This thesis presents a qualitative research on contextual theory and therapy according to Ivan Boszormenyi-Nagy. It encompasses a reconstruction of contextual theory, an analysis of contextual therapy practice and the development of a model for contextual therapy.
Objective: The aim of this study was to investigate age group, gender, and baseline depressive symptom severity as possible effect moderators in (1) cognitive versus behavioral based CBT-modules and (2) sequences of modules that started either with cognitive or behavioral modules in indicated depression prevention in adolescents. Method: We conducted a pragmatic cluster-randomized trial under four parallel conditions. Each condition consisted of four CBT-modules of three sessions (cognitive restructuring, problem solving, behavioral activation, relaxation), but the sequencing of modules differed. The CBT-modules and sequences were clustered into more cognitive versus more behavioral based approaches. The sample involved 282 Dutch adolescents with elevated depressive symptoms (Mage = 13.8; 55.7% girls, 92.9% Dutch). Assessments were conducted at baseline, after three sessions, at post-intervention and 6-month follow-up with self-reported depressive symptoms as the primary outcome. Results: We found no evidence for substantial moderation effects. Age group, gender, and depressive symptom severity level at baseline did not moderate the effects of cognitive versus behavioral modules after three sessions. No evidence was also found that these characteristics moderated the effectiveness of sequences of modules that started either with cognitive or behavioral modules at post-intervention and 6-month follow-up. Conclusion: Cognitive and behavioral based modules and sequences in the prevention of depression in adolescents might apply to a relatively wide range of adolescents in terms of age group, gender, and severity levels of depressive symptoms.
The aim of this study was to assess the feasibility, acceptability and preliminary effectiveness of Mindfulness-Based Compassionate Living (MBCL) as a follow-up intervention to Mindfulness Based Cognitive Therapy in adults with recurrent depression. We conducted an uncontrolled study in 17 patients with recurrent depression, in two successive groups. The first group contained novices to compassion training (N = 14); in the second group, ten of these participated again, in addition to three new participants (N = 13). The overall group contained 15 females and 2 males, aged between 37 and 71. The MBCL program was qualitatively evaluated using post-intervention focus group interviews in both groups. In addition, self-report questionnaires assessing depressive symptoms, worry and both self-compassion and mindfulness skills were administered before and after MBCL. No patients dropped out of the intervention. Average attendance was 7.52 (SD 0.73) out of eight sessions. Helpful elements were theory on the emotion regulation systems, practicing self-compassion explicitly and embodiment of a compassionate attitude by the teachers. Unhelpful elements were the lack of a clear structure, lack of time to practice compassion for self and the occurrence of the so-called back draft effect. We adapted the program in accordance with the feedback of the participants. Preliminary results showed a reduction in depressive symptoms in the second group, but not in the first group, and an increase in self-compassion in both groups. Worry and overall mindfulness did not change. MBCL appears to be feasible and acceptable for patients suffering from recurrent depressive symptoms who previously participated in MBCT. Selection bias may have been a factor as only experienced and motivated participants were used; this, however, suited our intention to co-create MBCL in close collaboration with knowledgeable users. Examination of the effectiveness of MBCL in a sufficiently powered randomised controlled trial is needed.
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Goed slapen is van belang voor de gezondheid, de alertheid en stressreductie van mensen. Echter kampen veel mensen met slaapproblemen, waarbij chronisch slecht slapen kan leiden tot o.a. cognitieve problemen (depressie en dementie) en het heeft een negatief effect op de kwaliteit van leven. Kwaliteit van slapen hangt samen met hoe de slaap wordt ervaren en of iemand voldoende uitrust en tevreden is over de slaap, echter is 63% van de Nederlanders ontevreden over de eigen slaapkwaliteit. Dit project richt zich op volwassenen met slaapproblemen. Door middel van co-creatie wordt er gewerkt aan een digitale slaapcoach, als verlengstuk van een slaapexpert. Uitgangspunt van de coach is de eerder ontwikkelde voedingscoach Halloliz. De nieuwe slaapcoach helpt bij het in kaart brengen van individuele factoren die de slaapkwaliteit verminderen, bij het verbeteren van slaapgedrag en bij het bestendigen hiervan. Er wordt gebruik gemaakt van Cognitive Behavior Therapy for Insomnia, waarbij het effect van interventies op slaapgedrag direct wordt verwerkt in een aangepast slaapplan. Het project richt zich op het ontwikkelen van een slaapcoach rekening houdend met adoptie en motivatie van de doelgroep om de coach te gebruiken. Adoptie hangt onder andere samen met de vorm en uitstraling van de slaapcoach, maar ook met de bereidheid van de gebruiker om het gedrag te veranderen. Daarnaast speelt motivatie een belangrijke rol bij het bestendigen van gedragsverandering. In het project wordt de patient journey in kaart gebracht en wordt uitgezocht hoe het ontwerp van de coach kan worden geoptimaliseerd richting adoptie, motivatie en uiteindelijk de gewenste gedragsverandering. Een consortium van experts in het ontwerpen (co-creatie) van eHealth oplossingen en gebruikersonderzoek zal het project uitvoeren. Deze worden bijgestaan door een klankbordgroep bestaande uit onder andere slaapexperts.
