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Ader L, Schick A, Vaessen T, Morgan C, Kempton MJ, Valmaggia L, McGuire P, Myin-Germeys I, Lafit G, Reininghaus U. The Role of Childhood Trauma in Affective Stress Recovery in Early Psychosis: An Experience Sampling Study. Schizophr Bull 2024:sbae004. [PMID: 38366989 DOI: 10.1093/schbul/sbae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
BACKGROUND AND HYPOTHESES Affective recovery, operationalized as the time needed for affect to return to baseline levels after daily stressors, may be a putative momentary representation of resilience. This study aimed to investigate affective recovery in positive and negative affect across subclinical and clinical stages of psychosis and whether this is associated with exposure to childhood trauma (sexual, physical, and emotional abuse). STUDY DESIGN We used survival analysis to predict the time-to-recovery from a daily event-related stressor in a pooled sample of 3 previously conducted experience sampling studies including 113 individuals with first-episode psychosis, 162 at-risk individuals, and 94 controls. STUDY RESULTS Negative affective recovery (ie, return to baseline following an increase in negative affect) was longer in individuals with first-episode psychosis compared with controls (hazard ratio [HR] = 1.71, 95% confidence interval [CI; 1.03, 2.61], P = .04) and in at-risk individuals exposed to high vs low levels of emotional abuse (HR = 1.31, 95% CI [1.06, 1.62], P = .01). Positive affective recovery (ie, return to baseline following a decrease in positive affect) did not differ between groups and was not associated with childhood trauma. CONCLUSIONS Our results give first indications that negative affective recovery may be a putative momentary representation of resilience across stages of psychosis and may be amplified in at-risk individuals with prior experiences of emotional abuse. Understanding how affective recovery contributes to the development of psychosis may help identify new targets for prevention and intervention to buffer risk or foster resilience in daily life.
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Affiliation(s)
- Leonie Ader
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Anita Schick
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Thomas Vaessen
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
- Department of Psychology, Health & Technology, Faculty of Behavioural, Management and Social Sciences (BMS), University of Twente, Enschede, The Netherlands
- Department of Neurosciences, Mind Body Research, KU Leuven, Leuven, Belgium
| | - Craig Morgan
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Lucia Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychiatry, KU Leuven, Leuven, Belgium
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Inez Myin-Germeys
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Ginette Lafit
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
- Research Group of Quantitative Psychology and Individual Differences, Faculty of Psychology, KU Leuven, Leuven, Belgium
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- ESRC Centre for Society and Mental Health, King's College London, London, UK
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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King ZD, Yu H, Vaessen T, Myin-Germeys I, Sano A. Investigating Receptivity and Affect Using Machine Learning: Ecological Momentary Assessment and Wearable Sensing Study. JMIR Mhealth Uhealth 2024; 12:e46347. [PMID: 38324358 PMCID: PMC10882474 DOI: 10.2196/46347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 11/01/2023] [Accepted: 11/21/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND As mobile health (mHealth) studies become increasingly productive owing to the advancements in wearable and mobile sensor technology, our ability to monitor and model human behavior will be constrained by participant receptivity. Many health constructs are dependent on subjective responses, and without such responses, researchers are left with little to no ground truth to accompany our ever-growing biobehavioral data. This issue can significantly impact the quality of a study, particularly for populations known to exhibit lower compliance rates. To address this challenge, researchers have proposed innovative approaches that use machine learning (ML) and sensor data to modify the timing and delivery of surveys. However, an overarching concern is the potential introduction of biases or unintended influences on participants' responses when implementing new survey delivery methods. OBJECTIVE This study aims to demonstrate the potential impact of an ML-based ecological momentary assessment (EMA) delivery system (using receptivity as the predictor variable) on the participants' reported emotional state. We examine the factors that affect participants' receptivity to EMAs in a 10-day wearable and EMA-based emotional state-sensing mHealth study. We study the physiological relationships indicative of receptivity and affect while also analyzing the interaction between the 2 constructs. METHODS We collected data from 45 healthy participants wearing 2 devices measuring electrodermal activity, accelerometer, electrocardiography, and skin temperature while answering 10 EMAs daily, containing questions about perceived mood. Owing to the nature of our constructs, we can only obtain ground truth measures for both affect and receptivity during responses. Therefore, we used unsupervised and supervised ML methods to infer affect when a participant did not respond. Our unsupervised method used k-means clustering to determine the relationship between physiology and receptivity and then inferred the emotional state during nonresponses. For the supervised learning method, we primarily used random forest and neural networks to predict the affect of unlabeled data points as well as receptivity. RESULTS Our findings showed that using a receptivity model to trigger EMAs decreased the reported negative affect by >3 points or 0.29 SDs in our self-reported affect measure, scored between 13 and 91. The findings also showed a bimodal distribution of our predicted affect during nonresponses. This indicates that this system initiates EMAs more commonly during states of higher positive emotions. CONCLUSIONS Our results showed a clear relationship between affect and receptivity. This relationship can affect the efficacy of an mHealth study, particularly those that use an ML algorithm to trigger EMAs. Therefore, we propose that future work should focus on a smart trigger that promotes EMA receptivity without influencing affect during sampled time points.
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Affiliation(s)
- Zachary D King
- Department of Electrical and Computer Engineering, Rice University, Houston, TX, United States
| | - Han Yu
- Department of Electrical and Computer Engineering, Rice University, Houston, TX, United States
| | - Thomas Vaessen
- Center For Contextual Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands
| | - Inez Myin-Germeys
- Center For Contextual Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Akane Sano
- Department of Electrical and Computer Engineering, Rice University, Houston, TX, United States
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Akcaoglu Z, Vaessen T, Velthorst E, Lafit G, Achterhof R, Nelson B, McGorry P, Schirmbeck F, Morgan C, Hartmann J, van der Gaag M, de Haan L, Valmaggia L, McGuire P, Kempton M, Steinhart H, Klippel A, Viechtbauer W, Batink T, van Winkel R, van Amelsvoort T, Marcelis M, van Aubel E, Reininghaus U, Myin-Germeys I. The temporal association between social isolation, distress, and psychotic experiences in individuals at clinical high-risk for psychosis. Psychol Med 2024:1-9. [PMID: 38179659 DOI: 10.1017/s0033291723003598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Psychotic experiences (PEs) and social isolation (SI) seem related during early stages of psychosis, but the temporal dynamics between the two are not clear. Literature so far suggests a self-perpetuating cycle wherein momentary increases in PEs lead to social withdrawal, which, subsequently, triggers PEs at a next point in time, especially when SI is associated with increased distress. The current study investigated the daily-life temporal associations between SI and PEs, as well as the role of SI-related and general affective distress in individuals at clinical high risk (CHR) for psychosis. METHODS We used experience sampling methodology in a sample of 137 CHR participants. We analyzed the association between SI, PEs, and distress using time-lagged linear mixed-effects models. RESULTS SI did not predict next-moment fluctuations in PEs, or vice versa. Furthermore, although SI-related distress was not predictive of subsequent PEs, general affective distress during SI was a robust predictor of next-moment PEs. CONCLUSIONS Our results suggest that SI and PEs are not directly related on a moment-to-moment level, but a negative emotional state when alone does contribute to the risk of PEs. These findings highlight the role of affective wellbeing during early-stage psychosis development.
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Affiliation(s)
- Zeynep Akcaoglu
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Thomas Vaessen
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
- Department of Psychology, Health & Technology, Faculty of Behavioural, Management and Social Sciences (BMS), University of Twente, Enschede, The Netherlands
| | - Eva Velthorst
- Department of Research, Community Mental Health Service GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands
| | - Ginette Lafit
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
- Faculty of Psychology and Educational Sciences, Research Group of Quantitative Psychology and Individual Differences, KU Leuven, Leuven, Belgium
| | - Robin Achterhof
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Barnaby Nelson
- Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Frederike Schirmbeck
- Department of Psychiatry, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, North Holland, Netherlands
- Arkin, Institute for Mental Health, Amsterdam, North Holland, The Netherlands
| | - Craig Morgan
- ESRC Centre for Society and Mental Health and Social Epidemiology Research Group, King's College London, London, London, UK
- Health Service and Population Research Department, Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jessica Hartmann
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg, Germany
| | - Mark van der Gaag
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, North Holland, The Netherlands
- Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, South Holland, The Netherlands
| | - Lieuwe de Haan
- Department of Early Psychosis, Amsterdam UMC, Location AMC, Amsterdam, North Holland, The Netherlands
| | - Lucia Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Philip McGuire
- NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Matthew Kempton
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, UK
| | - Henrietta Steinhart
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Annelie Klippel
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Lifespan Psychology, Faculty of Psychology, Open University, Heerlen, The Netherlands
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Tim Batink
- Department of Lifespan Psychology, Faculty of Psychology, Open University, Heerlen, The Netherlands
| | - Ruud van Winkel
- Department of Neurosciences, Psychiatry Research Group, Center for Clinical Psychiatry, KU Leuven, Leuven, Belgium
| | - Thérèse van Amelsvoort
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Machteld Marcelis
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, The Netherlands, https://www.ggze.nl/
| | - Evelyne van Aubel
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Ulrich Reininghaus
- ESRC Centre for Society and Mental Health and Social Epidemiology Research Group, King's College London, London, London, UK
- Health Service and Population Research Department, Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg, Germany
| | - Inez Myin-Germeys
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
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De Calheiros Velozo J, Habets J, George SV, Niemeijer K, Minaeva O, Hagemann N, Herff C, Kuppens P, Rintala A, Vaessen T, Riese H, Delespaul P. Designing daily-life research combining experience sampling method with parallel data. Psychol Med 2024; 54:98-107. [PMID: 36039768 DOI: 10.1017/s0033291722002367] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 11/07/2022]
Abstract
BACKGROUND Ambulatory monitoring is gaining popularity in mental and somatic health care to capture an individual's wellbeing or treatment course in daily-life. Experience sampling method collects subjective time-series data of patients' experiences, behavior, and context. At the same time, digital devices allow for less intrusive collection of more objective time-series data with higher sampling frequencies and for prolonged sampling periods. We refer to these data as parallel data. Combining these two data types holds the promise to revolutionize health care. However, existing ambulatory monitoring guidelines are too specific to each data type, and lack overall directions on how to effectively combine them. METHODS Literature and expert opinions were integrated to formulate relevant guiding principles. RESULTS Experience sampling and parallel data must be approached as one holistic time series right from the start, at the study design stage. The fluctuation pattern and volatility of the different variables of interest must be well understood to ensure that these data are compatible. Data have to be collected and operationalized in a manner that the minimal common denominator is able to answer the research question with regard to temporal and disease severity resolution. Furthermore, recommendations are provided for device selection, data management, and analysis. Open science practices are also highlighted throughout. Finally, we provide a practical checklist with the delineated considerations and an open-source example demonstrating how to apply it. CONCLUSIONS The provided considerations aim to structure and support researchers as they undertake the new challenges presented by this exciting multidisciplinary research field.
