Ger P J Keijsers

• Associate professor
• Professor at Radboud University

Introduction Bipolar disorder is a severe mental health problem with limited treatment success. There is a call for improving interventions, requiring an increased understanding of factors driving mood instability. One promising avenue is to study temporal associations between factors that appear relevant according to the emotional amplifier model...

Introduction: Implementation intentions are if-then plans linking behavior with contextual features, thereby preventing goal shifts away from superordinate goals. Implementation intentions may be an addition to standard treatment for binge eating due to their limited use of cognitive resources. Implementation intention effects may be increased by m...

It is unknown to what extent mental imagery and auditory verbal hallucinations (AVHs) are related. Trials evaluating this issue used both emotional and non‐emotional mental imagery tools, thereby complicating outcomes comparisons. Therefore, the present study aimed to systematically review the literature on mental imagery in individuals with AVHs t...

Binge eating disorder (BED) and bulimia nervosa (BN) are characterized by recurrent binge eating, episodes of consuming large amounts of food in a discrete period of time associated with a loss of control. Implementation intentions are explicit if-then plans that engender goal-directed action, and rely less on cognitive control than standard treatm...

Objective: Binge-eating disorder (BED) and bulimia nervosa (BN) are characterised by binge eating. Changing unwanted behaviour is difficult, as intentions do not automatically lead to action. Implementation intentions (IIs) may help bridging the gap between intentions and behaviour. IIs are 'if-then' plans promoting goal attainment. Effects are mo...

Different views exist regarding the nature of patients’ dependency in psychotherapy (trait versus contextual dependency), and its impact on treatment outcome and duration. Therefore we examined whether patients’ levels of care dependency changed over time during a 9-month treatment period, and whether care dependency was related to symptom reductio...

Introduction: The present study sought a better understanding of the sources of client-perceived quality of the working alliance. Methods: At the end of psychotherapy sessions 3 and 5, 60 outpatient clients completed the Working Alliance Inventory-client form (WAI-c) and the Counselor Rating Form (CRF) measuring perceived therapists’ social power....

Binge eating disorder (BED) and bulimia nervosa (BN) are characterized by binge eating. Frequently related to negative affect, binge eating is considered unwanted eating behavior. It is often preceded by a shift away from the goal of a healthy eating pattern. Implementation intentions are ‘if-then’ plans that may prevent such shifts in goals. In a...

Goal setting in psychological treatments may have favorable effects on patients’ motivation and treatment outcomes. Therefore, it seems important to detect when patients do not perceive clear treatment goals. The current study presents a questionnaire measuring patients’ perceived lack of goal clarity. The cross‐sectional study consisted of 742 adu...

La Dependencia de Cuidado Puede Ayudar y Dañar a el Tratamiento Psicológico: Un Estudio de Tratamiento Análogo con Estudiantes en Capacitación Clínica La dependencia de cuidado en el cuidado de la salud mental ha sido considerada como un efecto secundario negativo de los tratamientos. El estudio de tratamiento análogo examino si la dependencia de c...

The present study examined approach-avoidance, attentional and evaluation biases in Hair Pulling Disorder (HPD). Although none of the tasks showed indications of biased action tendencies in response to hair pulling-related pictures, or biased attention for hair pulling-related words, we found that patients were slower to react to hair pulling-relat...

Background: In line with previous research in alcohol addiction, we tested whether an Approach-Avoidance Training (AAT) prior to standard six-session Cognitive Behavior Therapy (CBT) for Hair Pulling Disorder (HPD) reduced problematic relapse, commonly found in this population. Method: Prior to CBT, 54 outpatients with a primary diagnosis of HPD we...

Objectives: Patients' dependency on the therapist or treatment has received little empirical attention. To examine care dependency, we aimed to develop a theory-driven questionnaire based on three hypothetical dimensions (passive-submissive dependency; active-emotional dependency; and lack of perceived alternatives) and to provide a preliminary ex...

