Maarten Kaarsemaker

Clinical Psychology, Cognitive Psychology



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    ABSTRACT: Obsessive-compulsive disorder (OCD) with poor insight has severe consequences for patients; nonetheless, no randomized controlled trial has ever been performed to evaluate the effectiveness of any treatment specifically for poor-insight OCD. A new psychotherapy for OCD, the inference-based approach (IBA), targets insight in OCD by strengthening normal sensory-driven reality testing. The goal of the present study is to compare the effectiveness of this new treatment to the effectiveness of cognitive behavior therapy (CBT) for patients with OCD with poor insight. A randomized controlled trial was conducted, in which 90 patients with OCD with poor insight received either 24 CBT sessions or 24 IBA sessions. The primary outcome measure was the Yale-Brown Obsessive Compulsive Scale (YBOCS). Secondary outcome measures were level of insight, anxiety and depressive symptoms, and quality of life. Mixed-effects models were used to determine the treatment effect. In both conditions, a significant OCD symptom reduction was reached, but no condition effects were established. Post hoc, in a small subgroup of patients with the worst insight (n = 23), it was found that the patients treated with the IBA reached a significantly higher OCD symptom reduction than the patients treated with CBT [estimated marginal mean = -7.77, t(219.45) = -2.4, p = 0.017]. Patients with OCD with poor insight improve significantly after psychological treatment. The results of this study suggest that both CBT and the IBA are effective treatments for OCD with poor insight. The IBA might be more promising than CBT for patients with more extreme poor insight. © 2015 S. Karger AG, Basel.
    Psychotherapy and Psychosomatics 08/2015; 84(5):284-293. DOI:10.1159/000382131 · 9.20 Impact Factor
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    ABSTRACT: Background: Studies on the relationship between adverse childhood experiences (ACEs) and obsessive-compulsive disorder (OCD) symptom severity are scarce. Available studies leave a considerable degree of uncertainty. The present study examines the relationship between ACEs and symptom severity, chronicity, and comorbidity in a sample of patients with OCD. Method: Baseline data of the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study, in which 382 referred patients with DSM-IV-diagnosed OCD participated, were analyzed. ACEs (physical abuse, sexual abuse, witnessing interparental violence, maternal dysfunction, paternal dysfunction, and early separation from a parent) were measured using a structured interview. Data were collected between September 2005 and November 2009. Results: None of the ACEs were related to OCD symptom severity or chronicity, nor was there a dose-response relationship between ACEs and OCD severity or chronicity, but results of linear regression analysis revealed that ACEs were related to comorbidity in patients with OCD (P < .001), in particular to comorbid affective disorders (P < .01), substance use disorders (P < .01), and eating disorders (P < .01), but not to comorbid anxiety disorders. Conclusions: Results of the study suggest that unlike in other psychiatric disorders, ACEs play no significant role in symptom severity and chronicity of OCD. This study was the first to reveal evidence for a relationship between ACEs and comorbidity in patients with OCD. Conclusions about trauma-relatedness of OCD based on studies finding higher trauma rates or severity among patients with OCD than among healthy controls, should be critically reconsidered, since presence of comorbidity might account for these differences.
    The Journal of Clinical Psychiatry 06/2014; 75(10). DOI:10.4088/JCP.13m08825 · 5.50 Impact Factor
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    ABSTRACT: The present study uses a relational frame approach (Hayes, Barnes-Holmes, and Roche, 2001) to perspective taking for individuals suffering from social anxiety disorder (SAD). Perspective taking is conceptualized as the ability to relate events in accordance with the deictic frames of I-You, Here-There, and Now-Then. We hypothesized that the systematic underrehearsal of such behavioral repertoires, set off by the characteristic avoidance of social encounters in patients with SAD, could contribute to an impairment of perspective taking. We examined deictic relational responding skills in a sample of adults suffering from SAD and compared their performances with an age-matched sample of healthy peers. Participants with SAD performed significantly less accurately across all trial types, with group differences reaching significance for reversed trials (i.e., trials demanding a shift in perspective taking). Results indicated more pronounced difficulties at an earlier stage of perspective taking for those individuals diagnosed with SAD. Methodological shortcomings and implications for further research and training were discussed.
    The Psychological record 03/2014; 64(1). DOI:10.1007/s40732-014-0013-3 · 0.96 Impact Factor
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    ABSTRACT: In half of Obsessive Compulsive Disorder (OCD) patients the disorder runs a chronic course despite treatment. The factors determining this unfavourable outcome remain unknown. The Netherlands Obsessive Compulsive Disorder Association (NOCDA) study is a multicentre naturalistic cohort study of the biological, psychological and social determinants of chronicity in a clinical sample. Recruitment of OCD patients took place in mental health organizations. Its design is a six-year longitudinal cohort study among a representative clinical sample of 419 OCD patients. All five measurements within this six-year period involved validated semi-structured interviews and self-report questionnaires which gathered information on the severity of OCD and its co-morbidity as well as information on general wellbeing, quality of life, daily activities, medical consumption and key psychological and social factors. The baseline measurements also include DNA and blood sampling and data on demographic and personality variables. The current paper presents the design and rationale of the study, as well as data on baseline sample characteristics. Demographic characteristics and co-morbidity ratings in the NOCDA sample closely resemble other OCD study samples. Lifetime co-morbid Axis I disorders are present in the majority of OCD patients, with high current and lifetime co-morbidity ratings for affective disorders (23.4% and 63.7%, respectively) and anxiety disorders other than OCD (36% current and 46.5% lifetime). Copyright © 2012 John Wiley & Sons, Ltd.
    12/2012; 21(4). DOI:10.1002/mpr.1372
  • Sabine Tjon Pian Gi · Jos Egger · Maarten Kaarsemaker · Reinier Kreutzkamp
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    ABSTRACT: For decades, personality was thought to be a set of stable characteristics. However, in the dimensional approach, personality traits are considered to vary on a continuum. This retrospective cohort study examines changes in personality traits, as measured by the NEO Five Factor Inventory, in anxiety-disordered inpatients. Paired sample T-test analyses are used to measure trait differences before and after treatment. Analyses of variance are applied to measure the influence of diagnosis on personality change, and regression analyses to investigate if the 90-item symptom checklist symptom reduction predicts personality trait changes. Results show that patients become less neurotic and more extravert at post-measurement, supported by large to medium effect sizes, and are not influenced by diagnostic category. Only 30% and 21% of the change in neuroticism and extraversion respectively, is explained by symptom reduction. It is concluded that personality traits neuroticism and extraversion can change over time in anxious inpatients while changes are not a direct consequence of a mood-state effect (symptom reduction). Results are compatible with a dimensional conceptualization of psychopathology, which will be incorporated in the future edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-V). Copyright © 2010 John Wiley & Sons, Ltd.
    Personality and Mental Health 11/2010; 4(4):237 - 245. DOI:10.1002/pmh.142 · 1.10 Impact Factor
  • M. Kaarsemaker · B. Jedding · A. Lange

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