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Affiliation(s)
| | - Jeroen Habets
- Department of Neurosurgery, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Sandip V George
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Koen Niemeijer
- Department of Psychology and Educational Sciences, Research Group of Quantitative Psychology and Individual Differences, KU Leuven, Leuven, Belgium
| | - Olga Minaeva
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Noëmi Hagemann
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Christian Herff
- Department of Neurosurgery, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Peter Kuppens
- Department of Psychology and Educational Sciences, Research Group of Quantitative Psychology and Individual Differences, KU Leuven, Leuven, Belgium
| | - Aki Rintala
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
- Faculty of Social and Health Care, LAB University of Applied Sciences, Lahti, Finland
| | - Thomas Vaessen
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
- Department of Neurosciences, Mind Body Research, KU Leuven, Leuven, Belgium
| | - Harriëtte Riese
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Li X, Lafit G, van Aubel E, Vaessen T, Hiekkaranta AP, Houben M, Beijer-Klippel A, de Haan L, Schirmbeck F, Reininghaus U, Myin-Germeys I. Emotion regulation in daily life in early psychosis: The role of contextual appraisals. Schizophr Res 2023; 261:130-138. [PMID: 37722209 DOI: 10.1016/j.schres.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 12/04/2022] [Revised: 05/19/2023] [Accepted: 09/11/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Little is known about whether and how contextual appraisals relate to emotion regulation (ER) strategy use across the ultra-high risk and first episode stages of psychosis. The present study extends previous research by investigating the extent to which different appraisal dimensions of the most negative and positive events of the day are associated with ER strategy use in individuals with ultra-high risk (UHR) and first-episode psychosis (FEP). METHOD Sixty-eight UHR individuals and fifty-five FEP individuals filled out an experience sampling evening questionnaire for six consecutive days, in which their appraisal of intensity, importance and perceived control concerning the most negative or positive event of the day, and the ER strategies they deploy in response to these events were measured. RESULTS Multilevel mixed effect models showed that intensity appraisal was most closely associated with ER strategy use, as opposed to importance and controllability appraisals. Higher intense negative events were associated with more rumination and social sharing, while less intense negative events were associated with more reappraisal. Higher intense positive events were associated with a greater number of deployed strategies and more efforts in using savoring, expression and social sharing. The UHR and FEP individuals did not significantly differ regarding effects of above-mentioned appraisal dimensions on ER. CONCLUSIONS These results provide evidence supporting ER flexibility in early psychosis, and event intensity emerged as the dimension most strongly associated with ER. Future research should better account for other situational factors (such as social context) that might affect ER use in psychosis.
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Affiliation(s)
- Xu Li
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven 3000, Belgium; School of Psychology, Central China Normal University, Wuhan 430079, China
| | - Ginette Lafit
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven 3000, Belgium; Faculty of Psychology and Educational Sciences, Research Group of Quantitative Psychology and Individual Differences, KU Leuven, Leuven 3000, Belgium
| | - Evelyne van Aubel
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven 3000, Belgium
| | - Thomas Vaessen
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven 3000, Belgium; Center for eHealth and Well-being Research, Department of Psychology, Health, and Technology, University of Twente, Twente 7500 AE, the Netherlands
| | - Anu P Hiekkaranta
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven 3000, Belgium
| | - Marlies Houben
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven 3000, Belgium; Department of Medical and Clinical Psychology, Tilburg University, 5037 AB Tilburg, the Netherlands
| | - Annelie Beijer-Klippel
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven 3000, Belgium; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht 6229 GT, the Netherlands; Faculty of Psychology, Department of Lifespan Psychology, Open University, Heerlen 6419 AT, the Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, the Netherlands
| | - Frederike Schirmbeck
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, the Netherlands
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim 68167, Germany; ESRC Centre for Society and Mental Health and Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London WC2R 2LS, UK
| | - Inez Myin-Germeys
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven 3000, Belgium.
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Leenaerts N, Vaessen T, Sunaert S, Ceccarini J, Vrieze E. How negative affect does and does not lead to binge eating-The importance of craving and negative urgency in bulimia nervosa. J Psychopathol Clin Sci 2023:2023-65822-001. [PMID: 37104790 DOI: 10.1037/abn0000830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Studies suggest that negative affect (NA) can trigger binge eating (BE) in patients with bulimia nervosa (BN). Important factors in this relation between NA and BE could be craving (an intense desire for a BE episode) and negative urgency (the tendency to act rashly when NA is high). Therefore, this study wants to firstly explore the relations between NA, craving, rash action, and BE in daily life and secondly whether craving and rash action mediate the relationship between NA and BE. A sample of 70 female patients with BN and 76 female healthy controls (HC) took part in an experience sampling study where they reported on momentary NA, craving, rash action, and eating behaviors in daily life in a burst-measurement design over a period of 12 months. Assessments occurred eight times a day on Thursdays, Fridays, and Saturdays in seven bursts of 3 weeks, all separated by 5-week periods of no assessment. First, NA predicted subsequent rash action in the whole sample but this was more pronounced in patients with BN. Second, NA predicted subsequent craving in patients with BN, but not in HC. Third, rash action and craving predicted subsequent BE in patients with BN. Fourth, NA had competing effects on eating in patients with BN, predicting subsequent BE through rash action and craving, but also predicting subsequent not eating. These results suggest that NA can lead to BE in daily life through rash action and craving, but that NA can also lead to dietary restriction. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Chubar V, Vaessen T, Noortgate WVD, Lutin E, Bosmans G, Bekaert B, Van Leeuwen K, Calders F, Weyn S, Bijttebier P, Goossens L, Claes S. Mild daily stress, in interaction with NR3C1 DNA methylation levels, is linked to alterations in the HPA axis and ANS response to acute stress in early adolescents. Psychoneuroendocrinology 2023; 150:106045. [PMID: 36796155 DOI: 10.1016/j.psyneuen.2023.106045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Daily Hassles (DH) or daily stress - is a mild type of stressor with unique contributions to psychological distress. Yet, most prior studies that investigate the effects of stressful life experiences focus on childhood trauma or on early life stress and little is known about the effects of DH on epigenetic changes in stress system related genes and on the physiological response to social stressors. METHODS In the present study, conducted among 101 early adolescents (mean age = 11.61; SD = 0.64), we investigated whether Autonomic Nervous System (ANS) (namely heart rate and heart rate variability) and Hypothalamic-Pituitary-Adrenal (HPA) axis functioning (measured as cortisol stress reactivity and recovery) are associated with DNA methylation (DNAm) in the glucocorticoid receptor gene (NR3C1), the level of DH and their interaction. To assess the stress system functioning the TSST protocol was used. RESULTS Our findings show that higher NR3C1 DNAm in interaction with higher levels of daily hassles, is associated with blunted HPA axis reactivity to psychosocial stress. In addition, higher levels of DH are associated with extended HPA axis stress recovery. In addition, participants with higher NR3C1 DNAm had lower ANS adaptability to stress, specifically lower parasympathetic withdrawal; for heart rate variability this effect was strongest for participants with higher level of DH. CONCLUSIONS The observation that interaction effects between NR3C1 DNAm levels and daily stress on the functioning of the stress-systems, are already detectable in young adolescents, highlights the importance of early interventions, not only in the case of trauma, but also daily stress. This might help to prevent stress-induced mental and physical disorders later in life.
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Affiliation(s)
- Viktoria Chubar
- Mind-Body Research Group, Department of Neuroscience, KU Leuven, Leuven, Belgium.
| | - Thomas Vaessen
- Mind-Body Research Group, Department of Neuroscience, KU Leuven, Leuven, Belgium; Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium
| | - Wim Van den Noortgate
- Methodology of Educational Sciences, Faculty of Psychology and Educational Sciences & itec, an imec research group at KU Leuven, Leuven, Belgium
| | - Erika Lutin
- ESAT Electrical Engineering, KU Leuven, Leuven, Belgium; imec-Belgium, Heverlee, Belgium
| | - Guy Bosmans
- Department of Clinical Psychology, KU Leuven, Belgium
| | - Bram Bekaert
- Department of Forensic Medicine, Laboratory of Forensic Genetics and Molecular Archaeology, KU Leuven, Leuven, Belgium; Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | - Karla Van Leeuwen
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Filip Calders
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Sofie Weyn
- School Psychology and Development in Context, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Patricia Bijttebier
- School Psychology and Development in Context, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Luc Goossens
- School Psychology and Child and Adolescent Development Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Stephan Claes
- Mind-Body Research Group, Department of Neuroscience, KU Leuven, Leuven, Belgium; University Psychiatric Center KU Leuven, Leuven, Belgium
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Vaessen T, Reininghaus U, van Aubel E, Beijer-Klippel A, Steinhart H, Myin-Germeys I, Waltz J. Neural correlates of daily-life affective stress reactivity in early psychosis: A study combining functional MRI and experience sampling methodology. Schizophr Res 2023; 255:93-101. [PMID: 36989675 DOI: 10.1016/j.schres.2023.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/01/2022] [Accepted: 03/18/2023] [Indexed: 03/31/2023]
Abstract
Affective reactivity to daily stressors are increased in individuals in the early stages of psychosis. Studies in psychosis patients and healthy individuals at increased psychosis risk show altered neural reactivity to stress in limbic (i.e., hippocampus [HC] and amygdala), prelimbic (i.e., ventromedial prefrontal cortex [vmPFC] and ventral anterior cingulate cortex [vACC]), and salience areas (i.e., Anterior Insula [AI]). We investigated whether a similar pattern of neural reactivity is present in early psychosis individuals and if brain activity in these regions is associated with daily-life stress reactivity. Twenty-nine early psychosis individuals (11 at-risk mental state and 18 first-episode psychosis) completed the Montreal Imaging Stress Task in conjunction with functional MRI. The study was part of a large-scale randomized controlled trial on the efficacy of an acceptance and commitment therapy-based ecological momentary intervention for early psychosis. All participants also provided experience sampling methodology (ESM) data on momentary affect and stressful activities in their everyday environment. Multilevel regression models were used to estimate if daily-life stress reactivity was moderated by activity in (pre)limbic and salience areas. Task-induced stress was associated with increased activation of the right AI and decreased activation in the vmPFC, vACC, and HC. Task-induced changes in vmPFC and vACC activity were associated with affective stress reactivity, whereas changes in HC and amygdala activity were associated with higher overall stress ratings. These preliminary results suggest region-specific roles in affective and psychotic daily-life stress reactivity in early psychosis. The observed pattern suggests that chronic stress plays a role in neural stress reactivity.
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Affiliation(s)
- Thomas Vaessen
- Center for Contextual Psychiatry, KU Leuven, Kapucijnenvoer 33, P.O. Box 7001, 3000 Leuven, Belgium; Department of Psychology, Health, & Technology, University of Twente, P.O. Box 217, 7500AE Enschede, the Netherlands.
| | - Ulrich Reininghaus
- Department Public Mental Health, Central Institute of Mental Health, J 5, 68159 Mannheim, Germany
| | - Evelyne van Aubel
- Center for Contextual Psychiatry, KU Leuven, Kapucijnenvoer 33, P.O. Box 7001, 3000 Leuven, Belgium
| | - Annelie Beijer-Klippel
- Center for Contextual Psychiatry, KU Leuven, Kapucijnenvoer 33, P.O. Box 7001, 3000 Leuven, Belgium; Department of Lifespan Psychology, Open University, P.O. Box 2960, 6401DL Heerlen, the Netherlands
| | - Henrietta Steinhart
- Center for Contextual Psychiatry, KU Leuven, Kapucijnenvoer 33, P.O. Box 7001, 3000 Leuven, Belgium
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, KU Leuven, Kapucijnenvoer 33, P.O. Box 7001, 3000 Leuven, Belgium
| | - James Waltz
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, P.O. Box 21247, Baltimore, MD 21228, USA
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9
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De Calheiros Velozo J, Lafit G, Viechtbauer W, van Amelsvoort T, Schruers K, Marcelis M, Goossens L, Simons CJP, Delespaul P, Claes S, Myin-Germeys I, Vaessen T. Delayed affective recovery to daily-life stressors signals a risk for depression. J Affect Disord 2023; 320:499-506. [PMID: 36208689 DOI: 10.1016/j.jad.2022.09.136] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study is to investigate the time to affective recovery from daily-life stressors between healthy controls (HC) and two groups with an increased risk for developing depression: individuals with subclinical symptoms of depression (SSD), and individuals remitted from a depressive episode with residual symptoms of depression (RRS). METHOD The experience sampling method (ESM) was used to measure affective recovery to daily-life stressors. Affective recovery was defined as the moment that negative affect (NA) returned to baseline level following the first stressful event of the day. We assessed two different operationalizations of the baseline: NA at the moment before the stressful event (t-1), and mean-person NA. The effect of stress intensity, and cumulative stress were also assessed. RESULTS Survival analyses showed significantly longer recovery times for the at risk groups in comparison to healthy individuals, albeit no significant difference was found between the two at risk groups (i.e. SSD and RRS). There was also an effect of cumulative stress, but not stress intensity on time to recovery in that cumulative stress resulted in significantly longer recovery times for all three groups. LIMITATIONS The present study is limited by the ESM sampling design, assessments take place post-stress and therefore do not capture peak stress. Additionally, we are only able to assess patterns at the group level. Finally, there is a significant age difference between groups. CONCLUSION Individuals at risk for depression display a delayed recovery to daily-life stressors when compared to healthy controls, which is not explained by differences in stress intensity or cumulative stress. Understanding what is driving this delay may help combat the development of depression.