The present study investigated automatic/implicit and controlled/explicit processes in snacking behavior. Participants who were bothered by their habit of eating snacks were compared to participants with another habit. A reaction time task was used to assess implicit action tendencies in which participants had to pull or push a joystick in reaction...

Objective: Treatment effects in psychotherapy outcome research are generally based on the reduction of symptoms. Standard inclusion of other beneficial treatment effects such as remoralization (increase of hope, self-efficacy, well-being) might lead to more elaborate findings in the field of psychotherapy. On the other hand, it is also possible th...

People with trichotillomania often have persistent negative beliefs about giving into one’s habit. Central in the present study was the hypothesis that the follow-up effects of cognitive therapy (CT), in which these negative beliefs are directly addressed, are better compared to the follow-up effects of behaviour therapy (BT). Fifty-six trichotillo...

The present study investigated implicit approach-avoidance action tendencies towards snack foods (pictorial Approach-Avoidance Task), implicit approach-avoidance associations (verbal approach-avoidance Single-Target IAT) and affective associations (verbal positive-negative Single-Target IAT) with snack foods in a group of unselected student partici...

Self-control cognitions arise right before or after someone gives in to an unwanted habit. This paper reports on the development of the 11-item Self-Control Cognition Questionnaire (SCCQ) in a series of three studies. In the first study (N = 308), we found that the SCCQ has a two-factor structure and is reliable. The factors were named ''Giving way...

This study investigated implicit self-control dispositions—implicit approach tendencies towards low-caloric food rather than towards high-caloric food—in dieters. Action tendencies were assessed and trained using the Approach-Avoidance Task (AAT). Additionally, positive/negative affective associations [Brief Implicit Association Test (BIAT)], appro...

Deze oratietekst stelt aan de orde of psychotherapiepatiënten opknappen door specifieke behandeltechnieken of door zogenaamde common factors (zoals de kwaliteit van de werkrelatie). Specifieke behandeltechnieken ontlenen hun effect aan het feit dat ze aangrijpen op verstoorde cognitieve processen die aan psychische stoornissen ten grondslag liggen....

Fatigue is a main feature of the burnout syndrome but also very common in other psychiatric disorders such as major depression and anxiety disorders. This raises the question of whether the level and appraisal of fatigue is experienced differently by individuals suffering from burnout than by those exhibiting anxiety disorders and major depression....

In recent years, there has been an increasing interest in the question whether job performance of burnout employees is impaired. Reduced job competence is one of the main features in most definitions of burnout and several studies suggest that the performance of burnout employees is indeed poorer compared to that of healthy employees. One of the fa...

Background: Older adults with panic disorder and agoraphobia (PDA) are underdiagnosed and undertreated, while studies of cognitive-behavioral therapy (CBT) are lacking. This study compares the effectiveness of CBT for PDA in younger and older adults. Methods: A total of 172 patients with PDA (DSM-IV) received manualized CBT. Primary outcome meas...

Veel burnout patiënten rapporteren cognitieve problemen. Presteren burnout patiënten ook minder goed op cognitieve taken? En met welke mechanismen hangen deze problemen samen? Onderzoek laat zien dat deze cognitieve problemen objectief zijn aan te tonen en dat ze meer met stress lijken samen te hangen dan met vermoeidheid. Bovendien zijn er verschi...

In de Forum-bijdrage ‘Over de identiteit van de procesgerichte psychotherapeut’ in het vorige nummer, legt Jan Derksen de lezer een groot aantal onderwerpen voor binnen de hedendaagse psychotherapie. Zijn bijdrage gaat over de DSM-5, zorgverzekeraars, vercommercialisering van behandelingen, klinisch-psychologisch onderzoek, psychiaters, het brein,...

Employees with burnout experience a persistent, negative work-related state of mind primarily characterized by exhaustion, decreased motivation, and a sense of reduced effectiveness. Although most employees with burnout (67%) were found to apply an efficient high-effort strategy like healthy controls, significantly more employees with burnout (33%)...

