Date van der Veen | University of Groningen (original) (raw)

Papers by Date van der Veen

International Psychogeriatrics, 2015

Theoretical/Methodological/Review Article Recent years have witnessed an emergence of two distinc... more Theoretical/Methodological/Review Article Recent years have witnessed an emergence of two distinct trends in the fields of psychopathology and psychiatry. The first trend is the network perspective on psychopathology, in which mental disorders are interpreted as the consequence of a dynamical interplay between symptoms and other clinically relevant variables (Borsboom, 2017; Borsboom & Cramer, 2013; Cramer & Borsboom, 2015; Cramer, Waldorp, van der Maas, & Borsboom, 2010). This literature uses symptom networks in an attempt to understand and predict the dynamics of psychopathology (Borsboom, 2017). From this perspective, symptoms are not seen as passive indicators of a mental disorder but rather play an active role, making symptoms prime candidates for interventions (Fried, Epskamp, Nesse, Tuerlinckx, & Borsboom, 2016). Since its introduction, the network perspective has grown into an extensive field of research in clinical psychology and psychiatry (Hofmann, Curtiss, & McNally, 2016; McNally, 2016; for an overview of recent literature, we refer the reader to the review of Fried et al., 2017). Second, technological advances have permitted the gathering of intensive measurements of symptoms, moods, and other daily fluctuating factors in patients and healthy controls with the experience sampling method (ESM; Aan het Rot,

American Journal of Geriatric Psychiatry, Apr 1, 2021

Studies on the course of depression often ignore comorbid anxiety disorders or anxiety symptoms. ... more Studies on the course of depression often ignore comorbid anxiety disorders or anxiety symptoms. We explored predictors of complete remission (no depression nor anxiety diagnoses at follow-up) and of the course of comorbid anxiety symptoms. We additionally tested the hypothesis that the course of anxiety disorders and symptoms in depressed patients is explained by negative life-events in the presence of high neuroticism or a low sense of mastery. Methods: An observational study of 270 patients (≥60 years) diagnosed with major depressive disorder and 2-year follow-up data, who participated in the Netherlands Study of Depression in Older persons (NESDO). Sociodemographic, somatic, psychiatric, and treatment variables were first explored as possible predictors. A multiple logistic regression analysis was used to examine their predictive value concerning complete remission. Subsequently, negative life-events, personality and their interaction were tested as potential predictors. Linear Mixed Models were used to assess whether the personality traits modified the effect of early and recent life-events, and time and their interactions on the course of the anxiety symptoms. Results: A total of 135 of 270 patients achieved complete remission. Depressed patients with a comorbid anxiety disorder at baseline less often achieved complete remission: 38 of 103 (37.0%) versus 97 of 167 (58.1%). The severity of depressive and anxiety symptomatology, the presence of a comorbid anxiety disorder, and a poorer physical health at baseline predicted nonremission. In line with our hypothesis, a less favorable

Journal of psychopathology and clinical science, Nov 1, 2022

Quality of Life Research, Nov 22, 2020

Purpose The experience sampling method (ESM) is used for intensive longitudinal time-series data ... more Purpose The experience sampling method (ESM) is used for intensive longitudinal time-series data collection during normal daily life. ESM data give information on momentary affect, activities and (social) context of, for example, patients suffering from mental disorders, and allows for person-specific feedback reports. However, current personalized feedback reports only display a selection of measured variables, and typically involve only summary statistics, thus not reflecting the dynamic fluctuations in affect and its influencing factors. To address this shortcoming, we developed a tool for dynamically visualizing ESM data. Methods We introduce a new framework, ESMvis, for giving descriptive feedback, focusing on direct visualization of the dynamic nature of raw data. In this ESM feedback approach, raw ESM data are visualized using R software. We applied ESMvis to data collected for over 52 weeks on a patient diagnosed with an obsessive-compulsive disorder with comorbid depression. Results We provided personalized feedback, in which both the overall trajectory and specific time moments were captured in a movie format. Two relapses during the study period could be visually determined, and subsequently confirmed by the therapist. The therapist and patient evaluated ESMvis as an insightful add-on tool to care-as-usual. Conclusion ESMvis is a showcase on providing personalized feedback by dynamic visualization of ESM time-series data. Our tool is freely available and adjustable, making it widely applicable. In addition to potential applications in clinical practice, ESMvis can work as an exploratory tool that can lead to new hypotheses and inform more complex statistical techniques.

