Compassion-focused therapy as guided self-help for enhancing public mental health: A randomized controlled trial.

OBJECTIVE: Despite promising results for compassion-focused therapy (CFT) as self-help, larger-scale trials including long-term follow-up data are needed to establish its effectiveness in the context of public mental health. Empirical evidence supporting its effectiveness in improving well-being is lacking. In a randomized controlled trial, the effects of CFT as guided self-help on well-being were evaluated. METHOD: Adults (mean age = 52.87, SD = 9.99, 74.8% female) with low to moderate levels of well-being were recruited in the Dutch population and randomized to CFT (n = 120) or a waitlist control group (n = 122). Participants completed the Mental Health Continuum-Short Form (well-being), Hospital Anxiety and Depression Scale (depression and anxiety), Perceived Stress Scale (stress), Self-Compassion Scale-Short Form (self-compassion), Forms of Self-Criticizing/Attacking and Reassurance Scale (self-criticism and self-reassurance), Positive and Negative Affect Schedule (positive/negative affect), and Gratitude questionnaire (gratitude) at baseline, postintervention (3 months), 3- and 9-month follow-up. RESULTS: Compared with the waitlist control group, the CFT group showed superior improvement on well-being at postintervention, d = .51, 95% CI [.25, .77], p < .001, and 3-month follow-up, d = .39, 95% CI [.13, .65], p < .001. No significant moderators were found. On all secondary outcome measures but positive affect, the intervention group showed significantly greater improvements up to 3-month follow-up. At 9-month follow-up, improvements on all measures were retained or amplified among CFT participants. CONCLUSIONS: CFT as guided self-help shows promise as a public mental health strategy for enhancing well-being and reducing psychological distress. (PsycINFO Database Record

Dutch Dataset Pain Rehabilitation in daily practice: Content, patient characteristics and reference data.

BACKGROUND: No core set of measurement tools exists to collect data within clinical practice. Such data could be useful as reference data to guide treatment decisions and to compare patient characteristics or treatment results within specific treatment settings. METHODS: The Dutch Dataset Pain Rehabilitation was developed which included the six domains of the IMMPACT core set and three new domains relevant in the field of rehabilitation (medical consumption, patient-specific goals and activities/participation). Between 2010 and 2013 the core set was implemented in 32 rehabilitation facilities throughout the Netherlands. RESULTS: A total of 8200 adult patients with chronic pain completed the core set at first consultation with the rehabilitation physician. Adult patients (18-90 years) suffering from a long history of pain (38% >5 years) were referred. Patients had high medical consumption and less than half were working. Although patients were referred with diagnosis of low back pain or neck or shoulder pain, a large group (85%) had multisite pain (39% 2-5 painful body regions; 46% >5 painful body regions). Scores on psychosocial questionnaires were high, indicating high case complexity of referred patients. Reference data for subgroups based on gender, pain severity, pain locations and on pain duration are presented. CONCLUSIONS: The data from this clinical core set can be used to compare patient characteristics of patients of other treatment setting and/or scientific publications. As treatment success might depend on case complexity, which is high in the referred patients, the advantages of earlier referral to comprehensive multidisciplinary treatment were discussed. SIGNIFICANCE: A detailed description of case complexity of patients with chronic pain referred for pain rehabilitation. Insight in case complexity of patients within subgroups on the basis of gender, pain duration, pain severity and pain location. These descriptions can be used as reference data for daily practice in the field of pain rehabilitation and can be used to evaluate, monitor and improve rehabilitation care in care settings nationwide as well as internationally.

Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review.

The number of acceptance- and mindfulness-based interventions for chronic pain, such as acceptance and commitment therapy (ACT), mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT), increased in recent years. Therefore an update is warranted of our former systematic review and meta-analysis of studies that reported effects on the mental and physical health of chronic pain patients. Pubmed, EMBASE, PsycInfo and Cochrane were searched for eligible studies. Current meta-analysis only included randomized controlled trials (RCTs). Studies were rated for quality. Mean quality did not improve in recent years. Pooled standardized mean differences using the random-effect model were calculated to represent the average intervention effect and, to perform subgroup analyses. Outcome measures were pain intensity, depression, anxiety, pain interference, disability and quality of life. Included were twenty-five RCTs totaling 1285 patients with chronic pain, in which we compared acceptance- and mindfulness-based interventions to the waitlist, (medical) treatment-as-usual, and education or support control groups. Effect sizes ranged from small (on all outcome measures except anxiety and pain interference) to moderate (on anxiety and pain interference) at post-treatment and from small (on pain intensity and disability) to large (on pain interference) at follow-up. ACT showed significantly higher effects on depression and anxiety than MBSR and MBCT. Studies' quality, attrition rate, type of pain and control group, did not moderate the effects of acceptance- and mindfulness-based interventions. Current acceptance- and mindfulness-based interventions, while not superior to traditional cognitive behavioral treatments, can be good alternatives.

