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Radboud University, 08 februari 2023, Promotores : Molleman, G.R.M., Engels, R.C.M.E., Velden, J. van der Co-promotor : Fransen-Kuppens, G.A.J., Contains fulltext : 288655.pdf (Publisher’s version ) (Closed access), Parents play an important role in the development of their children’s dietary, physical activity, and sedentary behaviors. Unhealthy habits can lead to childhood overweight and subsequent health issues. In this thesis, we describe which daily life situations parents of primary school children experience as difficult to stimulate healthy behavior. We identify typologies based on how consistently parents apply dietary and sedentary behavior rules, and found that these typologies are associated with socio-demographic characteristics, dietary and sedentary behavior in children, and the prevalence of overweight among children. In addition, many parents of overweight children underestimate their child’s weight status, particularly parents of children 4-8 years of age and parents of children who are obese. Experts have reached a consensus regarding which ‘HOW-advices’ help parents in order to stimulate healthy behaviors in their child, see the app www.adviezenvooreengezondeopvoeding.nl . Using a theoretical problem-solving model and the above findings, we developed the e-learning www.gezondeafsprakenmetjekind.nl for parents to strengthen parenting skills in difficult daily life situations and stimulate healthy behaviors in their child. Despite parents’ overall satisfaction with this e-learning, further research is needed to identify in which target group the e-learning is effective. Finally, it is important to recognize that merely strengthening parenting is not enough; indeed, It takes a healthy village to raise healthy children.

Contains fulltext : 297776.pdf (Publisher’s version ) (Closed access), Depressie komt veel voor onder jongeren en heeft verschillende negatieve gevolgen. Het huidige onderzoeksproject was gericht op het ontwikkelen en testen van toegepaste videogames met sociale interactie om het ontstaan en de toename van depressieve symptomen bij jongeren te helpen voorkomen. Hierbij richtten we ons op sociale risico's en beschermende factoren voor depressie. Het project resulteerde in de ontwikkeling van twee nieuwe toegepaste videogames (ScrollQuest en Moving Stories), dankzij een samenwerking van gameontwerpers, jongeren, artsen, schoolprofessionals en onderzoekers. Het onderzoek naar deze twee videogames heeft bijgedragen aan de kennis over het potentieel van videogames voor de preventie en het meten van mentale gezondheidsproblemen. Dit onderzoeksproject laat zien dat het goed is om door te gaan met de ontwikkeling van games voor mentale gezondheid, om andere toepassingen toe te voegen aan de reeds bestaande inspanningen om het welzijn van de jeugd te verbeteren en hen te helpen veerkrachtige volwassenen te worden., Radboud University, 28 november 2023, Promotores : Engels, R.C.M.E., Granic, I., Kleinjan, M., 185 p.

Contains fulltext : 230850.pdf (Publisher’s version ) (Open Access), The aim of the present study was to examine the additive effect of elements of cognitive behavioral therapy (CBT) on the video game Mindlight in decreasing anxiety of children with an autism spectrum disorder (ASD). A non-concurrent multiple baseline design with 8 children with ASD in the age of 8-12 was used. CBT did not have the hypothesized additive effect on Mindlight in decreasing anxiety of children with ASD. Instead, multiple participants already experienced a decrease in anxiety during the Mindlight sessions. Yet, several participants did experience a stabilization in anxiety at a low level during the CBT sessions. For now, it can be concluded that CBT does not have an additive effect on Mindlight.

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Contains fulltext : 242378.pdf (Publisher’s version ) (Open Access), Background: Suicidal thoughts and behaviors (STBs) among adolescents have hardly decreased despite preventative efforts. School-based prevention programs could have a great reach, yet suicide prevention is not an easy topic to address. To increase acceptability of school-based suicide prevention, it is important to evaluate whether programs that target known risk factors of STBs, such as depression, could be equally effective. Methods: We conducted a systematic literature search in major electronic databases. Outcomes were suicidal ideation and behaviors. Multivariate random effects meta-regression-analyses were conducted. Results: Eleven primary studies met the inclusion criteria, totalling 23,230 participants. The post-test effect size was small for both suicidal ideation (g = 0.15) and suicidal behaviors (g = 0.30). Meta-regression indicated that targeting known risk factors of STBs was not a significant modifier of effect size for ideation, indicating equal effectiveness. However, it was significant modifier of effect for behaviors, but only one intervention targeted know risk factors. Effects at follow-up (3-12 months) were also significant but small for both outcomes. Limitations: Substantial heterogeneity between studies was noted. Only few and small sample size studies could be included that targeted known risk factors of STBs. Therefore, these results should be interpreted with caution. Conclusions: School-based prevention of STBs shows some promise within three months post-test assessments, and potentially also have effects that are sustained over time. More studies are needed to make conclusions regarding school-based interventions that target risk factors of STBs.

Contains fulltext : 236485.pdf (Author’s version preprint ) (Open Access), Background: Depressive symptoms are highly prevalent among adolescents in Western countries. However, even though treatment for depressive symptoms is available, many adolescents do not seek help when they need it. Important barriers for help-seeking among adolescents include low mental health literacy and high stigma. We have developed the game-based school program Moving Stories, which combines mental health literacy training for depression with contact with someone with lived experience, both in the digital and non-digital world. Objective: The goal of the present study was to conduct a first test on the effectiveness of the newly developed game-based program Moving Stories, by means of a cluster randomized controlled trial. Methods: A total of 185 adolescents participated, divided over 10 classes from four schools. Half of the classes were randomly selected to follow the Moving Stories program, while the other half were in the control group, where no intervention was provided. Adolescents filled out digital questionnaires at four time points with questions on mental health literacy, stigma, depressive symptoms and the program itself (pre-test, post-test, three-months follow-up, six-months follow-up). Using R, we ran linear mixed effects models for all continuous outcome variables, and generalized linear mixed effects models for all binary outcome variables. Results: Compared to the control group, participants in the Moving Stories group improved at post-test in personal stigma (b = -0.53, 95% CI = [-1.02 - -0.03], t(179.16) = -2.08, P = .04). Effects on personal stigma lasted over time (three-months follow-up: b = -0.57, 95% CI = [-1.11 - -0.03], (174.39) = -2.07, P = .04). Most adolescents in the Moving Stories group participated in the introduction (98%) and contact session (94%), played the game for four or five days (83%), and indicated they would recommend the game to peers (92%). Conclusions: The results of the current study show the potential of the Movin

