Programs

Back
Oval Hall - Bulgarian Red Cross

Behavioural Medicine

Ivan Koychev, Melanie Schellekens, Martti T. Tuomisto, Rosalie van Woezik, Melanie P. J. Schellekens, Jon Fridrik Sigurdsson (chair) Speaker

Chair: Jon Fridrik Sigurdsson, Reykjavik University

14:00 CBT for Neuropsychiatric Symptoms of Parkinson’s Disease: A Review     of the Evidence
Ivan Koychev, University of Oxford
David Okai, Oxford University Hospitals NHS Foundation Trust

14:15 Are mindfulness and self-compassion related to psychological distress and communication in couples facing lung cancer? A dyadic approach
Melanie Schellekens, Helen Dowling Institute
Johan C. Karremans, Radboud University, Nijmegen, Behavioural Science Institute

14:30 Characteristics of Patients in Bariatric Surgery and the Development of their Weight
Martti T. Tuomisto, Univeristy of Tampere
Maaria Nikunen, Tampere University Hospital
Satu-Sisko Koivula, Univeristy of Tampere
Jyrki Ollikainen, Univeristy of Tampere
Lauri Parkkinen, Univeristy of Tampere
Ulla Siljamäki-Ojansuu, Tampere University Hospital

14:45 “Less Fear after Cancer”: Insights from a Tailored Online Self-help for Fear of Cancer Recurrence
Rosalie van Woezik, Helen Dowling Institute
van Helmondt, S. J, Helen Dowling Institute
de Vries, J., Tilburg University
van der Lee, M. L, Helen Dowling Institute

15:00 The interconnectedness of fatigue, depression and anxiety in cancer patients seeking psychological care: A network approach
Melanie P. J. Schellekens, Helen Dowling Institute
Marije D. J. Wolvers, Helen Dowling Institute
Tom Bootsma, Helen Dowling Institute
Maya J. Schroevers, University of Groningen
Angelique O. J. Cramer, Tilburg University
Marije L. van der Lee, Helen Dowling Institute

15:15 Online Mindfulness-based Cognitive Behavioral Therapy reduces Chronic Cancer-Related Fatigue. Results of a 3-armed Randomized Controlled Trial and insights about the working alliance in online therapy.
Marije L. van der Lee, Helen Dowling Institute, the Netherlands
F.Z. Bruggeman-Everts, J. Bruggeman, M.D.J. Wolvers, R. van de Schoot, M.M.R. Vollenbroek-Hutten

Abstracts:


1) CBT for Neuropsychiatric Symptoms of Parkinson’s Disease: A Review of the Evidence

Ivan Koychev, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; David Okai, Psychological Medicine Service, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

Neuropsychiatric symptoms are common in Parkinson's disease (PD) and have a disproportionate impact on quality of life and carer burden. Cognitive–behavioural therapy (CBT) is a viable alternative to pharmacological treatment and in this paper we will review the current evidence for its efficacy in the treatment of depression and anxiety, impulse-control disorder (ICD) and insomnia. We conducted a systematic search and identified a range of studies ranging from case reports to randomised controlled trials. The largest body of evidence concerned depression and anxiety symptoms. We found that CBT protocols were frequently modified to account for psychological problems that are more prevalent in PD: anxiety modules were prioritised with a focus on relaxation techniques, recognising motor symptoms as triggers of anxiety and the highly prevalent fear of falling. Loss of motivation is highly prevalent leading to a number of CBT protocols including behavioural activation modules with emphasis on activity scheduling around on/off periods Overall, there was consistent evidence for moderate improvement in self-reported depressive and anxiety scores post-treatment and at follow-up assessments of up to 3 months. This outcome is further strengthened by evidence of similar effects where CBT is delivered remotely as difficulty attending appointments physically is a major limiting factor PD patients’ access to CBT. Limited but encouraging evidence exists also for targeted treatment of insomnia and ICD. Overall, our review demonstrated growing evidence base for the treatment of neuropsychiatric symptoms of PD with CBT and highlighted the need for adequately powered studies in this area.

