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Objective: To investigate the effect of the Boston Psychiatric Rehabilitation (PR) Approach on attainment of personal rehabilitation goals, social functioning, empowerment, needs for care, and quality of life in people with severe mental illness (SMI) in the Netherlands. Method: A 24-month, multicentre, randomized controlled trial was used to compare the results of PR to care as usual (CAU). Patients with SMI were randomly assigned by a central randomization centre to PR (n = 80) or CAU (n = 76). The primary outcome of goal attainment was assessed by independent raters blind to treatment allocation. Measures for secondary outcomes were change in work situation and independent living, the Personal Empowerment Scale, the Camberwell Assessment of Needs, and the World Health Organization Quality of Life assessment. Effects were tested at 12 and 24 months. Data were analyzed according to intention to treat. Covariates were psychiatric centre, psychopathology, number of care contacts, and educational level of the professionals involved. Results: The rate of goal attainment was substantially higher in PR at 24 months (adjusted risk difference: 21%, 95% CI 4% to 38%; number needed to treat [NNT] = 5). The approach was also more effective in the area of societal participation (PR: 21% adjusted increase, CAU: 0% adjusted increase; NNT = 5) but not in the other secondary outcome measures. Conclusions: The results suggest that PR is effective in supporting patients with SMI to reach self-formulated rehabilitation goals and in enhancing societal participation, although no effects were found on the measures of functioning, need for care, and quality of life. [ABSTRACT FROM AUTHOR]

Background: Although the effectiveness of individual placement and support (IPS) has been well established, little is known about clients' perceptions of the model compared to usual vocational rehabilitation, nor about their experiences of searching for and returning to work with this kind of support. This qualitative study aimed to explore clients' views of the difficulties of obtaining and maintaining employment, their experiences of the support received from their IPS or Vocational Service workers and the perceived impact of work on clients' lives.Method: Semi-structured interviews were conducted with 48 people with psychotic disorders participating in a six-centre international randomised controlled trial of IPS compared to usual vocational rehabilitation. To assess their experiences of the services and the perceived effects of working, two IPS and two Vocational Service clients at each centre who had found work during the study period were interviewed, along with two IPS and two Vocational Service clients at each centre who had not.Results: IPS clients reported having received more help seeking and maintaining employment, whereas Vocational Service clients reported having received more help in finding sheltered employment or placements. Clients who had worked associated this with financial stability, improved social lives, increased self-esteem, integration into society and amelioration of their symptoms, as well as reduced feelings of boredom and isolation, but also reported increased levels of stress. IPS clients as well as Vocational Service ones reported not receiving enough follow-up support, despite this being proposed as a key feature of the model.Conclusion: Findings from the in-depth interviews reflect differences in service models that have also been tested quantitatively but further work in disaggregating the IPS model and assessing the impact of each component would be valuable. [ABSTRACT FROM AUTHOR]

Objective: This study compared three instruments that are used to measure empowerment of people with psychotic disorders. The study evaluated internal consistency, discriminant and convergent validity, sensitivity to symptom levels, and clinical usefulness.Methods: Fifty patients in the Netherlands were administered the Empowerment Scale (ES), the Personal Empowerment Scale (PES), and the Mental Health Confidence Scale (MHCS).Results: The MHCS had good internal consistency, whereas the levels for the ES and PES were just below what would be considered acceptable. The instruments demonstrated moderate correlations between total scores; correlations between subscale scores were weaker. Scores for all three instruments were comparably associated with symptom severity.Conclusions: All three instruments measure some aspect of empowerment among persons with severe mental illness. However, empowerment is too broadly defined to allow these instruments to have convergent validity. Among patients with psychotic disorders, the MHCS is recommended because it has good psychometric qualities and is clinically useful. [ABSTRACT FROM AUTHOR]

Background: Individuals with a psychotic disorder are at an increased risk of victimization, but evidenced-based interventions are lacking., Aims: A body-oriented resilience therapy ('BEATVIC') aimed at preventing victimization was developed and its effectiveness was assessed in a multicenter randomized controlled trial., Methods: 105 people with a psychotic disorder were recruited from six mental health centers. Participants were randomly allocated to 20 BEATVIC group sessions (n = 53) or befriending group sessions (n = 52). Short term effects on risk factors for victimization (e.g. social cognitive deficits, inadequate interpersonal behavior, low self-esteem, internalized stigma, aggression regulation problems), physical fitness and secondary outcomes were expected. At six-month follow-up, the effect on victimization (either a 50% reduction or an absence of victimization incidents) was examined., Results: Intervention-dropout was 28.30% for BEATVIC and 39.62% for befriending. In both conditions the majority of participants (60.5% BEATVIC vs 62.9% befriending) showed a reduction or absence of victimization incidents at six months follow-up, which was not significantly different according to condition. Multilevel analyses revealed no main effect of time and no significant time x group interaction on other outcome measures. Per protocol analyses (participants attending ≥ 75% of the sessions) did not change these results., Conclusions: Although a reduction or absence of victimization was found at short term follow-up for the majority of participants, BEATVIC was not more effective than the active control condition. No short-term additional effects on risk factors of victimization were found. Analysis of the data at 2-year follow-up is warranted to investigate possible effects in the long-term., Trial Registration Number: Current Controlled Trials: ISRCTN21423535., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 van der Stouwe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

One of the most commonly used techniques for the treatment of body image problems in eating disorders (ED) is body exposure (BE). However, evidence of its effectiveness in clinical populations is scarce. In the Positive Body Experience (PBE) protocol, the focus of positive BE is on aesthetic, functional and tactile aspects of the body. The current study evaluates the outcomes of positive BE with regard to changes in attitudinal body image and eating pathology, as well as the factors that influence these changes, in a sample of 84 adult female patients with different EDs who did not receive any other treatment for their EDs during the period in which BE treatment occurred. The results show significant positive changes in attitudinal body image, ED behaviors and depressive symptoms, with depressive symptoms at baseline mediating the changes in attitudinal body image. This study indicates that the PBE protocol is a suitable intervention for reducing negative attitudinal body image in anorexia and bulimia nervosa patients, as well as those with binge eating disorder. Furthermore, the results suggest that positive non-weight-related and functional body satisfaction are strong catalysts for change and that depressive symptoms play an important role in the ability to change. Additional RCTs are needed to gain more insight into the effects of PBE.

People with somatic symptom disorder or somatoform disorder are considered to have a troubled relationship to their body that is hard to assess with self-report questionnaires alone. To examine the potential value of own-body drawings as an assessment tool, objective features of drawings from 179 patients referred to treatment for somatoform disorder, were compared to those of 173 age-and-sex matched persons from the general population. While two factors had been found in the somatoform disorder sample, in the general population only the factor that reflected 'details' in own-body drawings was replicated. The two samples did not score differently on this factor. The general population sample showed a less strong association between objective body drawings scores on this 'details' factor and self-reported scores of body experience than the somatoform disorder sample. Moreover, the phenomenological contents of the drawings were more oriented towards health or appearance than the mostly mixed or unclear orientation of persons with somatoform disorder. Because the objective scoring of body drawings did not differ between groups while the contents of body drawings appeared to differ, the results suggest that this objective scoring of body drawings is not appropriate to distinguish people with and without somatoform disorder., (Copyright © 2022. Published by Elsevier B.V.)

Background One characteristic of somatoform (DSM-IV) and somatic symptom disorder (DSM-5) is the troubled relation of patients to their body. To assess body-relatedness, standardized observation by a physical therapist may add valuable information to questionnaires. Purpose : This study examines the feasibility of a physiotherapeutic observation instrument: the Body-Relatedness Observation Scale (BROS). Methods : Factorial validity and inter-rater reliability of observer scores were studied in 191 patients performing two short exercises, lying face up. Fourteen indicators of body-relatedness were selected, covering execution of instructions, perception of the body, muscle tension, and behavioral adaptation to somatic symptoms. Results : Inter-rater reliability values (Kappa or Intraclass correlation [ICC] according to model 1,1) were excellent for four observation scores, substantial for two, fair for two, and poor for six. Four out of five items relating to patients' ability to perceive the body had low inter-rater reliability values (ICC < 0.40 or Kappa < 0.20). Categorical principal components analysis with the eight reliable scores indicated a 1-factor structure including seven items with Cronbach's alpha 0.69. Conclusion : This initial analysis of a structured physical therapeutic observation for people with somatic symptom disorder indicated modestly sound psychometric quality of observations of execution of instructions, muscle tension, and behavioral adaptation, but not of patients' ability to perceive the body adequately. This shows that body-related observations are feasible and indicates the viability of further development of the BROS.

