Relapse prevention in patients with anxiety or depressive disorders

Esther Krijnen-de Bruin

    Research output: PhD ThesisPhD-Thesis - Research and graduation internal

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    In Chapter 2, we conducted a systematic review and meta-analysis in order to examine the effectiveness of current psychological interventions aimed at preventing relapse among patients with remitted anxiety or depressive disorders. We focused on the effectiveness of stand-alone psychological relapse prevention interventions, as well as those interventions combined with maintenance antidepressant treatment (M-ADM) or antidepressant medication (ADM) discontinuation. We demonstrated that for patients with remitted major depressive disorders (MDD), psychological interventions reduced the risk of relapse by 24% within the first 24 months (in comparison to treatment as usual (TAU)), and that this effect persisted for up to three years. When psychological interventions were offered in combination with M-ADM, the risk of relapse was also reduced by 24% within the first 24 months, in comparison to M-ADM alone. Chapters 3, 4 and 5 described the development, implementation and evaluation of the GET READY relapse prevention program. Chapter 3 outlined the protocol of the GET READY study. In Chapter 4, the usage of the GET READY program, course of symptoms of participants, and the association between usage intensity and course of symptoms was examined. These factors were investigated through conducting a pre-post study with 113 patients, who were either fully or partially in remission from anxiety and/or depressive disorders. It was observed that the core E-health modules, which focused on relapse psychoeducation and the relapse prevention plan, were used by 70-74% of the patients, while the optional modules were deemed to be elective and, as such, were used by less than 40% of the patients. According to a pre-defined usage intensity measure, around one in four patients were defined as ‘regular users’. Most patients remained stable while participating in the GET READY intervention. Having more FTF contact with MHPs was significantly associated with higher anxiety and depressive scores. In Chapter 5, we described the results of a qualitative study about the implementation and evaluation of the GET READY intervention, from the perspective of both patients and MHPs. Individual interviews (N=26) and two focus group interviews were conducted. These focus groups (comprising both patients and MHPs) showed that users were mostly positive about the GET READY intervention. Specifically, it was said that it created awareness of relapse risks, assigned an active role to patients themselves in relapse prevention, contained relevant components, and provided a sense of security and stability to patients. Alongside this, users also appreciated its usability and accessibility. However, the lack of motivation on the behalf of patients, lack of recognizability of the program due to its focus on both anxiety and depression, and the lack of support from MHPs limited the use of the program. The combination of E-health modules and FTF contact was considered to be essential, and it appeared that MHPs played a crucial role in terms of motivating and supporting patients in the use of the E-health program. In Chapter 6, we assessed the psychometric properties of a new questionnaire for measuring self-management strategies among patients with anxiety and depression: the ‘Assessment of Self-management in Anxiety and Depression’ (ASAD) questionnaire. Zoun et al. developed the ASAD, because there was no Dutch self-management questionnaire for patients with anxiety and depressive disorders. An exploratory and confirmatory factor analysis revealed three solid factors: Seeking support, Daily life strategies and Taking ownership. Furthermore, the factor analyses revealed that the number of questionnaire items could be reduced from 45 to 21. The evaluation indicated high levels of internal consistency and reliability for the 21 item ASAD short form (ASAD-SF). The identified factors can provide guidance for both patients and professionals with respect to what self-management strategies to apply.
    Original languageEnglish
    Awarding Institution
    • Vrije Universiteit Amsterdam
    • van Meijel, Benno, Supervisor, External person
    • van Straten, Annemieke, Supervisor
    • Muntingh, Anna, Co-supervisor, External person
    • Batelaan, Nelie Maaike, Co-supervisor, External person
    Award date17 Jun 2021
    Place of Publications.l.
    Print ISBNs9789464232981
    Publication statusPublished - 17 Jun 2021


    • Relapse prevention
    • anxiety disorder
    • depressive disorder
    • psychological interventions
    • relapse
    • recurrence
    • self-management
    • E-health
    • primary care


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