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Berkhof M, van der Stouwe ECD, Lestestuiver B, van’t Hag E, van Grunsven R, de Jager J, Kooijmans E, Zandee CER, Staring ABP, Pot-Kolder RMCA, Vos M, Veling W. Virtual reality cognitive-behavioural therapy versus cognitive-behavioural therapy for paranoid delusions: a study protocol for a single-blind multi-Centre randomised controlled superiority trial. BMC Psychiatry 2021; 21:496. [PMID: 34635063 PMCID: PMC8507393 DOI: 10.1186/s12888-021-03473-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Seventy per cent of patients with psychotic disorders has paranoid delusions. Paranoid delusions are associated with significant distress, hospital admission and social isolation. Cognitive-behavioural therapy for psychosis (CBTp) is the primary psychological treatment, but the median effect size is only small to medium. Virtual reality (VR) has a great potential to improve the effectiveness of CBTp. In a previous study, we found that VR based CBT (VRcbt) for paranoid delusions is superior to waiting list. As a next step, a direct comparison with CBTp is needed. The present study aims to investigate whether VRcbt is more effective and cost-effective than regular CBTp in treating paranoid delusions and improving daily life social functioning of patients with psychotic disorders. METHODS A total of 106 patients with DSM-5 diagnosis of psychotic disorder and at least moderate level of paranoid ideations will be recruited for this multicentre randomized controlled trial (RCT). Patients will be randomized to either VRcbt or standard CBTp for paranoid delusions. VRcbt consists of maximum 16 sessions in virtual social situations that trigger paranoid ideations and distress, delivered in an 8-12 week time frame. Standard CBTp also consists of maximum 16 sessions including exposure and behavioural experiments, delivered in an 8-12 week time frame. The two groups will be compared at baseline, post-treatment and six months follow-up. Primary outcome is the level of paranoid ideations in daily life social situations, measured with ecological momentary assessments (EMA) at semi-random moments ten times a day during seven days, before and after treatment. Every session, participants and therapists will rate the level of paranoid ideation and global clinical impression. DISCUSSION Comparison of VRcbt and CBTp will provide information about the relative (cost-) effectiveness of VRcbt for this population. VRcbt may become a preferred psychological treatment for paranoid delusions and social anxiety in patients with psychotic disorder. TRIAL REGISTRATION Netherlands Trial Register, NL7758. Registered on 23 May 2019.
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Affiliation(s)
- M. Berkhof
- grid.4830.f0000 0004 0407 1981University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - E. C. D. van der Stouwe
- grid.4830.f0000 0004 0407 1981University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - B. Lestestuiver
- grid.4830.f0000 0004 0407 1981University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - E. van’t Hag
- grid.4830.f0000 0004 0407 1981University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | | | - J. de Jager
- Mental Health Service Organization GGZ Noord-Holland-Noord, Heiloo, Heerhugowaard, The Netherlands
| | - E. Kooijmans
- grid.491369.00000 0004 0466 1666Pro Persona, Arnhem, Arnhem, The Netherlands
| | - C. E. R. Zandee
- Flexible Assertive Community Treatment Team, Outpatient Treatment Center, GGZ Delfland, Delft, The Netherlands
| | - A. B. P. Staring
- First Episode and Early Detection and Intervention Service, Altrecht Psychiatric Institute, Utrecht, The Netherlands
| | - R. M. C. A. Pot-Kolder
- grid.12380.380000 0004 1754 9227Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - M. Vos
- grid.4830.f0000 0004 0407 1981University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - W. Veling
- grid.4830.f0000 0004 0407 1981University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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van Oosterhout B, Smit F, Krabbendam L, Castelein S, Staring ABP, van der Gaag M. Letter to the Editor: Should we focus on quality or quantity in meta-analyses? Psychol Med 2016; 46:2003-2005. [PMID: 26888290 DOI: 10.1017/s003329171600009x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - F Smit
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction),Utrecht,The Netherlands
| | - L Krabbendam
- Department of Educational Neuroscience and Research Institute Learn!,Faculty of Psychology and Education,VU University,Amsterdam,The Netherlands
| | - S Castelein
- Lentis Psychiatric Institute,Lentis Research,Groningen,The Netherlands
| | - A B P Staring
- Altrecht Psychiatric Institute,Utrecht,The Netherlands
| | - M van der Gaag
- Department of Clinical Psychology,EMGO Institute for Health and Care Research, VU University,Amsterdam,The Netherlands
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van Oosterhout B, Smit F, Krabbendam L, Castelein S, Staring ABP, van der Gaag M. Metacognitive training for schizophrenia spectrum patients: a meta-analysis on outcome studies. Psychol Med 2016; 46:47-57. [PMID: 26190517 DOI: 10.1017/s0033291715001105] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Metacognitive training (MCT) for schizophrenia spectrum is widely implemented. It is timely to systematically review the literature and to conduct a meta-analysis. METHOD Eligible studies were selected from several sources (databases and expert suggestions). Criteria included comparative studies with a MCT condition measuring positive symptoms and/or delusions and/or data-gathering bias. Three meta-analyses were conducted on data gathering (three studies; 219 participants), delusions (seven studies; 500 participants) and positive symptoms (nine studies; 436 participants). Hedges' g is reported as the effect size of interest. Statistical power was sufficient to detect small to moderate effects. RESULTS All analyses yielded small non-significant effect sizes (0.26 for positive symptoms; 0.22 for delusions; 0.31 for data-gathering bias). Corrections for publication bias further reduced the effect sizes to 0.21 for positive symptoms and to 0.03 for delusions. In blinded studies, the corrected effect sizes were 0.22 for positive symptoms and 0.03 for delusions. In studies using proper intention-to-treat statistics the effect sizes were 0.10 for positive symptoms and -0.02 for delusions. The moderate to high heterogeneity in most analyses suggests that processes other than MCT alone have an impact on the results. CONCLUSIONS The studies so far do not support a positive effect for MCT on positive symptoms, delusions and data gathering. The methodology of most studies was poor and sensitivity analyses to control for methodological flaws reduced the effect sizes considerably. More rigorous research would be helpful in order to create enough statistical power to detect small effect sizes and to reduce heterogeneity. Limitations and strengths are discussed.