Sinds Bradley (1969) het burn-outsyndroom voor het eerst beschreef, nu ruim 30 jaar geleden, heeft deze metafoor voor een toestand van psychologische uitputting sterk aan populariteit gewonnen. Recent onderzoek toont aan dat vier procent van de Nederlandse beroepsbevolking dusdanige symptomen van burn-out heeft dat ze zich eigenlijk onder professio...

Relatively little is known about the course of symptoms in patients suffering from burnout and even less about the status of their cognitive functioning. We followed 40 burnout patients and 40 healthy controls who had participated in a previous study on the effect of motivational interventions on cognitive performance in an experimental task and re...

Burnout patients perform poorer on cognitive tasks than healthy controls. A possible explanation for this decreased performance is a relatively permanent reduced motivation to expend effort. In a previous study, we failed to enhance the performance of burnout patients using a monetary incentive and positive feedback. In an attempt to bypass cogniti...

Cognitive theories suggest that social anxiety disorder (SAD) is characterized by biased processing of negative facial expressions. Recently, however, it has been proposed that the fear of positive evaluation may play an additional, important role. In order to investigate which specific expressions evoke biased processing, 15 patients diagnosed wit...

Implicit cognitive processes are relevant in understanding the development and maintenance of psychopathology and dysfunctional behaviours. The present study investigated the role of implicit processes in pathological skin picking (PSP). Using an Approach-Avoidance Task (AAT), we examined automatic response tendencies towards skin picking-related p...

This study aims to evaluate the differential predictive values of age, age of onset and duration of illness on paroxetine and cognitive-behavioural therapy (CBT) outcome in late-life panic disorder with agoraphobia. Patients 60 years and older with a confirmed diagnosis of panic disorder with agoraphobia (n = 49) were randomly assigned to paroxetin...

It has been suggested that the motivation to spend effort is decreased in burnout patients, resulting in reduced cognitive performance. A question that remains is whether this decreased motivation can be reversed by motivational interventions. We investigated this by examining the effect of a motivational intervention on cognitive performance. We p...

It is essential that outcome research permit clear conclusions to be drawn about the efficacy of interventions. The common practice of nesting therapists within conditions can pose important methodological challenges that affect interpretation, particularly if the study is not powered to account for the nested design. An obstacle to the optimal des...

Scientific evidence is equivocal on whether Social Anxiety Disorder (SAD) is characterized by a biased negative evaluation of (grouped) facial expressions, even though it is assumed that such a bias plays a crucial role in the maintenance of the disorder. To shed light on the underlying mechanisms of face evaluation in social anxiety, the eye movem...

Studies on the relation between fatigue and performance often fail to find a strong and direct link, implying that multiple factors may be involved. A literature search on the fatigue-performance relationship suggests that two different conceptual frameworks are employed concerning the appraisal of fatigue in relation to performance: an adaptation-...

To collect empirical evidence concerning the effectiveness of the treatment of anxiety disorders in the elderly. Meta-analysis and randomised controlled trials. Meta-analysis showed that cognitive behavioural therapy (CBT) was more successful than waiting-list control or active control as a treatment for older persons with anxiety disorders. In a d...

Voor effectonderzoek naar behandelingen van psychische aandoeningen is tegenwoordig het medisch model leidend: men kijkt daarbij uitsluitend of goed meetbare symptomen verminderd zijn. Het alleen maar kijken naar symptoomvermindering heeft als nadeel dat niet duidelijk wordt in welke mate bij behandelingen ook zelfwaardering en hervonden vertrouwen...

To compare the agoraphobic cognitions of younger and older patients suffering from panic disorder with agoraphobia by means of existing questionnaires. Agoraphobic cognitions were assessed using the Agoraphobic Cognitions Questionnaire (ACQ) in 205 patients confirmed with confirmed panic disorder with agoraphobia (Diagnostic and Statistical Manual,...