Radboud University, 22 november 2021, Promotores : Granic, I., Engels, R.C.M.E. Co-promotor : Rooij, M.M.J.W. van, Contains fulltext : 239933.pdf (Publisher’s version ) (Open Access)

Item does not contain fulltext, Adolescent depression is a major concern for public health and is associated with negative consequences and outcomes. Identifying adolescent characteristics that might relate to the risk for developing depression is crucial. This study investigated bidirectional associations between coping strategies and depressive symptoms over time. The participants were 1,341 secondary school students from the Netherlands (X¯¯¯ = 13.91, SD = 0.55, 47.5% girls) who completed self-report questionnaires at six waves over 2.5 years. Cross-lagged models were used to investigate the associations between coping strategies and depressive symptoms. Coping strategies did not predict depressive symptoms over time. However, there was an indication of the reverse relationship. When adolescents experienced elevated depressive symptoms, they used fewer adaptive techniques to target stress. Gender differences were found in the use of avoidance. The inconsistencies of these findings with earlier studies are discussed and provide new directions for future research on working mechanisms underlying depression prevention programs.

Contains fulltext : 231016.pdf (Publisher’s version ) (Open Access), Introduction: According to the network perspective, psychopathology is the result of interactions between symptoms. A previous study used network analysis to identify central symptoms of adolescent depression. The aim of the current study was replicate and extend this study by including suicide ideation as a symptom of depression and evaluating which depression symptoms are contributing factors to suicide ideation in adolescents. Method: A large community sample (N = 5,888) of adolescents aged 11-16 years completed the Children's Depression Inventory (CDI-2). Network analysis was used to identify the network structure of the CDI-2 and which symptoms were directly related to suicide ideation in the network. Additionally, the network structure of adolescents who did and did not experience suicide ideation were compared. Results: Results pertaining the depression network were highly similar to the study we aimed to replicate. The most central symptoms in the depression network were loneliness, sadness, self-hatred, fatigue, self-deprecation and crying. Loneliness explained most variance of suicide ideation. Adolescents who experience suicide ideation had a similar network structure as those who do not. Adolescents with suicide ideation scored higher on all depression symptoms. Limitations: The use of cross-sectional data indicates that only undirected networks and results based on between-subject data could be estimated. Conclusions: Loneliness was a central factor for depression networks and also the most contributing factor of suicide ideation. Preventative efforts should consider taking experiences of loneliness into account as these are especially prevalent in adolescents. Suicide ideation seems more representative of depression symptom severity in adolescents.

CHI PLAY 2021 (18-21 October, 2021), Item does not contain fulltext, Rejection consists of a range of behaviors from ignoring another to explicitly excluding someone from an encounter. Currently available experimental tasks have shown that rejection has strong emotional, behavioral, and physical effects, but the tasks have some limitations. We argue that video games can address these limitations and have developed a new experimental task (ScrollQuest) to show the potential of video games as rejection research tools. The primary goal of the present study was to explore the effects of ScrollQuest. We analyzed data from 116 young adults who played both ScrollQuest and the rejection experimental task Cyberball. Playing ScrollQuest had more negative effects on mood, more negative interpretation effects were observed after playing ScrollQuest, and ScrollQuest was perceived as more enjoyable, compared to Cyberball. Our findings suggest that ScrollQuest might be an effective new experimental task to study rejection in a digital environment, but more work is needed to improve ScrollQuest.

Item does not contain fulltext, This study assessed the efficacy of a virtual reality biofeedback video game (DEEP) in reducing anxiety symptoms. In addition, changes in engagement and cognitive appraisals including self-efficacy, locus of control, and threat-challenge appraisals were measured and it was explored how these factors related to anxiety regulation. Undergraduates with elevated anxiety symptoms (N = 112) were randomly assigned to four training sessions with DEEP or a smartphone-guided breathing application. Trait anxiety was measured at screening, pretest, posttest, and 3 months later. State anxiety was assessed before and after each session. In addition, engagement and appraisals were assessed in each session. Participants in both conditions showed a significant decrease in trait anxiety symptoms from pre- to posttest and this decrease remained stable at follow-up. Furthermore, all participants decreased in state anxiety from pre- to postsession, except for DEEP sessions that included exposure. DEEP users increased in self-efficacy and observed resources to cope throughout the training. In addition, DEEP users felt more engaged in initial sessions than those who used the control application, but their engagement decreased toward the final session. In contrast, participants in the control group showed no change in appraisals nor engagement. Taken together, results demonstrate the potential of digital interventions such as biofeedback games and guided relaxation applications as anxiety regulation tools and show that self-efficacy and threat-challenge appraisals in particular are potential mechanisms of change in biofeedback interventions.