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Affiliation(s)
| | - F Smit
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction),PO Box 725,Utrecht,The Netherlands
| | - L Krabbendam
- Department of Educational Neuroscience and Research Institute Learn!,Faculty of Psychology and Education,VU University,Van der Boechorststraat 1,Amsterdam,The Netherlands
| | - S Castelein
- Lentis Psychiatric Institute,Lentis Research,PO Box 86,Groningen,The Netherlands
| | - A B P Staring
- Altrecht Psychiatric Institute,Mimosastraat 2-4,Utrecht,The Netherlands
| | - M van der Gaag
- Department of Clinical Psychology,EMGO Institute for Health and Care Research,VU University,PO Box 7057,Amsterdam,The Netherlands
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Velthorst E, Koeter M, van der Gaag M, Nieman DH, Fett AKJ, Smit F, Staring ABP, Meijer C, de Haan L. Adapted cognitive-behavioural therapy required for targeting negative symptoms in schizophrenia: meta-analysis and meta-regression. Psychol Med 2015; 45:453-465. [PMID: 24993642 DOI: 10.1017/s0033291714001147] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is an increasing interest in cognitive-behavioural therapy (CBT) interventions targeting negative symptoms in schizophrenia. To date, CBT trials primarily focused on positive symptoms and investigated change in negative symptoms only as a secondary outcome. To enhance insight into factors contributing to improvement of negative symptoms, and to identify subgroups of patients that may benefit most from CBT directed at ameliorating negative symptoms, we reviewed all available evidence on these outcomes. METHOD A systematic search of the literature was conducted in PsychInfo, PubMed and the Cochrane register to identify randomized controlled trials reporting on the impact of CBT interventions on negative symptoms in schizophrenia. Random-effects meta-analyses were performed on end-of-treatment, short-term and long-term changes in negative symptoms. RESULTS A total of 35 publications covering 30 trials in 2312 patients, published between 1993 and 2013, were included. Our results showed studies' pooled effect on symptom alleviation to be small [Hedges' g = 0.093, 95% confidence interval (CI) -0.028 to 0.214, p = 0.130] and heterogeneous (Q = 73.067, degrees of freedom = 29, p < 0.001, τ 2 = 0.081, I 2 = 60.31) in studies with negative symptoms as a secondary outcome. Similar results were found for studies focused on negative symptom reduction (Hedges' g = 0.157, 95% CI -0.10 to 0.409, p = 0.225). Meta-regression revealed that stronger treatment effects were associated with earlier year of publication, lower study quality and with CBT provided individually (as compared with group-based). CONCLUSIONS The co-occurring beneficial effect of conventional CBT on negative symptoms found in older studies was not supported by more recent studies. It is now necessary to further disentangle effective treatment ingredients of older studies in order to guide the development of future CBT interventions aimed at negative symptom reduction.