Remoralization as an outcome measure for psychological treatments was compared with symptom reduction (agoraphobic avoidance and cognitions). Twenty-four patients with panic disorder and agoraphobia received empirically supported treatment and were monitored across multiple time points for 28 weeks. Treatment resulted in reduced symptoms and enhanc...

Thirty-four college students suffering from pathological skin picking were randomly assigned to a four-session cognitive-behavioural treatment (n=17) or a waiting-list condition (n=17). Severity of skin picking, psycho-social impact of skin picking, strength of skin-picking-related dysfunctional cognitions, and severity of skin injury were measured...

Cognitive bias modification (CBM) studies suggest a causal role of interpretation biases in the aetiology and maintenance of Social Anxiety Disorder. However, it is unknown if the effects of induced biases transfer to behaviour. In two analogue studies, behavioural changes in response to aversive and positive stimuli were measured after the inducti...

The concept of burnout remains enigmatic since it is only determined by behavioral characteristics. Moreover, the differential diagnosis with depression and chronic fatigue syndrome is difficult. EEG-related variables in 13 patients diagnosed with burnout syndrome were compared with 13 healthy comparison subjects in order to explore the existence o...

In deze bijdrage wordt stilgestaan bij een verantwoord gebruik van psychologische, protocollaire Empirically Established Treatments (ESTs). Het aantal psychische stoornissen waarvoor ESTs beschikbaar komen neemt nog steeds toe. Tegelijkertijd blijkt het voor een aantal andere stoornissen alsmaar niet mogelijk om duidelijk ‘betere’ behandelingen te...

Remoralization is the process of restoration of morale. Remoralization constitutes an important step in the therapeutic change process. Because no appropriate self-report instrument was available to indicate the level of morale in mental health care, the Remoralization Scale (RS) was developed. In a first study (299 outpatients), a pool of 69 items...

Empirisch ondersteunde psychologische behandelingen (EST’s) en traditionele, individuspecifieke psychologische behandelingen vullen elkaar aan. Indien geïndiceerd, verdienen EST’s de voorkeur boven traditionele, psychologische behandelingen. Ondanks de aanvankelijke vraagtekens bij het onderzoek naar EST’s wordt steeds duidelijker dat EST’s met suc...

Sinds Bradley (1969) het burn-outsyndroom voor het eerst beschreef, nu ruim 30 jaar geleden, heeft deze metafoor voor een toestand van psychologische uitputting sterk aan populariteit gewonnen. Recent onderzoek toont aan dat vier procent van de Nederlandse beroepsbevolking dusdanige symptomen van burn-out heeft dat ze zich eigenlijk onder professio...

To examine the effectiveness of paroxetine and cognitive-behavioural therapy (CBT) in elderly patients suffering from panic disorder with or without agoraphobia (PD(A)). Forty-nine patients aged 60+ years with confirmed PD(A) were randomly assigned to 40 mg paroxetine, individual CBT, or to a 14-week waiting list. Outcomes, with avoidance behaviour...

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the short and long-term efficacy of different medication classes (benzodiazepines, selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), other medications) for differ...

To investigate whether social anxiety disorder is indeed characterized by a biased negative evaluation of facial expressions, 25 highly socially anxious (SA) participants and 30 non-anxious controls (NACs) were asked to respond to different ratios of neutral-angry or happy-angry face combinations (crowds). In an indirect Approach-Avoidance Task (AA...

To examine and estimate the efficacy of cognitive-behavioural therapy (CBT) for late-life anxiety disorders. A systematic review and meta-analysis of randomized controlled trials comparing CBT with i) a waiting-list control condition and ii) an active control condition controlling for non-specific effects in patients aged over 60 years and sufferin...

Exposure to premonitory sensations and response prevention of tics (ER) has been shown to be a promising new treatment for Tourette's syndrome (TS). The present study tested the hypothesis that habituation to unpleasant premonitory sensations associated with the tic is an underlying mechanism of change in ER. Patients rated the severity of sensatio...

