Lorenz J P van Doornen

• Prof.dr.
• Utrecht University

Introduction Experimental animal studies provided evidence for a synergistic effect of immunological and psychological stressors on subsequent sickness behaviors. Up to now, little corroborating evidence for such synergy exists for humans, in whom it may provide a mechanism leading to the expression of functional somatic symptoms. The aim of the pr...

An infant's optimal development is determined to a great extent by the adequate and sensitive responses of the caregiver. The adequacy and sensitivity of a reaction to an infant in distress (i.e. crying) will partly depend on the causal attributions of the crying and on the individual's sympathy for the infant. Being female, prior caring experience...

More control over migraine 6 months after the behavioural self-management training by lay trainers with migraine Despite the availability of evidence-based treatments for migraine many patients do not seek medical treatment. The primary aim of this study was to evaluate the changes at 6-month follow-up after a behavioural self-management training...

Objective Somatoform disorders (SDs) are characterized by chronic multiple functional somatic (FS) symptoms. It has been suggested that infections may be triggers for FS symptoms to occur, pointing to the immune system as a pathogenic factor in their development. The current study aimed to compare the prevalence of infections (i.e., infection load)...

Factors that are associated with pain perception remain incompletely understood, especially in the visceral pain field. Therefore, the current study aimed to investigate possible psychological and biological predictors of visceral pain sensitivity in healthy subjects. In a sample of 59 healthy premenopausal female subjects on hormonal contraceptive...

The aim of the present study was to address the lumper-splitter discussion on functional somatic syndromes by applying k-means cluster analyses on a heterogeneous sample of persons with unexplained somatic complaints. In favor of the lumper-side of the debate, clusters should differ only on the overall severity of the somatic complaints that were a...

Overtraining (OT) as a sports phenomenon can be caused by stressors on various levels (physical, emotional, psychological, and social) and evokes responses on these levels. This study evaluated research and new opportunities in the field of OT by introducing an integrated multidisciplinary approach, based on the single and multistressors approach....

Slow breathing and heart coherence training are being offered increasingly as treatments for anxiety, depression and stress-related mental and somatic complaints. Both of these interventions are aimed at influencing (i.e. increasing or optimising) heart rate variability and the mechanism involved is described in terms such as heart coherence, reson...

Introduction Experimental pain studies can provide unique insight into the dimensions of pain and into individual differences in pain responsiveness by controlling different aspects of pain-eliciting stimuli and pain measures. In experimental pain studies, pain responsiveness can be assessed as pain threshold, pain tolerance or pain ratings. The te...

The focus of this study is on the fit between the item content of scales measuring humorous coping and basic concepts of stress and coping theory. To investigate this fit 81 items from seven currently available humorous coping scales have been subjected to a facet analysis, using the tool of a mapping sentence. Three facets derived from stress and...

Fatigue is a common complaint among adolescents. We investigated the course of fatigue in females during the transition from adolescence to young adulthood and examined psychological, immunological, and life style risk factors for development of fatigue and chronic fatigue syndrome (CFS)-related symptoms. Six hundred and thirty-three healthy female...

Orientation: There is some evidence that job demands and job resources such as job control and humorous coping may contribute to the risk of upper respiratory tract infections (URTI). Research purpose: The purpose of this study was to test a model including these variables as well as job-related affect, in order to explore their role in the explana...

The aim of this study was to develop and evaluate a Questionnaire of Occupational Humorous Coping (QOHC), partly based on the model of emotion regulation by Gross (2001). Items intended to measure antecedent-focused, response-focused, and affiliative and aggressive-manipulative humorous coping methods were generated. Preliminary studies led to impr...

A non-clinical group high on heterogeneous medically unexplained symptoms (MUS; n=97) was compared with healthy controls (n=66) on the within-subject relationships between physiological measures using multilevel path analysis. Momentary experienced somatic complaints, mood (tension and depression), cardiac autonomic activity (inter-beat intervals,...

Overtraining (OT) as a sports phenomenon can be caused by stressors on various levels (physical, emotional, psychological, and social) and evokes responses on these levels. This study evaluated research and new opportunities in the field of OT by introducing an integrated multidisciplinary approach, based on the single and multistressors approach....

