Tag Archives: J. Fleer

Group and Individual Mindfulness-Based Cognitive Therapy (MBCT) Are Both Effective: a Pilot Randomized Controlled Trial in Depressed People with a Somatic Disease.






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Group and Individual Mindfulness-Based Cognitive Therapy (MBCT) Are Both Effective: a Pilot Randomized Controlled Trial in Depressed People with a Somatic Disease.

Mindfulness (N Y). 2016;7(6):1339-1346

Authors: Schroevers MJ, Tovote KA, Snippe E, Fleer J

Abstract
Depressive symptoms are commonly reported by individuals suffering from a chronic medical condition. Mindfulness-based cognitive therapy (MBCT) has been shown to be an effective psychological intervention for reducing depressive symptoms in a range of populations. MBCT is traditionally given in a group format. The aim of the current pilot RCT was to examine the effects of group-based MBCT and individually based MBCT for reducing depressive symptoms in adults suffering from one or more somatic diseases. In this study, 56 people with a somatic condition and comorbid depressive symptoms (i.e., Beck Depression Inventory-II [BDI-II] ≥14) were randomized to group MBCT (n = 28) or individual MBCT (n = 28). Patients filled out questionnaires at three points in time (i.e., pre-intervention, post-intervention, 3 months follow-up). Primary outcome measure was severity of depressive symptoms. Anxiety and positive well-being as well as mindfulness and self-compassion were also assessed. We found significant improvements in all outcomes in those receiving group or individual MBCT, with no significant differences between the two conditions regarding these improvements. Although preliminary (given the pilot nature and lack of control group), results suggest that both group MBCT and individual MBCT are associated with improvements in psychological well-being and enhanced skills of mindfulness and self-compassion in individuals with a chronic somatic condition and comorbid depressive symptoms. Our findings merit future non-inferiority trials in larger samples to be able to draw more firm conclusions about the effectiveness of both formats of MBCT.

PMID: 27909465 [PubMed – in process]

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Psychological burden at the time of diagnosis among Mexican breast cancer patients.






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Psychological burden at the time of diagnosis among Mexican breast cancer patients.

Psychooncology. 2016 Feb 12;

Authors: Pérez-Fortis A, Schroevers MJ, Fleer J, Alanís-López P, Veloz-Martínez MG, Ornelas-Mejorada RE, Sanderman R, Ranchor AV, Sánchez Sosa JJ

PMID: 26872293 [PubMed – as supplied by publisher]

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Delay in Diagnosis of Testicular Cancer; A Need for Awareness Programs.






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Delay in Diagnosis of Testicular Cancer; A Need for Awareness Programs.

PLoS One. 2015;10(11):e0141244

Authors: Öztürk Ç, Fleer J, Hoekstra HJ, Hoekstra-Weebers JE

Abstract
BACKGROUND AIM: To gain insight into patient and doctor delay in testicular cancer (TC) and factors associated with delay.
MATERIALS AND METHODS: Sixty of the 66 eligible men; median age 26 (range 17-45) years, diagnosed with TC at the University Medical Center Groningen completed a questionnaire on patients’ delay: interval from symptom onset to first consultation with a general practitioner (GP) and doctors’ delay: interval between GP and specialist visit.
RESULTS: Median patient reported delay was 30 (range 1-365) days. Patient delay and TC tumor stage were associated (p = .01). Lower educated men and men embarrassed about their scrotal change reported longer patient delay (r = -.25, r = .79 respectively). Age, marital status, TC awareness, warning signals, nor perceived limitations were associated with patient delay. Median patient reported time from GP to specialist (doctors’ delay) was 7 (range 0-240) days. Referral time and disease stage were associated (p = .04). Six patients never reported a scrotal change. Of the 54 patients reporting a testicular change, 29 (54%) patients were initially ‘misdiagnosed’, leading to a median doctors’ delay of 14 (1-240) days, which was longer (p< .001) than in the 25 (46%) patients whose GP suspected TC (median doctors’ delay 1(0-7 days).
CONCLUSIONS: High variation in patients’ and doctors’ delay was found. Most important risk variables for longer patient delay were embarrassment and lower education. Most important risk variable in GP’s was ‘misdiagnosis’. TC awareness programs for men and physicians are required to decrease delay in the diagnosis of TC and improve disease free survival.

PMID: 26606249 [PubMed – as supplied by publisher]

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Long-term effects of goal disturbance and adjustment on well-being in cancer patients.






Long-term effects of goal disturbance and adjustment on well-being in cancer patients.