Contains fulltext : 228141.pdf (Publisher’s version ) (Open Access), Introduction: A meta-analysis was conducted to examine the effectiveness of smoking cessation interventions tailored to parents of children aged 0-18 years. Methods: A systematic search was carried out in PsycInfo, Embase, and PubMed in March 2020. A manual search of the reference lists of the included studies and systematic reviews related to the topic was also performed. Two authors independently screened the studies based on the following inclusion criteria: (1) effect studies with control groups that examine smoking cessation interventions tailored to parents of children (0-18 years), and (2) full-text original articles written in English and published between January 1990 and February 2020. In total, 18 studies were included in the analyses. The TiDieR checklist and the Cochrane Risk of Bias Tool 2.0 were used to extract data and to assess the risk of bias. Consensus among authors was reached at each stage. Results: Random-effects meta-analyses were performed. With a total number of 8,560 parents, the pooled relative risk was 1.62 (95% CI 1.38-1.90; p < 0.00001), showing a modest effect of the interventions on smoking cessation. Overall, 13.1% of the parents in the intervention conditions reported abstinence versus 8.4% of the parents in the control conditions. Discussion/Conclusion: Smoking cessation interventions tailored to parents are modestly effective. To increase the effectiveness and the impact of these interventions in terms of controlling tobacco use and public health, it is crucial for further research to explore how these interventions can be improved.

Contains fulltext : 234274.pdf (Publisher’s version ) (Open Access), Introduction: Recently, a Dutch proactive parent-tailored telephone smoking cessation counselling program, Smoke-free Parents (SFP), was demonstrated to be effective in helping parents to quit smoking. This study aimed to examine the program’s uptake and the costs of two recruitment approaches (i.e. healthcare vs mass media) for SFP. In addition, parent’s barriers to participating in SFP and the characteristics of participating parents were assessed. Methods: As part of an effectiveness-implementation hybrid trial, 402 smoking parents were recruited via healthcare settings and mass media for an informal, proactive, and free phone call with a smoking cessation counsellor about SFP (the Netherlands, September 2016 - September 2018). Parents were asked whether they wanted to participate in SFP. If parents refused, reasons for decline and additional information (e.g. educational level) were collected. Results: Results revealed that 26.4% of the recruited parents participated in SFP. Although the program uptake of parents recruited via mass media was slightly, but not significantly, higher than via healthcare (27.3% vs 26.8%, p=0.92), the healthcare approach resulted in lower costs per participant (€99.62 vs €205.72). Smoking cessation counsellors were unable to reach almost one-third (32.7%) of the parents after they had agreed to be called about SFP. Conclusions: The present study showed that more than a quarter of all recruited parents participated in SFP and that the mass media approach and healthcare approach can be used to recruit parents for SFP. To increase the number of parents participating in SFP, it is important to overcome the identified barriers that prevent parents from participating.

Contains fulltext : 221417.pdf (Publisher’s version ) (Open Access), Suicide among adolescents is a significant health concern. Gaining more knowledge about markers that contribute to or protect against suicide is crucial. Perfectionism is found to be a personality trait that is strongly predictive for suicidality; it can be divided into personal standards perfectionism (PS) and concerns about mistakes and doubts perfectionism (CMD). This study investigated the association between PS, CMD, and suicidality in a sample of 273 Dutch secondary school students aged between 12 and 15 years old (M = 13.54, SD = 0.58, 55.8% males). We also examined whether adaptive, or maladaptive cognitive coping strategies influenced these associations. We hypothesized that students high in PS or CMD would experience an increased suicidality. Moreover, we expected that adaptive coping strategies would act as buffer between the association of perfectionism and suicidality, and that maladaptive coping strategies would strengthen this association. For analyses, we used a regression model with latent variables. The results showed that higher scores in perfectionism (PS and CMD) were related to an increase in suicidality. High levels of maladaptive coping in combination with high levels of perfectionism were associated with an increase in suicidality. Although adaptive coping was related to a decrease in suicidality, adaptive coping in interaction with PS and with CMD was not a predictor of suicidality. The results are relevant for prevention, and intervention programs. This paper makes recommendations for clinical practice and further research in order to prevent suicidality in adolescents.

28 juli 2021, Contains fulltext : 236485.pdf (Author’s version preprint ) (Open Access), Background: Depressive symptoms are highly prevalent among adolescents in Western countries. However, even though treatment for depressive symptoms is available, many adolescents do not seek help when they need it. Important barriers for help-seeking among adolescents include low mental health literacy and high stigma. We have developed the game-based school program Moving Stories, which combines mental health literacy training for depression with contact with someone with lived experience, both in the digital and non-digital world. Objective: The goal of the present study was to conduct a first test on the effectiveness of the newly developed game-based program Moving Stories, by means of a cluster randomized controlled trial. Methods: A total of 185 adolescents participated, divided over 10 classes from four schools. Half of the classes were randomly selected to follow the Moving Stories program, while the other half were in the control group, where no intervention was provided. Adolescents filled out digital questionnaires at four time points with questions on mental health literacy, stigma, depressive symptoms and the program itself (pre-test, post-test, three-months follow-up, six-months follow-up). Using R, we ran linear mixed effects models for all continuous outcome variables, and generalized linear mixed effects models for all binary outcome variables. Results: Compared to the control group, participants in the Moving Stories group improved at post-test in personal stigma (b = -0.53, 95% CI = [-1.02 - -0.03], t(179.16) = -2.08, P = .04). Effects on personal stigma lasted over time (three-months follow-up: b = -0.57, 95% CI = [-1.11 - -0.03], (174.39) = -2.07, P = .04). Most adolescents in the Moving Stories group participated in the introduction (98%) and contact session (94%), played the game for four or five days (83%), and indicated they would recommend the game to peers (92%). Conclusions: The results of the current study show the potential of the Movin