2) Are mindfulness and self-compassion related to psychological distress and communication in couples facing lung cancer? A dyadic approach

Melanie P. J. Schellekens, Helen Dowling Institute, Centre for Psycho-Oncology, Bilthoven, the Netherlands; Johan C. Karremans, Radboud University, Nijmegen, Behavioural Science Institute, the Netherlands; Miep A. van der Drift; Desiree G. M. van den Hurk; Johan Molema, Radboud university medical centre, Department of Lung Disease, Nijmegen, the Netherlands; Judith B. Prins, Radboud university medical centre, Department of Medical Psychology, Nijmegen, the Netherlands; Anne E. M. Speckens, Radboud university medical centre, Department of Psychiatry, Nijmegen, the Netherlands.


Introduction:
Lung cancer is the leading cause of cancer death worldwide. Patients suffer from severe physical symptoms and undergo intensive treatment. Both patients and their spouses report high rates of distress. Most studies have examined the factors associated with psychological and relational distress for patients and their spouses separately. Yet, partners in long-term relationships are interdependent, mutually affecting each other. Due to the increasing popularity of and evidence for mindfulness-based interventions in cancer, mindfulness and self-compassion have been identified as potentially helpful skills for those who are coping with cancer. This dyadic study (1) examined whether mindfulness skills and self-compassion are associated with lower psychological distress and better communication about cancer in couples facing lung cancer and (2) explored whether the mindfulness skills and self-compassion of one partner might be associated with the psychological distress and communication about cancer of the other partner.  

Method:
Using the Actor Partner Interdependence Model, self-reported mindfulness skills, self-compassion, psychological distress and communication about cancer were analyzed in a cross-sectional sample of 88 couples facing lung cancer.  

Results:
No main differences were found between patients and spouses regarding psychological distress or communication about cancer. Regarding psychological distress, we found that in both partners, one’s level of mindfulness skills (B=-.19, p=.002) and self-compassion (B=-.43, p=.001) were negatively related to distress. Regarding communication about cancer, one’s self-compassion (B=.03, p=.023) was negatively associated with communication in both partners while mindfulness was not. At a dyadic level we found that when one’s self-compassion was lower, the self-compassion of the partner was negatively related to one’s distress (B=.04, p=.028). A trend suggested that mindfulness of one partner was related to more open communication in the other partner (B=.01, p=.070).  

Discussion:
Findings are consistent with previous research showing mindfulness and self-compassion are related to psychological wellbeing and communication. Interestingly, dyadic findings suggested that when one’s own self-compassion is low, the self-compassion of one’s partner seems to buffer one’s own psychological distress. Furthermore, open communication was not predicted by one’s own levels of mindfulness but marginally by one’s partners’ mindfulness skills, emphasizing the role of the partner in communication. Note, however, that the cross-sectional design prevents us from drawing conclusion about the causal relationship between the predictors (mindfulness and self-compassion) and the outcome variables (psychological distress and communication about cancer).  

Conclusion:
Present findings give a first indication that mindfulness skills and self-compassion may go beyond the individual and could impact couple functioning. Future research should explore mindfulness and self-compassion in longitudinal dyadic designs to confirm their protective causal role in couples facing (lung) cancer.