Background: The purpose of this study was to investigate the cost-effectiveness and budget impact of the Boston University Approach to Psychiatric Rehabilitation (BPR) compared to an active control condition (ACC) to increase the social participation (in competitive employment, unpaid work, education, and meaningful daily activities) of individuals with severe mental illnesses (SMIs). ACC can be described as treatment as usual but with an active component, namely the explicit assignment of providing support with rehabilitation goals in the area of social participation., Method: In a randomized clinical trial with 188 individuals with SMIs, BPR ( n = 98) was compared to ACC ( n = 90). Costs were assessed with the Treatment Inventory of Costs in Patients with psychiatric disorders (TIC-P). Outcome measures for the cost-effectiveness analysis were incremental cost per Quality Adjusted Life Year (QALY) and incremental cost per proportional change in social participation. Budget Impact was investigated using four implementation scenarios and two costing variants., Results: Total costs per participant at 12-month follow-up were € 12,886 in BPR and € 12,012 in ACC, a non-significant difference. There were no differences with regard to social participation or QALYs. Therefore, BPR was not cost-effective compared to ACC. Types of expenditure with the highest costs were in order of magnitude: supported and sheltered housing, inpatient care, outpatient care, and organized activities. Estimated budget impact of wide BPR implementation ranged from cost savings to €190 million, depending on assumptions regarding uptake. There were no differences between the two costing variants meaning that from a health insurer perspective, there would be no additional costs if BPR was implemented on a wider scale in mental health care institutions., Conclusions: This was the first study to investigate BPR cost-effectiveness and budget impact. The results showed that BPR was not cost-effective compared to ACC. When interpreting the results, one must keep in mind that the cost-effectiveness of BPR was investigated in the area of social participation, while BPR was designed to offer support in all rehabilitation areas. Therefore, more studies are needed before definite conclusions can be drawn on the cost-effectiveness of the method as a whole., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Sanches, Feenstra, Swildens, van Busschbach, van Weeghel and van Asselt.)

Purpose: Differentiating the concept of body satisfaction, especially the functional component, is important in clinical and research context. The aim of the present study is to contribute to further refinement of the concept by evaluating the psychometric properties of the Dutch version of the Body Cathexis Scale (BCS). Differences in body satisfaction between clinical and non-clinical respondents are also explored., Method: Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to investigate whether functional body satisfaction can be distinguished as a separate factor, using data from 238 adult female patients from a clinical sample and 1060 women from two non-clinical samples in the Netherlands. Univariate tests were used to identify differences between non-clinical and clinical samples., Results: EFA identified functionality as one of three factors, which was confirmed by CFA. CFA showed the best fit for a three-factor model, where functionality, non-weight, and weight were identified as separate factors in both populations. Internal consistency was good and correlations between factors were low. Women in the non-clinical sample scored significantly higher on the BCS than women with eating disorders on all three subscales, with high effect sizes., Conclusions: The three factors of the BCS may be used as subscales, enabling researchers and practitioners to use one scale to measure different aspects of body satisfaction, including body functionality. Use of the BCS may help to achieve a more complete understanding of how people evaluate body satisfaction and contribute to further research on the effectiveness of interventions focussing on body functionality., Level of Evidence: Cross-sectional descriptive study, Level V., (© 2021. The Author(s).)

Introduction: Various studies have demonstrated that individuals with a psychotic disorder are at an increased risk of becoming a victim of crime. Little is known about gender differences in victimization types and in specific characteristics of victimization (e.g., perpetrator, location or disclosure). Knowledge on characteristics of victimization would provide clinicians with more insight which may be especially useful for tailoring interventions. The aim of this study is to examine gender differences in characteristics of violent and sexual victimization in patients with a psychotic disorder., Methods: Information on violent (threats, physical abuse) and sexual victimization (harassment, assault) was assessed in 482 individuals with a psychotic disorder who received mental health care. Patients were recruited through a routine outcome monitoring study and a clinical trial., Results: Men reported more threats with violence (20.7% vs. 10.5%, x 2  = 7.68, p = 0.01), whereas women reported more sexual assault (13.3% vs. 3.6%, x 2  = 15.43, p < 0.001). For violent victimization, women were more likely than men to be victimized by a partner, friend or family member (52.9% vs. 30.6%) as opposed to a stranger (11.8% vs. 40.3%; O.R. = 52.49) and to be victimized at home (60.0% vs. 29.3%) as opposed to on the street or elsewhere (40.0% vs. 70.3%; O.R. = 0.06). For sexual victimization, there was no difference in location and perpetrator between men and women. For sexual victimization and physical violence, no differences in disclosure were found, but women were more likely not to disclose threats with violence or to disclose threats to a professional or police (52.9% vs. 45.2%; O.R. = 30.33). All analyses were controlled for age, diagnosis and employment., Discussion: Gender patterns of victimization types and characteristics are similar for individuals with a psychotic disorder in comparison to the general population. Men were at higher risk of violent victimization, whereas women were at higher risk for sexual victimization. Men were more likely to become victimized in the streets or elsewhere by a stranger, whereas women seemed to be more often victimized at home by a partner, friend or a family member. Future studies may tailor interventions preventing victimization in psychosis according to gender., (© 2021. The Author(s).)

Objective: The objective of this review was to assess associations between Individual Placement and Support (IPS), employment, and personal and clinical recovery among persons with severe mental illness at 18-month follow-up., Methods: A systematic literature search identified randomized controlled trials (RCTs) comparing IPS with services as usual. Outcomes were self-esteem, empowerment, quality of life, symptoms of depression, negative or psychotic symptoms, anxiety, and level of functioning. A total of six RCTs reported data suitable for meta-analyses, and pooled original data from five studies were also analyzed., Results: Meta-analyses and analyses of pooled original data indicated that receipt of the IPS intervention alone did not improve any of the recovery outcomes. Participants who worked during the study period, whether or not they were IPS participants, experienced improved negative symptoms, compared with those who did not work (standardized mean difference [SMD]=-0.41, 95% confidence interval [CI]=-0.56, -0.26). For participants who worked, whether or not they were IPS participants, improvements were also found in level of functioning and quality of life (SMD=0.59, 95% CI=0.42, 0.77 and SMD=0.34, 95% CI=0.14, 0.54, respectively)., Conclusions: Employment was associated with improvements in negative symptoms, level of functioning, and quality of life.

Individuals with a psychotic disorder are at an increased risk of becoming the victim of a crime. A body-oriented resilience therapy (BEATVIC) aimed at preventing victimization by addressing putatively underlying factors was developed. One of these factors is social cognition, particularly facial affect processing. The current study investigated neural effects of BEATVIC on facial affect processing using two face processing tasks. Participants were randomized to either BEATVIC or a 'Befriending' control group. Twenty-seven patients completed an Emotional Faces task and the Wall of Faces task during fMRI, pre- and post-intervention. General linear model analyses yielded no differences between groups over time. Independent component analyses revealed increased activation of the salience network to angry and fearful faces in BEATVIC compared to Befriending. Increased activation of the salience network may suggest an increased alertness for potentially dangerous faces.

