Attentional bias (AB) is when certain stimuli catch attention quicker than others, which varies according to individual characteristics. The study investigated: (1) if there is an AB to or from...Show moreAttentional bias (AB) is when certain stimuli catch attention quicker than others, which varies according to individual characteristics. The study investigated: (1) if there is an AB to or from itch; (2) whether this differs between people with chronic itch and healthy controls; (3) and if there is a possible AB/stress association. This is because understanding ABs to/from itch further elucidates the experience of patients with chronic itch and possible future clinical applications. Furthermore, an explorative analysis compared two tasks measuring AB, namely the Posner cueing and dot-probe task. The two tasks, alongside a stress-questionnaire, were administered online to the participants (N=70). A (frequentist and Bayesian) RM ANOVA was done for the main analysis, and a within- subjects t-test for the explorative task-comparison. Given that the task-comparison found the two tasks differing significantly (p = 0.01 d = -0.31), the results of the two tasks were interpreted separately. Overall, indications of AB being biased away from itch stimuli was found. When the AB was contrasted between participant group (people with and without chronic itch), the Posner cueing task found no significant difference (p = 0.68, ηp 2 = 0.003) whereas the dot-probe task found an AB away from itch-stimuli in patients with chronic itch (p = 0.02, ηp 2 = 0.077). Similar pattern unfolded with the stress-association: the Posner cueing task finding that AB did not significantly differ with stress (p = 0.23, ηp 2 = 0.021). The dot-probe task did find that they significantly differed (p = 0.01, ηp 2 = 0.091) where with higher stress, the AB switched to being an AB towards itch stimuli. The discrepancy between the two tasks aligns with expectations considering that the tasks were found inequivalent - highlighting one of the strengths of this study being that the two tasks were compared. Altogether this points towards differences in what the two tasks tap into, and that the attention of people with chronic itch is biased as a function of stress. Summarizing, AB to itch differed between the two groups and was associated with stress when using dot-probe task, which did not apply to the Posner cueing task.Show less
This current study investigated the relationship between level of pain, expectancies, and avoidance in individuals with chronic low back pain. Research showed that individually expectancies and...Show moreThis current study investigated the relationship between level of pain, expectancies, and avoidance in individuals with chronic low back pain. Research showed that individually expectancies and avoidance behaviour influence pain experience. However, there seems to be little research into the combined influence. Seeing that research also showed that pinpointing a cause for the chronic low back pain is difficult, this study aimed to give insight into interacting factors that influence chronic low back pain. To gather data participants (N=18) filled in a questionnaire five times a day for two weeks. This provided insight into their levels of pain in the morning and the evening, if they expected to experience pain and if they were more likely to avoid movements, they expected to be painful. These statements were answered with answering scales, ranging from 0 (not at all) to 6 (extremely), given how likely that statement was for the participant. A mediation analysis inspecting possible relations between the level of pain and expectancies, the level of pain and avoidance, and the level of pain, expectancies and avoidance yielded no significant relations. Therefore, it could not be concluded that avoidance and/or expectancy are influencing the level of pain in the evening when compared to the level of pain in the morning. There were two significant findings, the impact of level of pain in the morning on expectancies and the impact of expectancies on avoidance. These findings are in line with what was found in existing literature and give incitement for further research on this topic. Another incitement for further research is the small sample used in this current study. The implication for the scientific field therefore is to perform this study on a bigger sample. Another consideration for further research would be to try and use a more diverse sample in both age and gender, this to make a more representative sample to draw conclusions for the general population. This could also lead to more substantial implications for the clinical field since this study did not have significant results.Show less
Objective: The period after successfully coming off treatment (SCOT) following a childhood cancer diagnosis is known to be a vulnerable time for parents in which increased levels of distress can...Show moreObjective: The period after successfully coming off treatment (SCOT) following a childhood cancer diagnosis is known to be a vulnerable time for parents in which increased levels of distress can play a significant role. It is important to know more about the distress experienced by parents during this period to determine whether an intervention should be used to help parents return to ‘normal life’. The aim of this study was therefore to gain better understanding of parental distress and factors related to their distress during the first year after their child has successfully completed treatment. Methods: A sample of 283 parents of children who had successfully completed cancer treatment in the previous year were included in this cross-sectional study. These parents, who were part of the SCOT group, were invited to complete the Distress Thermometer for Parents (DT-P) within one year after treatment completion. The DT-P consists of a thermometer score to measure experienced distress and problem domains (practical, social, emotional, physical, cognitive, and parenting). Parents in the SCOT group were compared with parents in the general population (NORM group) to see if their distress levels were higher. In addition, the association between distress and the problem domains and child- or parent-related factors (time since the end of treatment, cancer type, child’s age, parental disease, and perceived support) was examined. Results: Parents (73.9% mothers) in the SCOT group experienced higher levels of distress in the first year after SCOT compared to the general population (fathers SCOT: M=3.5, SD=2.6 vs. fathers NORM: M=2.8, SD=2.5; p=.032; mothers SCOT: M=4.1, SD=2.7 vs. mothers NORM: M=3.5, SD=2.7; p=.001). Emotional (p<.001), practical (p=.016), and physical (p=.005) problems were predictors of higher distress levels. Parents’ perceived support from their environment contributed also to their level of distress (p<.001). Conclusions: Parents of children who have successfully completed cancer treatment experience increased levels of distress in the first year after treatment compared to parents in the general population. There may be value in developing an intervention to ease this transition that specifically addresses their emotional well-being and highlights the importance of their social network during this vulnerable period.Show less
Background: Individuals with psychotic disorders (PD) often experience cognitive challenges, particularly in executive functioning (EF), crucial for daily functioning. Sleep disruptions, notably...Show moreBackground: Individuals with psychotic disorders (PD) often experience cognitive challenges, particularly in executive functioning (EF), crucial for daily functioning. Sleep disruptions, notably insomnia, are prevalent in PD, worsening symptoms and affecting overall well-being and treatment outcomes. Moreover, individuals with PD frequently engage in cannabis use, which can further impact EF. Gender differences may also play a role in how cannabis affects EF, though findings are varied. This study aims to deepen our understanding of the interplay between insomnia, EF, and cannabis use in PD individuals, while considering gender influences. We hypothesize that higher insomnia rates correlate with poorer EF in PD, with cannabis mediating this relationship. Additionally, we expect gender disparities to influence how cannabis affects EF. This study sheds light on critical factors affecting cognitive function in PD, aiding in tailored intervention strategies. Method: Data were collected from a randomly selected sample of patients (N=262) undergoing treatment at a mental health care clinic in the South-western part of the Netherlands at time of inclusion. Participants, aged between 18 and 65 at inclusion, had a primary diagnosis of a psychotic disorder. The current study utilized data from the Lichamelijke Klachten Vragenlijst (LKV), the Behavior Rating Inventory of Executive Function for Adults (BRIEF-A), and the Measurements in Addictions for Triage and Evaluation (MATE). Results: Significant correlations indicated a moderate positive association between insomnia and EF problems. However, mediation analysis did not support cannabis use as a mediator between insomnia and EF. Gender differences were explored through residual variances analysis, suggesting potential unaccounted factors impacting variability. Model fit indices revealed areas for improvement in explaining variance, warranting further examination and potential adjustments to refine the overall model fit. Conclusion: Higher rates of insomnia were related to higher rates of EF problems. There is no evidence for a mediating effect of cannabis use in this relationship. Gender differences did not seem to play a significant role in the effect of cannabis on EF. Future research should incorporate performance-based tasks alongside self-report measures to improve measurement precision. Future treatments could potentially benefit from incorporating interventions that address insomnia, as this may lead to potential enhancements in executive functioning.Show less
Background: Childhood emotional maltreatment by a primary caregiver is a key predictor for PTSD symptoms, yet limited research explores connections with specific symptoms, especially in children....Show moreBackground: Childhood emotional maltreatment by a primary caregiver is a key predictor for PTSD symptoms, yet limited research explores connections with specific symptoms, especially in children. Literature reports gender differences on emotional maltreatment and the experience of PTSD, so it is worth investigating the existence of differences when looking at separate symptoms. Objective: This study aims to investigate the correlation between childhood emotional maltreatment and PTSD symptomatology and identify gender differences in children and adolescents. Method: A sample of 237 children (mean age 15.5) with PTSD symptoms from a Dutch mental health institution (2012-2015) underwent assessment using anonymous questionnaires. Network analysis examined partial correlations between emotional abuse, neglect, intrusions, avoidance, arousal, and negative mood. Results: The network analysis showed a high correlation between emotional abuse and most PTSD symptoms. However, emotional neglect only exhibited a strong association with emotional abuse. Gender differences in how emotional maltreatment and PTSD symptoms interacted were found. Girls reported higher PTSD symptoms and emotional maltreatment than boys. Conclusions: This study highlights the important role of childhood emotional maltreatment in the development of PTSD, among children and adolescents. These results emphasize the need for the customization of PTSD treatment based on the type of maltreatment and gender.Show less