Acceptance and commitment therapy as guided self-help for psychological distress and positive mental health: a randomized controlled trial.

BACKGROUND: In order to reduce the high prevalence of depression, early interventions for people at risk of depression are warranted. This study evaluated the effectiveness of an early guided self-help programme based on acceptance and commitment therapy (ACT) for reducing depressive symptomatology. METHOD: Participants with mild to moderate depressive symptomatology were recruited from the general population and randomized to the self-help programme with extensive email support (n=125), the self-help programme with minimal email support (n=125) or to a waiting list control group (n=126). Participants completed measures before and after the intervention to assess depression, anxiety, fatigue, experiential avoidance, positive mental health and mindfulness. Participants in the experimental conditions also completed these measures at a 3-month follow-up. RESULTS: In the experimental conditions significant reductions in depression, anxiety, fatigue, experiential avoidance and improvements in positive mental health and mindfulness were found, compared with the waiting list condition (effect sizes Cohen's d=0.51-1.00). These effects were sustained at the 3-month follow-up. There were no significant differences between the experimental conditions on the outcome measures. CONCLUSIONS: The ACT-based self-help programme with minimal email support is effective for people with mild to moderate depressive symptomatology.

Cognitive behavioural treatment for chronic fatigue syndrome in a rehabilitation setting: effectiveness and predictors of outcome.

Cognitive behavioural therapy (CBT) was combined with graded exercise therapy (GET) for patients with chronic fatigue syndrome (CFS) in an uncontrolled implementation study of an inpatient multidisciplinary group therapy. During the intake procedure, 160 CFS patients completed a questionnaire on fatigue related measurements, physical impairment, depression, somatic and psychological attributions, somatic focus, and sense of control over symptoms. Pre-treatment physical activity level was measured with an actometer. At baseline, post-treatment and 6-month follow-up individual strength, subjective fatigue and physical impairment, were reassessed. Large effect sizes were found on subjective fatigue (1.2 post-treatment; 1.2 follow-up) and physical impairment (-.9 post-treatment; -.9 follow-up), Clinically significant improvement was found in 33.8% of the participants at post-treatment and 30.6% at follow-up. Individual strength at post-treatment was predicted by level of physical activity before treatment, and by sense of control over symptoms and physical activity at follow-up. Clinically significant improvement in subjective fatigue was predicted by not receiving a disablement insurance benefit, shorter duration of fatigue, higher sense of control over symptoms and, at follow-up by more pre-treatment physical activity. In conclusion, the intervention was effective for CFS patients. Cognitive behavioural factors that perpetuate fatigue symptoms are also predictors of treatment outcome.

[Favourable results of a rehabilitation programme with cognitive behavioural therapy and graded physical activity in patients with the chronic-fatigue syndrome]. / Gunstige resultaten van een revalidatieprogramma met cognitieve gedragstherapie en gedoseerde fysieke activiteit bij patiënten met het chronische-vermoeidheidssyndroom.

OBJECTIVE: To determine whether a specific course of interdisciplinary rehabilitation might lead to clinically significant changes in fatigue, experienced disability and physical function in patients with the chronic-fatigue syndrome (CFS). DESIGN: Prospective and uncontrolled. METHOD: 'Het Roessingh', a rehabilitation centre in Enschede, the Netherlands, has developed an interdisciplinary clinical rehabilitation programme for patients with CFS in cooperation with the 'Nijmeegs Kenniscentrum Chronische Vermoeidheid' [Chronic-Fatigue Knowledge Centre] in Nijmegen, the Netherlands. In this programme, physical, mental and social activities are gradually increased on the basis of cognitive behavioural principles and graded activity. Of the 127 successive persons who enrolled for the therapy during the period from August 2000 to December 2004, 99 fulfilled the inclusion criteria; they had a median duration of symptoms of 6 years. The results of treatment were evaluated by a measurement with the 'Checklist individuele spankracht' [Checklist individual muscle tone] before and after treatment and the scores on the 'Patiëntspecifieke beperkingen' [Patient-specific disability] and the Short form-36. The measured data were complete in 74 patients. RESULTS: Before rehabilitation, the levels of fatigue, disability and distress were high. After treatment, the studied population showed significant improvement in fatigue, experienced disability and physical function. The magnitude of the improvement was generally 'average'. At the end of treatment, 70% of the patients were clinically less fatigued, 68% experienced less disability and 55% functioned better physically. In 34% the level of fatigue was normalised after treatment, but 9.5% of the patients was more fatigue. CONCLUSION: The rehabilitation programme offered for CFS led to significant improvements in function and fatigue.