Burnout has been associated with increased risk of cardiovascular disease. This relationship may be mediated by a stress-related disruption in cardiac autonomic activity. The aim of the present study was to assess cardiac autonomic activity (sympathetic and parasympathetic) during a working day in burned out managers. Thirty burned out, 29 healthy...

There were two objectives of this research. First was to establish the utility of online digital assistance (ODA), a generic software-based method designed to support behavioral training (BT) in migraine. The second was to test whether ODA can produce additional effects in BT. Utility (feasibility and acceptability) was based on 44 patients with mi...

This ex post facto prospective study investigated whether symptoms of posttraumatic stress disorder (PTSD) are associated with increased physical health problems, while controlling for base-rates of symptoms and individual differences in neuroticism. Dutch army soldiers completed standardized questionnaires before they were deployed to Iraq (n = 47...

Physiological stress measures at work: relevance, limitations, and findings Physiological stress measures at work: relevance, limitations, and findings L. van Doornen & J. Houtveen, Gedrag & Organisatie, volume 22, September 2009, nr. 3, pp. 275-293 Physiological stress measures should only to a limited extent be considered as 'objective' indices o...

Binge eating episodes characterized by loss of control are hypothesized to be accompanied by changes in hypothalamic pituitary adrenal (HPA) axis functioning. Cortisol is an end product of this neuroendocrine stress system. The aim of this study was to examine the cortisol levels and the awakening cortisol response (ACR) in obese persons showing bi...

The efficacy of emotional disclosure in alleviating psychological and physical stress has been well documented in controlled laboratory studies. A next step is to evaluate its clinical utility in 'real world' settings. We adapted the emotional disclosure intervention for use in home-based settings by stimulating the suggested effective ingredients...

Physiological measurements of stress are believed to help with the 'objectivation' of the rather subjective phenomenon called 'stress'. Because there are only moderate interpersonal correlations between the subjective experience of work-stress and physiological stress measurements, the latter are useful mainly for comparing groups with high stress...

To evaluate the changes at 6-month follow-up after a home-based behavioral training (BT) provided by lay trainers with migraine to small groups of fellow patients. The need for self-management programs and cost-effective treatments gave rise to this study. In a previous randomized controlled trial, we compared the BT group with a waitlist-control g...

The predictive value for spontaneous improvement in individuals suffering from medically unexplained symptoms (MUS) was explored of (1) anxiety and depression obtained from questionnaires, (2) negative affective states obtained from experience-sampling, and (3) ambulatory-assessed real-life physiological recordings. Sixty-seven individuals with MUS...

Fatigue during adolescence is associated with somatic and psychological complaints that resemble the pattern of symptoms described for chronic fatigue syndrome (CFS). Studies in CFS and other stress-related syndromes suggested a dysfunction of the interactions between the hypothalamic-pituitary-adrenal axis (HPA-axis) and the immune system, i.e. a...

The purpose of this study was to investigate the stability of fatigue in adolescents and to explore whether psychological, somatic, and lifestyle factors are involved in the onset and persistence of fatigue during adolescence. In this longitudinal study, a total of 653 adolescent girls (aged 14.40 +/- 1.45 years) who previously participated in an e...

Strategies to regulate emotions (alexithymia, affect intensity, and emotional expression) were examined by questionnaires in 249 female and 96 male patients with rheumatoid arthritis (RA; age range: 19-87 years) and compared to the scores of 196 female control participants (age range: 19-82 years). Cross-sectional associations of emotion regulation...

The current study examined the extent to which symptom improvement and full return to work occurs among clinically burnt-out employees and what the influence of concurring sleep problems is with respect to health recovery. Fifty-nine burnt-out employees on extended sick leave assessed their symptoms for 2 weeks using an electronic diary. After 6 mo...

Disturbances in emotional functioning may contribute to psychological and physical symptoms in patients with fibromyalgia. This study examined emotions and emotion-regulation strategies in women with fibromyalgia and in controls, and how these variables relate to symptoms of fibromyalgia. We compared 403 women with fibromyalgia to 196 control women...