Background. Traumatic Brain Injury (TBI) is one of the most common forms of Acquired Brain Injury (ABI), and has a high incidence rate across the world. Following TBI, many patients experience...Show moreBackground. Traumatic Brain Injury (TBI) is one of the most common forms of Acquired Brain Injury (ABI), and has a high incidence rate across the world. Following TBI, many patients experience cognitive complaints, as well as physical complaints about their health. Their general wellbeing can also be an issue. Fortunately, for most patients these complaints typically improve over time. This study investigates patients’ memory, concentration, energy, as well as general wellbeing, over time. Methods. Patients received questionnaires about their health and wellbeing every three months following hospital release, with the main goal to track their health and wellbeing after TBI. That data was used for this research. Energy, concentration, and memory were all measured by one question in the questionnaire. General wellbeing was measured by taking the average ratings of all questions on the questionnaire. Analyses were done with three and six questionnaires over time, using repeated measures ANOVAs. Descriptive statistics were used from the first questionnaire. Results. This study found that while patients rated all these measures on average positively, they still did not feel the same as before the injury, and most experienced hindrances in daily life. When looking at the ANOVAs with three questionnaires, there was a significant improvement on concentration, energy, as well as general wellbeing over time. For all of these, most improvement took place between the first and the second questionnaires. Memory did not change significantly over time. None of the ANOVAs with six questionnaires had any significant changes over time. Conclusion. This study shows that patients may suffer from long-lasting effects of TBI. It questions whether more should be done for these patients following hospital release, to alleviate symptoms. This study has limitations concerning selection bias and drop out.Show less
Advance care planning (ACP) is a process in which the patient expresses their wishes regarding future medical care in the presence of their family and health care provider. ACP is generally...Show moreAdvance care planning (ACP) is a process in which the patient expresses their wishes regarding future medical care in the presence of their family and health care provider. ACP is generally accepted in Western countries and has a positive effect on end-of-life care for people with dementia. However, culture affects expectations and preferences regarding end-of-life care and decision making. This study compared the acceptability of and preference for two types of ACP interventions for patients with dementia in health care providers from the Netherlands, the US and Japan. One intervention focused on concrete treatment orders in which the patient makes specific decisions. The other focused on what the patient finds important in life, resulting in global goals of care. A total of 125 participants were assessed by means of a structured interview and a questionnaire. Participants found both types of ACP acceptable, in general and per country. A multinomial logistic regression analysis indicated no significant difference in acceptability of the concrete or the global ACP approach between countries when adjusted for age and gender. However, age was a significant predictor of acceptability of the concrete ACP approach (2 (2, 123) = 6.32, p = .042), with older participants being less likely to find it acceptable compared to not finding it acceptable (W(8) = 5.50, p = 0.019). Participants preferred the global ACP approach for patients with dementia. A multinomial logistic regression analysis indicated no significant differences in preference between countries when adjusted for age and gender in general. However, Dutch participants were less likely to prefer the global ACP approach (W(8) = 5.18, p = .023). The relationship between country and preference was not influenced by whether participants most strongly considered what the patient with dementia wants for themselves, what the patient’s family wants or what they as the health care provider want for their patient when making medical decisions. ACP is generally regarded as an acceptable form of care for patients with dementia by health care providers across countries. Future research could more specifically determine which cultural or demographic aspects affect health care providers’ views on different ACP approaches.Show less
This thesis sought to investigate the relationships between treatment delays in bipolar disorder (BD) and cognitive impairments which characterize the disorder, measured both objectively and...Show moreThis thesis sought to investigate the relationships between treatment delays in bipolar disorder (BD) and cognitive impairments which characterize the disorder, measured both objectively and subjectively. Previous studies have established that a long delay occurs between the onset of mood symptoms in BD and the first form of treatment received, estimates ranging between 6 and 11 years. Cognitive impairments in the domains of executive functions, processing speed and memory were found to persist in BD patients even during euthymia. Such cognitive impairments burden BD patients, prevent them from regaining an appropriate level of general functioning and diminish their quality of life. Thus, in order to determine whether treatment delay impacts the cognitive impairments present in BD, 69 participants were followed over the course of one year, at three different time points. The participants took part in clinical interviews, and then were asked to complete multiple measures, such as the YMRS, the QIDS, four WAIS subscales (Block Design, Arithmetic, Information and Digit symbol), and the Cognition subscale of the WHODAS. The average treatment delay found in the current sample was 14.53 years. The results of the current study suggest that longer treatment delays did not significantly predict worse cognitive functioning in BD patients, either when measured subjectively, or when measured objectively.Show less
