple regression analyses and univariate regression analyses were performed including 5 questionnaires measuring stigmatizing attitudes as outcomes and gender, familiarity and perceived vulnerability to disease as predictor variables. Results The study found a significant difference in the level of stigmatizing attitudes between the four conditions F (27, 1292) = 42.2, p < .001; Wilk’s Λ = .16, partial η2 = .46, with descriptively higher levels of stigmatizing attitudes in all health conditions when compared to the healthy control condition. In the Parkinson condition, women showed a significantly higher level of stigmatizing attitudes than men, and PVD was a significant predictor towards conditions which were perceived as contagious (psoriasis and common cold), which is in line with the behavioral immune system theory. In the psoriasis condition, higher levels of stigmatizing attitudes were predicted by greater familiarity. Conclusion This study provided insight into the extent of stigmatizing attitudes towards individuals with health conditions in the general population. The findings could be useful in defining target groups for stigmatization-reducing interventions, and could help develop these interventions, such as education and awareness campaigns or especially tailored interventions for men and women. Future research is recommended.Show less
Objective Breast cancer patients who are undergoing treatment often experience side effects as a consequence. Because patients speak a lot with their doctor during their disease process,...Show moreObjective Breast cancer patients who are undergoing treatment often experience side effects as a consequence. Because patients speak a lot with their doctor during their disease process, psychological interventions via doctor-patient communication can be used to positively influence patient outcomes, like side effect expectations. This experimental video-vignette study aimed to i) Investigate if clinician-expressed empathy and giving information about the nocebo-effect (e.g. when negative outcome expectations lead to worsening of a symptom) decreases the probability of patients’ expected side effects and ii) Determine whether a decrease in patients’ anxiety levels plays a mediating role between the effects of empathy and nocebo-effect information and side effect expectations. Methods Using a scripted video-vignette study, analogue patients (AP’s: healthy women, women with cancer and cancer survivors, N= 160) randomly watched one out of four videos. The video-vignettes differed in clinician’s communication: Absence or presence of clinician-expressed empathy and information on the nocebo-effect. Pre-video and post-video, APs’ state-anxiety levels were captured and post-video a manipulation check and side effect expectations (specific, partial and non-specific) were assessed. Data was analysed using anova, multiple regression- and mediation analysis. Results Between-group effects demonstrated that AP’s who received both clinician-expressed empathy and nocebo-information compared to no intervention at all showed the best results for expectations of specific side effects (p = .017). However this can be explained by a main effect of empathy on specific side effect expectations (β = -.254, 95% CI = -1.299 to -.324, p = .001). Exploratory analysis showed that this was specifically due to decreased expectations of hair loss (p=.003) and diarrhea (p=.009). The effects of both interventions on side-effects were in no case mediated by APs’ state anxiety levels. Conclusion The current experimental study demonstrated that clinician-expressed empathy might help to decrease APs’ specific side effects, yet this effect cannot be explained by a decrease in anxiety levels. When empathy by the doctor is combined with informing patients about the nocebo effect this might be a promising intervention to further decrease the degree of side effects for cancer patients. More research in a clinical care setting is needed to generalize the effects of the interventions to a clinical population and to gain insight into the underlying mechanism that remains unclear.Show less
Chronic pulmonary disease (COPD) is one of the leading causes of death worldwide. Even though COPD is a common chronic disease, patients that suffer from this disease do not receive palliative care...Show moreChronic pulmonary disease (COPD) is one of the leading causes of death worldwide. Even though COPD is a common chronic disease, patients that suffer from this disease do not receive palliative care as often as patients with other diseases. Therefore, the aim of this study was to broaden knowledge about the effectiveness of palliative care interventions for patients with COPD and their informal caregivers. This study focused on the effect of an integrated palliative care intervention on quality of life and spiritual wellbeing of the patient and the satisfaction with care of their informal caregiver. The eight participating hospital regions in the Netherlands were randomly allocated to the intervention or control condition by an independent statistician. Patients in the control condition (N = 97) received care as usual and patients in the intervention condition (N = 89) received integrated palliative care implemented by trained health professionals. The patients and their informal caregivers filled in questionnaires at multiple moments; baseline, three months after inclusion and six months after inclusion. Based on earlier research we hypothesized that the quality of life and spiritual wellbeing of the patients in the intervention group would improve over time. With respect to the informal caregivers, we hypothesized that their satisfaction with the hospital care and the care of the general practitioner would improve over time for the intervention group. Linear mixed model analysis was used to compare the control and intervention group over time. Results did not show an effect of the intervention on quality of life, spiritual wellbeing, and satisfaction with care over time. However, findings of this paper do contribute to a broadening of the knowledge about the effects of palliative care interventions for patients with COPD. This is important, as palliative care for patients with COPD is not as well studied as palliative care for other patient groups. Further research on palliative care for patients with COPD is recommended.Show less