Burnout results from chronic work stress. Its complaints may be related to HPA-axis disturbances or changes in immune function. In our studies the salivary cortisol awakening response, day-curve, and the suppressed level after dexamethasone intake were not different in a burned-out group compared to a control group. Nor was there a change in cortis...

It has been suggested that dysregulation of immune-to-brain communication plays a role in the biopsychological process underlying medically unexplained symptoms (MUS). Immune and non-immune stressors can both be involved in the activation of the central sickness-behavioural-system leading to complaints like malaise, pain and fatigue. We hypothesize...

In the adolescent population, fatigue is associated with somatic complaints, unrefreshing sleep, cognitive disturbances and symptoms of depression and anxiety. This pattern of symptoms resembles the one described in chronic fatigue syndrome (CFS). Since immunological alterations have been reported in CFS patients, we wondered whether also severely...

Burnout is generally defined as a state of severe exhaustion. So far, research has predominantly focused on relatively mild burnout in employees able to work despite their complaints. This study examines energy depletion in clinical burnout (e.g., the severest cases on extended sick leave) by comparing the diurnal patterns of fatigue and exhaustion...

People with medically unexplained symptoms (MUS) often have a comorbid history of stress and negative affect. Although the verbal-cognitive and (peripheral) physiological stress systems have shown a great degree of independence, at the same time it is claimed that chronic stress and negative affect can result in a disregulated physiological stress...

Carotid endarterectomy (CEA) is performed to prevent stroke, but the possible restorative function of CEA on neuropsychological functioning has frequently been considered. Restorative effects might be clearer in functions mediated by the hemisphere ipsilateral to the operated side than in those of the contralateral hemisphere. The present study exa...

The current study investigates the relationship between HPA-axis functioning and burnout symptoms by employing an electronic symptom diary. This diary method circumvents the retrospection bias induced by symptom questionnaires and allows to study relationships within-in addition to between-subjects. Forty two clinically burned-out participants comp...

Emotional engagement, cognitive restructuring, and positive future directedness are considered core elements to induce change in emotional disclosure interventions. Our aim was to examine the induction of these elements and the feasibility of an emotional disclosure intervention adapted for home application. The intervention emphasized expression o...

This article examines recovery through sleep in relation to sleep quality, exhaustion, and depression in clinical burnout. We focus on actual recovery per night, given its relevance to burnout improvement. Sixty clinically burned-out participants and 40 healthy controls recorded symptoms with an electronic diary for 2 weeks at random times per day....

We investigated whether women show larger heart rate variability (HRV) than men after controlling for a large number of health-related covariates, using two indices of HRV, namely respiratory sinus arrhythmia (RSA) and approximate entropy (ApEn). In a twin design, the heritability of both indices was examined. The covariation between RSA and ApEn,...

Fatigue is a common complaint among adolescents, especially in girls, and is associated with high rates of school absenteeism. Severe fatigue is often accompanied by psychological and physical symptoms. In the chronic fatigue syndrome (CFS) functioning of the hypothalamic-pituitary-adrenal (HPA)-axis has previously been found to be altered. The aim...

The Internet can facilitate diary monitoring (experience sampling, ecological momentary assessment) and behavioral coaching. Online digital assistance (ODA) is a generic tool for mobile Web-based use, intended as an adjuvant to face-to-face or Internet-based cognitive behavioral treatment based. A current ODA application was designed to support hom...

Burnout has a negative impact on physical health, but the mechanisms underlying this relation remain unclear. To elucidate these mechanisms, possible mediating physiological systems or risk factors for adverse health in burned-out employees should be investigated. The aim of the present study among 290 Dutch managers was to explore whether allostat...

Neonatal dexamethasone (DEX) for chronic lung disease is associated with adverse outcome. We compared behavioral and motor development at school age of children who neonatally received DEX to children neonatally treated with hydrocortisone (HC) in a retrospective matched cohort study. DEX- and HC-treated groups matched for gestational age, birth we...

e investigated whether women show larger heart rate variability (HRV) than men after controlling for a large number of health-related covari- ates, using two indices of HRV, namely respiratory sinus arrhythmia (RSA) and approximate entropy (ApEn). In a twin design, the heritability of both indices was examined. The covariation between RSA and ApEn,...