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Affiliation(s)
| | - G Lafit
- KU Leuven, Center for Contextual Psychiatry, Department of Neurosciences, Belgium; KU Leuven, Research Group of Quantitative Psychology and Individual Differences, Faculty of Psychology, Belgium
| | - W Viechtbauer
- KU Leuven, Center for Contextual Psychiatry, Department of Neurosciences, Belgium; Maastricht University Medical Center, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht, the Netherlands
| | - T van Amelsvoort
- Maastricht University Medical Center, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht, the Netherlands
| | - K Schruers
- Maastricht University Medical Center, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht, the Netherlands
| | - M Marcelis
- Maastricht University Medical Center, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht, the Netherlands; GGzE Institute for Mental Health Care, Eindhoven, the Netherlands
| | - L Goossens
- Maastricht University Medical Center, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht, the Netherlands
| | - C J P Simons
- Maastricht University Medical Center, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht, the Netherlands; GGzE Institute for Mental Health Care, Eindhoven, the Netherlands
| | - P Delespaul
- Maastricht University Medical Center, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht, the Netherlands
| | - S Claes
- KU Leuven, Mind Body Research, Department of Neurosciences, Belgium
| | - I Myin-Germeys
- KU Leuven, Center for Contextual Psychiatry, Department of Neurosciences, Belgium
| | - T Vaessen
- KU Leuven, Center for Contextual Psychiatry, Department of Neurosciences, Belgium; KU Leuven, Mind Body Research, Department of Neurosciences, Belgium; University of Twenty, Faculty of Behavioural, Management and Social Sciences, Psychology, Health & Technology, the Netherlands
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10
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De Calheiros Velozo J, Vaessen T, Lafit G, Claes S, Myin-Germeys I. Is daily-life stress reactivity a measure of stress recovery? An investigation of laboratory and daily-life stress. Stress Health 2022. [PMID: 36521434 DOI: 10.1002/smi.3213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/15/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
Typical measures of laboratory reactivity (i.e. difference between control and stress) and recovery (i.e. difference between stress and post-stress) were compared with a conventional measure of daily-life reactivity, best known as event-related stress. Fifty-three healthy individuals between 19 and 35 years of age took part in a laboratory session where stress was induced using the repeated Montreal Imaging Stress Task and 8 days of experience sampling method. Measures of negative affect, heart rate (HR), HR variability, and skin conductance level were collected. Findings show no strong associations between laboratory and daily life measures with the exception of laboratory affective recovery and daily life reactivity. Findings and their implications are discussed.
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Affiliation(s)
| | - Thomas Vaessen
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium.,Faculty of Behavioural, Management and Social Sciences, Psychology, Health & Technology, University of Twenty, Enschede, The Netherlands.,Department of Neurosciences, Mind Body Research, KU Leuven, Leuven, Belgium
| | - Ginette Lafit
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium.,Research Group of Quantitative Psychology and Individual Differences, Faculty of Psychology, KU Leuven, Leuven, Belgium
| | - Stephan Claes
- Department of Neurosciences, Mind Body Research, KU Leuven, Leuven, Belgium
| | - Inez Myin-Germeys
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
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11
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Lachowicz AM, Vaessen T, van Aubel E, Butjosa A, Reininghaus U, Myin-Germeys I, Bartels-Velthuis AA, Bruggeman R, Cahn W, de Haan L, Schirmbeck F, Simons CJ, van Os J. Effect of stressful life events on subclinical psychotic symptoms in first-degree relatives and healthy controls. Schizophr Res 2022; 250:92-99. [PMID: 36372001 DOI: 10.1016/j.schres.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 09/07/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022]
Abstract
Exposure to Stressful Life Events (SLEs) has been linked to psychosis. However, the combined effect of SLEs and familial risk on subclinical psychotic symptoms over time remains unknown. The objective of the present study was to investigate the effect of SLEs on the level of subclinical psychotic symptoms in individuals with and without familial vulnerability for psychosis. Data were collected from siblings of individuals diagnosed with psychotic disorder and healthy controls at baseline (N = 293) and three years later at follow-up (N = 928). We assessed self-reported and observer-rated subclinical positive, negative, and depressive psychotic symptoms. Participants reported the number of SLEs in the preceding 6 months. A multilevel multivariate regression analysis revealed a positive association between the retrospectively assessed number of SLEs and symptom levels, regardless of vulnerability status (p < .001 for all outcomes). The prospective analysis demonstrated that exposure to SLEs at baseline predicted higher levels of subclinical psychotic symptoms at follow-up. However, after controlling for the level of symptoms at baseline, these associations were no longer significant. Again, the vulnerability status did not modify these results. Nevertheless, siblings in our sample were approximating the end of the critical period for the development of psychotic disorder (mean age at baseline M = 29 and follow-up M = 34). The findings partly support the vulnerability-stress model of psychosis, yet do not confirm the role of familial risk in this association. SLEs may represent a risk factor for psychosis at a population level, thus supporting the continuity of the psychosis spectrum in terms of associated risk factors.
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Affiliation(s)
- Aleksandra M Lachowicz
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium.
| | - Thomas Vaessen
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Evelyne van Aubel
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Anna Butjosa
- Unitat de docència, recerca i innovació, Institut de Recerca Sant Joan de Déu, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Hospital Infanto-Juvenil Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; ESRC Centre for Society and Mental Health and Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
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12
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Weermeijer J, Lafit G, Kiekens G, Wampers M, Eisele G, Kasanova Z, Vaessen T, Kuppens P, Myin-Germeys I. Applying multiverse analysis to experience sampling data: Investigating whether preprocessing choices affect robustness of conclusions. Behav Res Methods 2022; 54:2981-2992. [PMID: 35141840 DOI: 10.3758/s13428-021-01777-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 12/24/2022]
Abstract
The experience sampling method (ESM) has revolutionized our ability to conduct psychological research in the natural environment. However, researchers have a large degree of freedom when preprocessing ESM data, which may hinder scientific progress. This study illustrates the use of multiverse analyses regarding preprocessing choices related to data exclusion (i.e., based on various levels of compliance and exclusion of the first assessment day) and the calculation of constructs (i.e., composite scores calculated as the mean, median, or mode) by reanalyzing established group differences in negative affect, stress reactivity, and emotional inertia between individuals with and without psychosis. Data came from five studies and included 233 individuals with psychosis and 223 healthy individuals (in total, 26,892 longitudinal assessments). Preprocessing choices related to data exclusion did not affect conclusions. For both stress reactivity and emotional inertia of negative affect, group differences were affected when negative affect was calculated as the mean compared to the median or mode. Further analyses revealed that this could be attributed to considerable differences in the within- and between-factor structure of negative affect. While these findings show that observed differences in affective processes between individuals with and without psychosis are robust to preprocessing choices related to data exclusion, we found disagreement in conclusions between different central tendency measures. Safeguarding the validity of future experience sampling research, scholars are advised to use multiverse analysis to evaluate the robustness of their conclusions across different preprocessing scenarios.
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Affiliation(s)
- Jeroen Weermeijer
- Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Herestraat 49 bus 1029, 3000, Leuven, Belgium.
| | - Ginette Lafit
- Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Herestraat 49 bus 1029, 3000, Leuven, Belgium
- Quantitative Psychology and Individual Differences, Department of Psychology and Education Sciences, KU Leuven, Leuven, Belgium
| | - Glenn Kiekens
- Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Herestraat 49 bus 1029, 3000, Leuven, Belgium
- Research Group of Clinical Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Martien Wampers
- Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Herestraat 49 bus 1029, 3000, Leuven, Belgium
| | - Gudrun Eisele
- Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Herestraat 49 bus 1029, 3000, Leuven, Belgium
| | - Zuzana Kasanova
- Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Herestraat 49 bus 1029, 3000, Leuven, Belgium
| | - Thomas Vaessen
- Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Herestraat 49 bus 1029, 3000, Leuven, Belgium
| | - Peter Kuppens
- Quantitative Psychology and Individual Differences, Department of Psychology and Education Sciences, KU Leuven, Leuven, Belgium
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Herestraat 49 bus 1029, 3000, Leuven, Belgium
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13
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Ader L, Schick A, Simons C, Delespaul P, Myin-Germeys I, Vaessen T, Reininghaus U. Positive Affective Recovery in Daily Life as a Momentary Mechanism Across Subclinical and Clinical Stages of Mental Disorder: Experience Sampling Study. JMIR Ment Health 2022; 9:e37394. [PMID: 36416883 PMCID: PMC9730210 DOI: 10.2196/37394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Identifying momentary risk and protective mechanisms may enhance our understanding and treatment of mental disorders. Affective stress reactivity is one mechanism that has been reported to be altered in individuals with early and later stages of mental disorder. Additionally, initial evidence suggests individuals with early and enduring psychosis may have an extended recovery period of negative affect in response to daily stressors (ie, a longer duration until affect reaches baseline levels after stress), but evidence on positive affective recovery as a putative protective mechanism remains limited. OBJECTIVE This study aimed to investigate trajectories of positive affect in response to stress across the continuum of mental disorder in a transdiagnostic sample. METHODS Using the Experience Sampling Method, minor activity-, event-, and overall stress and positive affect were assessed 10 times a day, with time points approximately 90 minutes apart on six consecutive days in a pooled data set including 367 individuals with a mental disorder, 217 individuals at risk for a severe mental disorder, and 227 controls. Multilevel analysis and linear contrasts were used to investigate trajectories of positive affect within and between groups. RESULTS Baseline positive affect differed across groups, and we observed stress reactivity in positive affect within each group. We found evidence for positive affective recovery after reporting activity- or overall stress within each group. While controls recovered to baseline positive affect about 90 minutes after stress, patients and at-risk individuals required about 180 minutes to recover. However, between-group differences in the affective recovery period fell short of significance (all P>.05). CONCLUSIONS The results provide first evidence that positive affective recovery may be relevant within transdiagnostic subclinical and clinical stages of mental disorder, suggesting that it may be a potential target for mobile health interventions fostering resilience in daily life.
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Affiliation(s)
- Leonie Ader
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Anita Schick
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Claudia Simons
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.,GGzE Institute for Mental Health Care, Eindhoven, Netherlands
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.,Department of Adult Psychiatry, Mondriaan Mental Health Trust, Heerlen, Netherlands
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium
| | - Thomas Vaessen
- Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium.,Faculty of Behavioural, Management and Social Sciences, Psychology, Health & Technology, University of Twente, Enschede, Netherlands
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,ESRC Centre for Society and Mental Health, King's College London, London, United Kingdom.,Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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14
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Myin-Germeys I, van Aubel E, Vaessen T, Steinhart H, Klippel A, Lafit G, Viechtbauer W, Batink T, van Winkel R, van der Gaag M, van Amelsvoort T, Marcelis M, Schirmbeck F, de Haan L, Reininghaus U. Efficacy of Acceptance and Commitment Therapy in Daily Life in Early Psychosis: Results from the Multi-Center INTERACT Randomized Controlled Trial. Psychother Psychosom 2022; 91:411-423. [PMID: 35306502 DOI: 10.1159/000522274] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/22/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION/OBJECTIVE This study aimed to investigate efficacy of Acceptance and Commitment Therapy in Daily Life (ACT-DL), combining face-to-face therapy with an Ecological Momentary Intervention (EMI), in addition to treatment as usual (TAU) for psychotic distress, in comparison to TAU. METHODS Individuals aged 15-65 years with clinically established ultra-high risk or first episode of psychosis were randomly assigned to TAU or ACT-DL+TAU. ACT-DL+TAU consisted of 8 ACT-sessions augmented with an EMI-app. The primary outcome was psychotic distress assessed with the Comprehensive Assessment scale of At Risk Mental State (CAARMS) at post-intervention and 6- and 12-month follow-up. Secondary outcomes were functioning, symptom severity, and momentary psychotic distress. We performed multivariate mixed models according to intent-to-treat principles. RESULTS Between June 1, 2015 and December 31, 2018, 668 participants were referred, of whom 148 were randomized to ACT-DL+TAU (n = 71) or TAU (n = 77). One hundred and fifteen (78%) provided primary outcome data at least at one follow-up assessment. There was no evidence of greater reduction in the primary outcome measure CAARMS distress in ACT-DL+TAU compared to TAU (χ2(3) = 2.36; p = 0.50). However, out of the tested secondary outcomes, global functioning (χ2(3) = 9.05; p = 0.033), and negative symptoms (χ2(3) = 19.91; p<0.001) improved in ACT-DL+TAU compared to TAU, as did momentary psychotic distress (χ2(3) = 21.56; p < 0.001). CONCLUSIONS INTERACT did not support a significant effect of ACT-DL over TAU on the primary outcome measure of psychotic distress as assessed with the CAARMS. Although significant improvements were found for some secondary outcome measures, further replication studies are needed to confirm the strength and specificity of these effects.