BMC Psychiatry, Mar 10, 2021

Background: Major depressive disorder (MDD) is a highly prevalent mental disorder with large dise... more Background: Major depressive disorder (MDD) is a highly prevalent mental disorder with large disease burden, high levels of relapse or persistence, and overall suboptimal outcomes of protocolized pharmacological and psychotherapeutic treatments. There is an urgent need to improve treatment effectiveness, possibly through systematic treatment personalization. In psychotherapeutic treatments this can be achieved by case conceptualization. To support this process, we developed the Therap-i module, which consists of personalized Experienced Sampling Methodology (ESM) and feedback. The Therap-i module is integrated into outpatient psychotherapeutic treatment as usual (TAU) for depression. The study aim is to investigate the efficacy of the Therap-i module in decreasing symptomatology in unresponsive or relapsing patients diagnosed with MDD. We hypothesize that the Therap-i module will contribute to TAU by i) decreasing depressive symptoms, and ii) improving general functioning, therapeutic working alliance, and illness perception. This paper provides details of the study rationale, aims, procedures, and a discussion on potential pitfalls and promises of the module. Methods: Patients diagnosed with MDD (n = 100) will enrol in a pragmatic two-armed randomized controlled trial. Randomization is stratified according to the patient's treatment resistance level assessed with the Dutch Method for quantification of Treatment Resistance in Depression (DM-TRD). All fill-out the Inventory of Depressive Symptomatology Self Report (IDS-SR), Outcome Questionnaire (OQ-45), Illness Perception Questionnaire Mental Health (IPQ-MH), and Work Alliance Inventory Self Report (WAI-SR). In the intervention arm, through close collaboration between patient, clinician, and researcher, a personalized ESM diary is developed based on the patient's case conceptualization. During the ESM monitoring period (8 weeks, 5 assessments/day), patients receive feedback three times, which is discussed among the abovementioned three parties. Both patients and clinicians will evaluate the Therap-i module. Results: Data collection is ongoing.

American Journal of Geriatric Psychiatry, Nov 1, 2014

BMC Medicine, Nov 23, 2020

Background: The complexity of psychopathology is evident from its multifactorial etiology and div... more Background: The complexity of psychopathology is evident from its multifactorial etiology and diversity of symptom profiles and hampers effective treatment. In psychotherapy, therapists approach this complexity by using case conceptualization. During this process, patients and therapists closely collaborate on a personalized working theory of the patient's psychopathology. This is a challenging process and shows low reliability between therapists. With the experience sampling method (ESM), time-series data-valuable for case conceptualization-can be systematically gathered in a patient's normal daily life. These data can be analyzed and visualized in person-specific networks (PSNs). PSNs may support case conceptualization by providing a schematic representation of association patterns between affective, cognitive, behavioral, and context variables. Main text: We adopt a clinical perspective in considering how PSNs might be implemented to serve case conceptualization and what their role could be in psychotherapy. We suggest PSNs to be based on personalized ESM assessment to capture the unique constellation of variables in each patient. We reflect on the lack of a gold standard for creating PSNs, which may result in substantially different PSNs and thereby disparate information for case conceptualization. Moreover, even if PSNs are created in a consistent manner, results remain ambiguous as they are subject to multiple interpretations. Therefore, associations in PSNs do not allow for firm conclusions about a patient's psychopathology, but they may nevertheless be valuable in the process of case conceptualization. PSNs are based on systematically gathered, ecologically valid ESM data and provide a unique personalized perspective. When used responsibly, PSNs may be able to support case conceptualization by generating questions that serve as a starting point for a dialog between therapists and patients. Well-targeted questions are an essential tool for therapists to gain insight into the patients' psychopathology patterns and improve the quality of case conceptualization. Conclusions: PSNs have limitations in terms of the reliability of the insights they provide directly. However, taking these challenges into account, we believe they have potential as a tool to help therapists and patients in their collaborative exploration of a patient's psychopathology. Clearly, this would need to be validated in future clinical research.

