Assistant professor Clinical Psychology, studying validity issues of psychological methodology and empirical data in psychotherapy research. At the intersection between psychological research and philosophy of science, I am interested in the epistemic and clinical value of 'the data' and 'the evidence' as ground for scientific facts and their dissemination into clinical practice.
Introduction: Different types of psychotherapy are effective for treating major depressive disord... more Introduction: Different types of psychotherapy are effective for treating major depressive disorder across groups yet show large within-group differences. Patient personality style is considered a potentially useful variable for treatment matching. Objective: This study is the first experimental test of the interaction between therapeutic approach and patients’ dependent versus self-critical personality styles. Methods: A pragmatic stratified parallel trial was carried out with 100 adult patients diagnosed with DSM-IV-TR major depressive disorder. They were randomly assigned to short-term (16–20 sessions) cognitive behavioral therapy (CBT) or short-term psychodynamic psychotherapy (STPP). Patients were assessed at baseline, during therapy, post-therapy, and at 3- and 6-month follow-up. Primary outcome is depression severity measured by the Hamilton Rating Scale for Depression posttreatment. Primary analysis was by intention to treat. This trial is registered with the ISRCTN registry (www.isrctn.com), number ISRCTN17130982. Results: The intention-to-treat sample consisted of 100 participants; 40 with self-critical and 60 with dependent personality styles were randomized to either CBT (n = 50) or STPP (n = 50). We observed no interaction effect (−0.34 [−6.14, 5.46]) between therapy and personality style and found no evidence for a difference in effectiveness between the treatments in general in terms of symptom reduction and maintained benefits at 6-month follow-up. Conclusion: We found no evidence that dependent versus self-critical personality styles moderate the relation between treatment and outcome in depression. Research using individual patient data could gain further insight into why specific therapeutic approaches work better for specific patients.
This longitudinal study assessed the impact of the COVID-19 pandemic on children with autism spec... more This longitudinal study assessed the impact of the COVID-19 pandemic on children with autism spectrum disorder (ASD; n = 62) by measuring emotional and behavioral problems before and during the pandemic, and by comparing this change to a matched sample of typically developing (TD) children (n = 213). Moreover, we examined whether indicators of parental well-being promoted resilience of children with ASD. Results showed that the mean change in problems did not differ between children with ASD and TD children. Importantly, some children showed an increase in problems, while others showed resilience. Parental well-being indicators were not related to resilience among children with ASD. The interindividual variability in responses, particularly among children with ASD, highlights the need for personalized support.
The COVID-19 pandemic and its corresponding measures to prevent the spread of the virus have impa... more The COVID-19 pandemic and its corresponding measures to prevent the spread of the virus have impacted us all, possible in particular youth with a pre-existing diagnosis of autism spectrum disorder (ASD). This study aimed to investigate the impact of the COVID-19 pandemic in children with ASD. Pre- and during COVID-19 data were collected. Data on ASD characteristics (SRS-2), and emotional and behavioral data (BPM-P) were available of respectively 39 and 31 participants. Results showed no significant difference with regard to ASD characteristics over time. However, the COVID-19 pandemic resulted in an increase in emotional and behavioral problems. Parents reported an increase in internalizing, externalizing, and attention problems. Boys seem to be particularly vulnerable to develop more internalizing problems.
This longitudinal study has two aims: (1) Investigate the impact of COVID-19 on behavior problems... more This longitudinal study has two aims: (1) Investigate the impact of COVID-19 on behavior problems of children with ASD as compared to children from the general population. (2) Examine to what extent parental mental health and social connectedness are related to resilience of children with ASD during COVID-19.
The COVID-19 pandemic presents each of us with a challenge, but it can be particularly demanding ... more The COVID-19 pandemic presents each of us with a challenge, but it can be particularly demanding for children and adolescents with ASD. ASD is a developmental disorder, which is characterized by limitations in social communication, as well as repetitive behavioral patterns, limited interests and activities. Current circumstances rely heavily on the capacities in which many children and adolescents with ASD already experience problems, specifically in terms of social contact and coping with change. Due to COVID-19 we expect that many children and adolescents with ASD, given the diagnostic characteristics and frequent comorbid problems, will experience more stress, anxiety, depression, loneliness, and a deterioration in functioning. We also anticipate that they will have difficulty with the constantly changing information surrounding the virus. Further, we expect that parents of children with ASD, who must take on extra care responsibilities and differing roles in addition to their ow...
Psychotherapy research is characterized by a quest for evidence-based treatment. Systematic numer... more Psychotherapy research is characterized by a quest for evidence-based treatment. Systematic numerical comparison by means of randomized controlled trials is held as objective methodology resulting in evidence on efficacy of psychological treatments. In this pursuit, numbers are taken as speaking for themselves. However, I argue that the assumed procedural objectivity does not yield objectivity of evidence resulting from the method of choice. This discussion I base on the analysis of a clinical case example from our own mixed method psychotherapy research, in which the numbers could speak for themselves, yet the conclusion does not at all.
Achtergrond De American Psychological Association erkent ruim 320 evidence-based treatments (EBTs... more Achtergrond De American Psychological Association erkent ruim 320 evidence-based treatments (EBTs), op basis van treatment manuals die wetenschappelijk effectief zijn bevonden. Zowel klinisch als beleidsmatig worden behandelprotocollen toenemend omarmd als garantie voor kwaliteitszorg. In de klinische praktijk klinkt echter kritiek op de toepasbaarheid in individuele therapie. In dit paper gaan we de empirische evidentie na voor de meerwaarde van behandeling op basis van een behandelprotocol. Methode In een systematisch literatuuronderzoek onderzochten we vier hypothesen die gesteund zouden moeten worden voor geprotocolleerd behandelen als factor in behandeleffectiviteit: geprotocolleerde behandeling (1) is effectiever dan treatment-as-usual en (2) dan syndroomspecifieke niet-geprotocolleerde behandeling, (3) heeft een grotere effect size en (4) wordt gemedieerd door manual adherence. Resultaten Er werd nauwelijks empirisch onderzoek gevonden waarin geprotocolleerde met niet-geproto...