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Affiliation(s)
- Inez Myin-Germeys
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Evelyne van Aubel
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Thomas Vaessen
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Henrietta Steinhart
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Annelie Klippel
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Faculty of Psychology, Open University, Heerlen, The Netherlands
| | - Ginette Lafit
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium.,Faculty of Psychology and Educational Sciences, Research Group of Quantitative Psychology and Individual Differences, KU Leuven, Leuven, Belgium
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Tim Batink
- Faculty of Psychology, Open University, Heerlen, The Netherlands
| | - Ruud van Winkel
- Department of Neurosciences, Psychiatry Research Group, Center for Clinical Psychiatry, KU Leuven, Leuven, Belgium
| | - Mark van der Gaag
- Department of Clinical Psychology, VU Amsterdam, Amsterdam, The Netherlands
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Machteld Marcelis
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, The Netherlands
| | - Frederike Schirmbeck
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,ESRC Centre for Society and Mental Health and Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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15
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Klippel A, Schick A, Myin-Germeys I, Rauschenberg C, Vaessen T, Reininghaus U. Modelling the temporal interplay between stress and affective disturbances in pathways to psychosis: an experience sampling study. Psychol Med 2022; 52:2776-2785. [PMID: 33678198 PMCID: PMC9647515 DOI: 10.1017/s0033291720004894] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 11/19/2020] [Accepted: 02/12/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND One putative psychological mechanism through which momentary stress impacts on psychosis in individuals with increased liability to the disorder is via affective disturbance. However, to date, this has not been systematically tested. We aimed to investigate whether (i) cross-sectional and temporal effects of momentary stress on psychotic experiences via affective disturbance, and (ii) the reverse pathway of psychotic experiences on stress via affective disturbance were modified by familial liability to psychosis. METHODS The Experience Sampling Method was used in a pooled data set of six studies with three groups of 245 individuals with psychotic disorder, 165 unaffected first-degree relatives, and 244 healthy control individuals to index familial liability. Multilevel moderated mediation models were fitted to investigate indirect effects across groups cross-sectionally and multilevel cross-lagged panel models to investigate temporal effects in the proposed pathways across two measurement occasions. RESULTS Evidence on indirect effects from cross-sectional models indicated that, in all three groups, effects of stress on psychotic experiences were mediated by negative affect and, vice versa, effects of psychotic experiences on stress were mediated by negative affect, with all indirect effects being weakest in relatives. Longitudinal modelling of data provided no evidence of temporal priority of stress in exerting its indirect effects on psychotic experiences via affective disturbance or, vice versa. CONCLUSIONS Our findings tentatively suggest a rapid vicious cycle of stress impacting psychotic experiences via affective disturbances, which does, however, not seem to be consistently modified by familial liability to psychosis.
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Affiliation(s)
- Annelie Klippel
- Department of Neurosciences, Center for Contextual Psychiatry (CCP), KU Leuven, Leuven, Belgium
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Lifespan Psychology & Department of Methods and Statistics, Faculty of Psychology and Educational Sciences, Open University, The Netherlands
| | - Anita Schick
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Inez Myin-Germeys
- Department of Neurosciences, Center for Contextual Psychiatry (CCP), KU Leuven, Leuven, Belgium
| | - Christian Rauschenberg
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Thomas Vaessen
- Department of Neurosciences, Center for Contextual Psychiatry (CCP), KU Leuven, Leuven, Belgium
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- Health Service and Population Research Department, Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
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16
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Yang H, Yu H, Sridhar K, Vaessen T, Myin-Germeys I, Sano A. More to Less (M2L): Enhanced Health Recognition in the Wild with Reduced Modality of Wearable Sensors. Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:3253-3256. [PMID: 36086549 DOI: 10.1109/embc48229.2022.9871472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Accurately recognizing health-related conditions from wearable data is crucial for improved healthcare outcomes. To improve the recognition accuracy, various approaches have focused on how to effectively fuse information from multiple sensors. Fusing multiple sensors is a common choice in many applications, but may not always be feasible in real-world scenarios. For example, although combining biosignals from multiple sensors (i.e., a chest pad sensor and a wrist wearable sensor) has been proved effective for improved performance, wearing multiple devices might be impractical in the free-living context. To solve the challenges, we propose an effective more to less (M2L) learning framework to improve testing performance with reduced sensors through leveraging the complementary information of multiple modalities during training. More specifically, different sensors may carry different but complementary information, and our model is designed to enforce collaborations among different modalities, where positive knowledge transfer is encouraged and negative knowledge transfer is suppressed, so that better representation is learned for individual modalities. Our experimental results show that our framework achieves comparable performance when compared with the full modalities. Our code and results will be available at https://github.com/comp-well-org/More2Less.git.
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17
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Vanderheijden C, Vaessen T, Yakkioui Y, Riedl R, Temel Y, Hovinga K, Hoogland G. LIM and SH3 protein 1 (LASP1) differentiates malignant chordomas from less malignant chondrosarcomas. J Neurooncol 2022; 158:81-88. [PMID: 35507100 PMCID: PMC9166821 DOI: 10.1007/s11060-022-04012-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/06/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Chordomas are malignant tumors that develop along the neuraxis between skull-base and sacrum. Chondrosarcomas show similarities with chordomas, yet show less malignant behavior. LIM and SH3 protein 1 (LASP1) is a cytoskeletal protein known to promote the malignant behavior of tumors. LASP1 was previously identified as a possibly overexpressed protein in a chordoma proteomics experiment. In this study we compare LASP1 expression in chordoma and chondrosarcoma tissue. METHODS Biopsies of primary tumors were collected from surgically treated chordoma (n = 6) and chondrosarcoma (n = 6) patients, flash-frozen upon collection and collectively analyzed for LASP1 RNA (real-time PCR) and protein expression (western blotting). Additionally, tissue micro array (TMA)-based immunohistochemistry was applied to an archive of 31 chordoma and 1 chondrosarcoma specimen. RESULTS In chordoma samples, LASP1 mRNA was detected in 4/6 cases and a strong 36 kDa immunoreactive protein band was observed in 4/5 cases. In contrast, 0/6 chondrosarcoma samples showed detectable levels of LASP1 mRNA and only a weak 36 kDa band was observed in 4/5 cases. Immunohistochemical analysis showed LASP1 expression in all chordoma samples, whereas chondrosarcoma specimen did not show immunoreactivity. CONCLUSION LASP1 is strongly expressed in the majority of chordoma cases and shows low expression in chondrosarcoma tissue. Since LASP1 is known to function as oncogene and regulate cell proliferation in other tumor types, this study implicates a role for LASP1 in chordoma biology. Further studies are warranted to improve understanding of LASP1's expression and functioning within chordoma, both in vitro and in vivo.
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Affiliation(s)
- Cas Vanderheijden
- Department of Neurosurgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Thomas Vaessen
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Youssef Yakkioui
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Neurosurgery, Noordwest Hospital, Alkmaar, The Netherlands
| | - Robert Riedl
- Department of Pathology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Yasin Temel
- Department of Neurosurgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Koos Hovinga
- Department of Neurosurgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Govert Hoogland
- Department of Neurosurgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
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18
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Schiweck C, Gholamrezaei A, Hellyn M, Vaessen T, Vrieze E, Claes S. Exhausted Heart Rate Responses to Repeated Psychological Stress in Women With Major Depressive Disorder. Front Psychiatry 2022; 13:869608. [PMID: 35509881 PMCID: PMC9058080 DOI: 10.3389/fpsyt.2022.869608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/04/2022] [Accepted: 03/29/2022] [Indexed: 12/25/2022] Open
Abstract
Past research links depression and blunted cardiac vagal reactivity to chronic stress. Yet, to our knowledge no experiment investigates heart rate (variability) responses to a repeated laboratory stressor in patients with depression. Repeated exposure may provide valuable information on stress reactivity in depression. Fifty-nine women (30 inpatients diagnosed with depression and 29 matched controls) underwent two consecutive runs of a mental arithmetic stress paradigm consisting of one baseline and two exposures to control, stress, and recovery phases of 5 min each, in a case-control design. Subjective stress and electrocardiography were recorded. Variance of heart rate (HR) and root mean square of successive RR interval differences (RMSSD) were analyzed using linear mixed models. Overall, physiological parameters (HR and RMSSD) and subjective stress showed a strong group effect (all p < 0.001). In both groups, subjective stress and HR increased in response to stress, but the subjective stress levels of patients with depression did not return to baseline levels after the first stressor and for the remainder of the experiment (all p < 0.004 compared to baseline). Patients' HR reactivity responded oppositely: while HR recovered after the first stress exposure, no reactivity was observed in response to the second exposure. These findings may suggest that the often-reported blunted HR/HRV response to stressors results from exhaustion rather than an incapacity to react to stress. The altered HR reactivity could indicate allostatic (over-) load in depression.
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Affiliation(s)
- Carmen Schiweck
- Department for Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany.,Psychiatry Research Group, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Ali Gholamrezaei
- Faculty of Medicine and Health, Pain Management Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - Maxim Hellyn
- Department for Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany
| | - Thomas Vaessen
- Psychiatry Research Group, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Elske Vrieze
- Psychiatry Research Group, Department of Neurosciences, KU Leuven, Leuven, Belgium.,University Psychiatric Centre, KU Leuven, Leuven, Belgium
| | - Stephan Claes
- Psychiatry Research Group, Department of Neurosciences, KU Leuven, Leuven, Belgium.,University Psychiatric Centre, KU Leuven, Leuven, Belgium
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19
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Kirtley OJ, Lafit G, Vaessen T, Decoster J, Derom C, Gülöksüz S, De Hert M, Jacobs N, Menne-Lothmann C, Rutten BPF, Thiery E, van Os J, van Winkel R, Wichers M, Myin-Germeys I. The relationship between daily positive future thinking and past-week suicidal ideation in youth: An experience sampling study. Front Psychiatry 2022; 13:915007. [PMID: 36245862 PMCID: PMC9556869 DOI: 10.3389/fpsyt.2022.915007] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 04/07/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Reduced positive future thinking has been associated with suicidal ideation and behavior in adults, and appears to be exacerbated by negative affect. Yet, this has received little attention in youth. Prior research has also focused on longer-term future thinking, e.g., months and years, and relied on lab-based assessments. Using the experience sampling method (ESM), we investigated whether short-term future thinking in daily life was associated with suicidal ideation in youth and explored the role of affect in the future thinking-suicidal ideation relationship. A community sample of N = 722 adolescent twins and their non-twin siblings completed ESM as part of the TwinssCan study (n = 55 with, and n = 667 without, past-week suicidal ideation). Participants completed self-report questionnaires, including on past-week suicidal ideation as part of the SCL-90. Subsequently, daily future thinking was assessed each morning for six days with ESM. To investigate the relationship between daily positive future thinking and past-week suicidal ideation, we estimated a mixed-effects linear regression model with a random intercept for participant, including age and sex as covariates. The relationship between daily positive future thinking, past-week suicidal ideation, and average positive and negative affect from the previous day was investigated by estimating two separate mixed-effects linear regression models (one for negative affect, one for positive affect), with a random intercept for participant, and random slopes for average positive and negative affect. Our results showed that participants reporting higher past-week suicidal ideation also reported significantly less daily positive future thinking during the ESM period, and this association remained significant when controlling for previous-day average positive and negative affect. Higher average positive affect from the previous day was significantly associated with higher positive future thinking. Although average negative affect from the previous day was associated with lower positive future thinking, this association was not statistically significant. Our findings indicate that short-term future thinking relates to suicidal ideation among a non-clinical sample of adolescents. Future research should investigate the directionality of the future thinking-suicidal ideation relationship, in order to investigate whether impaired future thinking may be an early warning signal for escalating suicidal ideation in youth.