BMC Medicine, Apr 8, 2020

Background: The past decades of research have seen an increase in statistical tools to explore th... more Background: The past decades of research have seen an increase in statistical tools to explore the complex dynamics of mental health from patient data, yet the application of these tools in clinical practice remains uncommon. This is surprising, given that clinical reasoning, e.g., case conceptualizations, largely coincides with the dynamical system approach. We argue that the gap between statistical tools and clinical practice can partly be explained by the fact that current estimation techniques disregard theoretical and practical considerations relevant to psychotherapy. To address this issue, we propose that case conceptualizations should be formalized. We illustrate this approach by introducing a computational model of functional analysis, a framework commonly used by practitioners to formulate case conceptualizations and design patient-tailored treatment. Methods: We outline the general approach of formalizing idiographic theories, drawing on the example of a functional analysis for a patient suffering from panic disorder. We specified the system using a series of differential equations and simulated different scenarios; first, we simulated data without intervening in the system to examine the effects of avoidant coping on the development of panic symptomatic. Second, we formalized two interventions commonly used in cognitive behavioral therapy (CBT; exposure and cognitive reappraisal) and subsequently simulated their effects on the system. Results: The first simulation showed that the specified system could recover several aspects of the phenomenon (panic disorder), however, also showed some incongruency with the nature of panic attacks (e.g., rapid decreases were not observed). The second simulation study illustrated differential effects of CBT interventions for this patient. All tested interventions could decrease panic levels in the system.

American Journal of Geriatric Psychiatry, Mar 1, 2015

Introduction: Many problems prevalent in the geriatric population, such as dementia and depressio... more Introduction: Many problems prevalent in the geriatric population, such as dementia and depression, have traditionally been treated in the primary care setting, only being referred to a geriatric specialist when it is considered to be more advanced. While this does have benefits and improves access to healthcare, it presents challenges of its own and there has been a push to improve coordination between mental health and primary care. It has been noted that depression and early stage of dementia are often undiagnosed or inadequately treated by non-psychiatric or non-geriatric specialties. Primary care physicians may not be as likely to prescribe the full range of available or approved medications, or may not be comfortable with higher doses of psychiatric medications for example. There may also be a delay in appropriate referral of these patients to a specialist that could affect the outcome for these patients on the long run. Therefore, not only medical professions, but also patients call for integration of mental health and primary care to reduce the fragmented and inadequate care of mental health problems in primary care patients. Methods: We would like to use the electronic medical records from Carilion Roanoke Memorial Hospital, one of the largest hospitals in Virginia, to gather data on patients with such illnesses who are being followed by primary care, geriatric psychiatry, and geriatric medicine and to compare the pharmacological interventions. Statistical analysis including Statistical Distributions, ANOVA, T tests, and Chi-squared test are applied to analyze the patient's diagnosis, treatments and the prognosis of about eight thousands geriatric patients in the database, in which, the patients are classified according to gender and age groups including 60-70 years old, 70 to 80 years old and over 80 years old. The differences in diagnosis interventions, treatment plan, psychotropic medication applications and dosing, as well as the long-term prognosis of depression and dementia in the geriatric population in the Roanoke Valley area are compared. Results: The preliminary data shows that benzodiazepines, particularly clonazepam and alprazolam, are the most often prescribed sedatives by primary care in treating depression or dementia with behavior disturbance. These medications have significant adverse effects, such patient falls and worsening dementia, therefore, significantly increase morbidity in geriatric patients. Preliminary data also shows that it is common for drugs to be prescribed under the effective dose for the illness. In addition, because of the lack of experience in diagnosis illness using the latest criteria and scales, patients in primary care then to have high rates of under diagnosis of dementia and depression. Conclusions: With our findings, we hope to emphasize the importance to improve care integration between psychiatry and primary care so that patients will be treated with appropriate medications at the appropriate time, as well as have appropriate and timely referrals to geriatric psychiatry when needed.