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Affiliation(s)
- E Velthorst
- Academic Medical Center,Department of Psychiatry, Amsterdam,The Netherlands
| | - M Koeter
- Academic Medical Center,Department of Psychiatry, Amsterdam,The Netherlands
| | - M van der Gaag
- Parnassia Psychiatric Institute,The Hague,The Netherlands
| | - D H Nieman
- Academic Medical Center,Department of Psychiatry, Amsterdam,The Netherlands
| | - A-K J Fett
- Academic Medical Center,Department of Psychiatry, Amsterdam,The Netherlands
| | - F Smit
- Department of Clinical Psychology, EMGO Institute for Health and Care Research,VU University,Amsterdam,The Netherlands
| | - A B P Staring
- Altrecht Psychiatric Institute,Utrecht,The Netherlands
| | - C Meijer
- Academic Medical Center,Department of Psychiatry, Amsterdam,The Netherlands
| | - L de Haan
- Academic Medical Center,Department of Psychiatry, Amsterdam,The Netherlands
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Croes CF, van Grunsven R, Staring ABP, van den Berg DPG, de Jongh A, van der Gaag M. [Imagery in psychosis: EMDR as a new intervention in the treatment of delusions and auditory hallucinations]. Tijdschr Psychiatr 2014; 56:568-576. [PMID: 25222093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Historically, psychotherapy has focused on the treatment of patients' verbal representations (thoughts) and has proved particularly successful in the cognitive behavioural treatment of psychosis. However, there is mounting evidence that visual representations (imagery) play an important role in the onset and maintenance of psychiatric disorders, including psychotic symptoms. There are indications that heightened emotionality and vividness of visual representations are associated with severity of psychotic experiences. This may imply that a reduction in the vividness and emotionality of the psychosis-related imagery can lessen the suffering and stress, caused by the the psychotic symptoms. AIM To introduce EMDR as a possible type of psychological treatment for patients suffering from psychosis-related imagery. METHOD Three outpatients who had a psychotic disorder and suffered from auditory hallucinations and delusions were treated with EMDR in an average of six sessions. Treatment was performed by three therapists in different psychiatric institutions. All three were experienced in administrating CBT and EMDR. RESULTS Treatment with EMDR reduced patients' level of anxiety, depression and the severity of psychotic symptoms. In addition, patients reported less avoidant behaviour and greater cognitive insight. CONCLUSION The results of the study suggest that EMDR reduces the vividness and emotionality of imagery in psychosis which in turn alleviates the patients' psychotic symptoms. Further research into other possible types of interventions for the treatment of imagery in psychosis is recommended.
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Kortrijk HE, Mulder CL, van Vliet D, van Leeuwen C, Jochems E, Staring ABP. Changes in motivation for treatment in precontemplating dually diagnosed patients receiving assertive community treatment. Community Ment Health J 2013; 49:733-41. [PMID: 23288491 DOI: 10.1007/s10597-012-9582-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 12/25/2012] [Indexed: 11/30/2022]
Abstract
In a population of dually diagnosed patients receiving assertive community treatment we used the theoretical framework of the transtheoretical model to establish (a) the proportions and characteristics of patients who were not motivated for treatment for psychiatric symptoms and substance use, (b) the proportion of patients who moved towards behavioral change after about 1 year, and examine how this change was related with clinical outcome; and (c) the sequence of change processes. Chi square tests and T tests were used to compare the patient characteristics and outcomes of patients who remained in precontemplation with those who progressed. During follow-up, 47 % of the patients came out of the precontemplation phase for treatment of psychiatric symptoms and 38 % for substance use behavior. Those who remained in precontemplation benefited less from treatment. Of those who did move forward, most appeared to become motivated for psychiatric treatment before becoming motivated to reduce substance use.
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Affiliation(s)
- H E Kortrijk
- Bavo-Europoort Psychiatric Institute, Prins Constantijnweg 48-54, 3066 TA, Rotterdam, The Netherlands,
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Staring ABP, Blaauw E, Mulder CL. The effects of assertive community treatment including integrated dual diagnosis treatment on nuisance acts and crimes in dual-diagnosis patients. Community Ment Health J 2012; 48:150-2. [PMID: 21556786 DOI: 10.1007/s10597-011-9406-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 04/25/2011] [Indexed: 10/18/2022]
Abstract
We investigated whether Assertive Community Treatment (ACT) combined with Integrated Dual Diagnosis Treatment (IDDT) is associated with a decrease in nuisance acts and crime convictions in dual-diagnosis repeated offenders. Forty-three patients were monitored from 21 months before until 12 months after the start of ACT-IDDT, using police data and the Health of the Nation Outcome Scales (HoNOS). Results show that while nuisance acts and convictions increased in the 21 months before the start of ACT-IDDT, nuisance acts decreased and convictions stabilized during the next 12 months. The decrease in nuisance acts was associated with a decrease in substance abuse.
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Affiliation(s)
- A B P Staring
- Altrecht Psychiatric Institute, ABC straat 8, Utrecht, The Netherlands.