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Affiliation(s)
- Olivia J Kirtley
- Department of Neurosciences, Center for Contextual Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Brain Institute, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Child and Youth Institute, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ginette Lafit
- Department of Neurosciences, Center for Contextual Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium.,Research Group of Quantitative Psychology and Individual Differences, Faculty of Psychology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Thomas Vaessen
- Department of Neurosciences, Center for Contextual Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Psychology, Health, and Technology, Center for eHealth and Well-being Research, University of Twente, Enschede, Netherlands
| | | | - Catherine Derom
- Department of Human Genetics, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - Sinan Gülöksüz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Marc De Hert
- Leuven Brain Institute, Katholieke Universiteit Leuven, Leuven, Belgium.,University Psychiatric Centre, Katholieke Universiteit Leuven, Kortenberg, Belgium.,Department of Neurosciences, Centre for Clinical Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium.,Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
| | - Nele Jacobs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health and Teaching Network, EURON, Maastricht University, Maastricht, Netherlands.,Faculty of Psychology, Open University of the Netherlands, Heerlen, Netherlands
| | - Claudia Menne-Lothmann
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health and Teaching Network, EURON, Maastricht University, Maastricht, Netherlands
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
| | - Evert Thiery
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health and Teaching Network, EURON, Maastricht University, Maastricht, Netherlands.,Brain Center Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
| | - Ruud van Winkel
- University Psychiatric Centre, Katholieke Universiteit Leuven, Kortenberg, Belgium.,Department of Neurosciences, Centre for Clinical Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Marieke Wichers
- Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Inez Myin-Germeys
- Department of Neurosciences, Center for Contextual Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Brain Institute, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Child and Youth Institute, Katholieke Universiteit Leuven, Leuven, Belgium
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20
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Vaessen T, Rintala A, Otsabryk N, Viechtbauer W, Wampers M, Claes S, Myin-Germeys I. The association between self-reported stress and cardiovascular measures in daily life: A systematic review. PLoS One 2021; 16:e0259557. [PMID: 34797835 PMCID: PMC8604333 DOI: 10.1371/journal.pone.0259557] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 10/21/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Stress plays an important role in the development of mental illness, and an increasing number of studies is trying to detect moments of perceived stress in everyday life based on physiological data gathered using ambulatory devices. However, based on laboratory studies, there is only modest evidence for a relationship between self-reported stress and physiological ambulatory measures. This descriptive systematic review evaluates the evidence for studies investigating an association between self-reported stress and physiological measures under daily life conditions. METHODS Three databases were searched for articles assessing an association between self-reported stress and cardiovascular and skin conductance measures simultaneously over the course of at least a day. RESULTS We reviewed findings of 36 studies investigating an association between self-reported stress and cardiovascular measures with overall 135 analyses of associations between self-reported stress and cardiovascular measures. Overall, 35% of all analyses showed a significant or marginally significant association in the expected direction. The most consistent results were found for perceived stress, high-arousal negative affect scales, and event-related self-reported stress measures, and for frequency-domain heart rate variability physiological measures. There was much heterogeneity in measures and methods. CONCLUSION These findings confirm that daily-life stress-dynamics are complex and require a better understanding. Choices in design and measurement seem to play a role. We provide some guidance for future studies.
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Affiliation(s)
- Thomas Vaessen
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Center for Mind-Body Research, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Aki Rintala
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Faculty of Social Services and Health Care, LAB University of Applied Sciences, Lahti, Finland
| | - Natalya Otsabryk
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Wolfgang Viechtbauer
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Martien Wampers
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
- University Psychiatric Center KU Leuven, KU Leuven-University of Leuven, Leuven, Belgium
| | - Stephan Claes
- Center for Mind-Body Research, Department of Neurosciences, KU Leuven, Leuven, Belgium
- University Psychiatric Center KU Leuven, KU Leuven-University of Leuven, Leuven, Belgium
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
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21
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Reininghaus U, Klippel A, Steinhart H, Vaessen T, van Nierop M, Viechtbauer W, Batink T, Kasanova Z, van Aubel E, van Winkel R, Marcelis M, van Amelsvoort T, van der Gaag M, de Haan L, Myin-Germeys I. Correction to: Efficacy of Acceptance and Commitment Therapy in Daily Life (ACT-DL) in early psychosis: study protocol for a multi-centre randomized controlled trial. Trials 2021; 22:538. [PMID: 34399823 PMCID: PMC8369606 DOI: 10.1186/s13063-021-05513-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany. .,Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands. .,ESRC Centre for Society and Mental Health and Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Annelie Klippel
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Henrietta Steinhart
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Thomas Vaessen
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Martine van Nierop
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Tim Batink
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Zuzana Kasanova
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Evelyne van Aubel
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Ruud van Winkel
- Universitair Psychiatrisch Centrum KU Leuven, Kortenberg, Belgium
| | - Machteld Marcelis
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Therese van Amelsvoort
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology, VU Amsterdam, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, University of Amstderdam, Amsterdam, The Netherlands
| | - Inez Myin-Germeys
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
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22
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De Calheiros Velozo J, Vaessen T, Pruessner J, Van Diest I, Claes S, Myin-Germeys I. The repeated Montreal Imaging Stress Test (rMIST): Testing habituation, sensitization, and anticipation effects to repeated stress induction. Psychoneuroendocrinology 2021; 128:105217. [PMID: 33882371 DOI: 10.1016/j.psyneuen.2021.105217] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/22/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND A psychosocial task that can induce comparable levels of stress repeatedly is fundamental to effectively study changes in stress reactivity over time or as a result of an intervention. However, existing tasks have struggled to provide consistent stress responses across repeated trials. AIM The goal was to assess the efficacy of two different designs of the repeated Montreal Imaging Stress Test (rMIST) in reproducing the same pattern of reactivity over two separate sessions. METHODS In two different studies, stress was induced using the rMIST on two separate sessions, one week apart. Each study used a different task design. In the first study (53 participants [45 women]; mean age=24.16 [SD=3.29]), the rMIST consisted of a single-longer stress exposure, while the second study (30 participants [27 women]; mean age=21.81 [SD=2.09]) consisted of several shorter stress exposures per session. Self-reported (i.e perceived stress [PS] and negative affect [NA]), physiological (i.e heart rate [HR], root mean square of successive differences [RMSSD]) and hormonal (i.e. salivary cortisol) measures of stress were used. RESULTS Stress reactivity was comparable across the two repeated stress sessions in both studies. However, baseline HR in the second session increased relative to the first session in the first study, and there was no cortisol response. Additionally, there was a decrease in HR and HRV reactivity within the session on the second study, suggesting a habituation effect not between but within the session itself. CONCLUSION The rMIST overcomes some of the challenges associated with repeated stress induction. However, an anticipation effect and a lack of cortisol response indicate that further adjustments to the task are necessary. Finally, task design is important for repeated stress reactivity.
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Affiliation(s)
- Joana De Calheiros Velozo
- Department of Neurosciences, Research group Psychiatry, Center for Contextual Psychiatry, KU Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium.
| | - Thomas Vaessen
- Department of Neurosciences, Research group Psychiatry, Center for Contextual Psychiatry, KU Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium; Department of Neurosciences, Research group Psychiatry, Mind Body Research, KU Leuven, UZ Herestraat 49, 3000 Leuven, Belgium
| | - Jens Pruessner
- Faculty of Medicine, McGill Centre for Studies in Aging & Douglas Institute, McGill University, 6825 Boulevard LaSalle, Verdun, Montreal, QC, Canada; Department of Psychology, University of Konstanz, Universitaetsstrasse 10, 78464 Konstanz, Germany
| | - Ilse Van Diest
- Department of Psychology and Educational Sciences, Health Psychology Research group, KU Leuven, Tiensestraat 102, 3000 Leuven, Belgium
| | - Stephan Claes
- Department of Neurosciences, Research group Psychiatry, Mind Body Research, KU Leuven, UZ Herestraat 49, 3000 Leuven, Belgium
| | - Inez Myin-Germeys
- Department of Neurosciences, Research group Psychiatry, Center for Contextual Psychiatry, KU Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium
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23
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Leenaerts N, Vaessen T, Ceccarini J, Vrieze E. How COVID-19 lockdown measures could impact patients with bulimia nervosa: Exploratory results from an ongoing experience sampling method study. Eur Psychiatry 2021. [PMCID: PMC9528430 DOI: 10.1192/j.eurpsy.2021.750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionPreliminary results indicate that COVID-19 lockdown measures could lead to an increase in eating disorder pathology. However, some patients could be more vulnerable to experience such an increase than others. The reason why some patients are more susceptible to the impact of lockdown measures is still not known.ObjectivesTo analyze the impact of the Belgian COVID-19 lockdown measures on the surroundings, social context, negative affect (NA), positive affect (PA) and binge eating frequency of patients with bulimia nervosa (BN).Methods
The data of 15 female patients with BN from an ongoing experience sampling method study were analyzed. Mixed effects models compared surroundings, social context, NA, PA and binge eating before and after the implementation of the lockdown measures.Results
After the implementation of the lockdown measures, significant changes in surroundings and social context were found as well as an increase in NA (p < 0.001) and decrease in PA (p = 0.015). Patients who experienced an increase in binge eating frequency also experienced a stronger increase in NA (p = 0.012) and decrease in PA (p = 0.026) after the lockdown measures were implemented.ConclusionsFuture research should also look at changes in surroundings, social context, affect and how these interact with factors such as personality traits and coping styles when investigating why some patients are more susceptible to the negative effects of lockdown measures than others.
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24
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Leenaerts N, Vaessen T, Ceccarini J, Vrieze E. How COVID-19 lockdown measures could impact patients with bulimia nervosa: Exploratory results from an ongoing experience sampling method study. Eat Behav 2021; 41:101505. [PMID: 33831813 PMCID: PMC9759935 DOI: 10.1016/j.eatbeh.2021.101505] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 03/04/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The impact of COVID-19 lockdown measures on patients with an eating disorder remains unclear, but preliminary results indicate that some patients could be more vulnerable to experience an increase in eating disorder pathology than others. To provide possible directions for future research, this report explored the impact of the Belgian COVID-19 lockdown measures on patients with bulimia nervosa (BN). METHODS The data of 15 female patients with BN from an ongoing experience sampling method study were analyzed. Mixed effects models compared surroundings, social context, negative affect (NA), positive affect (PA) and binge eating before and after the implementation of the lockdown measures. RESULTS After the implementation of the lockdown measures, significant changes in surroundings and social context were found as well as an increase in NA and decrease in PA. Patients who experienced a higher binge eating frequency during the lockdown also experienced a stronger change in NA and PA. CONCLUSIONS Future research should also look at changes in surroundings, social context, affect and how these interact with factors such as personality traits and coping styles when investigating why some patients are more susceptible to the negative effects of lockdown measures than others.
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Affiliation(s)
| | - Thomas Vaessen
- Mind-body Research, Biomedical Sciences Group, KU Leuwven, Belgium,Center for Contextual Psychiatry, Biomedical Sciences Group, KU Leuven, Belgium
| | - Jenny Ceccarini
- Department of Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Belgium
| | - Elske Vrieze
- Mind-body Research, Biomedical Sciences Group, KU Leuwven, Belgium
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25
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Sinnaeve R, Vaessen T, van Diest I, Myin-Germeys I, van den Bosch LMC, Vrieze E, Kamphuis JH, Claes S. Investigating the stress-related fluctuations of level of personality functioning: A critical review and agenda for future research. Clin Psychol Psychother 2021; 28:1181-1193. [PMID: 33590556 DOI: 10.1002/cpp.2566] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 12/14/2022]
Abstract
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-11) proposed a dimensional approach to the assessment of personality disorders (PDs). Both models dictate that the clinician first determines PD severity before assessing maladaptive traits, invoking the level of personality functioning (LPF) construct. We consider LPF a promising dimensional construct for translational research because of its clinical importance and conceptual overlap with the Research Domain Criteria (RDoC) Social Processes. We aim to identify biomarkers that co-vary with fluctuations in LPF in adulthood, ultimately to predict persistent decrease in LPF, associated with suicidality and morbidity. However, a theoretical framework to investigate stress-related oscillations in LPF is currently missing. In this article, we aim to fill this hiatus with a critical review about stress and LPF. First, we discuss acute stress and LPF. We briefly present the basics of the neurophysiological stress response and review the literature on momentary and daily fluctuations in LPF, both at a subjective and physiological level. Second, we review the effects of chronic stress on brain function and social behaviour and recapitulate the main findings from prospective cohort studies. This review underlies our suggestions for multimethod assessment of stress-related oscillations in LPF and our theoretical framework for future longitudinal studies, in particular studies using the experience sampling method (ESM).