American Journal of Geriatric Psychiatry, Mar 1, 2014

European Psychiatry, Jul 1, 2017

$Research paper thumbnail of Cannabidiol enhancement of exposure therapy in treatment refractory patients with social anxiety disorder and panic disorder with agoraphobia: A randomised controlled trial$

European Neuropsychopharmacology, Jun 1, 2022

Background: Phobic anxiety disorders are among the most prevalent psychiatric disorders and are b... more Background: Phobic anxiety disorders are among the most prevalent psychiatric disorders and are burdensome in terms of loss of quality of life and work productivity. Evidence-based treatments are relatively successful in the majority of patients, especially exposure therapy. However, a substantial subset of patients fails to achieve or stay in remission. Preclinical and genetic research have yielded evidence that the cannabinoid system is involved in the extinction of fear, presumed to underlie the beneficial effects of exposure therapy in phobic disorders. A cannabinoid constituent that may enhance endocannabinoid signaling is cannabidiol (CBD), a non-psychoactive component of cannabis. Hence, the addition of CBD to exposure therapy is expected to strengthen effects of treatment. To determine the added benefit of CBD on exposure therapy, we conduct a randomized controlled trial, in which patients in whom previous treatment as usual has not yielded sufficient response receive either CBD or placebo preceding 8 exposure sessions in a double-blind fashion. A subsidiary aim is to explore which (combination of) clinical, behavioral and genetic profiles of patients are related to treatment response. Methods/design: This is an 8-week multicenter, randomized, double-blind, placebo-controlled trial. Seventy-two patients with social phobia or panic disorder with agoraphobia with incomplete response to earlier treatment will be included from outpatient clinics in the Netherlands. Patients are randomized to augmentation of exposure therapy with 300 mg CBD or placebo. The study medication is administered orally, 2 h preceding each of the eight 90 min exposure sessions. Measurements will take place at baseline, first administration of medication, every session, mid-treatment, last administration of medication, post-treatment and at 3 and 6 months' follow-up. The primary outcome measure is the score on the Fear Questionnaire (FQ). In addition, determinants of the expected treatment enhancing effect of CBD will be explored. Discussion: This is the first trial to investigate whether the addition of CBD to exposure therapy is effective in reducing phobic symptoms in treatment refractory patients with social phobia or panic disorder with agoraphobia.

$Research paper thumbnail of P.102 Cannabidiol enhancement of exposure therapy in treatment refractory patients with phobias: first results after augmented in vivo exposure therapy$

European Neuropsychopharmacology, 2020

An integrated approach is presented for predicting granule particle size using Partial Correlatio... more An integrated approach is presented for predicting granule particle size using Partial Correlation (PC) analysis and Artificial Neural Networks (ANNs). In this approach, the proposed model is an abstract form from the ANN model, which intends to reduce model complexity via reducing the dimension of the input set and consequently improving the generalization capability of the model. This study involves comparing the capability of the proposed model in predicting granule particle size with those obtained from ANN and Multi Linear Regression models, with respect to some indicators. The numerical results confirm the superiority of the proposed model over the others in the prediction of granule particle size. In order to develop a predictive-control strategy, by employing the proposed model, several scenarios are developed to identify the most suitable process settings with respect to the desired process response. Utilization of these scenarios paves the way for decisions about spray drying to be made consistently and correctly without any need for judgmental speculations or expensive trial-and-error tests.

