The measurement of remoralization. An extension of contemporary...


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Titel The measurement of remoralization. An extension of contemporary psychotherapy outcome research
Looptijd 01 / 2006 - 10 / 2010
Status Afgesloten
Dissertatie Ja
Onderzoeknummer OND1317879
Leverancier gegevens ZonMw


Om te bepalen of een bepaalde behandeling van psychische aandoeningen effectief is, volgt men het medisch model. Men kijkt of goed meetbare symptomen verminderd zijn en verbindt daar ook in toenemende mate consequenties aan voor de financiering. Maar door alleen te kijken naar symptoomvermindering is het niet duidelijk of de patiënt ook meer zelfvertrouwen of toekomstperspectief heeft gekregen. Remoralisatie noemen behandelaars dat. En dat is volgens patiënten en behandelaars minstens zo'n belangrijk behandelresultaat. Wiede Vissers ontwikkelde en testte een remoralisatievragenlijst. Ze stelde vast dat symptoomvermindering en remoralisatie bij paniekpatiënten samen gingen, zelfs wanneer de behandeling alleen gericht was op symptoomvermindering of op remoralisatie. Ook was er een directe relatie tussen remoralisatie en de mate waarin patiënten beter functioneerden op meerdere levensterreinen. Die relatie was er niet tussen remoralisatie en symptoomvermindering. Meten van remoralisatie is volgens de promovenda daarom minstens zo belangrijk als het meten van symptoomvermindering.

Samenvatting (EN)

The new Dutch multidisciplinary evidence-based guidelines for the treatment of anxiety disorders have been welcomed by practitioners as well as researchers. But there is also criticism for them. Critics claim that the exclusive attention paid to symptom reduction in order to establish the effects of treatment is too restricted and that other treatment effects, such as regaining hope and restoring self-esteem are systematically overlooked. These complementary or additional treatment effects are captured by the term 'remoralization'. In this study, the relation between symptom reduction and remoralization will be investigated. The main research question is: are there really two separate treatment effects to be considered? If so, what, if any is their relation with the other? In the first phase of the study, two treatment packages will be developed. The first treatment is an exposure in-vivo treatment (ET) aimed at reducing symptoms, the second treatment is aimed at enhancing remoralization (RT). In the second phase of the study, 90 patients suffering from panic disorder with agoraphobia and waiting for their formal treatment to start, will be randomly assigned to RT, ET, or a waiting list (WL) condition. The treatments consist of 4 weekly sessions including homework assignments and are conducted by carefully trained therapists. One week after the fourth session, treatment effects will be assessed by measuring remoralization effects and symptom reduction. In the third phase of the study, the patients in the treatment conditions will receive the alternative treatment in a counterbalanced design. Post-measurements take place one week after the fourth session of the patient's second treatment. Recently, guidelines for the treatment of anxiety disorders were published in the Netherlands by the Task Force on Multidisciplinary Guideline Development in Mental Health (Spinhoven et al., 2003). These evidence-based guidelines indicate the most effective psychopharmacological and psychological treatments and best clinical practice for each of the seven anxiety disorders. These guidelines were welcomed by many mental health workers but criticized by others. Critics claim that these guidelines result from a biased line of outcome research and that they are of limited use in clinical practice (Takens, 2004). The question is: how is this possible? In their historical analysis of treatment outcome research, Goldfried and Wolfe (1996) originates the current research paradigm in the 1980s. Within this paradigm, the treatment effects of standardized treatments are compared with the results of other, equally well-defined treatments or control groups. Patients are strictly diagnosed according to the DSM-IV criteria for a specific disorder and randomly assigned to the treatment conditions. Sources of variance (patient-, therapist-, and treatment variation) outside the focus of interest of the researcher are reduced as much as possible. This research paradigm proved to be highly successful. Over the years, it showed which treatments produced the best results for patients suffering from particular disorders. The project aims to answer the following main questions: First, are remoralization and symptom reduction distinguishable outcomes in the treatment of patients with an anxiety disorder or do they represent aspects of the same psychological change and therefore always go hand in hand? Second, the sequence of these effects will be studied: what should be treated first? In other words, is one sequence of treatments more effective than the other? These questions are translated into the three phases of the present study. The proposed project is directed at the targeted patient groups of anxiety disorders from the Dutch ZonMW research programme GeestKracht. Although symptom reduction as a result of treatment for anxiety disorders has been extensively documented, little is known about additional effects. It is unclear whether symptom reduction and remoralization effects overlap, whether the one precedes the other, or whether both effects follow a separate route. In order to make a clear and testable starting point, the present project seeks to answer the following main question: can psychotherapeutic treatment produce symptom reduction separately from remoralization effects, and can it produce remoralization effects separately from symptom reduction? This study investigates the research question within the field of anxiety disorders for a number of reasons. Firstly, the treatments and treatment effects in patients suffering from anxiety disorders are probably the best documented in mental health care. Secondly, marked reduction of symptoms is obtainable and has repeatedly been documented. Thirdly, the current project is embedded in a research programme with considerable research experience in this field of anxiety disorders. The proposed research project will be carried out in three phases. Phase 1 can be seen as the preliminary part. In this phase, we adapt two existing treatments into 4-session, manualized research treatments. One is aimed at decreasing avoidance behaviour of patients with panic and agoraphobia by ET, the other at enhancing remoralization by using (RT). ET and RT will be tested in ten patients with panic disorder and agoraphobia. In Phase 2 of the proposed research project, ninety patients with panic disorder and agoraphobia will be randomly assigned to one of three research conditions: ET, RT or WL condition. Pre and post measurements of panic and agoraphobia symptoms, and remoralization will be conducted.

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A74000 Geestelijke gezondheidszorg
D51000 Psychologie

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