There is an increasing demand from health professionals to develop recommendations about evidence-based and ethical use of placebo effects in the clinical practice, but the underlying mechanisms...Show moreThere is an increasing demand from health professionals to develop recommendations about evidence-based and ethical use of placebo effects in the clinical practice, but the underlying mechanisms behind the placebo effect are not all known yet. One of these mechanisms is observational learning, which is the topic of this study. The current research has two research aims. First, the influence of observational learning on the placebo effect is investigated. Second, the mediating effect of pain expectations in the role of observational learning on the placebo effect is studied. Based on previous findings it was expected that observational learning would induce placebo responses and that pain expectations would mediate this effect. Twenty-three healthy students from 18 to 30 years old participated in this study, which was a single-blinded randomized controlled trial. Placebo analgesia was measured as the difference in pain scores between the activation and the deactivation of a sham device over the course of 18 trials. Pain scores were given on the Numeric Rating Scale (NRS), with scores between 0 and 10. Placebo analgesia was compared in two groups: an observational learning group and a control group. Both groups received painful stimuli in combination with fake activation ore fake deactivation of a sham device. Participants in the observational learning group watched a video in which a model showed analgesic effects after every pain stimuli when the sham device was activated (ON) but not when the sham device was deactivated (OFF). The control group also got to see a video, but in this video there was no relation between the pain scores of the model and de activation/deactivation of the sham device. The results show that observational learning did not lead to placebo analgesia (F(4.392,92.228) = .557, p = .710). Furthermore, pain expectations did not mediate the relation between observational learning and the placebo effect (b = 0.01, 95% CI [-0.04, 0.10]). These findings contradict previous research that did find a placebo effect induced by observational learning and a mediating role of expectations. Future research should focus on the circumstances in which observational learning does induce a placebo effect. When observational learning does induce placebo responses, the mediating factor of pain expectation should be re-evaluated.Show less
This cross-sectional study aimed to understand the role of age in the relationship of time spent on leisure activities (LA) and subjective well-being (SWB) with the data collected by the surveys of...Show moreThis cross-sectional study aimed to understand the role of age in the relationship of time spent on leisure activities (LA) and subjective well-being (SWB) with the data collected by the surveys of the LISS Panel in the late months of 2018 (N=5013). The mean age of the participants was 53 (SD = 18) with an even spread of male participants (46%) and female participants (54%). In this study a distinction was made between four types of leisure: digital, creative, sport and cultural. With the use of regression analyses and ANOVAs, this research analysed the relationship between time spent on LA and SWB (1), the relationship between age and time spent on LA (2) and the possible moderation effect of age on the relationship of time spent on LA and SWB (3). The analyses of the first research question showed a mostly positive relationship between time spent on different LA and SWB. Only digital leisure has a significant negative relationship, though the effect size was very small for all significant relationships found. Secondly (2), age related negatively to time spent on digital and cultural leisure, positively to creative leisure and did not relate significantly to sports-related leisure. Lastly (3), only the moderation analysis of age on the relationship between time spent on creative leisure and SWB came out significant (Beta = .05, t = 3.36, p = .001), even though the effect sizes were negligible. Overall, this results do not fully support the hypotheses. Either other factors and relationships play a larger role in predicting SWB or the limitations of this study make it not possible to produce clear results. The study gives the suggestion for future research to examine the relationship between age and the underlying mechanisms that make up the effect of leisure activity on SWB. If this study would be replicated, advice is given to use a longitudinal design and take into account the effects of the COVID19 pandemic on leisure.Show less
Prior expectation in painful situationsmakes thepain experiencemove more towards this expectation. However, in life we do not always receivepreciseindications of the upcoming pain,leadingtofeelings...Show morePrior expectation in painful situationsmakes thepain experiencemove more towards this expectation. However, in life we do not always receivepreciseindications of the upcoming pain,leadingtofeelings ofuncertainty. Therefore research is needed to investigate the effect of uncertainty in painful situations.In this thesis we exploredthe effect of preciseoverpredictions ofpaincompared to imprecise overpredictions of pain.We expectedthat precise overpredictionsresult in a higher pain rating than imprecise overpredictions. We also investigatedthe effect of trait anxiety and intolerance of uncertainty on theeffects of these imprecisecues, since worrying and rumination might result in catastrophizing. Allhealthy23 participants included in this within-subject weretested by showingthemimprecise and precisepain indications, which were calledcues. After this,moderatelypainfulelectrical stimuli were applied,whichthe participant was asked to rate.No significant effect wasfound on the pain experience of the participant when comparing precise and imprecise overpredictions. Also,trait anxiety and intolerance of uncertainty did notshow a significant moderation effecton the pain experience in face of uncertain overpredictions.We concluded that precise andimprecise overpredictions ofpain do not show a differenceinthe amount of pain experienced. Furthermore, trait anxiety and the level of intolerance of uncertainty do not make peoplescoring high on these scalesexperience more pain in uncertain situationscompared to people who do not score high.Show less