Background: Although there is consensus on the importance of involving informal caregivers of people with severe mental illness, interventions are needed to support this., Aim: To explore whether the use of the 'Triangle of Care Card', an instrument developed to help strengthen the role of care-givers in their contact with workers, increases quality of cooperation and care., Method: Three outpatient mental health teams and twelve teams for supported housing started working with the card. Information from files and questionnaires were used to monitor change and compare this with the changes during the same year in ten other teams., Results: Use of the Triangle of Care Card was sparse. When it was used, a broader range of subjects were discussed, including the needs of caregivers. Also, clients were more involved. In teams where the card was introduced, the clients' networks became more apparent and there was an increase in face-to-face meetings with members of this network., Conclusion: Introduction of the Triangle of Care Card leads to change in the involvement of caregivers. However, implementation is problematic and therefore the increase in quality of the cooperation with caregivers and quality of care is yet small.

Background: People with severe mental illnesses (SMIs) have difficulty participating in society through work or other daily activities., Aims: To establish the effectiveness with which the Boston University Approach to Psychiatric Rehabilitation (BPR) improves the level of social participation in people with SMIs, in the Netherlands., Method: In a randomized controlled trial involving 188 people with SMIs, we compared BPR (n = 98) with an Active Control Condition (ACC, n = 90) (Trial registration ISRCTN88987322). Multilevel modeling was used to study intervention effects over two six-month periods. The primary outcome measure was level of social participation, expressed as having participated in paid or unpaid employment over the past six months, as the total hours spent in paid or unpaid employment, and as the current level of social participation. Secondary outcome measures were clients' views on rehabilitation goal attainment, Quality of Life (QOL), personal recovery, self-efficacy, and psychosocial functioning., Results: During the study, social participation, QOL, and psychosocial functioning improved in patients in both groups. However, BPR was not more effective than ACC on any of the outcomes. Better social participation was predicted by previous work experience and a lower intensity of psychiatric symptoms., Conclusions: While ACC was as effective as BPR in improving the social participation of individuals with SMIs, much higher percentages of participants in our sample found (paid) work or other meaningful activities than in observational studies without specific support for social participation. This suggests that focused rehabilitation efforts are beneficial, irrespective of the specific methodology used., (Copyright © 2020 Sanches, Swildens, Schaefer, Moerbeek, Feenstra, van Asselt, Danner, van Weeghel and van Busschbach.)

Purpose Personality disorders (PDs) are associated with severe functional impairment and subsequent high societal costs, increasing the need to improve occupational functioning in PD. Individual placement and support (IPS) is an effective, evidence-based method of supported employment, which so far has been tested in various mixed patient populations with severe mental illness (SMI, including PDs). However, the effectiveness of IPS for PDs per se remains uninvestigated. Methods Data from the SCION trial were used, including 31 SMI patients with PDs and 115 SMI patients with other primary diagnoses (primarily psychotic disorders). First, the interaction effect of diagnosis (PD vs other SMI) and intervention (IPS vs traditional vocational rehabilitation) was studied. Second, in the IPS condition, difference between diagnostic groups in time to first job was studied. Results We did not find evidence of a moderating effect of PD diagnosis on the primary effect of IPS (proportion who started in regular employment) (OR = 0.592, 95% CI 0.80-4.350, p = 0.606) after 30 months. Also, PD diagnosis did not moderate the effect of time until first job in IPS. Conclusions From the present explorative analysis we did not find evidence for a moderating effect of PD diagnosis on the effectiveness of IPS among PD participants. This indicates that IPS could be as effective in gaining employment in participants with PD as it is in participants with other SMI. Future studies, implementing larger numbers, should confirm whether IPS is equally effective in PDs and study whether augmentations or alterations to the standard IPS model might be beneficiary for PD.

Background: Sexual abuse in individuals with (above) average iq is associated with a wide range of behavioural and psychological clinical characteristics, including characteristics regarding body experience. However, research on the clinical characteristics of sexually abused individuals with borderline intellectual functioning or mild intellectual disability (bif-mid) is scarce. OBJECTIVE To provide an overview of the literature on the clinical characteristics of sexually abused individuals with bif-mid.
METHOD: PubMed, Embase, PsycInfo, cinahl, Cochrane Library and Web of Science were searched for relevant publications using terms related to 'intellectual disability' and 'sexual abuse'.
RESULTS: Seven studies were included. The studies in question mostly reported behavioural and psychological characteristics such as challenging behaviour, sexualised behaviour or posttraumatic stress, anxiety or depressive symptoms associated with sexual abuse in individuals with bif-mid. None of the studies reported problems regarding body experience. CONCLUSIONS Sexual abuse in individuals with bif-mid is associated with a broad range of behavioural and psychological characteristics similar to that of individuals with (above) average iq. Whether sexually abused individuals with bif-mid have similar problems in body experience as sexually abused individuals with (higher than) average iq needs to be investigated.

Background: Sexual abuse in individuals with average IQ or above is associated with a wide range of behavioural, psychological and body-related characteristics. It is unknown whether individuals with intellectual disability (ID) and a history of sexual abuse suffer from similar clinical characteristics., Objective: The aim of the review is to provide an overview of the literature on the clinical characteristics of individuals with ID who have experienced sexual abuse., Method: PubMed, Embase, PsycInfo, CINAHL, Cochrane Library and Web of Sciences were searched for relevant publications using terms related to concepts of "intellectual disability" and "sexual abuse". Two independent reviewers screened and selected articles for inclusion in the study, resulting in seven studies., Results: The studies mostly reported behavioural and psychological characteristics such as aggression, self-injury, or posttraumatic stress, anxiety or depressive symptoms associated with sexual abuse in individuals with ID. None mentioned body-related characteristics., Conclusions: Similar to individuals with average IQ or above, sexual abuse in individuals with ID is associated with a broad range of behavioural and psychological characteristics. Conduct disorders, self-injury, inappropriate sexualised talk and poor feelings of personal safety seem to be more indicative for the ID population. Anxiety, depression and PTSD are prevalent in individuals with and without ID who both have experienced sexual abuse. Whether individuals with ID experience body-related characteristics is unclear., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Purpose To study associations between the level of self-reported work motivation and employment outcomes in people with severe mental illness (SMI) enrolled in a vocational rehabilitation program. Methods Data of 151 study participants, collected from a randomised controlled trial with a 30-month follow-up period, were used for a secondary data analysis. Multiple logistic regression, linear regression and cox regression analyses were performed to analyse the association between the level of work motivation at baseline and job obtainment, duration of job, and time until job obtainment during the 30-month follow-up period. Results No statistically significant associations were found between the level of work motivation and job obtainment (OR 1.83, 95% CI 0.55-6.06, p = 0.32), job duration (B = - 0.74, 95% CI - 2.37 to 0.89, p = 0.37, R-squared = 0.03), or time until job obtainment (HR = 1.53, 95% CI 0.64-3.68, p = 0.34). Conclusions The results of this study show no statistically significant associations between the level of work motivation and employment outcomes in people with SMI enrolled in a vocational rehabilitation program. These associations may be underestimated due to range restriction of the work motivation's level. Further research is recommended to increase knowledge on the associations between work motivation and employment outcomes, as it could be relevant for further understanding success in vocational rehabilitation.

Individuals with psychosis are at an increased risk of victimization. Processing of facial expressions has been suggested to be associated with victimization in this patient group. Especially processing of angry expressions may be relevant in the context of victimization. Therefore, differences in brain activation and connectivity between victimized and nonvictimized patients during processing of angry faces were investigated. Thirty-nine patients, of whom nineteen had experienced threats, assaults, or sexual violence in the past 5 years, underwent fMRI scanning, during which they viewed angry and neutral facial expressions. Using general linear model (GLM) analyses, generalized psychophysiological (gPPI) analysis and independent component analyses (ICA) differences in brain activation and connectivity between groups in response to angry faces were investigated. Whereas differences in regional brain activation GLM and gPPI analyses yielded no differences between groups, ICA revealed more deactivation of the sensorimotor network in victimized participants. Deactivation of the sensorimotor network in response to angry faces in victimized patients, might indicate a freeze reaction to threatening stimuli, previously observed in traumatized individuals.