Health-related quality of life in patients with systemic lupus erythematosus: development and validation of a lupus specific symptom checklist.

Reliable and sensitive measures are needed to evaluate the quality of life (QoL) in patients with systemic lupus erythematosus (SLE). No lupus specific questionnaires are available. This study describes the development and validation of a disease-specific questionnaire for lupus patients, which assesses the presence and burden of 38 disease- and treatment-related symptoms: the SLE Symptom Checklist (SSC). Reliability and reproducibility were tested in respectively 87 and 28 stable SLE patients. The internal consistency (Cronbach's alpha coefficients 0.89) and test-retest reliability (Pearson product-moment correlation coefficient between 0.67 and 0.87) were satisfactory. Concurrent validity was supported by significant, but moderate correlations with other measures of subjective well-being and functional status. Responsiveness was measured in 17 patients with lupus nephritis treated with cyclophosphamide, at start of therapy and 1 year thereafter. A significant change in number of symptoms and total distress level was found. It is concluded that the SSC has satisfactory psychometric properties and appears suitable for both clinical and research purposes.

Patient factors related to the presentation of fatigue complaints: results from a women's general health care practice.

The aim of this study was to examine which patient-related factors predicted: (1) fatigue, (2) the intention to discuss fatigue and (3) the actual discussion of fatigue during consultation with a GP in a women's general health care practice. Patients were asked to complete two questionnaires: one before and one after consultation. The patient-related factors included: social-demographic characteristics; fatigue characteristics; absence of cognitive representations of fatigue; nature of the requests for consultation; and other complaints. Some 74% of the 155 respondents reported fatigue. Compared to the patients that were not fatigued, the fatigued patients were more frequently employed outside the home, had higher levels of general fatigue, and a higher need for emotional support from their doctor. A minority (12%) intended to discuss fatigue during consultation. Of the respondents returning the second questionnaire (n = 107), 22% reported actually discussing their fatigue with the GP while only 11% had intended to do so. In addition to the intention to discuss fatigue during consultation, the following variables related to actually discussing fatigue: living alone, caring for young children, higher levels of general fatigue, absence of cognitions with regard to the duration of the fatigue, and greater psychological, neurological, digestive, and/or musculoskeletal problems as the reason for consultation. Fatigue was found to be the single reason for consultation in only one case. It is concluded that fatigue does not constitute a serious problem for most patients and that discussion of fatigue with the GP tends to depend on the occurrence of other psychological or physical problems and the patient's social context.

Gender differences in fatigue: biopsychosocial factors relating to fatigue in men and women.

BACKGROUND: Fatigue is a common problem, which is found more frequently among women than men. To date, neither the etiology of fatigue nor the factors that explain the gender difference in its incidence are still fully understood. METHODS: In a sample of men (n = 4,681) and women (n = 4,698) (age range, 15-64 years) in the Dutch National Survey of Morbidity and Interventions in General Practice, the gender differences in the underlying biological, psychological, and social factors of fatigue were analyzed. RESULTS: Both general and gender-specific factors were recognized. Men and women who experience complaints of fatigue appeared to be younger and more highly educated. They had more acute health complaints and more psychosocial problems and also showed a lower level of perceived health. Among women, only gender-specific biological complaints and psychosocial problems were related to fatigue. In addition, relevant sociodemographic variables included taking care of young children and being employed. Among men, fatigue was particularly related to having handicaps and severe chronic complaints. Taking care of young children did not make a difference in the male sample. CONCLUSIONS: Fatigue can only be adequately understood in a multicausal model with biomedical and psychosocial factors. Complaints of fatigue are too often ignored in general practice. By adopting a patient-centered style of communication, physicians can acquire a more complete picture of the patients' fatigue.

Complaints of fatigue: related to too much as well as too little external stimulation?