Background: Five patients aged 64 to 74 years with obsessive-compulsive disorder were treated successfully, one with cognitive behavioural therapy and four with a combination of antidepressants and cognitive behavioural therapy. The current multidisciplinary guidelines on anxiety treatment, which cover the age-range 18 to 65 years, are a good star...

Five variables were investigated with regard to their possible predictive value for cognitive behavioural treatment (CBT) outcome in a large sample of panic disorder (PD) patients. The variables were initial symptom severity, comorbid anxiety or depressive disorders, comorbid cluster C personality disorders, and initial motivation for treatment. A...

Dit artikel is een licht gewijzigde bewerking van het voorlaatste hoofdstuk ‘De volhardingsfase: motiveren bij lopende behandelingen’ uit het boek Motiveringsstrategieën in de ambulante psychotherapie dat in oktober 2007 bij uitgeverij Bohn Stafleu van Loghum te Houten zal verschijnen. Het hoofdstuk bespreekt verschillende strategieën om cliënten t...

Exposure and response prevention (ER), a behavioral treatment program consisting of exposure to premonitory sensory experiences during prolonged tic suppression, was shown to be a promising new treatment for tics in Tourette's syndrome (TS). In this study, the commonly reported paradoxical increase in tic frequency following voluntary tic suppressi...

‘En dan zijn we nu aanbeland bij de rationale van de behandeling.’

Het is niet bij alle patiënten gemakkelijk om tot een goede start van de therapie te komen, waarbij de patiënt zich geaccepteerd en begrepen voelt en beïnvloeding door de therapeut kan toelaten. Soms hebben patiënten een stijl van omgaan met anderen die het eerder beschreven proces van acceptatie, aansluiting, begrip en empathie in de weg staan. De...

Wat betekent ‘veranderen met behulp van therapie’? Er is een aantal antwoorden mogelijk. Soms gaat het om iets ontdekken over jezelf, iets nieuws voelen of ervaren waartoe je tot op dat moment niet in staat was. Soms ook gaat het om de ruimte vinden voor het nemen van een belangrijk besluit. Dikwijls betekent veranderen de tijd nemen om te oefenen...

In dit boek stelden we allereerst de vraag waarom motiveren voor psychotherapie nodig is. Het antwoord dat wij gaven, ligt voor de hand. Psychotherapie is een behandelvorm waarin niet de behandelaar, maar de patiënt het grootste deel van het werk moet doen. Dat werk komt er bovendien op neer aspecten van zichzelf – bepaald gedrag of de manier waaro...

Acceptatie van de behandeling, acceptatie van zichzelf en praten over de klachten brengen reeds veranderingen teweeg. Vervolgens moet in de activeringsfase verdere verandering op gang worden gebracht.

In de jaren zeventig van de vorige eeuw groeide de kritiek op de psychologisch-psychodynamisch georiënteerde classificatie van psychische stoornissen in de psychiatrie van die tijd. Zorgverzekeraars, onderzoekers en medici bekritiseerden de onduidelijke diagnostiek en de moeilijk te beoordelen psychopathologiemodellen van de DSM-II (APA, 1968). In...

Binnen de klachtgerichte vormen van psychotherapie geldt de werkwijze dat een therapeut en een patiënt zich verbinden aan een behandelcontract. Het behandelcontract bevat het geformuleerde doel van de behandeling, de beoogde therapeutische procedures, een tijdsplan en een methode om de behandelresultaten vast te stellen. De therapeut is de bewaker...

Post-treatment evaluation studies of behaviour therapy (BT) for trichotillomania (TTM) have shown that BT is successful in reducing symptoms in this impulse-control disorder. The present study was aimed at investigating gain maintenance at long-term follow-up. TTM-related symptoms and other symptom characteristics were evaluated in 28 patients suff...