Suicidal ideation is more prevalent in people with Borderline Personality Disorder. Negative self-conscious emotions, such as shame and guilt, may be related to this relationship. In this study the...Show moreSuicidal ideation is more prevalent in people with Borderline Personality Disorder. Negative self-conscious emotions, such as shame and guilt, may be related to this relationship. In this study the relationship between suicidal ideation and borderline personality traits was explored. Shame and guilt were analysed as possible mediators. The Personality Assessment Inventory – Borderline Scale was used to assess borderline personality traits, and Ecological Momentary Assessment was used to gather data on suicidal ideation, guilt and shame four times a day, over the course of three weeks via an app. The sample consisted of (N = 82) adults with a history of a suicide attempt or moderate-to-severe suicidal ideation in the past year. The relationships were analysed using a parallel mediation model consisting of multiple multilevel regression analyses. All steps of the model showed significant relationships. The last step showed that instead of typical mediation, the model indicated suppression, because of an increase in the association between borderline personality traits and suicidal ideation when accounting for shame and guilt. More research is necessary to explore the possible cause of these findings.Show less
This research aims to investigate the topology of the brain during reward processing and the influence of dopamine and norepinephrine on this network. So far, most research about reward processing...Show moreThis research aims to investigate the topology of the brain during reward processing and the influence of dopamine and norepinephrine on this network. So far, most research about reward processing has concentrated on specific brain areas and connections between particular regions, rather than the brain's organization and architecture. By investigating this organisation, gaps in our understanding of the brain architecture can be addressed, which could in turn lead to a better understanding of pathologies that disrupt the brain’s architecture. It is hypothesized that the brain will be more integrated during reward processing, and that increased dopamine and norepinephrine activity will result in a more integrated brain organisation. To test this prediction, the Global Efficiency (GE) of a total of 132 Regions of Interest (ROIs) and BOLD- activity of the Substantia Nigra/Ventral Tegmental Area (SN/VTA) and the Locus Coeruleus (LC) were obtained during a reward processing task, which 38 participants completed. During a functional magnetic resonance imaging (fMRI) scan, participants completed a reward- emotion recognition test. As predicted, in the reward condition, the paired t-test showed a higher GE in comparison to the no-reward condition in several nodes, mostly in the default mode network. These findings imply that the brain is more integrated when processing reward than when it is not processing reward. However, the catecholamines showed no significant correlation with this integration. Future research is needed to investigate the topology and influence of different catecholamines in more detail. The implications of these findings will be discussed.Show less
Background Alzheimer's dementia (AD) and mild cognitive impairment (MCI) are neurodegenerative conditions associated with cognitive decline. Previous research suggests that motor impairments are...Show moreBackground Alzheimer's dementia (AD) and mild cognitive impairment (MCI) are neurodegenerative conditions associated with cognitive decline. Previous research suggests that motor impairments are also present in individuals with MCI and AD. This thesis study aims to evaluate motor sequence learning abilities in patients with amnestic MCI (aMCI) and AD compared to healthy controls. This thesis study also explores the relationship between amyloid-β burden, a known biomarker for MCI and AD, and motor sequence learning to study whether such motor learning could also be a behavioral biomarker. This is because measuring amyloid-β is very costly and invasive, and thus the search for other biomarkers is important. Methods A cross-sectional design was employed, and participants included 28 AD patients, 33 aMCI patients, and 53 healthy controls. Motor sequence learning was assessed using a computerized task measuring reaction time and accuracy per trial, and with this information the rate and final amount of learning was calculated, i.e. how fast and how much information the participants are able to learn, respectively. Amyloid-β burden was measured using PET imaging, with higher burden reflecting more severity of the symptoms of aMCI and AD. Results The final amount of learning was not different amongst the groups, and the rate of learning was only significantly different between the AD and aMCI groups, with the AD groups showing a faster rate of learning. The AD and healthy control group did not, however, differ significantly in terms of rate of learning. The amount of amyloid-β in the brain was not associated with motor sequence learning abilities. Conclusion The findings suggest that motor sequence learning abilities are preserved in individuals with aMCI and AD, both in terms of how fast and how much they learn. In fact, patients with AD showed a faster rate of learning than patients with aMCI, although this was not found when comparing the AD patients with the healthy individuals. It is possible that this finding is because patients had more to learn by the end of the task than the aMCI group given that their memory is worse, and displayed a faster rate of learning due to this. This thesis study also suggests that motor sequence learning is not a behavioral biomarker for aMCI and AD. The search for less invasive and more easily measurable biomarkers continues to be imperative.Show less