The central aim of the present study was to examine differences in the functioning of the hypothalamic-pituitary-adrenal (HPA) axis between 29 burned-out, 33 work-engaged, and 26 healthy reference managers, as identified with the Maslach Burnout Inventory-General Survey and the Utrecht Work Engagement Scale. All of the managers were employed in a l...

Burnout is a stress-induced work-related syndrome. It is associated with a higher incidence of infections possibly pointing to a compromised immune system. In the present study, endocrine and ex vivo immune function of severe cases of burnout were investigated. Endocrine and immune variables were compared in 56 persons with burnout and 38 healthy c...

Several studies have investigated the association between burnout and HPA-axis functioning, but the results are far from consistent. This does not preclude the possibility that within a group of burnout patients a recovery of symptoms in a longitudinal course corresponds to (changes in) cortisol parameters. The latter possibility is tested in the p...

Our aim with this study was to assess the relation between chronic fatigue syndrome in adolescents and fatigue and associated symptoms in their fathers and mothers, more specifically the presence of chronic fatigue syndrome-like symptoms and psychologic distress. In this cross-sectional study, 40 adolescents with chronic fatigue syndrome according...

The current study sought to find indications for the appropriateness of a model in which eating patterns and exercise beliefs influence binge eating and physical exercise, respectively, that, in turn, influence outcome after gastric banding for severe obesity. Participants were 157 patients (144 females, 13 males) who completed questionnaires appro...

The purpose of this study was to determine the prevalence of severe fatigue in adolescent boys and girls, to explore the role of lifestyle factors in fatigue, and to investigate whether severe fatigue in a healthy population is associated with depression, anxiety, and comorbid factors also observed in chronic fatigue syndrome patients. In a sample...

Restorative effects of carotid endarterectomy (CEA) on cognitive functioning in patients with severe atherosclerotic disease presuppose the existence of cognitive deficits prior to the intervention. Thorough examination of this premise received only minor attention. The present study assessed symptomatic and asymptomatic patients with severe unilat...

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...

Differences in genetic influence on death from CHD between males and females have been reported. Haemostatic factors have consistently been associated with risk for coronary heart disease (CHD), but sex differences in genetic architecture have not been studied. This study in middle-aged twins investigates whether there are sex differences in means...

Burnout is presumed to be the result of chronic stress, and chronic stress is known to affect the HPA-axis. To date, studies on HPA-axis functioning in burnout have showed inconsistent results. In the present study, a large sample (n=74) of clinically diagnosed burnout individuals, mostly on sick-leave, were included and compared with 35 healthy co...

Differences in genetic influence on death from CHD between males and females have been reported. Haemostatic factors have consistently been associated with risk for coronary heart disease (CHD), but sex differences in genetic architecture have not been studied. This study in middle-aged twins investigates whether there are sex differences in means...

The central aim of the present study among 572 Dutch employees was to examine whether burnout and its positive antipode—work engagement—could be differentiated on the basis of personality and temperament. We expected burnout to be characterized by high neuroticism and low extraversion, and engagement by low neuroticism and high extraversion. Additi...

Electronic diaries overcome important drawbacks of retrospective reports and capture fluctuations of psychological states and behavior. This study represents the first use of this method in clinically burned-out participants and aims to establish its feasibility concerning participant acceptability, compliance, and reactivity in this sample. Electr...

Aangezien mensen een belangrijk deel van hun leven op hun werk doorbrengen, is het van groot belang om de oorzaken en gevolgen van werkstress in kaart te brengen. Dit is niet alleen omdat stress nu eenmaal onaangenaam is, maar ook omdat langdurige werkstress de gezondheid kan beïnvloeden. We moeten dan niet alleen denken aan effecten op de psychisc...