Adolescence is a formative period for socio-emotional development which is threatened by the COVID-19 pandemic. The current longitudinal study examined two aims: (1) the short- and long-term effects of the pandemic on young people’s mood (i.e. vigor, tension, and depression levels) and emotional reactivity (i.e. fluctuations in daily mood), and (2) the impact of stressors on mood, emotional reactivity, self-oriented (i.e. maladaptive behavior towards COVID-19 rules) and other-benefitting behaviors (i.e. behavior aimed at helping and comforting others). We conducted an online two-week daily diary study among 462 Dutch adolescents (Mage = 15.27 years, 64% females) and 371 young adults (Mage = 21.49 years, 81% females) in May 2020, with a follow-up in November 2020 (N = 238 and 231, respectively adolescents and young adults). In May 2020, young adults and older relative to younger adolescents showed higher levels and more fluctuations in tension and depression and lower levels of vigor. Vigor levels decreased and tension and depression levels increased between May 2020 and November 2020, especially

Contains fulltext : 230589.pdf (publisher's version ) (Open Access), Our most recent RCT provides evidence that indicated depression prevention is effective in reducing depressive symptoms in adolescents when implemented in the school community. In the present study we further test the potential effects of this prevention approach on symptoms related to depression: anxiety, suicidality, somatic symptoms, and perfectionism. We conducted exploratory analyses in 130 adolescents with elevated depressive symptoms aged between 12 and 16 years old (M = 13.59; SD = 0.68; 63.8% girls) who were randomly assigned to the experimental (OVK 2.0) or active control condition (psycho-education). Self-reported anxiety, suicidality, somatic symptoms, and perfectionism were assessed at pretest, post intervention, as well as 6- and 12-months follow-up. Latent growth curve analyses revealed that there was a significant decrease in anxiety in both conditions and that this decrease was significantly larger in the intervention condition than in the control condition. Somatic symptoms and socially prescribed perfectionism decreased significantly in the intervention condition and suicidality decreased significantly in the control condition. Yet there was no difference in decrease in suicidality, somatic symptoms, and perfectionism between the two conditions. This study suggest that screening on depressive symptoms and providing a CBT depression prevention program for adolescents with elevated depressive symptoms, can decrease comorbid symptoms of anxiety and therefore ensure better outcomes. We discuss the clinical implications as well suggestions for future research. Clinical Trial Registration: The study is registered in the Dutch Trial Register for RCTs (NTR5725). Date registered: 11th of March 2016.

Contains fulltext : 243983.pdf (Publisher’s version ) (Open Access), Background: Stigma and limited mental health literacy impede adolescents getting the help they need for depressive symptoms. A serious game coupled with a classroom session led by lived experience workers (LEWs) might help to overcome these barriers. The school-based Strong Teens and Resilient Minds (STORM) preventive program employed this strategy and offered a serious game, Moving Stories. The current study was carried out to assess inhibiting and promoting factors for scaling up Moving Stories once its effectiveness has been ascertained. Methods: Moving Stories was offered in three steps: (1) introductory classroom session, (2) students playing the game for five days, (3) debriefing classroom session led by lived experience worker. Data was collected on the number of participating students, costs of offering Moving Stories, and was further based on the notes of the debriefing sessions to check if mental health first aid (MHFA) strategies were addressed. Results: Moving Stories was offered in seven high-schools. Coverage was moderate with 982 participating students out of 1880 (52%). Most participating students (83%) played the Moving Stories app three out of the five days. Qualitative data showed that the MHFAs were discussed in all debriefing sessions. Students showed great interest in lived experience workers’ stories and shared their own experiences with depression. Conclusions: Bringing Moving Stories to scale in the high-school setting appears feasible, but will remain logistically somewhat challenging. Future implementation and scale-up of Moving Stories could benefit from improved selection and training of LEWs that played such an important role in grabbing the full attention of students and were able to launch frank discussions about depressive disorder and stigma in classrooms. Trial registration The study is registered in the Dutch Trial Register: Trial NL6444 (NTR6622: https://www.trialregister.nl/trial/6444).

Contains fulltext : 233816.pdf (Publisher’s version ) (Open Access), Adolescence is a formative period for socio-emotional development which is threatened by the COVID-19 pandemic. The current longitudinal study examined two aims: (1) the short- and long-term effects of the pandemic on young people's mood (i.e. vigor, tension, and depression levels) and emotional reactivity (i.e. fluctuations in daily mood), and (2) the impact of stressors on mood, emotional reactivity, self-oriented (i.e. maladaptive behavior towards COVID-19 rules) and other-benefitting behaviors (i.e. behavior aimed at helping and comforting others). We conducted an online two-week daily diary study among 462 Dutch adolescents (Mage = 15.27 years, 64% females) and 371 young adults (Mage = 21.49 years, 81% females) in May 2020, with a follow-up in November 2020 (N = 238 and 231, respectively adolescents and young adults). In May 2020, young adults and older relative to younger adolescents showed higher levels and more fluctuations in tension and depression and lower levels of vigor. Vigor levels decreased and tension and depression levels increased between May 2020 and November 2020, especially for younger adolescents. There were positive associations between instability of negative emotions (i.e. tension and depression fluctuations) and the exposure to stressors (i.e. family stress and inequality of online homeschooling) in the adolescent sample. Together, this study demonstrates vulnerability regarding young people's mood and emotional reactivity during the COVID-19 pandemic, especially for adolescents who experience more stressors.