Purpose: In this study, longitudinal associations between sports participation and health-related quality of life (HRQoL) were explored. Sports participation was operationalized as membership of a sports club, frequency of sports participation, performing individual versus team sports and performing indoor versus outdoor sports. The concept of HRQoL referred to the self-perceived enjoyment and satisfaction with one's personal health situation., Methods: Data from 618 fourth-grade primary school children were included at baseline; 10-13 months later, 417 children (response rate 67.5%) were retained. At both time points, children reported on sports participation (Move and Sports Monitor Questionnaire-youth aged 8-12 years) and health-related quality of life (KIDSCREEN-52). Because of the clustering of children in schools, data were analysed using linear mixed models. Analyses were adjusted for sex, age, BMI, household composition, SES and frequency of sports participation., Results: The questionnaires were fully completed by 417 children. High sports-active children showed better scores on almost all dimensions of HRQoL than moderate [difference (B) = - 1.82 (p = 0.05) to - 1.51 (p = 0.05)] or low ports-active children [difference (B) = - 3.67 (p < 0.001) to - 1.95 (p = 0.03)] and non-sports club members [difference (B) = - 5.58 (p < 0.001) to - 2.65 (p = 0.02)]. Unlike frequency, the other examined characteristics of sports participation were only to a limited extent longitudinal associated with HRQoL., Conclusion: As frequency is more relevant than the form of sports participation, children should be encouraged to perform any kind of sports activity on a very regular base.

Purpose: To investigate factors that influence participation in and needs for work and other daytime activities among individuals with severe mental illnesses (SMI)., Methods: A latent class analysis using routine outcome monitoring data from 1069 patients was conducted to investigate whether subgroups of individuals with SMI can be distinguished based on participation in work or other daytime activities, needs for care in these areas, and the differences between these subgroups., Results: Four subgroups could be distinguished: (1) an inactive group without daytime activities or paid employment and many needs for care in these areas; (2) a moderately active group with some daytime activities, no paid employment, and few needs for care; (3) an active group with more daytime activities, no paid employment, and mainly met needs for care; and (4) a group engaged in paid employment without needs for care in this area. Groups differed significantly from each other in age, duration in MHC, living situation, educational level, having a life partner or not, needs for care regarding social contacts, quality of life, psychosocial functioning, and psychiatric symptoms. Differences were not found for clinical diagnosis or gender., Conclusions: Among individuals with SMI, different subgroups can be distinguished based on employment situation, daytime activities, and needs for care in these areas. Subgroups differ from each other on patient characteristics and each subgroup poses specific challenges, underlining the need for tailored rehabilitation interventions. Special attention is needed for individuals who are involuntarily inactive, with severe psychiatric symptoms and problems in psychosocial functioning.

Introduction: Although people with a psychotic disorder are approximately four to six times more often victimized than the general population, victimization is not routinely assessed in mental healthcare. This study investigates prevalence, context and risk factors of victimization in patients with a psychotic disorder in the Northern, relatively rural region of the Netherlands. Moreover, disclosure rates and awareness of psychiatrists are examined., Method: Information on personal crime (threats, assaults and sexual violence), property and other forms of crime, the context of victimization and disclosure was routinely assessed in 353 patients with a psychotic disorder who received care at a mental health facility. In addition, involved psychiatrists reported on last year's victimization incidents in their patients., Results: One third of the patients reported victimization in the previous year. More than half of the crimes were committed by someone acquainted and took place in the victim's own home or a place familiar to the victim. Younger age, having a comorbid disorder, drug use and perpetration of a crime were all positively associated with victimization. Approximately half of the reported personal crimes were disclosed to a health care professional but only in 16% of the cases the involved psychiatrist report to know about the incident., Conclusion: This study confirms that people with a history of psychosis have an increased risk of becoming the victim of a crime. Although our results suggest that in fifty percent of cases the patients did share the information with professionals, a substantial proportion of incidents appear to go still unnoticed., Competing Interests: The authors have declared that no competing interests exist.

Background: In children physical activity has been shown to be associated with health-related quality of life (HRQoL). This study further explores this association for specific characteristics of sports participation, namely membership of a sports club, frequency of sports participation, performing individual versus team sports, performing indoor versus outdoor sports, while differentiating between specific dimensions in the physical, psychological and social domain of HRQoL., Methods: Cross-sectional data were collected from Dutch primary school children aged 10 to 12 years. They completed the Movement and Sports Monitor Questionnaire Youth aged 8 to 12 years (MSMQ) and the KIDSCREEN-52, an HRQoL questionnaire for children and adolescents. The data were examined using linear multilevel analyses because of the clustering of children in schools., Results: The questionnaires were completed by 1876 children (response rate 81.3%). Membership of a sports club, moderate or high frequency of sports participation, and performing outdoor sports were all significantly associated with better HRQoL. These associations were largely found in the physical domain of HRQoL, to a lesser degree in the social domain, and to a limited extent in the psychological domain., Conclusion: The association between sports participation and HRQoL in children depends on both characteristics of sports participation and the domain of life that is concerned. These differences offer starting points for developing tailor-made sports programs for children.

Several studies suggest that sports participation is beneficial for psychosocial health. There is, however, only a limited number of studies about the relationship of specific characteristics of sports participation with psychosocial health. The present study investigated associations between characteristics of sports participation and three aspects of psychosocial health, i.e. internalising problems, externalising problems and prosocial behaviour. The examined characteristics of sports participation pertained to individual versus team sports, indoor versus outdoor sports, involvement in competition or not, and contact sports versus non-contact sports. Cross-sectional data were collected from 1768 Dutch children aged 10-12 years who were member of a sports club. These children completed the Movement and Sports Monitor Questionnaire Youth aged 8-12 years (MSMQ) and the Strength and Difficulties Questionnaire (SDQ). Linear multilevel analyses and logistic generalised estimating equation were conducted. Children participating in team sports, outdoor sports, or competition showed fewer internalising problems than children engaged in individual sports, indoor sports, or only training. The associations with internalising problems were stronger for boys than for girls. Children participating in non-contact sports showed fewer externalising problems than children performing non-contact sports as well as contact sports. Children practising indoor sports or non-contact sports showed better prosocial behaviour than children doing outdoor or contact sports. In conclusion, the form of sports participation seemed to matter highly with respect to internalising problems, especially for boys, and, to a lesser extent, with respect to externalising problems and prosocial behaviour. This offers starting points for developing tailor-made sports programmes for children.

Although there is ample empirical evidence that traumatic events, postmigration stress, and acculturation problems have a great impact on the mental health of refugees, so far no studies have included cultural identity after migration in the equation. This mixed-methods study conducted among Afghan and Iraqi refugee and asylum-seeker psychiatric patients aims to fill this gap. Associations between postmigration stress, symptoms of anxiety and depression disorders, and symptoms of posttraumatic stress disorder were significant. When differentiated for the two groups, associations with postmigration stress were no longer significant for Afghan patients, who were predominantly younger and more often single, lower educated, and without resident status compared with Iraqi patients. Qualitative results indicate that, in addition to psychopathology and postmigration stress, acculturation problems contribute to confusion of cultural identity. The findings suggest that reduction of postmigration stress and acculturation problems may clarify cultural identity and as such may contribute to posttraumatic recovery.

Background: Individuals with eating disorders tend to internalise their anger and aggression excessively. However, an evidence-based intervention, targeted on this persistent issue, was missing until now. Therefore, a body and movement oriented intervention was developed, which supports patients to reframe and redirect anger and aggression against the destructive influence of the eating disorder.
AIM: To study the effectiveness of the aggression regulation intervention.
METHOD: The intervention was tested in a first randomised controlled trial (RCT) in an outpatient setting and in a two-center RCT in a multidisciplinary day hospital setting. Coping with anger was measured by the Self-Expression and Control Scale (SECS). Eating disorder pathology was measured by the Eating Disorder Examination Questionnaire (EDE-Q).
RESULTS: Both RCTs delivered first evidence for the brief body and movement oriented intervention to reduce excessive anger internalisation in individuals with eating disorders. Moreover, in the outpatient trial the eating disorder pathology was significantly more reduced in the intervention group compared to the control group.
CONCLUSION: There is first evidence for the effectiveness of a body and movement oriented approach of reducing excessive anger internalisation in individuals with eating disorders.