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Affiliation(s)
- Roland Sinnaeve
- University Psychiatric Center KU Leuven, Kortenberg, Belgium.,Department of Neurosciences, Mind Body Research, KU Leuven, Leuven, Belgium
| | - Thomas Vaessen
- Department of Neurosciences, Mind Body Research, KU Leuven, Leuven, Belgium.,Department of Neurosciences, Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Ilse van Diest
- Faculty of Psychology and Educational Sciences, Health Psychology Research Group, KU Leuven, Leuven, Belgium
| | - Inez Myin-Germeys
- Department of Neurosciences, Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | | | - Elske Vrieze
- University Psychiatric Center KU Leuven, Kortenberg, Belgium.,Department of Neurosciences, Mind Body Research, KU Leuven, Leuven, Belgium
| | - Jan Henk Kamphuis
- Faculty of Social and Behavioural Sciences, Programme group Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Stephan Claes
- University Psychiatric Center KU Leuven, Kortenberg, Belgium.,Department of Neurosciences, Mind Body Research, KU Leuven, Leuven, Belgium
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26
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Schneider M, Vaessen T, van Duin EDA, Kasanova Z, Viechtbauer W, Reininghaus U, Vingerhoets C, Booij J, Swillen A, Vorstman JAS, van Amelsvoort T, Myin-Germeys I. Affective and psychotic reactivity to daily-life stress in adults with 22q11DS: a study using the experience sampling method. J Neurodev Disord 2020; 12:30. [PMID: 33187471 PMCID: PMC7666493 DOI: 10.1186/s11689-020-09333-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 11/04/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND 22q11.2 deletion syndrome (22q11DS) is a genetic disorder associated with an increased risk of psychiatric disorders. Vulnerability for psychopathology has been related to an increased reactivity to stress. Here, we examined affective states, perceived stress, affective and psychotic reactivity to various sources of environmental stress using the experience sampling method (ESM), a structured diary technique allowing repeated assessments in the context of daily life. METHODS Adults with 22q11DS (n = 31; age, 34.1 years) and matched healthy controls (HCs; n = 24; age, 39.9 years) were included. ESM was used to assess affective states, perceived stress, and stress reactivity. Data were analyzed using multilevel regression models. RESULTS Adults with 22q11DS displayed overall higher levels of negative affect but comparable levels of positive affect compared to HCs. Higher levels of perceived stress were reported by individuals with 22q11DS. Comparable affective and psychotic reactivity in relation to all types of environmental stress was observed between the two groups. CONCLUSION The results point toward higher levels of negative affect and differences in the perception of daily hassles in 22q11DS but no difference in affective or psychotic reactivity to stress. This study contributes to the growing literature regarding the impact of stress on the development of psychopathology in the 22q11DS population.
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Affiliation(s)
- Maude Schneider
- Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, Boulevard du Pont d'Arve 40, 1205, Geneva, Switzerland. .,Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Kapucijnenvoer 33 Bus 7001 (Blok H), 3000, Leuven, Belgium.
| | - Thomas Vaessen
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Kapucijnenvoer 33 Bus 7001 (Blok H), 3000, Leuven, Belgium
| | - Esther D A van Duin
- Department of Psychiatry & Neuropsychology, Maastricht University, Minderbroedersberg 4-6, Maastricht, 6211 LK, The Netherlands.,Institute for Interdisciplinary Studies, University of Amsterdam, PO Box 94224, Science Park 904, Amsterdam, 1090 GE, The Netherlands
| | - Zuzana Kasanova
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Kapucijnenvoer 33 Bus 7001 (Blok H), 3000, Leuven, Belgium
| | - Wolfgang Viechtbauer
- Department of Psychiatry & Neuropsychology, Maastricht University, Minderbroedersberg 4-6, Maastricht, 6211 LK, The Netherlands
| | - Ulrich Reininghaus
- Department of Psychiatry & Neuropsychology, Maastricht University, Minderbroedersberg 4-6, Maastricht, 6211 LK, The Netherlands.,Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, David Goldberg Centre, King's College London, 18 De Crespigny Park, London, SE5 8AF, UK.,Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159, Mannheim, Germany
| | - Claudia Vingerhoets
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Jan Booij
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Ann Swillen
- Department of Human Genetics, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Center for Human Genetics, Hospital Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium
| | - Jacob A S Vorstman
- Department of Psychiatry, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Burton Wing, Toronto, Ontario, M5G 1X8, Canada.,Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, 686 Bay St., Toronto, Ontario, M5G 0A4, Canada
| | - Thérèse van Amelsvoort
- Department of Psychiatry & Neuropsychology, Maastricht University, Minderbroedersberg 4-6, Maastricht, 6211 LK, The Netherlands
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Kapucijnenvoer 33 Bus 7001 (Blok H), 3000, Leuven, Belgium
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27
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van Aubel E, Bakker JM, Batink T, Michielse S, Goossens L, Lange I, Schruers K, Lieverse R, Marcelis M, van Amelsvoort T, van Os J, Wichers M, Vaessen T, Reininghaus U, Myin-Germeys I. Blended care in the treatment of subthreshold symptoms of depression and psychosis in emerging adults: A randomised controlled trial of Acceptance and Commitment Therapy in Daily-Life (ACT-DL). Behav Res Ther 2020; 128:103592. [PMID: 32146218 DOI: 10.1016/j.brat.2020.103592] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 02/05/2020] [Accepted: 02/19/2020] [Indexed: 02/07/2023]
Abstract
In this study, the feasibility and efficacy of Acceptance and Commitment Therapy in Daily Life (ACT-DL), ACT augmented with a daily life application, was investigated in 55 emerging adults (age 16 to 25) with subthreshold depressive and/or psychotic complaints. Participants were randomized to ACT-DL (n = 27) or to active control (n = 28), with assessments completed at pre- and post-measurement and 6- and 12-months follow-up. It took up to five (ACT-DL) and 11 (control) months to start group-based interventions. Participants attended on average 4.32 out of 5 ACT-DL sessions. On the app, they filled in on average 69 (48%) of signal-contingent beep-questionnaires, agreed to 15 (41%) of offered beep-exercises, initiated 19 on-demand exercises, and rated ACT-DL metaphors moderately useful. Relative to active control, interviewer-rated depression scores decreased significantly in ACT-DL participants (p = .027). Decreases in self-reported depression, psychotic-related distress, anxiety, and general psychopathology did not differ between conditions. ACT-DL participants reported increased mean NA (p = .011), relative to active controls. Mean PA did not change in either group, nor did psychological flexibility. ACT-DL is a feasible intervention, although adaptations in future research may improve delivery of and compliance with the intervention. There were mixed findings for its efficacy in reducing subthreshold psychopathology in emerging adults. Dutch Trial Register no.: NTR3808.
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Affiliation(s)
- Evelyne van Aubel
- Department of Neurosciences, Center for Contextual Psychiatry (CCP), University of Leuven, Leuven, Belgium.
| | - Jindra Myrthe Bakker
- Department of Neurosciences, Center for Contextual Psychiatry (CCP), University of Leuven, Leuven, Belgium; Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Tim Batink
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands; U-Center, Epen, Netherlands.
| | - Stijn Michielse
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Liesbet Goossens
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Iris Lange
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Koen Schruers
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Health Psychology, Faculty of Psychology, University of Leuven, Leuven, Belgium.
| | - Ritsaert Lieverse
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Machteld Marcelis
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands; Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, the Netherlands.
| | - Thérèse van Amelsvoort
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Jim van Os
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Psychosis Studies, Institute of Psychiatry, King's College London, King's Health Partners, London, England, United Kingdom; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Marieke Wichers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry (UCP), Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), the Netherlands.
| | - Thomas Vaessen
- Department of Neurosciences, Center for Contextual Psychiatry (CCP), University of Leuven, Leuven, Belgium.
| | - Ulrich Reininghaus
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Public Mental Health, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany; Center for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Inez Myin-Germeys
- Department of Neurosciences, Center for Contextual Psychiatry (CCP), University of Leuven, Leuven, Belgium.
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28
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Reininghaus U, Klippel A, Steinhart H, Vaessen T, van Nierop M, Viechtbauer W, Batink T, Kasanova Z, van Aubel E, van Winkel R, Marcelis M, van Amelsvoort T, van der Gaag M, de Haan L, Myin-Germeys I. Efficacy of Acceptance and Commitment Therapy in Daily Life (ACT-DL) in early psychosis: study protocol for a multi-centre randomized controlled trial. Trials 2019; 20:769. [PMID: 31878966 PMCID: PMC6933690 DOI: 10.1186/s13063-019-3912-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 11/15/2019] [Indexed: 01/01/2023] Open
Abstract
Background Psychotic experiences, social functioning and general psychopathology are important targets for early intervention in individuals with Ultra-High-Risk state (UHR) and a first-episode psychosis (FEP). Acceptance and Commitment Therapy (ACT) is a promising, next-generation Cognitive Behavioural Therapy (CBT) that aims to modify these targets, but evidence on sustainable change and its underlying mechanisms in individuals’ daily lives remains limited. The aim of the INTERACT study is to investigate the efficacy of a novel ecological momentary intervention, Acceptance and Commitment Therapy in Daily Life (ACT-DL) in a multi-centre randomised controlled trial of individuals with UHR or FEP. Methods/design In a multi-centre randomised controlled trial, individuals aged 16–65 years with UHR or FEP will be randomly allocated to ACT-DL in addition to treatment as usual (TAU) as the experimental condition or a control condition of TAU only, which will include – for the entire study period – access to routine mental health care and, where applicable, CBT for psychosis (CBTp). Outcomes will be assessed at baseline (i.e. before randomisation), post-intervention (i.e. after the 8-week intervention period), and 6-month and 12-month follow-ups (i.e. 6 and 12 months after completing the intervention period) by blinded assessors. The primary outcome will be distress associated with psychotic experiences, while secondary outcomes will include (momentary) psychotic experiences, social functioning and psychopathology. Process measures to assess putative mechanisms of change will include psychological flexibility, stress sensitivity and reward experiences. In addition, acceptability, treatment adherence and treatment fidelity of ACT-DL will be assessed. Discussion The current study is the first to test the efficacy of ACT-DL in individuals with UHR and FEP. If this trial demonstrates the efficacy of ACT-DL, it has the potential to significantly advance the treatment of people with UHR and FEP and, more generally, provides initial support for implementing mHealth interventions in mental health services. Trial registration Netherlands Trial Register, ID: NTR4252. Registered on 26 September 2013.