3) Characteristics of Patients in Bariatric Surgery and the Development of their Weight

Martti T. Tuomisto, Faculty of Social Sciences (Psychology), University of Tampere, Finland; Maaria Nikunen, Department of Clinical Nutrition, Tampere University Hospital, Tampere, Finland; Satu-Sisko Koivula, Faculty of Social Sciences (Psychology), University of Tampere, Finland; Jyrki Ollikainen, Faculty of Natural Sciences, University of Tampere, Finland; Lauri Parkkinen, Faculty of Social Sciences (Psychology), University of Tampere, Finland; Ulla Siljamäki-Ojansuu, Department of Clinical Nutrition, Tampere University Hospital, Tampere, Finland;


Knowledge for the basis of choice of patients for bariatric surgery is not well established even if bariatric surgery is the treatment of choice for extreme obesity. In this report, from 80 to 90 patients’ results are reported depending on availability as the research project is going on. Psychometric instruments used in the assessments were the following: (1) Weight and Lifestyle Inventory (WALI), and (2) the Questionnaire of Risk Situations for Overeating. The mean BMI of the group was reduced during the four phases of the project up to one-year after the operation: 43.3 (SD = 4.3), 42.4 (4.5), 37.2 (4.2), and 32.9 (5.3), F = 26.46 (1, 85), p = .000005. The operated patients had the following characteristics 2 months before the operation: The mean BMI was 42.3 (SD = 5.0); the mean age was 47.4 (8.5) years. According to the WALI, 43.5% had binge eating; 23.2% could often not stop eating when started; 40.0% considered weight and body shape to be among the most important things in their life. However, none of the patients had purging behaviour. The majority (78.3%) of the group had obstacles preventing exercise (such as pain in their knees, joints, and back). The patients watched TV 2.6 hours per day, 30.0% considered themselves to have low self-esteem, and 45.1% had mental health problems. However, 77.8% had family who supported their efforts in weight management. The most worrying thing for this patient group was that 36.2% had experienced physical abuse, 26.1% had had sexual abuse, and 44.9% had had alcoholism in their family. It was surprising that 17.4% of the group had all these three serious issues in their family and 62.3% had at least one of these issues in the family! The current situation was also problematic for many as 36.2% had work stress that was more serious than usual. The biggest risk situations for overeating were common holidays, when having an urge for eating, and when having stress. The most common risk situations for overeating were these: when in good mood, when having stress, and when tired. When we analysed the risk situations as groups, the biggest risk was associated with special events (e.g., common holidays, 78.9% had at least one such risk situation with rather big risk), environment in general was associated with the next biggest risk (e.g., in good weather, 67.8%), physiological state (e.g., tiredness, 64.4%), emotional state (e.g., good mood, 63.3%), and social problems (e.g., problems in the family, 44.4%), respectively. This patient group has serious problems in their history, and the development of their characteristics and symptoms during the bariatric process and after that merit careful analysis and conclusions.

4) “Less Fear after Cancer”: Insights from a Tailored Online Self-help for Fear of Cancer Recurrence

Martti T. Tuomisto, Faculty of Social Sciences (Psychology), University of Tampere, Finland; Maaria Nikunen, Department of Clinical Nutrition, Tampere University Hospital, Tampere, Finland; Satu-Sisko Koivula, Faculty of Social Sciences (Psychology), University of Tampere, Finland; Jyrki Ollikainen, Faculty of Natural Sciences, University of Tampere, Finland; Lauri Parkkinen, Faculty of Social Sciences (Psychology), University of Tampere, Finland; Ulla Siljamäki-Ojansuu, Department of Clinical Nutrition, Tampere University Hospital, Tampere, Finland;