Fatigue has been acknowledged as a widespread problem associated with a variety of factors. In the present paper, we attempt to explain fatigue complaints on the basis of Pennebaker's (1982) "competition of cues" notion. Competition of cues suggests that both extremely low and extremely high levels of external stimulation in daily life may be related to relatively higher frequencies of complaint. The dimensional structure of external stimulation is first explored and then the shape of the relation between external stimulation (i.e., stimuli perceived in daily life) and fatigue was studied in a sample of 777 general-practice patients. Other risk factors for fatigue and moderating factors are also taken into consideration. Results show that quantity and quality of external stimulation can be distinguished. Both high quantity (high "experienced overload") and low quality (low "attractiveness of external stimulation") are related to higher fatigue frequencies. "Experienced overload" is a particularly strong predictor, in addition to "perceived health" of fatigue complaints. It is concluded that the "quality-quantity model for understanding fatigue" proposed here highlights psychological factors important for any theoretical framework of fatigue.

What is behind "I'm so tired"? Fatigue experiences and their relations to the quality and quantity of external stimulation.

In the present study, it is hypothesized that both low quality and high quantity of external stimulation are related to elevated levels of fatigue. This is proposed by the Quality-Quantity model for understanding fatigue (QQuF model). The relations between the quality and quantity of external information and the Multidimensional Fatigue Inventory (MFI-20) are examined. Moreover, the role of depression (measured with the CES-D) in relation to the QQuF model is explored. The results show low quality of external stimulation, that is, low "attractiveness of external stimulation," relating to all five dimensions of fatigue. A high quantity of external stimulation, that is, high "experienced overload," related primarily to general and mental fatigue. The QQuF model was only slightly moderated by depression, but depression directly and strongly related to all dimensions of fatigue. It is concluded that fatigue related to low quality of external stimulation can be distinguished from fatigue related to a high quantity of external stimulation. This distinction is useful when considering theoretical issues and treatment of fatigue.

General practitioners' attributions of fatigue.

In this paper general practitioners' (GPs') somatic-psychosocial attributions of fatigue are examined. The attribution process during medical consultations was studied by relating the GPs' judgements of the somatic-psychosocial character of their patients' fatigue to patient-related characteristics, on the one hand, and medical-consultation characteristics on the other hand. The study was based on 2097 contact registrations from the Dutch National Study of Morbidity and Intervention in General Practice by the NIVEL (Netherlands Institute of Primary Health Care). In order to explain the GPs' attributions, patient-related characteristics were added stepwise in a multiple regression analysis. Sociodemographic characteristics explained only 1.8% of the variance. Other complaints explained an additional 14.3% with psychosocial complaints being most influential. Knowledge of an underlying disease/problem explained an additional 9.9% of the variance. All of the characteristics together explained 26.0% of the attributions by the GPs. More psychosocially-attributed fatigue was found to correlate with consultations characterized by less physical examination, more diagnostic procedures to reassure, fewer diagnostic procedures to discover underlying pathology, more counselling, less medical treatment, less prescription and a longer duration than consultations with more somatically attributed fatigue. It is concluded that GPs do not discriminate between social groups when attributing fatigue to either somatic or psychosocial causes. The presence and character of other complaints and underlying diseases/problems, rather, relate to the GPs' somatic psychosocial attributions, which are then associated with particular aspects of the consultation.

Adaptive tasks, coping and quality of life of chronically ill patients: the cases of Parkinson's disease and chronic fatigue syndrome.

This article is a report of a larger study on the relationship between adaptive tasks, coping and quality of life, taking Parkinson's disease and chronic fatigue syndrome (CFS) as examples. The concept of adaptive tasks or disease-related stressors testing the adaptive capacities of chronically ill patients (N=134) was explored by applying the method of concept mapping. Results show that patients both with Parkinson's disease and with CFS generally refer to the same themes when asked for the adaptive tasks their disease brings about. However, the actual contents of these adaptive tasks differ as well as their impact on coping and quality of life. In the case of patients with Parkinson's disease, objective disease characteristics appear to be more important in predicting quality of life than in the case of patients with CFS, whose evaluation of adaptive tasks is predictive of quality of life.

Integration of coping and social support perspectives: implications for the study of adaptation to chronic diseases.

In this article, empirical studies dealing with the relationship between coping and social support are discussed in order to identify promising themes for research on adaptation to chronic diseases. Although only few studies deal with this issue explicitly, the review reveals that four ways to study the relationship between coping and social support can be distinguished: (a) seeking social support as a coping strategy; (b) social support as a coping resource; (c) social support as dependent on the way individual patients cope; and (d) coping by a social system. It is argued that all four ways of integrating coping and social support contribute to a better understanding of adaptation to chronic diseases. However, exploring the interrelatedness of both concepts by studying social support as a coping resource and social support as dependent on the patient's own coping behavior appear to be especially fruitful in the short term, as they: (a) provide a better insight in the social determinants of coping, and (b) may help to clarify the way social support affects health and well-being.