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Affiliation(s)
- Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany. .,Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands. .,ESRC Centre for Society and Mental Health and Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Annelie Klippel
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Henrietta Steinhart
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Thomas Vaessen
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Martine van Nierop
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Tim Batink
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Zuzana Kasanova
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Evelyne van Aubel
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Ruud van Winkel
- Universitair Psychiatrisch Centrum KU Leuven, Kortenberg, Belgium
| | - Machteld Marcelis
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Therese van Amelsvoort
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology, VU Amsterdam, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, University of Amstderdam, Amsterdam, The Netherlands
| | - Inez Myin-Germeys
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
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29
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Vaessen T, Viechtbauer W, van der Steen Y, Gayer-Anderson C, Kempton MJ, Valmaggia L, McGuire P, Murray R, Garety P, Wykes T, Morgan C, Lataster T, Lataster J, Collip D, Hernaus D, Kasanova Z, Delespaul P, Oorschot M, Claes S, Reininghaus U, Myin-Germeys I. Recovery from daily-life stressors in early and chronic psychosis. Schizophr Res 2019; 213:32-39. [PMID: 30930036 DOI: 10.1016/j.schres.2019.03.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/10/2019] [Accepted: 03/13/2019] [Indexed: 01/17/2023]
Abstract
Initial affective and psychotic reactivity to daily stressors is altered in psychosis, and most notably in early psychosis. In addition to altered initial stress reactivity, results from studies using Experience Sampling Methodology (ESM) and psychophysiological measures indicate that impaired recovery from mild stressors may also be a risk factor for mental illness. The current ESM study investigated affective recovery from daily stressors in chronic psychosis patients (CP; n = 162), individuals at early stages of psychosis (EP; n = 127), and healthy volunteers (HV; n = 220) assessing fluctuations in negative affect (NA), tension, and suspiciousness ten times a day on six consecutive days. Recovery was operationalized for all three variables as the return to baseline (i.e., level at t-1) following the first stressful event of a day (i.e., t0). The EP group showed a delayed recovery of NA (t1-t3: B = 0.185; p = .007 and B = 0.228; p = .002) and suspiciousness (t1: B = 0.223; p = .010 and B = 0.291; p = .002) compared to HV and CP, respectively. Delayed recovery was detected for tension as well (t1-t2: EP > HV: B = 0.242; p = .040 and EP > CP: B = 0.284; p = .023), but contrary to both other momentary states, this effect disappeared when controlling for subsequent stressful events. There were no significant differences in recovery between HV and CP. These results suggest that in EP, stressful daily events have longer-lasting effects on overall negative affect and subclinical psychotic-like experiences. Future studies should incorporate physiological and endocrine measures in order to integrate recovery patterns of the different stress systems.
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Affiliation(s)
- Thomas Vaessen
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium; Department of Neurosciences, Mind-Body Research Group, KU Leuven, Leuven, Belgium.
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Yori van der Steen
- GGzE, Institute for Mental Health Care Eindhoven and De Kempen, Eindhoven, the Netherlands; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Charlotte Gayer-Anderson
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK
| | - Lucia Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College, London, UK
| | - Robin Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College, London, UK
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College, London, UK
| | - Til Wykes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College, London, UK
| | - Craig Morgan
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College, London, UK
| | - Tineke Lataster
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Johan Lataster
- Faculty of Psychology and Educational Sciences, Open University, Heerlen, the Netherlands; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Dina Collip
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Dennis Hernaus
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Zuzana Kasanova
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Margreet Oorschot
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Stephan Claes
- Department of Neurosciences, Mind-Body Research Group, KU Leuven, Leuven, Belgium
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany; Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK
| | - Inez Myin-Germeys
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
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30
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van Duin EDA, Vaessen T, Kasanova Z, Viechtbauer W, Reininghaus U, Saalbrink P, Vingerhoets C, Hernaus D, Booij J, Swillen A, Vorstman J, van Amelsvoort T, Myin-Germeys I. Lower cortisol levels and attenuated cortisol reactivity to daily-life stressors in adults with 22q11.2 deletion syndrome. Psychoneuroendocrinology 2019; 106:85-94. [PMID: 30959234 DOI: 10.1016/j.psyneuen.2019.03.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/25/2019] [Accepted: 03/21/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND 22q11.2 deletion syndrome (22q11DS) is a genetic disorder associated with neurodevelopmental, anxiety and mood disorders, as well as an increased risk for developing psychosis. Cortisol levels and stress reactivity reflect hypothalamic-pituitary-adrenal (HPA)-axis activity, and are believed to be altered in individuals that often experience daily-life stress, depression, and psychotic symptoms. However, it is unknown whether individuals with 22q11DS display an altered stress reactivity. METHODS We included 27 adults with 22q11DS (mean age: 34.1 years, 67% female) and 24 age and sex-matched healthy controls (HC; mean age: 39.9 years, 71% female) into an experience sampling study. Throughout 6 consecutive days, we measured participants' subjective stress related to current activity and at the same time collected salivary cortisol samples. Multilevel regression models were used to analyze cortisol reactivity to activity-related stress. RESULTS Diurnal cortisol levels were significantly lower in the 22q11DS group compared to HCs (B=-1.03, p < 0.001). 22q11DS adults displayed significantly attenuated cortisol reactivity to activity-related stress compared to HCs (B = -0.04, p = 0.026). Post-hoc exploratory analysis revealed that these results were independent from 22q11DS psychiatric diagnosis or medication use. CONCLUSION These results indicate that adults with 22q11DS have lower cortisol levels and attenuated cortisol response to daily stress, possibly resulting from an increased sensitization of the HPA-axis. This suggests that alterations in HPA-axis functioning, previously reported in several psychiatric disorders including post-traumatic stress disorder (PTSD), psychotic disorder, and mood disorder, also appear to be present in adults with 22q11DS.
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Affiliation(s)
- Esther D A van Duin
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands
| | - Thomas Vaessen
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium.
| | - Zuzana Kasanova
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Wolfgang Viechtbauer
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Ulrich Reininghaus
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, the Netherlands; Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Peter Saalbrink
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Claudia Vingerhoets
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands
| | - Dennis Hernaus
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Jan Booij
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands
| | - Ann Swillen
- Department of Human Genetics, KU Leuven - Leuven University, Leuven, Belgium; Center for Human Genetics, Hospital Gasthuisberg, Leuven, Belgium
| | - Jacob Vorstman
- Department of Psychiatry, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada; Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Thérèse van Amelsvoort
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
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Vaessen T, Steinhart H, Batink T, Klippel A, Van Nierop M, Reininghaus U, Myin-Germeys I. ACT in daily life in early psychosis: an ecological momentary intervention approach. Psychosis 2019. [DOI: 10.1080/17522439.2019.1578401] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- T. Vaessen
- KU Leuven, Department of Neuroscience, Center for Contextual Psychiatry, Leuven, Belgium
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, South Limburg Mental Health Research and Teaching Network, Maastricht, The Netherlands
| | - H. Steinhart
- KU Leuven, Department of Neuroscience, Center for Contextual Psychiatry, Leuven, Belgium
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, South Limburg Mental Health Research and Teaching Network, Maastricht, The Netherlands
| | - T. Batink
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, South Limburg Mental Health Research and Teaching Network, Maastricht, The Netherlands
- U-center, Epen, The Netherlands
| | - A. Klippel
- KU Leuven, Department of Neuroscience, Center for Contextual Psychiatry, Leuven, Belgium
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, South Limburg Mental Health Research and Teaching Network, Maastricht, The Netherlands
| | - M. Van Nierop
- KU Leuven, Department of Neuroscience, Center for Contextual Psychiatry, Leuven, Belgium
| | - U. Reininghaus
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, South Limburg Mental Health Research and Teaching Network, Maastricht, The Netherlands
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - I. Myin-Germeys
- KU Leuven, Department of Neuroscience, Center for Contextual Psychiatry, Leuven, Belgium
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Vaessen T, Kasanova Z, Hernaus D, Lataster J, Collip D, van Nierop M, Myin-Germeys I. Overall cortisol, diurnal slope, and stress reactivity in psychosis: An experience sampling approach. Psychoneuroendocrinology 2018; 96:61-68. [PMID: 29906787 DOI: 10.1016/j.psyneuen.2018.06.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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] [Received: 03/26/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Results from experimental studies suggest that psychosis and psychosis liability are associated with increased cortisol levels and blunted cortisol reactivity, and that use of antipsychotics may reduce these aberrations. Here, we report on overall cortisol, diurnal slope, and cortisol stress reactivity in everyday life in psychosis and psychosis liability using the experience sampling method (ESM). METHODS Our sample consisted of individuals diagnosed with psychotic disorder currently on (MPD; n = 53) or off antipsychotic medication (NMPD; n = 20), first-degree relatives of psychotic patients (REL; n = 47), and healthy volunteers (HV; n = 67). Saliva samples were collected throughout the day on six consecutive days and analyzed for cortisol levels. Simultaneously, stressfulness of the current activity was assessed with ESM questionnaires. RESULTS We found no group differences in overall cortisol level between groups, but REL had a steeper diurnal slope than HV; in MPD a trend was found in the same direction. Regarding reactivity to stressful activities, results indicated attenuation of the cortisol response in both patient groups compared to HV. CONCLUSION These results do not confirm reports of increased cortisol levels in psychosis, but provide evidence of stress-related cortisol alterations in everyday life.
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Affiliation(s)
- Thomas Vaessen
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Belgium; Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
| | - Zuzana Kasanova
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Belgium
| | - Dennis Hernaus
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Johan Lataster
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Faculty of Psychology and Educational Sciences, Open University, Heerlen, The Netherlands
| | - Dina Collip
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Martine van Nierop
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Belgium
| | - Inez Myin-Germeys
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Belgium
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Kasanova Z, Ceccarini J, Frank MJ, van Amelsvoort T, Booij J, van Duin E, Steinhart H, Vaessen T, Heinzel A, Mottaghy F, Myin-Germeys I. Intact striatal dopaminergic modulation of reward learning and daily-life reward-oriented behavior in first-degree relatives of individuals with psychotic disorder. Psychol Med 2018; 48:1909-1914. [PMID: 29233195 DOI: 10.1017/s0033291717003476] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 12/24/2022]
Abstract
BACKGROUND Abnormalities in reward learning in psychotic disorders have been proposed to be linked to dysregulated subcortical dopaminergic (DA) neurotransmission, which in turn is a suspected mechanism for predisposition to psychosis. We therefore explored the striatal dopaminergic modulation of reward processing and its behavioral correlates in individuals at familial risk for psychosis. METHODS We performed a DA D2/3 receptor [18F]fallypride positron emission tomography scan during a probabilistic reinforcement learning task in 16 healthy first-degree relatives of patients with psychosis and 16 healthy volunteers, followed by a 6-day ecological momentary assessment study capturing reward-oriented behavior in the everyday life. RESULTS We detected significant reward-induced DA release in bilateral caudate, putamen and ventral striatum of both groups, with no group differences in its magnitude nor spatial extent. In both groups alike, greater extent of reward-induced DA release in all regions of interest was associated with better performance in the task, as well as in greater tendency to be engaged in reward-oriented behavior in the daily life. CONCLUSIONS These findings suggest intact striatal dopaminergic modulation of reinforcement learning and reward-oriented behavior in individuals with familial predisposition to psychosis. Furthermore, this study points towards a key link between striatal reward-related DA release and pursuit of ecologically relevant rewards.
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Affiliation(s)
- Zuzana Kasanova
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven - Leuven University, Leuven, Belgium
| | - Jenny Ceccarini
- Division of Nuclear Medicine and Molecular Imaging, Department of Imaging & Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Michael J Frank
- Department of Cognitive, Linguistic and Psychological Sciences, Brown University, Providence, USA
| | - Thérèse van Amelsvoort
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Jan Booij
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Esther van Duin
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Henrietta Steinhart
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven - Leuven University, Leuven, Belgium
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Thomas Vaessen
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven - Leuven University, Leuven, Belgium
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Alexander Heinzel
- Department of Nuclear Medicine, University Hospital RWTH Aachen University, Aachen, Germany
| | - Felix Mottaghy
- Department of Nuclear Medicine, University Hospital RWTH Aachen University, Aachen, Germany
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven - Leuven University, Leuven, Belgium
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Myin-Germeys I, Kasanova Z, Vaessen T, Vachon H, Kirtley O, Viechtbauer W, Reininghaus U. Experience sampling methodology in mental health research: new insights and technical developments. World Psychiatry 2018; 17:123-132. [PMID: 29856567 PMCID: PMC5980621 DOI: 10.1002/wps.20513] [Citation(s) in RCA: 254] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In the mental health field, there is a growing awareness that the study of psychiatric symptoms in the context of everyday life, using experience sampling methodology (ESM), may provide a powerful and necessary addition to more conventional research approaches. ESM, a structured self-report diary technique, allows the investigation of experiences within, and in interaction with, the real-world context. This paper provides an overview of how zooming in on the micro-level of experience and behaviour using ESM adds new insights and additional perspectives to standard approaches. More specifically, it discusses how ESM: a) contributes to a deeper understanding of psychopathological phenomena, b) allows to capture variability over time, c) aids in identifying internal and situational determinants of variability in symptomatology, and d) enables a thorough investigation of the interaction between the person and his/her environment and of real-life social interactions. Next to improving assessment of psychopathology and its underlying mechanisms, ESM contributes to advancing and changing clinical practice by allowing a more fine-grained evaluation of treatment effects as well as by providing the opportunity for extending treatment beyond the clinical setting into real life with the development of ecological momentary interventions. Furthermore, this paper provides an overview of the technical details of setting up an ESM study in terms of design, questionnaire development and statistical approaches. Overall, although a number of considerations and challenges remain, ESM offers one of the best opportunities for personalized medicine in psychiatry, from both a research and a clinical perspective.