Introduction Fear of Cancer Recurrence (FCR) is one of the most long-term symptoms for breast cancer survivors. Considering the rising number of breast cancer survivors, FCR is an increasing problem in the psycho-oncological domain. Since cancer recurrence is not only a relevant, but also rational fear for cancer survivors, regular Cognitive Behavioral Therapy (CBT) may not be sufficient, therefore a specific tailored CBT online self-help program “Less Fear after Cancer” (LFaC) was developed. This program aimed to provide an easy-accessible intervention where patients learn to handle and reduce their FCR. We will present insights about feasibility and usability acquired by analyzing data gathered in the trial: user data and interviews with patients. Methods For the RCT we invited 1165 women with curatively treated breast cancer from a consecutive cohort in 8 different hospitals in the Netherlands to fill out the Dutch version of the Fear of Cancer Inventory (FCRI-NL) (part A), 516 agreed to participate. We also invited them to the online self-help  trial (part B) to which 262 agreed. Of the 262 women, 130 were randomized to the intervention and 132 to care as usual (CAU). Of the women in the intervention we tracked login times and responses during the use of the self-help training. Furthermore, semi-structured interviews were conducted with participants from the intervention group. Apart from that we interviewed a group of patients (n=13), not participating in the RCT,  who applied themselves at the Helen Dowling Institute to use the online self-help and invited them to fill out an open-ended questionnaire (n=15). Results Women that agreed to be randomized to the self-help (part B) were younger (Mdiff = 5.5, p <.001) and had higher levels of FCR (Mdiff= 3.03, p <.001) compared to women that only agreed to fill out the FCRI (part A) . User data of the online self-help training indicated 87 participants in the intervention group (66.9%) used the program. Moreover, participants in the intervention group completed 2 modules on average, of the total three basic modules and 4 optional modules. Eleven participants (73%) indicated they benefited from the program. Interviews revealed that participants missed personal guidance during the program. Discussion This study gave insights about feasibility and usability of the “Less Fear after Cancer” online self-help. The online self-help was perceived as helpful. However, user data showed low adherence. Patients missed personal guidance. Therefore, including more support in the online self-help might increase adherence. Conclusion Online self-help for Fear of Cancer Recurrence could be useful for cancer patients. However, more research is needed to study the effect of these trainings on FCR. This study helped to identify the strengths and limitations of a CBT-based online self-help.

5) The interconnectedness of fatigue, depression and anxiety in cancer patients seeking psychological care: A network approach

Melanie P. J. Schellekens, Marije D. J. Wolvers, Tom Bootsma, Helen Dowling Institute, Centre for Psycho-Oncology, Bilthoven, the Netherlands; Maya J. Schroevers, University Medical Centre Groningen, University of Groningen, Department of Health Psychology, Groningen, the Netherlands; Angelique O. J. Cramer, Tilburg University, Department of Methodology and Statistics, Tilburg, the Netherlands; Marije L. van der Lee, Helen Dowling Institute, Centre for Psycho-Oncology, Bilthoven, the Netherlands.


Introduction:
Researchers have extensively studied fatigue, depression and anxiety in cancer patients. Several risk and protective factors have been identified to account for these symptoms. While these studies have provided valuable insights, current research findings are limited, most importantly because studies have mainly tested unidirectional relationships between these constructs, consequently ignoring the notion that many of the constructs are interconnected and can have reciprocal relationships. In order to gain more understanding in the complex nature of these symptoms and their relationship with protective and risk factors, it might be more suitable to take a network approach. The network approach conceptualizes symptoms and related factors as elements of a complex dynamical systems, in which  symptoms are mutually interacting with one another. The aim of the present study is to help understand the interconnectedness among patients’ symptoms and risk and protective factors.

Method:
We used baseline data from a sample of cancer patients seeking psychological care (n=342). The relationship among symptoms of fatigue, depression and anxiety, as well as potential risk and protective factors, including  physical symptoms, social withdrawal, illness cognitions (i.e. acceptance of illness, helplessness, perceived benefits of illness), goal adjustment and partner support were explored using network modelling. Networks are made up of (1) nodes, which represent the selected symptoms, risk and protective factors, and (2) edges, which represent the statistical relationship between the nodes. Network modelling allows to examine which nodes are most central in the network (i.e. the number and strength of the direct connections of a node).

Results:
Among symptoms, depressed mood, enjoying life and worthlessness were most central in the network. Regarding the risk and protective factors, accepting the cancer and feeling helpless regarding the uncontrollable nature of the cancer  appeared highly embedded in the network. In particular, the relationship between helplessness and fatigue was strong.