Burnout is characterized by exhaustion, cynicism, and feelings of reduced competence. These complaints may be reflected in disturbances in the main stress regulatory endocrine system: the hypothalamus pituitary adrenal (HPA) axis. In this study, the HPA-axis hormone cortisol was sampled after awakening and during the day in 22 participants with cli...

Post-treatment evaluation studies of behaviour therapy (BT) for trichotillomania (TTM) have shown that BT is successful in reducing symptoms in this impulse-control disorder. The present study was aimed at investigating gain maintenance at long-term follow-up. TTM-related symptoms and other symptom characteristics were evaluated in 28 patients suff...

The linear mixed-effects model has been widely used for the analysis of continuous longitudinal data. This paper demonstrates that the linear mixed model can be adapted and used for the analysis of structured repeated measurements. A computational advantage of the proposed methodology is that there is no extra burden on the analyst since any softwa...

In dit artikel presenteren de auteurs een gecontroleerd onderzoek (N= 43) naar de behandeling van trichotillomanie, waarin gedragstherapie werd vergeleken met fluoxetine (60 mg) en een wachtlijstconditie. Na twaalf weken bleek dat de gedragstherapie zeer effectief was (effect size 3.80) en effectiever dan fluoxetine of een wachtlijst. In een open v...

Psychometric properties of the Dutch version of the Maslach Burnout Inventory General Survey, the MBI-DV, were examined in individuals with and without clinical burnout. The factor structure, the utility of the MBI-DV as a screening instrument in addition to a clinical interview for diagnosing clinical burnout, as well as construct validity and rel...

Professional burnout is a stress-related disorder, having mental exhaustion due to work stress as its most important characteristic. Burned out individuals also often complain about attentional problems. However, it is currently not clear whether such complaints are based on true cognitive deficits or whether they merely reflect the way burned out...

The Nijmegen Motivation List for Prevention (NML-P) is a new instrument to assess the motivation of participants for involvement in preventive group interventions. The aim of the current study was to explore the underlying dimensions of the NML-P and the predictive potential of the instrument for those participating in a psychoeducational preventiv...

The intentional nature of tics provides the opportunity to apply behavioural interventions aimed at tic reduction through interruption of stimulus-response sequences. The aim of this study has been to evaluate the effect of exposure and response prevention (ER) versus habit reversal (HR) in 43 Tourette's syndrome (TS) patients. The three outcome me...

Cortisol disturbance in employees suffering burnout; a pilot study Cortisol disturbance in employees suffering burnout; a pilot study P. Mommersteeg, C. Heijnen, G. Keijsers, M. Verbraak & L. van Doornen, Gedrag & Organisatie, volume 17, February 2004, nr. 1, pp. 18-31. Burnout symptoms are the result of chronic job stress and insufficient recovery...

De essentië le kenmerken van de obsessieve-compulsieve stoornis of dwangstoornis zijn de steeds terugkerende dwanggedachten en of dwanghandelingen. Dwanggedachten (obsessies) zijn ideeën, gedachten, beelden of flitsen die steeds terugkeren of aanhouden en die aanzienlijke angst en ongemak oproepen. Ze worden ervaren als onvrijwillig, intrusief, zin...

In de afgelopen twintig jaar zijn op universiteiten en specialistische onderzoeksinstituten psychologische behandelingen ontwikkeld die worden uitgevoerd aan de hand van een protocol. Een protocol behelst een stapsgewijze beschrijving van de behandeling zoals deze door behandelaars uitgevoerd dient te worden. Meestal, maar niet altijd, gaat het hie...

De ongewenste gewoonten die hier worden besproken zijn in de DSM-IV (APA, 1994) ondergebracht onder ‘stoornissen in de impulscontrole niet elders geclassi- ficeerd.’ Kenmerkend voor patiënten die hieraan lijden is dat zij een impuls of neiging, die op de een of andere manier schadelijk is voor zichzelf of anderen, niet kunnen weerstaan. Voor het be...