The prophylactic effect of carotid endarterectomy (CEA) against stroke has been well established. As a consequence of the restoration of cerebral blood supply and reduced risk of stroke, cognitive functioning and perceived health may improve. Fifty-one patients with severe atherosclerotic disease of the carotid artery but without history of major s...

Patients with rheumatoid arthritis face the challenge of adjusting to adverse health consequences and accompanying emotions. Styles of emotion regulation may affect health. Purpose: The objective is to examine associations between styles of emotion regulation and perceived health, consisting of psychological well-being, social functioning, physical...

To examine whether emotion regulation predicts change of perceived health in patients with rheumatoid arthritis (RA). Sixty six patients (44 female, 22 male; mean (SD) age 57.7 (11.6) years) participated in a prospective study. Hierarchical regression analysis was used to predict change of perceived health between study entry and follow up (1(1/2)...

Emotion regulation is hypothesized to be related to health through neuroendocrine-immune changes. This study examined the role of the neuroendocrine variables 24-h urinary cortisol and noradrenaline, and the immune variable serum interleukin 6 as mediators between emotion regulation styles and health (perceived health and disease activity: erythroc...

Carotid endarterectomy (CEA) might improve cognitive functioning, but studies thus far have produced mixed results. The aim of the present study was to examine the effect of CEA on cognitive functions in a methodologically more strict design, first by testing the presumption of preoperative cognitive impairment and second through a better control f...

To investigate the association between perioperative microembolism and cognitive outcome 3 months after carotid endarterectomy (CEA). Prospective study. Patients were tested 1 day before and 3 months after surgery with neuropsychological tests measuring a wide range of cognitive functions. Number of microemboli was monitored with transcranial Doppl...

Emotion regulation has been associated with perceived health in rheumatoid arthritis, which is diagnosed three times more often in women than men. Our aim was to examine gender differences in styles of emotion regulation (ambiguity, control, orientation, and expression) and gender-specificity of the associations between emotion regulation and perce...

This study examined the effects of exposure to job strain on independent predictors of cardiovascular disease (ambulatory blood pressure, heart rate, and heart rate variability). The participants comprised a homogeneous group of 159 healthy female nurses [mean age 35.9 (SD 8.5) years]. The choice of this population minimized variance attributable t...

The aim of this cross-sectional study was to examine short and long-term eating behavior after laparoscopic adjustable gastric banding (LAGB) and the relationship of binge eating with weight and quality of life outcome. 250 patients (221 female, 29 male, mean age 39.6 years, age range 22-61) filled out questionnaires to evaluate quality of life and...

Work stress is associated with an increased risk for cardiovascular disease (CVD). Exaggerated cardiovascular reactivity to work-related stressors or incomplete recovery after work is a proposed mechanism underlying this increase in risk. This study examined the effects of work stress on 24-hour profiles of the pre-ejection period (PEP), a measure...

Genet. Epidemiol. 16:426-- 446, 1999. 1999 Wiley-Liss, Inc. Key words: heritability; twins; insulin resistance; truncated data; assay batch effects; reciprocal causation model *Correspondence to: Dr. Harold Snieder, Twin Research & Genetic Epidemiology Unit, St Thomas' Hospital, Lambeth Palace Road, London, UK SE1 7EH. E-mail: h.snieder@umds.ac.uk...

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...

The morning shift in cardiac sympatho-vagal balance seems involved in the increased risk of cardiovascular incidents at that time. To investigate the contribution of the biological clock in autonomic cardiac control, we investigated the presence of a diurnal rhythm independent of external factors, and of a circadian phase-dependent effect of modera...

To investigate sympathetic (SNS) and parasympathetic (PNS) nervous system activity in patients with recently diagnosed rheumatoid arthritis (RA), and to analyze the association between activity of these systems and disease activity, and complaints that frequently occur in RA, viz., pain, fatigue, negative mood, and stiffness. To assess sympathetic...

The aim of this cross-sectional study was to examine short and long-term physical, mental and, particularly, social quality of life (QoL) of patients with severe obesity after laparoscopic adjustable gastric banding (LAGB). 250 patients (221 female, 29 male, mean age 39.6 years, age range 22-61) filled out questionnaires to evaluate several aspects...