Psychotic disorders often have been linked with violence. However, studies have shown that people with a psychotic disorder are more often victim than perpetrator of violence. The objective of this meta-analysis was to review prevalence rates for different types of victimization and to identify risk factors associated with victimization. Based on a search in MEDLINE, PsycINFO, and Web of Science, 27 studies were found with samples consisting of adults with a psychotic disorder and possible victimization occurring during adulthood and data on "violent victimization," "sexual victimization," "non-violent victimization," and/or "victimization not otherwise specified." The median prevalence rate for violent victimization was 20%, for sexual victimization 20%, nonviolent victimization 19%, and for victimization not otherwise specified 19%. Victimization rates were approximately 4-6 times higher than in the general community. Meta-analyses showed the following significant risk factors: delusion (OR = 1.69), hallucinations (OR = 1.70), manic symptoms (OR = 1.66), drugs (OR = 1.90) or alcohol abuse (OR = 2.05), perpetration of a crime (OR = 4.33), unemployment (OR = 1.31), and homelessness (OR = 2.49). Other risk factors like previous victimization, impaired social functioning, personality disorder, and living in a disadvantaged neighborhood were found only in 1 or 2 studies. Based on the results, we conclude that, depending on the examined time period, 1 in 5 (assessment period ≤3 y) or 1 in 3 (assessment period entire adulthood) people with a psychotic disorder was victim of a crime. Clinical, behavioral, and sociodemographic factors were significantly associated with victimization, as well as previous victimization. Prospective research into risk factors is needed to capture causal trajectories of victimization.

Background: Apart from changes in mood and cognition, depressive disorders are also characterized by changes in body experience, changes that largely influence daily functioning and aggravate distress. In order to gain more insight into this important issue, three domains of body experience - body attitude, body satisfaction and body awareness - and their associations with symptom severity of depression were studied pre- and post-treatment in a clinical sample of depressed patients in a multidisciplinary setting., Methods: Body attitude (Dresden Body Image Questionnaire), body satisfaction (Body Cathexis Scale), body awareness (Somatic Awareness Questionnaire) and severity of depressive symptoms (Inventory of Depressive Symptomatology) were measured. Differences between pre-treatment and post-treatment scores were studied with paired t-tests. Associations between body experience and depression were analysed with Pearson correlations and partial correlations., Results: At the start of treatment, patients scored significantly lower than a healthy comparison sample on body attitude and body satisfaction, but not on body awareness. After treatment, depression scores decreased with large effect sizes, scores for body attitude and body satisfaction increased with medium effect sizes and body awareness scores increased slightly. Medium pre-treatment and strong post-treatment associations were found between depression severity and body attitude and between depression severity and body satisfaction., Limitations: The design does not allow to draw causal conclusions. Because of the multidisciplinary treatment no information is available on the specific contribution of interventions targeting body experience., Conclusions: The study provides evidence for medium to strong associations in clinically depressed patients between body attitude, body satisfaction and depression., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: People with a psychotic disorder have an increased risk of becoming the victim of a crime. To prevent victimization a body-oriented resilience therapy using kickboxing exercises was developed. This study aims to explore the feasibility of the therapy, to improve the therapy protocol and to explore suitable outcomes for a RCT., Methods: Twenty-four adults with a psychotic disorder received 20 weekly group sessions in which potential risk factors for victimization and strategies for dealing with them were addressed. Sessions were evaluated weekly. During pre and post assessment participants completed questionnaires on, among other, victimization, aggression regulation and social functioning., Results: The short recruitment period indicates the interest in such an intervention and the willingness of clients to participate. Mean attendance was 85.3 and 88% of the participants completed fifteen or more sessions. The therapy protocol was assessed as adequate and exercises as relevant with some small improvements to be made. The victimization and aggression regulation questionnaires were found to be suitable outcome measurements for a subsequent RCT., Conclusion: The results support the feasibility of the BEATVIC therapy. Participants subjectively evaluated the intervention as helpful in their attempt to gain more self-esteem and assertiveness. With some minor changes in the protocol the effects of BEATVIC can be tested in a RCT., Trial Registration: The trial registration number (TRN) is 35949 (date submitted 09/11/2018). Retrospectively registered.

This study presents first test results of a new performance-based, psychomotor method to measure anger expression and control, based on voice expression and physical force production in directional movement of arms and legs, called the Method of Stamp Strike Shout (MSSS). Recorded are the standardized impact of stamping on a force plate, hitting a punching bag, and the amplitude of shouting in a microphone at various force levels. The premise is, that these body behaviours stand for the 'urge to act or shout' that belongs to anger-related emotions. The MSSS is meant to be applied in addition to potentially biased self-report questionnaires and has been designed for diagnostic as well as therapeutic purposes in clinical practice. First, this paper focusses on the instrumentation, internal structure and reliability of the MSSS. An explorative study in a student sample (n = 104) shows correlation patterns between increasing and decreasing levels of force production within each subtest (Stamp, Strike and Shout) and between the three subtests. We found excellent internal consistency of the three subtests and high test-retest reliability. The parameters of increasing and decreasing force levels form the slopes of what we call a force pyramid. To adjust for the clustering within persons, aggregated outcomes were calculated: sum scores per subtest as an indication of total force produced, two linear contrast scores to indicate the rate of increase / decrease, and two quadratic contrast scores as measures of the curvature of the slopes. On all subtests, all aggregated scores showed differences between men and women, also when controlled for weight. To test the validity of the MSSS, the second part of the paper examines the relationship between force parameters and anger coping style, measured by the Self-Expression and Control Scale (SECS). The results suggest that the Shout subtest was the most sensitive indicator for anger coping style, showing negative correlations with Anger In, for women as well as men. For women, higher amplitude was also associated with higher Anger Out and lower amplitude with higher Anger Control. The Stamp subtest showed weak positive correlations with the Anger In subscales, whereas no correlations were found on the Strike subtest. Further, a more robust comparison was made between two groups of participants who reported to have an internalizing versus an externalizing anger coping style. Results indicated that internalizing women as well as men used less force than externalizing participants on all three subtests, especially on the Shout subtest. This was confirmed by lower mean sum scores on the Shout subtest for internalizing women compared with externalizing women. No differences in linear contrast scores were shown between internalizing and externalizing participants. The quadratic contrast scores suggested differences of the curvation of the slopes between women with more or less anger control when stamping, and men with more or less anger control when striking. As this is an explorative study, findings should be interpreted with caution., Competing Interests: The authors have declared that no competing interests exist.

Background: Although body-related problems are common in patients with somatoform disorder, research focusing on how patients with somatoform disorder perceive and evaluate their body is scarce. The present study compared differences in body image between patients with somatoform disorder and respondents from a general population sample. It also examined differences within the somatoform disorder group between men and women and between the diagnostic subgroups conversion disorder, pain disorder and undifferentiated somatoform disorder., Methods: Data were obtained from 657 patients (67.5% female) with somatoform disorder (DSM-IV-TR 300.7, 300.11, 300.81, 300.82) and 761 participants (58.6% female) from the general population. The Dresden Body Image Questionnaire (DBIQ) was used to assess body image in five domains: body acceptance, vitality, physical contact, sexual fulfilment, and self-aggrandizement. Confirmatory factor analysis and analyses of variance were performed. Since differences in age and sex were found between the somatoform disorder sample and the comparison sample, analyses were done with two samples of 560 patients with somatoform disorder and 351 individuals from the comparison sample matched on proportion of men and women and age., Results: Patients scored significantly lower than the comparison sample on all DBIQ domains. Men scored higher than women. Patients with conversion disorder scored significantly higher on vitality and body acceptance than patients with undifferentiated somatoform disorder and pain disorder., Conclusions: The mostly large differences in body image between patients with somatoform disorder and the comparison sample as well as differences between diagnostic subgroups underline that body image is an important feature in patients with somatoform disorder. The results indicate the usefulness of assessing body image and treating negative body image in patients with somatoform or somatic symptom disorder.