Radboud University, 30 oktober 2020, Promotores : Otten, R., Engels, R.C.M.E. Co-promotor : Creemers, D.H.M., Contains fulltext : 225326.pdf (publisher's version ) (Open Access), In the clinical setting, a large proportion of children with autism experience anxiety. Because anxiety is an important cause of impairment for children with autism, it is necessary that effective anxiety interventions are implemented for these children. Recently, an applied game called Mindlight has been developed that is focused on decreasing anxiety in children. A randomized controlled trial (RCT) examined whether Mindlight was effective in decreasing anxiety in 122 children with autism in the age of 8-16 years old in a clinical setting. Results of this study showed that Mindlight was more effective than a control game in decreasing parent-rated anxiety, but not in decreasing child-rated anxiety. Based on experiences during the RCT, it was investigated whether the addition of elements of cognitive behavioral therapy (CBT) could further enhance the effect of Mindlight. Results showed that Mindlight in combination with CBT is a potential effective treatment for at least some children with autism and anxiety. Future research is needed to give a better insight in the individual factors that could predict which type of children with autism benefit from which type of anxiety treatment.

Contains fulltext : 221349.pdf (publisher's version ) (Open Access), Background: Adolescent depression is a global mental health concern. Identification and effective prevention in an early stage are necessary. The present randomized, controlled trial aimed to examine the effectiveness of Cognitive Behavioral Therapy (CBT)-based depression prevention in adolescents with elevated depressive symptoms. This prevention approach is implemented in school communities, which allows to examine effects under real-life circumstances. Methods: A total of 5222 adolescents were screened for elevated depressive symptoms in the second grade of secondary schools; 130 adolescents aged between 12 and 16 years old (M = 13.59;SD = 0.68; 63.8% girls) were randomly assigned to the experimental (OVK 2.0) or control condition (psycho-education). Self- and parent-reported depressive symptoms were assessed at pretest and post intervention, as well as 6- and 12-months follow-up. Clinical assessment of depression was assessed at pretest and 6-months follow-up. Results: Intent-to-treat analyses revealed that the decrease in adolescent-rated depressive symptoms was significantly larger in the intervention condition than in the control condition. There was no significant difference in decrease of parent-rated depressive symptoms between both conditions. Conclusions: Based on the findings, we recommend the implementation of screening and prevention in schools, according the basics of this study design. Since this is a new step forward, we discuss the clinical impact and challenges, as well possibilities for future research.

Contains fulltext : 216834.pdf (Publisher’s version ) (Closed access), Background and objectives: In the clinical setting, a large proportion of children with an autism spectrum disorder (ASD) experience impairing anxiety symptoms. Recently, an applied videogame called Mindlight has been developed that focuses on decreasing anxiety in children. The present study involved a randomized controlled trial (RCT) investigating the effect of Mindlight on (sub)clinical anxiety symptoms in children with an ASD. Methods: In total, 109 children of 8-16 years old with an ASD and (sub)clinical anxiety symptoms were randomly assigned to the experimental (N = 53) or the control (N = 56) condition. Children in the experimental condition played Mindlight, children in the control condition played a commercial game (Triple Town) for 1 h per week, for six consecutive weeks. All children and parents completed assessments at baseline, post-intervention and 3-months follow-up. Results: Results showed no differences in decrease of child-rated anxiety symptoms between both conditions. However, the decrease of parent-rated anxiety symptoms was significantly larger in the experimental condition. Limitations: Mechanisms of change associated with treatment outcomes were not investigated in the present study. Therefore, it remains unclear which specific or non-specific factors contributed to the decrease in anxiety symptoms in both conditions. Conclusions: The present study provided some preliminary evidence that video games are a promising new intervention vehicle for children with an ASD and anxiety, at least according to parents. However, further research on working mechanisms is needed, in order to specify to what extent and for which children with ASD Mindlight could be an effective anxiety treatment.

Contains fulltext : 216609.pdf (publisher's version ) (Open Access), Depressive disorders are highly prevalent during adolescence and they are a major concern for individuals and society. The Response Style Theory and the Scar Theory both suggest a relationship between response styles and depressive symptoms, but the theories differ in the order of the development of depressive symptoms. Longitudinal reciprocal prospective relationships between depressive symptoms and response styles were examined in a community sample of 1343 adolescents. Additionally, response style was constructed with the traditional approach, which involves examining three response styles separately without considering the possible relations between them, and with the ratio approach, which accounts for all three response styles simultaneously. No reciprocal relationships between depressive symptoms and response style were found over time. Only longitudinal relationships between response style and depressive symptoms were significant. This study found that only depressive symptoms predicted response style, whereas the response style did not emerge as an important underlying mechanism responsible for developing and maintaining depressive symptoms in adolescents. These findings imply that prevention and intervention programs for adolescents with low depressive symptoms should not focus on adaptive and maladaptive response style strategies to decrease depressive symptoms, but should focus more on behavioral interventions.

Contains fulltext : 219824.pdf (publisher's version ) (Open Access)

Contains fulltext : 220953.pdf (publisher's version ) (Open Access), BACKGROUND: Parents' underestimation of their child's weight status can hinder active participation in overweight prevention programs. We examined the level of agreement between the parents' perception of their child's weight status and the child's actual weight status, moderating factors, and change over time. METHODS: This cross-sectional study used data collected in 2009 (n = 8105), 2013 (n = 8844) and 2017 (n = 11,022) from a community-based survey conducted among parents of children age 2-12 years in the Netherlands. Parents classified their perception of their child's weight status on a 5-point Likert scale. In 2009 and 2013, the child's BMI was calculated from self-reported data by parents. The level of agreement between the parent's perception of the weight status and the actual weight status was examined using Cohen's kappa. The role of demographic factors on parents' perception were examined using logistic regression. RESULTS: In 2009, 2013 and 2017, 6%, 6% and 5% of the parents, respectively, classified their child as heavy/extremely heavy. In 2009 and 2013, 64.7% and 61.0% of parents, respectively, underestimated the weight status of their overweight child. This was even higher among parents of obese children. Overall, the agreement between the parents' perception and the actual weight status improved from 2009 (kappa = 0.38) to 2013 (kappa = 0.43) (p<0.05), but remained unsatisfactory. The parents' underestimation of their child's overweight/obesity status was associated with the child's age in 2009 and 2013 (2-7 years; OR: 0.18), the child's gender in 2009 (male; OR: 0.55), and the parents' education level in 2009 (middle and high education; OR: 0.56 and 0.44 respectively). CONCLUSIONS: Parents' underestimation of their child's weight status remains alarmingly high, particularly among parents of young, obese children. This underestimation is a barrier to preventing childhood overweight/obesity. Healthcare professionals should take this underestimation