Although the role of social support in promoting employees' health and well-being has been studied extensively, the evidence is inconsistent, sometimes even suggesting that social support might have negative effects. The authors examined some psychological processes that might explain such effects. On the basis of the threat-to-self-esteem model, t...

Burnout symptoms of emotional exhaustion, depersonalisation and reduced personal accomplishment are the result of chronic stress. Specifically the hypothalamus pituitary adrenal (HPA)-axis is involved in long-term stress adaptation. Upon stimulation the HPA-axis releases cortisol from the adrenal medulla. Cortisol maintains the stress response and...

The essential feature of functional somatic syndromes is the presence of symptoms without medical explanation. the syndromes have a high psychiatric co-morbidity, and stress and anxiety are assumed to play a role, at least in the maintenance of the complaints. Psychophysiological models traditionally attribute the symptoms to stress or anxiety-rela...

The prioritized processing of threat is suggested to be motivated by anxiety, regulated by the parasympatheticus, and biased to the right hemisphere. However, according to an anterior dimensional model of negative affect this is unlikely to be true when threat is of social origin. Social threat is communicated by the angry facial expression, and re...

Background: Carotid endarterectomy (CEA) is a surgical procedure to remove atherosclerotic plaque from one of the carotid arteries in patients with severe stenosis. The purpose is to prevent future cerebral ischemic attacks. Whether patients, in addition, improve in cognitive functions and quality of life (QoL) was investigated in this study. Metho...

Carotid endarterectomy (CEA) is a surgical procedure to remove atherosclerotic plaque from the inside of one of the carotid arteries. The aim is to prevent a future cerebral ischemic attack. Besides this medical purpose, patients are expected to improve in mental functioning and have an increased quality of life (QoL). Twenty-two patients with seve...

There is evidence that the hypothalamic pituitary adrenal (HPA) axis is subresponsive in patients with rheumatoid arthritis (RA). We assessed HPA axis responses to experimental stressors mimicking daily life challenges in patients with RA to determine whether HPA axis activity is associated with Th1 and Th2 activity. ACTH and cortisol responses in...

Recently, it was demonstrated how individuals with high levels of testosterone selectively attend toward angry faces. It was argued that this suggests that high levels of testosterone are associated with an aggressive, dominating personality style. In this study, the authors used a double-blind, placebo-controlled design to examine whether exogenou...

Recently, it was demonstrated how individuals with high levels of testosterone selectively attend toward angry faces. It was argued that this suggests that high levels of testosterone are associated with an aggressive, dominating personality style. In this study, the authors used a double-blind, placebo-controlled design to examine whether exogenou...

The aim of this study was to determine the genetic contribution to the variation in testosterone and the aggression-hostility-anger (AHA) syndrome in middle-aged twins. Moreover, the relation between testosterone and this syndrome, and possible common genetic mechanisms were investigated. Towards this end, blood samples were collected at two time p...

To investigate the diurnal courses of cortisol and the daytime states: pain, fatigue, negative mood, and stiffness of patients with rheumatoid arthritis, as well as the association between the cortisol and state courses, 9 repeated measurementson 2consecutive days were taken in the real-life environment of 25 recently diagnosed patients (19 women,...

This study examined the possible effects of job demands, decision latitude, and job-related social support on risk indicators for cardiovascular disease (CVD) in 165 female nurses. Job strain was measured with the Job Content Questionnaire; CVD risk was measured with insulin, total cholesterol, triglyceride (TG), high-density lipoprotein cholestero...

This study examined the possible effects of job demands, decision latitude, and job-related social support on risk indicators for cardiovascular disease (CVD) in 165 female nurses. Job strain was measured with the Job Content Questionnaire; CVD risk was measured with insulin, total cholesterol, triglyceride (TG), high-density lipoprotein cholestero...

Work stress has repeatedly been associated with an increased risk for cardiovascular disease. This study tested whether this relationship could be explained by exaggerated cardiovascular reactivity to work or impaired recovery in leisure time. Vagal tone was assessed as a possible determinant of these work stress effects. Participants included 109...