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Staring ABP, Van der Gaag M, Koopmans GT, Selten JP, Van Beveren JM, Hengeveld MW, Loonen AJM, Mulder CL. Treatment adherence therapy in people with psychotic disorders: randomised controlled trial. Br J Psychiatry 2010; 197:448-55. [PMID: 21119150 DOI: 10.1192/bjp.bp.110.077289] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Interventions to improve adherence to treatment in people with psychotic disorders have produced inconclusive results. We developed a new treatment, treatment adherence therapy (TAT), whose intervention modules are tailored to the reasons for an individual's non-adherence. AIMS To examine the effectiveness of TAT with regard to service engagement and medication adherence in out-patients with psychotic disorders who engage poorly. METHOD Randomised controlled study of TAT v. treatment as usual (TAU) in 109 out-patients. Most outcome measurements were performed by masked assessors. We used intention-to-treat multivariate analyses (Dutch Trial Registry: NTR1159). RESULTS Treatment adherence therapy v. TAU significantly benefited service engagement (Cohen's d = 0.48) and medication adherence (Cohen's d = 0.43). Results remained significant at 6-month follow-up for medication adherence. Near-significant effects were also found regarding involuntary readmissions (1.9% v. 11.8%, P = 0.053). Symptoms and quality of life did not improve. CONCLUSIONS Treatment adherence therapy helps improve engagement and adherence, and may prevent involuntary admission.
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Affiliation(s)
- A B P Staring
- Erasmus University Medical Center, Department of Psychiatry, Rotterdam, The Netherlands.
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Kortrijk HE, Staring ABP, van Baars AWB, Mulder CL. Involuntary admission may support treatment outcome and motivation in patients receiving assertive community treatment. Soc Psychiatry Psychiatr Epidemiol 2010; 45:245-52. [PMID: 19412561 DOI: 10.1007/s00127-009-0061-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 04/14/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Patients with severe mental illness who are treated in assertive community treatment (ACT) teams are sometimes involuntarily admitted when they are dangerous to themselves or others, and are not motivated for treatment. However, the consequences of involuntary admission in terms of psychosocial outcome and treatment motivation are largely unknown. We hypothesized that involuntary admission would improve psychosocial outcome and not adversely affect their treatment motivation. METHODS In the context of routine 6-monthly outcome monitoring in the period January 2003-March 2008, we used the Health of the Nation Outcome Scales (HoNOS) and a motivation-for-treatment scale to assess 260 severely mentally ill patients at risk for involuntary admission. Mixed models with repeated measures were used for data analyses. RESULTS During the observation period, 77 patients (30%) were involuntarily admitted. Relative to patients who were not involuntarily admitted, these patients improved significantly in HoNOS total scores (F = 17,815, df = 1, p < 0.001) and in motivation for treatment (F = 28.139, df = 1, p < 0.001). Patients who were not involuntarily admitted had better HoNOS and motivation scores at baseline, but did not improve. CONCLUSIONS Involuntary admission in the context of ACT was associated with improvements in psychosocial outcome and motivation for treatment. There are no indications that involuntary admission leads to deterioration in psychosocial outcome or worsening of motivation for treatment.
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Staring ABP, Mulder CL, Duivenvoorden HJ, De Haan L, Van der Gaag M. Fewer symptoms vs. more side-effects in schizophrenia? Opposing pathways between antipsychotic medication compliance and quality of life. Schizophr Res 2009; 113:27-33. [PMID: 19525092 DOI: 10.1016/j.schres.2009.05.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 05/02/2009] [Accepted: 05/21/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Non-compliance with medication often has long-term detrimental effects in patients with schizophrenia. However, when patients are compliant, it is not certain whether they experience short-term improved quality of life. By simultaneously reducing symptoms and increasing side-effects, compliance with antipsychotics may have opposing effects on a patient's perceived quality of life. AIM This study aimed to identify any clinical-empirical evidence for two pathways between compliance and quality of life. METHOD To evaluate various pathways between compliance (Service Engagement Scale plus a one-item rating), psychotic symptoms (Positive and Negative Syndromes Scale), adverse medication effects (Subjective Wellbeing under Neuroleptics scale), and quality of life (EQ-5D), we used Structural Equation Modeling on cross-sectional data of 114 patients with a psychotic disorder. RESULTS Compliance was not directly related to quality of life (r=0.004). The best-fitting model (chi(2)=1.08; df=1) indicated that high compliance was associated with fewer psychotic symptoms (beta=-0.23) and more adverse medication effects (beta=0.22). Symptoms (beta=-0.17) and adverse medication effects (beta=-0.48) were both related to lower quality of life. DISCUSSION Our results suggest that compliance with antipsychotics has two opposing pathways towards quality of life, albeit indirect ones. While compliance was associated with less severe psychotic symptoms, and was thus related to higher quality of life, it was also associated with more adverse medication effects, and was thus related to lower quality of life. However, due to our study design, we cannot draw firm conclusions on causality. Two possible clinical implications of the results for compliance and interventions are discussed.
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Affiliation(s)
- A B P Staring
- Erasmus University Medical Center, Dr. Molewaterplein 50, 3015 GE Rotterdam, The Netherlands.
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