Objective: A key aspect of psychiatric rehabilitation is supporting individuals with serious mental illness in reaching personal goals. This study aimed to investigate whether various aspects of the working alliance predict successful goal attainment and whether goal attainment improves subjective quality of life, independent of the rehabilitation approach used., Methods: Secondary analyses were conducted of data from a Dutch randomized clinical trial on goal attainment by individuals supported with the Boston University approach to psychiatric rehabilitation (N=80) or a generic approach (N=76). Working alliance was measured with the Working Alliance Inventory (WAI) from the practitioner's perspective. Rehabilitation practitioners had backgrounds in social work, nursing, or vocational rehabilitation. Multiple logistic regression and multiple regression analyses explored effects of working alliance on goal attainment and of goal attainment on subjective quality of life at 24 months. Analyses were controlled for client- and process-related predictors, baseline quality of life, and rehabilitation approach., Results: The WAI goal subscale predicted goal attainment at 24 months. No effect was found for the bond or task subscale. Goal attainment significantly predicted quality of life at 24 months. These effects were independent of the rehabilitation approach used., Conclusions: A good bond between client and practitioner is not enough to attain successful rehabilitation outcomes. Findings suggest that it is important to discuss clients' wishes and ambitions and form an agreement on goals. Attaining rehabilitation goals directly influenced the subjective quality of life of individuals with serious mental illness, which underscores the importance of investing in these forms of client support.

Background: It is well known that sports participation is positively associated with psychosocial health in children, but details about this association over time are lacking. This study aimed to explore longitudinal associations between several characteristics of sports participation and three aspects of psychosocial health (internalizing problems, externalizing problems and prosocial behaviour) in Dutch children aged 10-12 years., Methods: Data from 695 fourth-grade primary school children were included at baseline; 10-13 months later, 487 children (response rate 70.1%) were retained. At both time points, children reported on their sports participation (Move and Sports Monitor Questionnaire - Youth Aged 8-12 Years) and psychosocial health (Strength and Difficulties Questionnaire). Longitudinal associations between several characteristics of sports participation and the three aspects of psychosocial health were analysed using linear mixed models, both clustering the repeated measures within children and clustering the children within schools. In addition to crude analyses, analyses were performed adjusting for sex, age, BMI, household composition, SES and frequency of sports participation., Results: Membership in a sports club, moderate or high frequency of sports participation, performing team sports, performing outdoor sports, performing contact sports and involvement in competition were longitudinally associated with fewer internalizing problems. The longitudinal association of higher frequency of sports participation with fewer internalizing problems was stronger as a child's BMI increased. The association of performing team sports with fewer internalizing problems was only observed for boys. Membership in a sports club and moderate or high frequency of sports participation were also longitudinally associated with better prosocial behaviour. These associations with prosocial behaviour were stronger for girls. None of the characteristics of sports participation examined were longitudinally associated with externalizing problems., Conclusions: This study shows that from a longitudinal perspective, fewer internalizing problems and better prosocial behaviour were seen in children who were active in sports. Fewer internalizing problems were also associated with the kind of sports participation; for example, with performing outdoor sports. No associations were found for externalizing problems. Future research should preferably take the form of an intervention to investigate whether the observed statistical associations are of a causal nature.

A body of evidence has revealed positive effects of physical exercise on behavioral, cognitive and physical outcomes in patients with schizophrenia. Notably, the effect of exercise at the neural level may be particularly relevant as well as it is hypothesized that exercise may stimulate the brain in a way that might normalize neural alterations related to the disorder. The aim of the current systematic review was to provide an up to date overview of studies investigating the neural effects of exercise in individuals with a schizophrenia spectrum disorder and healthy individuals. The majority of included studies focused on hippocampal effects, reporting beneficial effects of exercise. In addition, in schizophrenia increased extrastriate body area (EBA) activation and increased white matter fiber integrity in tracts relevant to the disorder were found and in healthy individuals decreased connectivity of the dorsolateral prefrontal cortex (DLPFC) indicating greater cognitive efficiency was reported. Comparing individuals with a schizophrenia spectrum disorder and healthy individuals within a similar age range, most studies found similar effects on hippocampal volume and white matter tracts for both groups, although the effect in schizophrenia spectrum disorders may be attenuated which is in line with previous literature on brain plasticity. The current review indicates a lack of studies investigating neural correlates other than the hippocampus. Although those studies that did focus on other neural correlates revealed promising results, these have not been replicated in other studies and call for replication. Furthermore, future studies should expand their focus, by investigating neural mechanisms underlying positive effects of physical exercise on positive symptoms, negative symptoms and symptoms such as depression, social withdrawal and social cognition.

Objective: This article describes a measure developed to assess fidelity of working with the Boston University approach to Psychiatric Rehabilitation (BPR) in Dutch mental health care. The instrument is intended to measure and improve BPR adherence and clinician competence on an individual level and within individual rehabilitation processes., Method: Rotating pairs of 4 BPR specialists used Fidelity of Rehabilitation (FiRe) to evaluate the fidelity of BPR as applied in 114 rehabilitation processes. The content of these processes was documented by the 27 rehabilitation practitioners who delivered the approach., Results: Interrater reliability (.66) was good as were correlations between the first and second assessments (.74), also increasing over time. FiRe was able to distinguish those delivering the approach at an expert level from nonexperts, expressing concurrent validity. FiRe was also related to practitioner attitude toward rehabilitation, a possibly similar construct. In this study, the average level of BPR adherence according to our fidelity model was low. During the 10.5-month review period, overall FiRe scores improved slightly, but this effect was not significant. However, practitioners reported that feedback based on FiRe helped them to enhance their skills., Conclusions and Implications for Practice: This first version of FiRe is a valid and reliable instrument with which to gain insight into the quality and fidelity of individual practitioners' rehabilitation practices. The instrument used in this study will be further developed in line with study results. More importantly, FiRe raises questions about the definition of good BPR, a topic that should be explored more extensively in future research. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Background: Body image has implications for psychosocial functioning and quality of life and its disturbance is reported in a broad range of psychiatric disorders. In view of the lack of instruments in Dutch measuring body image as a broad concept, we set out to make an instrument available that reflects the multidimensional character of this construct by including more dimensions than physical appearance. The Dresden Körperbildfragebogen (DBIQ, Dresden Body Image Questionnaire) particularly served this purpose. The DBIQ consists of 35 items and five subscales: body acceptance, sexual fulfillment, physical contact, vitality, and self-aggrandizement. The main objective of the present study was to evaluate the psychometric properties of the Dutch translation of the Dresden Body Image Questionnaire (DBIQ-NL) in a non-clinical sample., Methods: The psychometric properties of the DBIQ-NL were examined in a non-clinical sample of 988 respondents aged between 18 and 65. We investigated the subscales' internal consistency and test-retest reliability. In order to establish construct validity we evaluated the association with a related construct, body cathexis, and with indices of self-esteem and psychological wellbeing. The factor structure of the DBIQ-NL was examined via confirmatory factor analysis (CFA). The equivalence of the measurement model across sex and age was evaluated by multiplegroup confirmatory factor analyses., Results: Confirmatory factor analyses showed a structure in accordance with the original scale, where model fit was improved significantly by moving one item to another subscale. Multiple group confirmatory factor analysis across sex and age demonstrated partial strong invariance. Internal consistency was good with little overlap between the subscales. Temporal reliability and construct validity were satisfactory., Conclusion: Results indicate that the DBIQ-NL is a reliable and valid instrument for non-clinical subjects. This provides a sound basis for further investigation of the DBIQ-NL in a clinical sample.