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Affiliation(s)
- Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Zuzana Kasanova
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Thomas Vaessen
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Hugo Vachon
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Olivia Kirtley
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Wolfgang Viechtbauer
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
- School for Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Ulrich Reininghaus
- School for Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Hwang B, You J, Vaessen T, Myin-Germeys I, Park C, Zhang BT. Deep ECGNet: An Optimal Deep Learning Framework for Monitoring Mental Stress Using Ultra Short-Term ECG Signals. Telemed J E Health 2018; 24:753-772. [PMID: 29420125 DOI: 10.1089/tmj.2017.0250] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Stress recognition using electrocardiogram (ECG) signals requires the intractable long-term heart rate variability (HRV) parameter extraction process. This study proposes a novel deep learning framework to recognize the stressful states, the Deep ECGNet, using ultra short-term raw ECG signals without any feature engineering methods. METHODS The Deep ECGNet was developed through various experiments and analysis of ECG waveforms. We proposed the optimal recurrent and convolutional neural networks architecture, and also the optimal convolution filter length (related to the P, Q, R, S, and T wave durations of ECG) and pooling length (related to the heart beat period) based on the optimization experiments and analysis on the waveform characteristics of ECG signals. The experiments were also conducted with conventional methods using HRV parameters and frequency features as a benchmark test. The data used in this study were obtained from Kwangwoon University in Korea (13 subjects, Case 1) and KU Leuven University in Belgium (9 subjects, Case 2). Experiments were designed according to various experimental protocols to elicit stressful conditions. RESULTS The proposed framework to recognize stress conditions, the Deep ECGNet, outperformed the conventional approaches with the highest accuracy of 87.39% for Case 1 and 73.96% for Case 2, respectively, that is, 16.22% and 10.98% improvements compared with those of the conventional HRV method. CONCLUSIONS We proposed an optimal deep learning architecture and its parameters for stress recognition, and the theoretical consideration on how to design the deep learning structure based on the periodic patterns of the raw ECG data. Experimental results in this study have proved that the proposed deep learning model, the Deep ECGNet, is an optimal structure to recognize the stress conditions using ultra short-term ECG data.
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Affiliation(s)
- Bosun Hwang
- 1 Department of Computer Science and Engineering, Seoul National University , Seoul, Korea
| | - Jiwoo You
- 2 Department of Computer Engineering, Kwangwoon University , Nowon-gu, Seoul, Korea
| | - Thomas Vaessen
- 3 KU Leuven, Department of Neurosciences, Center for Contextual Psychiatry , Leuven, Belgium
| | - Inez Myin-Germeys
- 3 KU Leuven, Department of Neurosciences, Center for Contextual Psychiatry , Leuven, Belgium
| | - Cheolsoo Park
- 2 Department of Computer Engineering, Kwangwoon University , Nowon-gu, Seoul, Korea
| | - Byoung-Tak Zhang
- 1 Department of Computer Science and Engineering, Seoul National University , Seoul, Korea
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Batink T, Bakker J, Vaessen T, Kasanova Z, Collip D, van Os J, Wichers M, Germeys I, Peeters F. Acceptance and Commitment Therapy in Daily Life Training: A Feasibility Study of an mHealth Intervention. JMIR Mhealth Uhealth 2016; 4:e103. [PMID: 27634747 PMCID: PMC5070582 DOI: 10.2196/mhealth.5437] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 04/10/2016] [Accepted: 05/30/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND With the development of mHealth, it is possible to treat patients in their natural environment. Mobile technology helps to bridge the gap between the therapist's office and the "real world." The ACT in Daily Life training (ACT-DL) was designed as an add-on intervention to help patients practice with acceptance and commitment therapy in their daily lives. The ACT-DL consists of two main components: daily monitoring using experience sampling and ACT training in daily life. OBJECTIVES To assess the acceptability and feasibility of the ACT-DL in a general outpatient population. A secondary objective was to conduct a preliminary examination of the effectiveness of the ACT-DL. METHODS An observational comparative study was conducted. The experimental group consisted of 49 patients who volunteered for ACT-DL, and the control group consisted of 112 patients who did not volunteer. As part of an inpatient treatment program, both groups received a 6-week ACT training. Participants went home to continue their treatment on an outpatient basis, during which time the experimental group received the 4-week add-on ACT-DL. Acceptability and feasibility of the ACT-DL was assessed weekly by telephone survey. Effectiveness of the ACT-DL was evaluated with several self-report questionnaires ( Flexibility Index Test (FIT-60): psychological flexibility, Brief Symptom Inventory: symptoms, Utrechtse Coping List: coping, and Quality of life visual analog scale (QoL-VAS): quality of life). RESULTS More than three-quarters of the participants (76%) completed the full 4-week training. User evaluations showed that ACT-DL stimulated the use of ACT in daily life: participants practiced over an hour a week (mean 78.8 minutes, standard deviation 54.4), doing 10.4 exercises (standard deviation 6.0) on average. Both ACT exercises and metaphors were experienced as useful components of the training (rated 5 out of 7). Repeated measures ANCOVA did not show significant effects of the ACT-DL on psychological flexibility (P=.88), symptoms (P=.39), avoidant coping (P=.28), or quality of life (P=.15). CONCLUSIONS This is the first study that uses experience sampling to foster awareness in daily life in combination with acceptance and commitment therapy to foster skill building. Adherence to the ACT-DL was high for an intensive mHealth intervention. ACT-DL appears to be an acceptable and feasible mHealth intervention, suitable for a broad range of mental health problems. However, short-term effectiveness could not be demonstrated. Additional clinical trials are needed to examine both short-term and long-term effects.
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Affiliation(s)
- Tim Batink
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht University, Maastricht, Netherlands.
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Kasanova Z, Hernaus D, Vaessen T, van Amelsvoort T, Winz O, Heinzel A, Pruessner J, Mottaghy FM, Collip D, Myin-Germeys I. Early-Life Stress Affects Stress-Related Prefrontal Dopamine Activity in Healthy Adults, but Not in Individuals with Psychotic Disorder. PLoS One 2016; 11:e0150746. [PMID: 27007554 PMCID: PMC4805207 DOI: 10.1371/journal.pone.0150746] [Citation(s) in RCA: 13] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 02/18/2016] [Indexed: 12/20/2022] Open
Abstract
Early life stress may have a lasting impact on the developmental programming of the dopamine (DA) system implicated in psychosis. Early adversity could promote resilience by calibrating the prefrontal stress-regulatory dopaminergic neurotransmission to improve the individual's fit with the predicted stressful environment. Aberrant reactivity to such match between proximal and distal environments may, however, enhance psychosis disease risk. We explored the combined effects of childhood adversity and adult stress by exposing 12 unmedicated individuals with a diagnosis of non-affective psychotic disorder (NAPD) and 12 healthy controls (HC) to psychosocial stress during an [18F]fallypride positron emission tomography. Childhood trauma divided into early (ages 0-11 years) and late (12-18 years) was assessed retrospectively using a questionnaire. A significant group x childhood trauma interaction on the spatial extent of stress-related [18F]fallypride displacement was observed in the mPFC for early (b = -8.45, t(1,23) = -3.35, p = .004) and late childhood trauma (b = -7.86, t(1,23) = -2.48, p = .023). In healthy individuals, the spatial extent of mPFC DA activity under acute psychosocial stress was positively associated with the severity of early (b = 7.23, t(11) = 3.06, p = .016) as well as late childhood trauma (b = -7.86, t(1,23) = -2.48, p = .023). Additionally, a trend-level main effect of early childhood trauma on subjective stress response emerged within this group (b = -.7, t(11) = -2, p = .07), where higher early trauma correlated with lower subjective stress response to the task. In the NAPD group, childhood trauma was not associated with the spatial extent of the tracer displacement in mPFC (b = -1.22, t(11) = -0.67), nor was there a main effect of trauma on the subjective perception of stress within this group (b = .004, t(11) = .01, p = .99). These findings reveal a potential mechanism of neuroadaptation of prefrontal DA transmission to early life stress and suggest its role in resilience and vulnerability to psychosis.
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Affiliation(s)
- Zuzana Kasanova
- Department of Neuroscience, KU Leuven–University of Leuven, Leuven, Belgium
| | - Dennis Hernaus
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, School for Mental Health and NeuroScience MHeNS Maastricht University, Maastricht, The Netherlands
| | - Thomas Vaessen
- Department of Neuroscience, KU Leuven–University of Leuven, Leuven, Belgium
| | - Thérèse van Amelsvoort
- Department of Neuroscience, KU Leuven–University of Leuven, Leuven, Belgium
- Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Oliver Winz
- Department of Nuclear Medicine, University Hospital RWTH Aachen University, Aachen, Germany
| | - Alexander Heinzel
- Department of Nuclear Medicine, University Hospital RWTH Aachen University, Aachen, Germany
| | - Jens Pruessner
- Department of Psychiatry, Douglas Mental Health Institute, McGill University, Montreal, Quebec, Canada
| | - Felix M. Mottaghy
- Department of Nuclear Medicine, University Hospital RWTH Aachen University, Aachen, Germany
- Department of Nuclear Medicine, Maastricht University Hospital, Maastricht, The Netherlands
| | - Dina Collip
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, School for Mental Health and NeuroScience MHeNS Maastricht University, Maastricht, The Netherlands
| | - Inez Myin-Germeys
- Department of Neuroscience, KU Leuven–University of Leuven, Leuven, Belgium
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Vaessen T, Hernaus D, Myin-Germeys I, van Amelsvoort T. The dopaminergic response to acute stress in health and psychopathology: A systematic review. Neurosci Biobehav Rev 2015. [PMID: 26196459 DOI: 10.1016/j.neubiorev.2015.07.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Previous work in animals has shown that dopamine (DA) in cortex and striatum plays an essential role in stress processing. For the first time, we systematically reviewed the in vivo evidence for DAergic stress processing in health and psychopathology in humans. All studies included (n studies=25, n observations=324) utilized DA D2/3 positron emission tomography and measured DAergic activity during an acute stress challenge. The evidence in healthy volunteers (HV) suggests that physiological, but not psychological, stress consistently increases striatal DA release. Instead, increased medial prefrontal cortex (mPFC) DAergic activity in HV was observed during psychological stress. Across brain regions, stress-related DAergic activity was correlated with the physiological and psychological intensity of the stressor. The magnitude of stress-induced DA release was dependent on rearing conditions, personality traits and genetic variations in several SNPs. In psychopathology, preliminary evidence was found for stress-related dorsal striatal DAergic hyperactivity in psychosis spectrum and a blunted response in chronic cannabis use and pain-related disorders, but results were inconsistent. Physiological stress-induced DAergic activity in striatum in HV may reflect somatosensory properties of the stressor and readiness for active fight-or-flight behavior. DAergic activity in HV in the ventral striatum and mPFC may be more related to expectations about the stressor and threat evaluation, respectively. Future studies with increased sample size in HV and psychopathology assessing the functional relevance of stress-induced DAergic activity, the association between cortical and subcortical DAergic activity and the direct comparison of different stressors are necessary to conclusively elucidate the role of the DA system in the stress response.
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Affiliation(s)
- Thomas Vaessen
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, School for Mental Health and Neuroscience MHeNS, Maastricht University, The Netherlands.
| | - Dennis Hernaus
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, School for Mental Health and Neuroscience MHeNS, Maastricht University, The Netherlands
| | - Inez Myin-Germeys
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, School for Mental Health and Neuroscience MHeNS, Maastricht University, The Netherlands
| | - Thérèse van Amelsvoort
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, School for Mental Health and Neuroscience MHeNS, Maastricht University, The Netherlands
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