Qual Life Res. 2015 Oct 7;

Authors: Janse M, Sprangers MA, Ranchor AV, Fleer J

Abstract
PURPOSE: To investigate the impact of personal goal disturbance after cancer diagnosis on well-being over time, and a possible moderating role of goal adjustment tendencies and actual goal adjustment strategies.
METHODS: Participants (n = 186) were interviewed three times: within a month, 7 months (treatment period), and 18 months (follow-up period) after being diagnosed with colorectal cancer. Participants were asked to freely mention three to ten personal goals. Goal disturbance was assessed by the patients’ ratings of the amount of hindrance experienced in goal achievement. Goal adjustment tendencies were assessed using the Goal Disengagement and Re-engagement Scale and actual goal adjustment (i.e. goal flexibility) by the number of goal adjustment strategies used. Outcome measures were overall quality of life and emotional functioning, assessed with the cancer-specific EORTC QLQ-C30.
RESULTS: Hierarchical regression analyses showed that goal disturbance predicted well-being over both the treatment and the follow-up period. Additionally, the negative effect of goal disturbance on well-being was less for patients who scored higher on goal disengagement and not significant for patients who were more flexible in their use of actual goal adjustment strategies.
CONCLUSIONS: The present study is the first to test the theoretical assumption that goal adjustment is beneficial after goal disturbance. Whereas these findings need to be confirmed in future research, the possibly beneficial role of goal disengagement and actual goal adjustment strategies can be used for psychological interventions.

PMID: 26446093 [PubMed – as supplied by publisher]

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People with cancer use goal adjustment strategies in the first 6 months after diagnosis and tell us how.






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People with cancer use goal adjustment strategies in the first 6 months after diagnosis and tell us how.

Br J Health Psychol. 2015 Sep 28;

Authors: Janse M, Ranchor AV, Smink A, Sprangers MA, Fleer J

Abstract
OBJECTIVES: Theory has offered suggestions on how people may adjust their personal goals after goal disturbance or altered life situations. However, the actual use of these goal adjustment strategies has rarely been studied. This study aimed to investigate whether the goal adjustment strategies identified in the literature are used in the first 6 months following a diagnosis of cancer and whether alternative strategies can be identified.
DESIGN: Exploratory design with a qualitative method of data collection.
METHODS: Patients were asked to list their current personal goals within a month after being diagnosed with colorectal cancer. Six months later, they were asked what had happened to each of these goals. For each goal, raters scored whether (1) it was achieved or being pursued as planned, (2) a known strategy was used, or (3) an alternative strategy was used.
RESULTS: Patients with colorectal cancer (n = 130) reported that more than half of their goals had been achieved or were being pursued as planned. The remaining goals (n = 210) required goal adjustment strategies. Patients used five of six known strategies that involved mostly limited adjustment. Additionally, they used combinations of goal adjustment strategies, and two alternative strategies were identified.
CONCLUSIONS: This study found that patients with cancer use goal adjustment strategies, and it provides illustrations on how these strategies are used, thus deepening and extending existing knowledge of and theory on goal adjustment. Future studies should take the newly identified strategies into account as well as the possible use of combinations of strategies. Statement of contribution What is already known on this subject? The successful pursuit of personal goals is important for maintaining well-being. However, an unexpected and serious illness such as cancer can lead to the need to adjust goals, either because they have become difficult or impossible to attain due to physical hindrance of the illness and/or its treatment, or because other goals have become important due to the confrontation with the fragility of life. Theories have proposed options of how people may deal with their personal goals, but whether these so-called goal adjustment strategies are actually used by cancer patients, and whether there are alternative strategies we need to take into account, is still unclear. What does this study add? This study employs a qualitative method of data collection to study what actually happens to cancer patients’ goals during the first 6 months after diagnosis. This study found that almost all goal adjustment strategies from theory are indeed used by cancer patients and that they mostly use strategies which involve only limited adjustment and a continued focus on the original goal. We found that patients with cancer use combinations of strategies and two alternative strategies, thereby complementing and expanding theories on goal adjustment.

PMID: 26412011 [PubMed – as supplied by publisher]

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Studying learning in the healthcare setting: the potential of quantitative diary methods.






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Studying learning in the healthcare setting: the potential of quantitative diary methods.
Perspect Med Educ. 2015 Jul 17;
Authors: Ciere Y, Jaarsma D, Visser A, Sanderman R, Snippe E, Fleer J
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Cognitive behavioral therapy and mindfulness-based cognitive therapy for depressive symptoms in patients with diabetes: design of a randomized controlled trial.






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Cognitive behavioral therapy and mindfulness-based cognitive therapy for depressive symptoms in patients with diabetes: design of a randomized controlled trial.