Background : A crucial but often overlooked impact of early life exposure to trauma is its far-reaching effect on a person's relationship with their body. Several domains of body experience may be negatively influenced or damaged as a result of early childhood trauma. Objective : The aim of this study was to investigate disturbances in three domains of body experience: body attitude, body satisfaction, and body awareness. Furthermore, associations between domains of body experience and severity of trauma symptoms as well as frequency of dissociation were evaluated. Method : Body attitude was measured with the Dresden Body Image Questionnaire, body satisfaction with the Body Cathexis Scale, and body awareness with the Somatic Awareness Questionnaire in 50 female patients with complex trauma and compared with scores in a non-clinical female sample ( n  = 216). Patients in the clinical sample also filled out the Davidson Trauma Scale and the Dissociation Experience Scale. Results : In all measured domains, body experience was severely affected in patients with early childhood trauma. Compared with scores in the non-clinical group, effect sizes in Cohen's d were 2.7 for body attitude, 1.7 for body satisfaction, and 0.8 for body awareness. Associations between domains of body experience and severity of trauma symptoms were low, as were the associations with frequency of dissociative symptoms. Conclusions : Early childhood trauma in women is associated with impairments in self-reported body experience that warrant careful assessment in the treatment of women with psychiatric disorders.

Objective: Despite the increasing recognition in clinical practice of body image problems in other than appearance related mental disorders, the question remains how aspects of body image are affected in different disorders. The aim of this study was to measure body image in patients with a variety of mental disorders and to compare scores with those in the general population in order to obtain more insight in the relative disturbance of body image in the patients group compared to healthy controls. In a further exploration associations with self-reported mental health, quality of life and empowerment were established as well as the changes in body image in patients over time., Methods: 176 women and 91 men in regular psychiatric treatment completed the Dresden Body Image Questionnaire, the Outcome Questionnaire, the Manchester Short Assessment of Quality of Life and the Mental Health Confidence Scale. Measurements were repeated after four months., Results: Patients with mental disorders, especially those with post-traumatic stress disorder (PTSD), scored significantly lower on body image, with large effect sizes, in comparison with the healthy controls. Scores of patients from different diagnostic groups varied across domains of body image, with body acceptance lowest in the group with eating disorders, and sexual fulfillment extremely low in PTSD. Vitality did not differ significantly between the various disorders. Gender differences were large for body acceptance and sexual fulfillment and small for vitality. Associations of body image with self-reported mental health, quality of life and empowerment were moderate to strong. After four months of treatment positive changes in body image were observed., Conclusions: Negative body image is a common problem occurring in most patients with mental disorders. Diagnosis-specific profiles emerge, with PTSD being the most affected disorder. Body acceptance and sexual fulfillment were the most differentiating aspects of body image between diagnoses. Changes in body image occur over the course of treatment., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: The objective is to evaluate a body and movement-oriented intervention on aggression regulation, specifically aimed towards reducing anger internalization in patients with an eating disorder., Method: Patients were randomized to treatment-as-usual (TAU) plus the intervention (n = 38) or to TAU only (n = 32). The intervention was delivered by a psychomotor therapist. TAU consisted of multidisciplinary day treatment (3-5 days per week during 3-9 months). Anger coping (Self-Expression and Control Scale) and eating pathology (Eating Disorder Examination-Self-report Questionnaire) were measured at baseline and follow-up. Differences between pre-intervention and post-intervention scores were tested by using repeated measures ANOVA., Results: The intervention group showed a significantly larger decrease of anger internalization than the control group (η 2  = 0.16, p = 0.001). Both groups showed a significant reduction in eating pathology, but differences between groups were not significant., Discussion: A body and movement-oriented therapy seems a viable add-on for treating anger internalization in patients with an eating disorder. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association., (© 2016 John Wiley & Sons, Ltd and Eating Disorders Association.)

Objective: Self-stigma is highly prevalent in schizophrenia and can be seen as an important factor leading to low self-esteem. It is however unclear how psychological factors and actual adverse events contribute to self-stigma. This study empirically examines how symptom severity and the experience of being victimized affect both self-stigma and self-esteem., Methods: Persons with a schizophrenia spectrum disorder (N = 102) were assessed with a battery of self-rating questionnaires and interviews. Structural equation modelling (SEM) was subsequently applied to test the fit of three models: a model with symptoms and victimization as direct predictors of self-stigma and negative self-esteem, a model with an indirect effect for symptoms mediated by victimization and a third model with a direct effect for negative symptoms and an indirect effect for positive symptoms mediated by victimization., Results: Results showed good model fit for the direct effects of both symptoms and victimization: both lead to an increase of self-stigma and subsequent negative self-esteem. Negative symptoms had a direct association with self-stigma, while the relationship between positive symptoms and self-stigma was mediated by victimization., Conclusions: Our findings suggest that symptoms and victimization may contribute to self-stigma, leading to negative self-esteem in individuals with a schizophrenia spectrum disorder. Especially for patients with positive symptoms victimization seems to be an important factor in developing self-stigma. Given the burden of self-stigma on patients and the constraining effects on societal participation and service use, interventions targeting victimization as well as self-stigma are needed., Competing Interests: The authors have declared that no competing interests exist.

Background: Individuals with a psychotic disorder are at an increased risk of becoming victim of a crime or other forms of aggression. Research has revealed several possible risk factors (e.g. impaired social cognition, aggression regulation problems, assertiveness, self-stigma, self-esteem) for victimization in patients with a psychotic disorder. To address these risk factors and prevent victimization, we developed a body-oriented resilience training with elements of kickboxing: BEATVIC. The present study aims to evaluate the effectiveness of the intervention., Methods/design: Seven mental health institutions in the Netherlands will participate in this study. Participants will be randomly assigned to either the BEATVIC training or the control condition: social activation. Follow-ups are at 6, 18 and 30 months. Short term effects on risk factors for victimization will be examined, since these are direct targets of the intervention and are thought to be mediators of victimization, the primary outcome of the intervention. The effect on victimization will be investigated at follow-up. In a subgroup of patients, fMRI scans will be made before and after the intervention period in order to assess potential neural changes associated with the effects of the training., Discussion: This study is the first to examine the effectiveness of an intervention targeted at victimization in psychosis. Methodological issues of the study are addressed in the discussion of this paper., Trial Registration: Current Controlled Trials: ISRCTN21423535 . Retrospectively registered 30-03-2016.

Unlabelled: WHAT IS KNOWN ON THE SUBJECT?: The combination of coping with their mental health problems and caring for children makes parents vulnerable. Family-centred practice can help to maintain and strengthen important family relationships, and to identify and enhance the strengths of a parent with a mental illness, all contributing to the recovery of the person with the mental illness. WHAT THIS PAPER ADDS TO THE EXISTING KNOWLEDGE?: Taking the strength and the opportunities formulated by parents themselves as a starting point is fairly new. Parents with severe mental illness find strength for parenting in several ways. They feel responsible, and this helps them to stay alert while parenting, whereas parenthood also offers a basis for social participation through school contacts and the child's friendships. Dedication to the parent role provides a focus; parents develop strengths and skills as they find a balance between attending to their own lives and caring for their children; and parenting prompts them to find adequate sources of social support. In this study these strategies were found to be the fundamentals of recovery related to parenting. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses can support and coach patients who are identified as parents, and self-chosen parenting related goals are set and addressed. A family-focused approach by nurses can be used to prevent problems for children and their families, identify their strengths as well as vulnerabilities, and address the challenges to build resilience., Introduction: Understanding of the problems of parents with mental illness is growing. Gaining insight into strategies for parenting, while taking the opportunities formulated by these parents themselves as a starting point is fairly new., Question: What are the strategies of parents with a mental illness to be successful?, Method: Experiences of 19 mothers and eight fathers with a mental illness were explored with in-depth interviews. Data were content analysed, using qualitative methods., Results: Next to feelings of inadequacy, interviewees also describe how children enrich and structure their lives and are not only a burden but serve as distraction from problems. Developing activities that interest both child and parent provides avenues for emerging strength. Mental illness constrains fathers, but also gives opportunities to develop a meaningful relation with their children., Discussion: Strategies like being fully dedicated to the parental role, finding a balance between attention for one's own life and parenting and finding adequate sources of support are found to be fundamental for recovery in the parent role. Implications for practice Peer groups can be of valuable help and mental health workers can support parents to set self-chosen parenting related goals., (© 2016 John Wiley & Sons Ltd.)