Stigmatization frequently occurs in individuals with a skin condition such as psoriasis, which can negatively influence their mental health and disease status. While stigma is known to be the...Show moreStigmatization frequently occurs in individuals with a skin condition such as psoriasis, which can negatively influence their mental health and disease status. While stigma is known to be the leading cause of disability for these individuals, little is known about stigmatizing attitudes among the general population and its correlates. This study aimed to examine stigmatizing attitudes towards psoriasis among the Dutch population and investigated possible predictors. An online survey was administered to 124 participants, which were recruited based on convenience sampling. A 3 x 1 within-subject cross-sectional design was used, investigating the difference in stigmatizing attitudes towards the health conditions psoriasis and common cold (included due to COVID-19), and a healthy control condition. To describe the different conditions, vignettes were used. A one-way repeated measure Manova examined differences between the three conditions on stigmatizing attitudes (assessed by a social distance scale, a direct and indirect version of the impact of skin condition in daily life scale, stereotype endorsement scale, and emotion ratings). In addition, zero-order correlations and multiple regression analyses investigated possible predictors of stigmatizing attitudes towards psoriasis, including sociodemographic variables, familiarity and knowledge about psoriasis, indicators of the behavioral immune system and fear of corona. Manova analysis displayed higher stigmatizing attitudes towards individuals with psoriasis as compared to the control group (p<.001). Besides, overall higher stigmatizing attitudes towards a common cold as compared to the psoriasis group were found. Higher stigmatizing attitudes towards psoriasis were correlated with lower knowledge, higher pathogen disgust, higher perceived infectability, male gender, and familiarity with psoriasis. No correlations were found regarding age, education, fear of corona, or gem aversion. Multiple regression displayed male gender, higher levels of pathogen disgust, and lower levels of knowledge about psoriasis to be predictors of stigmatizing attitudes (p<.05). Stigmatizing attitudes towards psoriasis is shown to be prevalent in Dutch society. As stigmatizing attitudes were shown to be related to reduced knowledge and male gender, future interventions might focus on these factors. Besides, different age groups and professions could be investigated in future studies. Further research is needed, as stigma towards psoriasis is rarely been investigated among the public.Show less
This thesis aims at transferring the Job Demands-Resources model (JD-R) to the university context, in order to examine processes of health, motivation and performance of higher education students....Show moreThis thesis aims at transferring the Job Demands-Resources model (JD-R) to the university context, in order to examine processes of health, motivation and performance of higher education students. Additionally, the role of mindfulness is looked at. Academic resources (autonomy, role clarity, feedback, relationship with supervisors and relationship with fellow students) and academic demands (role conflict, pace and amount of work and mental workload), student engagement, exhaustion and mindfulness were assessed, as well as performance with a time lag. The study follows a nonexperimental and cross-sectional design with a longitudinal element. Sixty-four students completed a first online questionnaire, 16 a second. Scales from the following questionnaires were utilized: Questionnaire on the Experience and Evaluation of Work (QEEW), Utrecht Work Engagement Scale – student version (UWES-SS), Burn-out Assessment Tool (BAT), Mindfulness Attention and Awareness Scale (MAAS-Short). Performance was operationalised as the number of ECTS-points obtained. Correlations, linear and multiple regression analyses, F-tests (ANOVA) and t-tests for coefficients were conducted with a significance level of p<.05 and a confidence interval of 95%. Role clarity predicted engagement (ß = .347, p = .013, Adjusted R2 = .215), pace and amount of work exhaustion (ß = .364, p = .003, Adjusted R2 = .119) (H1). Both role clarity (ß = .489, p = .001, Adjusted R2 = .201) (H2) and mindfulness (ß = .333, p = .005, Adjusted R2 = .335) (H5) moderated the effect of pace and amount of work on exhaustion. More mindfulness was related to higher role clarity (ß = .25, p = .034, Adjusted R2 = .047), feedback (ß = .371, p = .002, Adjusted R2 = .124), and relationship with supervisors (ß = .318, p = .018, Adjusted R2 = .087) (H3). Mindfulness positively related to engagement (ß = .315, p = .011, Adjusted R2 = .085) and negatively to exhaustion (ß = -.283, p = .024, Adjusted R2 = .065) (H4). Due to low participation rates, only correlations with performance were calculated. Relationship with fellow students correlated with performance (r(15) = .567, p = .027) (H6). The present study shows that the JD-R model is applicable to the university context. Mindfulness has direct and indirect beneficial effects on motivation and well-being of students. In order to promote study engagement and reduce exhaustion, universities should enhance role clarity and mindfulness of students, while seeking to lower pace and amount of work.Show less