BMC Psychol. 2013;1(1):17

Authors: Tovote KA, Fleer J, Snippe E, Bas IV, Links TP, Emmelkamp PM, Sanderman R, Schroevers MJ

Abstract
BACKGROUND: Depressive symptoms are a common problem in patients with diabetes, laying an additional burden on both the patients and the health care system. Patients suffering from these symptoms rarely receive adequate evidence-based psychological help as part of routine clinical care. Offering brief evidence-based treatments aimed at alleviating depressive symptoms could improve patients’ medical and psychological outcomes. However, well-designed trials focusing on the effectiveness of psychological treatments for depressive symptoms in patients with diabetes are scarce. The Mood Enhancement Therapy Intervention Study (METIS) tests the effectiveness of two treatment protocols in patients with diabetes. Individually administered Cognitive Behavioral Therapy (CBT) and Mindfulness-Based Cognitive Therapy (MBCT) are compared with a waiting list control condition in terms of their effectiveness in reducing the severity of depressive symptoms. Furthermore, we explore several potential moderators and mediators of change underlying treatment effectiveness, as well as the role of common factors and treatment integrity.
METHODS/DESIGN: The METIS trial has a randomized controlled design with three arms, comparing CBT and MBCT with a waiting list control condition. Intervention groups receive treatment immediately; the waiting list control group receives treatment three months later. Both treatments are individually delivered in 8 sessions of 45 to 60 minutes by trained therapists. Primary outcome is severity of depressive symptoms. Anxiety, well-being, diabetes-related distress, HbA1c levels, and intersession changes in mood are assessed as secondary outcomes. Assessments are held at pre-treatment, several time points during treatment, at post-treatment, and at 3-months and 9-months follow-up. The study has been approved by a medical ethical committee.
DISCUSSION: Both CBT and MBCT are expected to help improve depressive symptoms in patients with diabetes. If MBCT is at least equally effective as CBT, MBCT can be established as an alternative approach to CBT for treating depressive symptoms in patients with diabetes. By analyzing moderators and mediators of change, more information can be gathered for whom and why CBT and MBCT are effective.
TRIAL REGISTRATION: Clinical Trials NCT01630512.

PMID: 25566369 [PubMed]

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Changes in cancer patients’ personal goals in the first 6 months after diagnosis: the role of illness variables.






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Changes in cancer patients’ personal goals in the first 6 months after diagnosis: the role of illness variables.

Support Care Cancer. 2014 Dec 6;

Authors: Janse M, Ranchor AV, Smink A, Sprangers MA, Fleer J

Abstract
PURPOSE: Setting and pursuing personal goals is a vital aspect of our identity and purpose in life. Cancer can put pressure on these goals and may be a reason for people to adjust them. Therefore, this paper investigates (1) changes in cancer patients’ goals over time and (2) the extent to which illness characteristics relate to goal changes.
METHODS: At both assessment points (1 and 7 months post-diagnosis), colorectal cancer patients (n = 198) were asked to list their current goals and rate them on hindrance of illness, attainability, likelihood of success, temporal range and importance. All goals were coded by two independent raters on content (i.e. physical, psychological, social, achievement and leisure). Patients’ medical data were obtained from the national cancer registry.
RESULTS: Over time, patients reported a decrease in illness-related hindrance, higher attainability and likelihood of success, a decrease in total number of goals, goals with a shorter temporal range, and more physical and fewer social goals. At both assessments, patients with more advanced stages of cancer, rectal cancer, a stoma, and receiving additional chemotherapy and/or radiotherapy reported more illness-related hindrance in goal attainment, but only patients with a stoma additionally reported lower attainability, likelihood of success and more short-term goals.
CONCLUSIONS: The results of this study support the assumption that cancer patients adjust their goals to changing circumstances and additionally show how patients adjust their goals to their illness. Moreover, we demonstrate that illness variables impact on goal change.

PMID: 25479825 [PubMed – as supplied by publisher]

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Prior public health agency contacts of individuals committing suicide.






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Prior public health agency contacts of individuals committing suicide.
Psychol Rep. 1982 Jun;50(3 Pt 2):1319-24
Authors: Fleer J, Pasewark RA
PMID: 7111591 [PubMed – indexed for MEDLINE]

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Postmortem diagnosis of testicular cancer.






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Postmortem diagnosis of testicular cancer.
Lancet. 2002 Nov 9;360(9344):1511-2
Authors: Fleer J, Hoekstra HJ, Sleijfer DT, Lutke Holzik MF, Hoekstra-Weebers JE
PMID: 12433547 [PubMed – indexed for MEDL… Continue reading

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