Objective: The objective of the study is to evaluate the effect of a brief body and movement oriented intervention on aggression regulation and eating disorder pathology for individuals with eating disorders., Method: In a first randomized controlled trial, 40 women were allocated to either the aggression regulation intervention plus supportive contact or a control condition of supportive contact only. The intervention was delivered by a psychomotor therapist. Participants completed questionnaires on anger coping and eating disorder pathology. Independent samples t-tests were performed on the difference between pre-treatment and post-treatment scores., Results: Twenty-nine participants completed questionnaires at pre-intervention and post-intervention. The intervention resulted in a significantly greater improvement of anger coping, as well as of eating disorder pathology., Discussion: Results indicate that body and movement-oriented aggression regulation may be a viable add-on for treating eating disorders. It tackles a difficult to treat emotion which may have a role in blocking the entire process of treating eating disorders., (Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.)

Background: In the Netherlands the Boston psychiatric rehabilitation approach (bpr) is one of the most widely implemented rehabilitation methods. So far, little research has been done on the efficacy of this approach., Aim: To investigate the effect of bpr on the attainment of personal rehabilitation goals, social functioning and empowerment and on care requirements and quality of life in persons with severe mental illness (smi) in the Netherlands., Method: In a multicentre randomised controlled trial (rct:, Clinical Trial Registration Number: isrctn73683215) patients with smi were randomly assigned to bpr (n = 80) or 'care as usual' (cau; n = 76). The primary outcome was the attainment of the rehabilitation goal as formulated by the patient. The secondary outcomes were a change in the work situation and in the degree of independent living, in care requirements (Camberwell Assessment of Needs), in empowerment (Personal Empowerment Scale) and in the quality of life (who-qol). The effects were tested at 12 and 24 months., Results: The degree of goal attainment was substantially higher in bpr at both 12 months (adjusted risk difference: 16%; 95%ci, 2 to 31; nnt = 7) and 24 months (adjusted risk difference: 21%, 95%ci, 4% to 38%; nnt = 5). The approach was also more effective in the area of societal participation (bpr: 21% adjusted increase, cau: 0% adjusted increase; nnt = 5), but not in the other secondary outcome measures., Conclusion: The results suggest that bpr is effective in supporting patients with smi to reach self-formulated rehabilitation goals and in enhancing their societal participation.

Objective: To identify and compare caregiver burden and expressed emotion (EE) in adult substance use disorder (SUD) patients with and without co-occurring attention deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD). To examine possible differences in correlations between caregiver burden and EE across patient groups., Design and Methods: Cross-sectional study with measures of perceived burden (Involvement Evaluation Questionnaire: IEQ), subjective stress (General Health Questionnaire: GHQ) and perceptions of expressed emotion (Level of Expressed Emotion: LEE) in informal caregivers for patients with SUD, SUD+ADHD or SUD+ASD., Findings: No differences in caregiver burden or expressed emotion when caregivers for patients with SUD were compared to caregivers for patients with SUD+ADHD. A moderate but non-significant difference for caregivers of patients with SUD versus SUD+ASD, which disappeared when the number of contact hours between patient and caregiver for the SUD only group was controlled for. The IEQ sum scores also substantially correlated with the LEE sum scores., Conclusion: Informal caregivers for patients with only SUD show higher levels of burden and EE than informal caregivers for patients with SUD and a co-occurring ASD. This difference was largely explained by the higher number of contact hours between patient and caregiver in the SUD only group.

Background: People with Severe Mental Illness (SMI) frequently experience problems with regard to societal participation (i.e. work, education and daily activities outside the home), and require professional support in this area. The Boston University approach to Psychiatric Rehabilitation (BPR) is a comprehensive methodology that can offer this type of support. To date, several Randomised Controlled Trials (RCT's) investigating the effectiveness of BPR have yielded positive outcomes with regard to societal participation. However, information about the cost-effectiveness and budgetary impact of the methodology, which may be important for broader dissemination of the approach, is lacking. BPR may be more cost effective than Care As Usual (CAU) because an increase in participation and independence may reduce the costs to society. Therefore, the aim of this study is to investigate, from a societal perspective, the cost-effectiveness of BPR for people with SMI who wish to increase their societal participation. In addition, the budget impact of implementing BPR in the Dutch healthcare setting will be assessed by means of a budget impact analysis (BIA) after completion of the trial., Methods: In a multisite RCT, 225 adults (18-64 years of age) with SMI will be randomly allocated to the experimental (BPR) or the control condition (CAU). Additionally, a pilot study will be conducted with a group of 25 patients with severe and enduring eating disorders. All participants will be offered support aimed at personal rehabilitation goals, and will be monitored over a period of a year. Outcomes will be measured at baseline, and at 6 and 12 months after enrolment. Based on trial results, further analyses will be performed to assess cost-effectiveness and the budgetary impact of implementation scenarios., Discussion: The trial results will provide insight into the cost-effectiveness of BPR in supporting people with SMI who would like to increase their level of societal participation. These results can be used to make decisions about further implementation of the method. Also, assessing budgetary impact will facilitate policymaking. The large sample size, geographic coverage and heterogeneity of the study group will ensure reliable generalisation of the study results., Trial Registration: Current Controlled Trials: ISRCTN88987322. Registered 13 May 2014.

Objective: The aim of this pilot implementation study was to explore the initial experiences with and impact of Parenting with Success and Satisfaction (PARSS), a psychiatric rehabilitation and recovery-based, guided self-help intervention, for parents with severe mental illnesses., Methods: Changes in the PARSS intervention group were compared with changes in a control group in a nonequivalent control group design. Outcome measures included: parenting satisfaction reported by parents; parenting success reported by mental health practitioners and family members; empowerment as reported by parents, practitioners and family members; and parents' reported quality of life. Additional process data were obtained on relationship with practitioner, quality of contact, satisfaction with the intervention and fidelity., Results: Parenting satisfaction increased after 1 year for the PARSS group, but not for the control group. Parents' reports of empowerment did not change for either group. The scores of parents' empowerment reported by practitioners and family members increased in the control group, with no such change in the PARSS group. Quality of life improved significantly for the intervention group. Process measures showed that, although PARSS was not always implemented as intended, both parents and practitioners expressed satisfaction with the intervention., Conclusions and Implications for Practice: The first experiences with PARSS were mixed. This intervention, implemented by mental health practitioners, has the potential to function as a useful tool for supporting parents. Attention must be paid to enhancing intervention implementation and fidelity., ((PsycINFO Database Record (c) 2014 APA, all rights reserved).)

Objective: Whereas in the U.S. and Canada the Individual Placement and Support (IPS) model has proven to be highly effective in enhancing employment perspectives for persons with severe mental illnesses, the evidence base is less abundant in countries with a different socioeconomic climate. The aim of this study was to examine the effectiveness of IPS in the Dutch socioeconomic context., Method: A multisite randomized controlled trial was performed following 151 persons with severe mental illnesses expressing an explicit wish for regular employment, comparing IPS with traditional vocational rehabilitation (TVR). Primary outcome was the proportion of persons who were competitively employed over a period of 30 months. Secondary outcomes were self-reported quality of life, self-esteem and mental health. Additionally, the impact of being engaged in competitive employment on these secondary outcomes was examined., Results: In 30 months, 44% of IPS participants found competitive work, compared with 25% of participants supported by TVR. No direct effect of IPS on mental health, self-esteem or quality of life was found. Being competitively employed before follow-up measurements was significantly associated with an increase in mental health, self-esteem and quality of life., Conclusions and Implications for Practice: This study strongly confirms that IPS is an effective method in helping people with severe mental illnesses find competitive work also in countries characterized by a relatively protective socioeconomic climate putting up unintended barriers to employment. The implementation of IPS on a larger scale seems warranted, and new studies are needed on the mechanisms through which IPS works.