Radboud University, 10 september 2020, Promotor : Engels, R.C.M.E. Co-promotores : Luijten, M., Sescousse, G.T., Contains fulltext : 221892.pdf (publisher's version ) (Open Access)

Contains fulltext : 219431.pdf (preprint version ) (Open Access), Biofeedback has shown to be a promising tool for the treatment of anxiety however several theoretical as well as practical limitations have prevented widespread adaptation until now. With current technological advances and the increasing interest in the use of self-monitoring technology to improve mental health we argue that this is an ideal time to launch a new wave of biofeedback training. In this review we reflect on the current state of biofeedback training including the more traditional techniques and mechanisms that have been thought to explain the effectiveness of biofeedback such as the integration of operant learning and meditation techniques and changes in interoceptive awareness and physiology. Subsequently, we propose an integrative model that includes a set of cognitive appraisals as potential determinants of adaptive trajectories within biofeedback training such as: growth mindset, self-efficacy, locus of control, and threat-challenge appraisals. Finally, we present a set of detailed guidelines based on the integration of our model with the mechanics and mechanisms offered by emerging interactive technology to encourage a new phase of research and implementation using biofeedback. There is a great deal of promise for future biofeedback interventions that harness the power of wearables and video games, and that adopt a user-centred approach to help people regulate their anxiety in a way that feels engaging, personal, and meaningful.

Contains fulltext : 217238pub.pdf (publisher's version ) (Open Access), Alcohol is mainly consumed in social settings, in which people often adapt their drinking behavior to that of others, also called imitation of drinking. Yet, it remains unclear what drives this drinking in a social setting. In this study, we expected to see stronger brain and behavioral responses to social compared to non-social alcohol cues, that would be associated with drinking in a social setting. The sample consisted of 153 beer-drinking males, aged 18-25 years. Brain responses to social alcohol cues were measured during an alcohol cue exposure task in the scanner. Behavioral responses to social alcohol cues were measured using a stimulus-response compatibility task, providing an index of approach bias towards these cues. Drinking in a social setting was measured in a laboratory mimicking a bar environment. Specific brain responses to social alcohol cues were observed in the bilateral superior temporal sulcus and the left inferior parietal lobe. There was no approach bias towards social alcohol cues specifically, however, we did find an approach bias towards alcohol (versus soda) cues in general. Brain responses and approach bias towards social alcohol cues were unrelated and not associated with actual drinking. Thus, we found no support for a relation between drinking in a social setting on the one hand, and brain cue-reactivity or behavioral approach biases to social alcohol cues on the other hand. This suggests that, in contrast to our hypothesis, drinking in a social setting may not be driven by brain or behavioral responses to social alcohol cues.

Introduction:A meta-analysis was conducted to examine the effectiveness of smoking cessation interventions tailored to parents of children aged 0-18 years. Methods: A systematic search was carried out in PsycInfo, Embase, and PubMed in March 2020. A manual search of the reference lists of the included studies and systematic reviews related to the topic was also performed. Two authors independently screened the studies based on the following inclusion criteria: (1) effect studies with control groups that examine smoking cessation interventions tailored to parents of children (0-18 years), and (2) full-text original articles written in English and published between January 1990 and February 2020. In total, 18 studies were included in the analyses. The TiDieR checklist and the Cochrane Risk of Bias Tool 2.0 were used to extract data and to assess the risk of bias. Consensus among authors was reached at each stage. Results: Random-effects meta-analyses were performed. With a total number of 8,560 parents, the pooled relative risk was 1.62 (95% CI 1.38-1.90; p < 0.00001), showing a modest effect of the interventions on smoking cessation. Overall, 13.1% of the parents in the intervention conditions reported abstinence versus 8.4% of the parents in the control conditions. Discussion/Conclusion: Smoking cessation interventions tailored to parents are modestly effective. To increase the effectiveness and the impact of these interventions in terms of controlling tobacco use and public health, it is crucial for further research to explore how these interventions can be improved.

Suicide among adolescents is a significant health concern. Gaining more knowledge about markers that contribute to or protect against suicide is crucial. Perfectionism is found to be a personality trait that is strongly predictive for suicidality; it can be divided into personal standards perfectionism (PS) and concerns about mistakes and doubts perfectionism (CMD). This study investigated the association between PS, CMD, and suicidality in a sample of 273 Dutch secondary school students aged between 12 and 15 years old (M = 13.54, SD = 0.58, 55.8% males). We also examined whether adaptive, or maladaptive cognitive coping strategies influenced these associations. We hypothesized that students high in PS or CMD would experience an increased suicidality. Moreover, we expected that adaptive coping strategies would act as buffer between the association of perfectionism and suicidality, and that maladaptive coping strategies would strengthen this association. For analyses, we used a regression model with latent variables. The results showed that higher scores in perfectionism (PS and CMD) were related to an increase in suicidality. High levels of maladaptive coping in combination with high levels of perfectionism were associated with an increase in suicidality. Although adaptive coping was related to a decrease in suicidality, adaptive coping in interaction with PS and with CMD was not a predictor of suicidality. The results are relevant for prevention, and intervention programs. This paper makes recommendations for clinical practice and further research in order to prevent suicidality in adolescents.