Discussion:
The present study supported the network conceptualization of symptoms: rather than being equivalent manifestations of a common underlying disorder, symptoms appeared to exist within a causally connected network. A key implication of the network approach is that by identifying and changing nodes in the network it should be possible to modify the activation of other nodes and consequently change the functioning of the network. Dynamic networks on the level of the individual could inform therapists on how to best treat this person. Given the present findings, acceptance and helplessness would be prime candidates to explore in future studies on individual dynamic networks.

Conclusion:
The extent to which people adjust to cancer (acceptance, helplessness) seems strongly related to cancer patients’ symptoms (fatigue, depression and anxiety). Longitudinal studies should explore these constructs in individual networks to confirm their causal role and whether they can inform us on what psychological treatment would be most suitable for the individual cancer patient

Online Mindfulness-based Cognitive Behavioral Therapy reduces Chronic Cancer-Related Fatigue. Results of a 3-armed Randomized Controlled Trial and insights about the working alliance in online therapy.

1 Helen Dowling Institute, Scientific Research Department, Bilthoven, the Netherlands
2 University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine Group, Enschede, the Netherlands
3 Roessingh Research and Development, Telemedicine Group, Enschede, the Netherlands
4 Utrecht University, Department of Methods and Statistics, Utrecht, the Netherlands
5 North-West University, Vanderbijlpark, South Africa
6 Ziekenhuis Groep Twente, ZGT Academy, Almelo, the Netherlands

F.Z. Bruggeman-Everts 1,2, MSc; J. Bruggeman1,2,  M.D.J. Wolvers2,3, MSc; R. van de Schoot4,5, PhD; M.M.R. Vollenbroek-Hutten2,3,6, PhD, Prof; M.L van der Lee1, PhD;

Introduction:
About one third of all patients who have been successfully treated for cancer, suffer from Chronic Cancer-Related Fatigue (CCRF). Effective and easily accessible interventions are needed for this growing group of patients that often suffer from limitations that make it hard for them to travel. Online interventions can improve access. Results of a 3-armed RCT investigating the clinical effectiveness of guided online Mindfulness-based Cognitive Behavioral Therapy for reducing CCRF compared to a guided web-based activity intervention and an active control condition will be presented. Furthermore results about the importance of patient-therapist working alliance online will discussed.
Method:
Severely fatigued cancer survivors were recruited; 167 participants were randomized into: (1) psychologist guided online mindfulness-based cognitive therapy (eMBCT) (n=55);(2) physiotherapist-guided ambulant activity feedback therapy encompassing the use of an accelerometer (AAF) (n=62); or (3) an unguided active control condition receiving psycho-educational e-mails (PE) (n=50). All interventions lasted nine weeks. Fatigue severity was self-assessed six times from baseline (T0b) to six months (T2) (Checklist Individual Strength – fatigue severity subscale; primary outcome). Patient-therapist working alliance was investigated by ethnographic field study.
Results:
Multiple group latent growth curve analysis, corrected for individual time between assessments, showed that fatigue severity decreased significantly more in eMBCT and AAF compared to PE. Field study showed patients provided the eMBCT therapists with individual insights through their biographical writings, as well as writings about daily experiences. These writings enabled the therapist to attune methods and feedback to the specific context of individual patients. Therapists had access to detailed biographical information and seemed very motivated to respond to challenges their patients faced. On the other hand we noted limitations of online therapy in personalizing care, that might explain dropout.
Discussion:
Both the eMBCT and AAF are effective for managing fatigue severity compared to receiving psycho-educational e-mails. Advantages as well as limitations of  online therapy for establishing working alliance between patient and therapist were found.
Conclusion:
Guided Online interventions are effective and the working alliance helps to personalize therapy.

Trial Registration: The Netherlands National Trial Register (NTR3483). (Archived by WebCite at http://www.webcitation.org/6NWZqon3o).

Jon Fridrik Sigurdsson от Reykjavik University