Heliyon, Mar 1, 2023

Background: The experience sampling methodology (ESM) is increasingly being suggested as a clinic... more Background: The experience sampling methodology (ESM) is increasingly being suggested as a clinical tool in mental health care, as it offers ecologically valid, microlevel information on psychopathological processes. Patients and clinicians have recommended that applications of ESM should be personalized and integrated into the existing clinical process, but there is still much uncertainty about how implementation may look like. Objective: To provide an example of personalized ESM assessment and feedback being integrated into psychotherapy for depression, specifically looking at the collaborative use of ESM in case conceptualization.Methods: George, a 27-year-old man diagnosed with depression, and his therapist participated in the Therap-i randomized controlled trial, which investigates the efficacy of a personalized ESM module added to psychotherapy. Together, they created a personalized ESM questionnaire, aiming to capture their hypotheses and questions regarding George’s case conceptualization. George then filled out his ESM questionnaire five times per day, for 8 weeks. During this period, ESM data were discussed and interpreted by George, his therapist, and a researcher, in three feedback sessions. In these sessions, data were visualized in a flexible feedback interface that allowed for collaborative exploration of George’s data. Both patient and therapist evaluated the module through questionnaires and George also participated in a semi-structured evaluation interview.Results: George’s ESM questionnaire included personalized items on the topics of self-esteem and open versus withdrawn behavior. He completed 241 (89.3%) assessments. Discussions during the feedback sessions focused on two core themes: First, George’s low energy level, which was further explored with regard to his sleep, medication, and activity patterns. Second, his low sense of self-esteem, which led to an in-depth exploration of his thinking patterns and social interactions. The ESM module was seen as useful and insightful by both George and therapist. Conclusions: This case shows how ESM and ESM-based feedback can stimulate the collaborative exploration of the patient’s complaints, and how it can provide useful insights for treatment. We discuss how our personalized ESM module relates to current clinical principles and practices, and make suggestions for further implementation.

Code to reproduce analyses. This file provides the code to reproduce all analyses discussed in th... more Code to reproduce analyses. This file provides the code to reproduce all analyses discussed in this report in the open-source software R. All materials are made available in the open-science-framework repository: https://osf.io/spb37/.

Mathematical background. This file includes the mathematical background, including differential e... more Mathematical background. This file includes the mathematical background, including differential equations for the system variables and interventions, as well as parameter choices and initial values to conduct the simulations.

Journal of Affective Disorders, 2019

Background: The locus of control (LOC) construct has been associated with onset, course, and seve... more Background: The locus of control (LOC) construct has been associated with onset, course, and severity of anxiety and depression. We investigated the stability of LOC, the bidirectional relationships between LOC and symptom severity of anxiety and depression over nine years, and the influence of intermediate positive and negative life-events on these associations. Methods: Data came from five assessment waves over nine years of 2052 subjects with an anxiety or depressive disorder or healthy controls. First, the stability of LOC (assessed with 5-item Mastery Scale) was tested. Next, associations between LOC, anxiety severity (Beck Anxiety Inventory), depression severity (Inventory of Depressive Symptomatology), and intermediate positive and negative life-events (20-item List of Threatening Experience Questionnaire) were determined with structural equation modeling. Results: LOC was rather stable over nine years (r = .62), and scores increased slightly with age (i.e. became more internal). LOC yielded equal stability estimates as symptom levels of anxiety and depression did over nine years. A more external LOC predicted higher anxiety and depression severity, but did not influence the incidence of positive and negative life-events. Higher depression severity and more negative life-events predicted the development of a more external LOC, whereas more positive life-events predicted a more internal LOC. Anxiety severity had no effect on LOC. Limitations: Life-events were assessed with self-report measures. Conclusions: The prospective associations between LOC and meaningful changes in anxiety and depressive symptom severity and experienced life-events may yield important new insights for clinical interventions.

One of the promises of the experience sampling methodology (ESM) is that it could be used to iden... more One of the promises of the experience sampling methodology (ESM) is that it could be used to identify relevant targets for treatment, based on a statistical analysis of an individual’s emotions, cognitions and behaviors in everyday-life. A requisite for clinical implementation is that outcomes of person-centered analyses are not wholly contingent on the researcher performing them. To evaluate how much researchers vary in their analytical approach and to what degree outcomes vary based on analytical choices, we crowdsourced the analysis of one individual patient’s ESM data to 12 prominent research teams, asking them what symptom(s) they would advise the treating clinician to target in subsequent treatment. The dataset was from a 25-year-old male with a primary diagnosis of major depressive disorder and comorbid generalized anxiety disorder, who completed momentary assessments related to depression and anxiety psychopathology prior to psychotherapy. Variation was evident at different ...