BACKGROUND: Adolescent depression is a global mental health concern. Identification and effective prevention in an early stage are necessary. The present randomized, controlled trial aimed to examine the effectiveness of Cognitive Behavioral Therapy (CBT)-based depression prevention in adolescents with elevated depressive symptoms. This prevention approach is implemented in school communities, which allows to examine effects under real-life circumstances. METHODS: A total of 5222 adolescents were screened for elevated depressive symptoms in the second grade of secondary schools; 130 adolescents aged between 12 and 16 years old (M = 13.59; SD = 0.68; 63.8% girls) were randomly assigned to the experimental (OVK 2.0) or control condition (psycho-education). Self- and parent-reported depressive symptoms were assessed at pretest and post intervention, as well as 6- and 12-months follow-up. Clinical assessment of depression was assessed at pretest and 6-months follow-up. RESULTS: Intent-to-treat analyses revealed that the decrease in adolescent-rated depressive symptoms was significantly larger in the intervention condition than in the control condition. There was no significant difference in decrease of parent-rated depressive symptoms between both conditions. CONCLUSIONS: Based on the findings, we recommend the implementation of screening and prevention in schools, according the basics of this study design. Since this is a new step forward, we discuss the clinical impact and challenges, as well possibilities for future research. TRIAL REGISTRATION: The st

Background: Tackling the increasing global problem of childhood overweight and obesity requires an integrated approach. Studies increasingly emphasize the importance of the parents' role in interventions designed to prevent overweight in children. The aim of this study was to develop a unified set of recommendations for healthy parenting practices that can be applied by all professionals who work with children age 4-13 years and can contribute to strengthening the integrated approach to childhood overweight. Methods: A modified Delphi procedure was used to reach consensus regarding what these pedagogical recommendations should encompass. The 30 panelists were professionals and researchers who work with children age 4-13 in the domains of health care, overweight, parenting, education, nutrition, and/or sports. The procedure consisted of: i) extracting existing pedagogical recommendations from national guidelines and professional protocols, ii) appraising and prioritizing these recommendations in terms of relevance through two rounds of questionnaires, and iii) meeting to discuss and approve the set of recommendations. Results: Consensus was reached for one set of eleven pedagogical theme-based recommendations designed to support and instruct parents how to stimulate healthy energy balance-related behaviors in their child. Each recommendation contained information regarding: i) which behaviors in the child and/or parent are important, ii) why this is important, and iii) how parents can stimulate this behavior by applying parenting skills in daily life. The eleven themes were: modeling, positive parenting, breakfast, varied diet, sugar-sweetened beverages, snacks, physical activity, playing sports, quantity of screen time, screen time during meals, and sleep. Conclusion We developed a set of recommendations for healthy parenting that can be used by various professionals working with children age 4-13 and can contribute to creating an integrated approach to childhood ov

BACKGROUND: Parents' underestimation of their child's weight status can hinder active participation in overweight prevention programs. We examined the level of agreement between the parents' perception of their child's weight status and the child's actual weight status, moderating factors, and change over time. METHODS: This cross-sectional study used data collected in 2009 (n = 8105), 2013 (n = 8844) and 2017 (n = 11,022) from a community-based survey conducted among parents of children age 2-12 years in the Netherlands. Parents classified their perception of their child's weight status on a 5-point Likert scale. In 2009 and 2013, the child's BMI was calculated from self-reported data by parents. The level of agreement between the parent's perception of the weight status and the actual weight status was examined using Cohen's kappa. The role of demographic factors on parents' perception were examined using logistic regression. RESULTS: In 2009, 2013 and 2017, 6%, 6% and 5% of the parents, respectively, classified their child as heavy/extremely heavy. In 2009 and 2013, 64.7% and 61.0% of parents, respectively, underestimated the weight status of their overweight child. This was even higher among parents of obese children. Overall, the agreement between the parents' perception and the actual weight status improved from 2009 (kappa = 0.38) to 2013 (kappa = 0.43) (p<0.05), but remained unsatisfactory. The parents' underestimation of their child's overweight/obesity status was associated with the child's age in 2009 and 2013 (2-7 years; OR: 0.18), the child's gender in 2009 (male; OR: 0.55), and the parents' education level in 2009 (middle and high education; OR: 0.56 and 0.44 respectively). CONCLUSIONS: Parents' underestimation of their child's weight status remains alarmingly high, particularly among parents of young, obese children. This underestimation is a barrier to preventing childhood overweight/obesity. Healthcare professionals should take this underestimation

Depressive disorders are highly prevalent during adolescence and they are a major concern for individuals and society. The Response Style Theory and the Scar Theory both suggest a relationship between response styles and depressive symptoms, but the theories differ in the order of the development of depressive symptoms. Longitudinal reciprocal prospective relationships between depressive symptoms and response styles were examined in a community sample of 1343 adolescents. Additionally, response style was constructed with the traditional approach, which involves examining three response styles separately without considering the possible relations between them, and with the ratio approach, which accounts for all three response styles simultaneously. No reciprocal relationships between depressive symptoms and response style were found over time. Only longitudinal relationships between response style and depressive symptoms were significant. This study found that only depressive symptoms predicted response style, whereas the response style did not emerge as an important underlying mechanism responsible for developing and maintaining depressive symptoms in adolescents. These findings imply that prevention and intervention programs for adolescents with low depressive symptoms should not focus on adaptive and maladaptive response style strategies to decrease depressive symptoms, but should focus more on behavioral interventions.

Contains fulltext : 217797pub.pdf (publisher's version ) (Open Access), Impaired brain processing of alcohol-related rewards has been suggested to play a central role in alcohol use disorder. Yet, evidence remains inconsistent and mainly originates from studies in which participants passively observe alcohol cues or taste alcohol. Here, we designed a protocol in which beer consumption was predicted by incentive cues and contingent on instrumental action closer to real life situations. We predicted that anticipating and receiving beer (compared with water) would elicit activity in the brain reward network and that this activity would correlate with drinking level across participants. The sample consisted of 150 beer-drinking males, aged 18 to 25 years. Three groups were defined based on alcohol use disorders identification test (AUDIT) scores: light drinkers (n = 39), at-risk drinkers (n = 64), and dependent drinkers (n = 47). fMRI measures were obtained while participants engaged in the beer incentive delay task involving beer- and water-predicting cues followed by real sips of beer or water. During anticipation, outcome notification and delivery of beer compared with water, higher activity was found in a reward-related brain network including the dorsal medial prefrontal cortex, orbitofrontal cortex, and amygdala. Yet, no activity was observed in the striatum, and no differences were found between the groups. Our results reveal that anticipating, obtaining, and tasting beer activates parts of the brain reward network, but that these brain responses do not differentiate between different drinking levels.

A randomized controlled trail was conducted to examine the effectiveness of a depression and anxiety prevention program ‘Een Sprong Vooruit’ (A Leap Forward) among adolescent girls (N = 142) with a high familial risk. The results showed neither effects of the prevention program directly after the intervention, nor at 6 or 12 months follow-up on depression and anxiety symptoms. Further, latent growth curve modeling (LGCM) was used to examine whether the growth functions for the intervention and the control condition were different. The slope representing the change in depression symptoms was not significantly different between the intervention and the control condition. For anxiety symptoms, the difference between slopes was also not significant. Based on findings, we suggested that these high-risk adolescent girls might benefit more from a more intensive prevention program.

Item does not contain fulltext, Objective: Children with autism spectrum disorder (ASD) often have comorbid depressive symptoms and suicidal ideation. The aim of this study was to examine levels of depressive symptoms and suicidal ideation in a sample of children with ASD, normal cognitive functioning and elevated anxiety. Methods: In total, 93 children aged 8-16 years with ASD and with normal cognitive functioning and (sub)clinical anxiety symptoms participated in the present study. Both parents and children filled in questionnaires to measure the level of depressive symptoms. Moreover, children reported their level of suicidal ideation. Results: More than 35% of the children with ASD reported clinical levels of depressive symptoms while, according to parents, even more than 75% of these children showed clinical levels of depressive symptoms. Girls reported significantly higher levels of depressive symptoms than boys. Moreover, 32.2% of the children with ASD and anxiety had suicidal thoughts and 2.2% of the children showed active suicidal ideation. No gender differences were found in suicidal ideation. Conclusions: The findings indicated that children with ASD, normal cognitive functioning and anxiety symptoms have an increased prevalence of clinical depressive symptoms and suicidal ideation. Therefore, depressive symptoms and suicidal ideation should be assessed when working with anxious children with ASD.

Contains fulltext : 204740.pdf (publisher's version ) (Open Access), Background: Parental support is an important element in overweight prevention programs for children. The purpose of this study was to examine everyday life situations in which mothers encounter difficulties encouraging healthy energy balance-related behavior in their school-age children. Methods: We formed four focus groups containing 6-9 participants each. The participants were mothers of Dutch, Turkish, or Moroccan descent with a child 8-13 years of age. All focus group sessions were recorded, transcribed, and coded. Content was analyzed conventionally using ATLAS.ti 6. Results: Twenty-seven difficult everyday life situations were identified in 14 settings. The five most frequently reported situations were a daily struggle regarding eating vegetables, eating breakfast on time before going to school, eating candy and snacks between meals, and spending excessive time watching television and using the computer. A perceived loss of parental control, the inability to establish rules and the failure to consistently enforce those rules were the most commonly cited reasons for why the mothers experience these situations as being difficult. Conclusions: We identified five difficult everyday life situations related to healthy energy balance-related behavior. These five difficult situations were used as the input for developing a web-based parenting program designed to prevent children from becoming overweight. We reasoned that if we use these situations and the underlying reasons, many parents would recognize these situations and are willing to learn how to deal with them and complete the e-learning.

Item does not contain fulltext, Playful competition is an important hallmark of healthy child development. Playful competition facilitates moral learning, rewards perspective-taking skills, and challenges children to healthily regulate unpleasant emotions such as frustration, anger, and jealousy. Despite this, research on the effects of competitive video gaming has focused on antisocial outcomes, such as declines in prosocial behavior. Moreover, methodological shortcomings such as experimental studies using designs with poor generalizability, and a lack of longitudinal studies, leave open the influence of competitive gaming on social development among preadolescent children. This longitudinal study therefore investigated the relation between competitive gaming and changes in children's social development across 3 measures: conduct problems, peer relations, and prosocial behavior. At 2 timepoints, 1 year apart, 184 Dutch children (8.31-12.68 years old) reported their gaming frequency and listed their favorite games to play, and their parents reported their children's psychosocial health. Children's nominations were coded as including or not including a competitive video game. Children who nominated a competitive game at the first time point were more likely to show a decrease in conduct problems and an improvement in peer relations. No interactions were observed between competitive gaming and gaming frequency. These results encourage future research to investigate the social benefits of playful competitive gaming among peers, and for future studies to take other variables such as violent content, cooperative play, and real world competitive play into account.