This dissertation is focused on the validity of “the data” that are collected in psychotherapy re... more This dissertation is focused on the validity of “the data” that are collected in psychotherapy research for the purpose of evidencing treatment efficacy. In the ‘Evidence Based Treatment’ (EBT) paradigm, researchers rely on the so-called ‘gold standard methodology’ to gather sound and trustworthy evidence, which increasingly influences the organization of mental health care worldwide (Kazdin & Sternberg, 2006). In the gold standard, data are collected by quantified self-report measures, to assess the presence and severity of symptoms before and after treatment. When the pre-post difference is larger for a group of people that received the treatment of interest and a group of people who received no or an alternative treatment (Chambless & Ollendick, 2001), the treatment of interest is called effective. In this methodological procedure, researchers tend to assume that when this gold standard methodology is conducted properly, “the data” will speak for themselves. However, when evidenc...
European Journal of Psychotherapy & Counselling, 2021
Analysis of single cases represents an essential strategy for developing our understanding of par... more Analysis of single cases represents an essential strategy for developing our understanding of paradoxical outcome and illusory mental health. Based on findings from both practice-based and randomized controlled outcome studies, 35-40% of clients fail to improve over the course of psychotherapy.We examined the prevalence of failure cases in the Single Case Archive, a database that includes more than 3000 psychotherapy case studies from a variety of ISI-ranked journals. We found that only 4% of these studies describe any form of failure in treatment. Thematic analysis of the titles and abstracts of failure case studies revealed that the majority did not focus on investigating the nature or meaning of failure but were primarily interested in other theoretical and practical matters. We propose a number of explanations for this apparent publication bias in case study research and discuss implications for further research.
Aim “All have won, and all must have prizes,” - so the dodo bird verdicts the statistical indiffe... more Aim “All have won, and all must have prizes,” - so the dodo bird verdicts the statistical indifference between ‘evidence based’ types of psychotherapy. Evidence is understood as the result of randomized controlled (RCT) research. This ‘golden standard’ design requires samples that are homogeneous with regard to symptom(s) - following from the statistical assumptions in central tendency statistics. Symptom specific measures are used to select patients scoring above cut-off, resulting in samples characterized by tight and simple symptom patterns. Whereas the external validity of this procedure is heavily critiqued, I study the internal validity of a priori methodological assumptions in RCT efficacy research. In this paper, I address the clinical and epistemic plausibility of sample selection by a quantified symptom measure for depression, the BDI-II, which was found to be a reliable screening measure for Major Depressive Disorder. Method In a pilot study on our mixed method psychother...
Introduction: Different types of psychotherapy are effective for treating major depressive disord... more Introduction: Different types of psychotherapy are effective for treating major depressive disorder across groups yet show large within-group differences. Patient personality style is considered a potentially useful variable for treatment matching. Objective: This study is the first experimental test of the interaction between therapeutic approach and patients’ dependent versus self-critical personality styles. Methods: A pragmatic stratified parallel trial was carried out with 100 adult patients diagnosed with DSM-IV-TR major depressive disorder. They were randomly assigned to short-term (16–20 sessions) cognitive behavioral therapy (CBT) or short-term psychodynamic psychotherapy (STPP). Patients were assessed at baseline, during therapy, post-therapy, and at 3- and 6-month follow-up. Primary outcome is depression severity measured by the Hamilton Rating Scale for Depression posttreatment. Primary analysis was by intention to treat. This trial is registered with the ISRCTN registry (www.isrctn.com), number ISRCTN17130982. Results: The intention-to-treat sample consisted of 100 participants; 40 with self-critical and 60 with dependent personality styles were randomized to either CBT (n = 50) or STPP (n = 50). We observed no interaction effect (−0.34 [−6.14, 5.46]) between therapy and personality style and found no evidence for a difference in effectiveness between the treatments in general in terms of symptom reduction and maintained benefits at 6-month follow-up. Conclusion: We found no evidence that dependent versus self-critical personality styles moderate the relation between treatment and outcome in depression. Research using individual patient data could gain further insight into why specific therapeutic approaches work better for specific patients.
This longitudinal study assessed the impact of the COVID-19 pandemic on children with autism spec... more This longitudinal study assessed the impact of the COVID-19 pandemic on children with autism spectrum disorder (ASD; n = 62) by measuring emotional and behavioral problems before and during the pandemic, and by comparing this change to a matched sample of typically developing (TD) children (n = 213). Moreover, we examined whether indicators of parental well-being promoted resilience of children with ASD. Results showed that the mean change in problems did not differ between children with ASD and TD children. Importantly, some children showed an increase in problems, while others showed resilience. Parental well-being indicators were not related to resilience among children with ASD. The interindividual variability in responses, particularly among children with ASD, highlights the need for personalized support.
The COVID-19 pandemic and its corresponding measures to prevent the spread of the virus have impa... more The COVID-19 pandemic and its corresponding measures to prevent the spread of the virus have impacted us all, possible in particular youth with a pre-existing diagnosis of autism spectrum disorder (ASD). This study aimed to investigate the impact of the COVID-19 pandemic in children with ASD. Pre- and during COVID-19 data were collected. Data on ASD characteristics (SRS-2), and emotional and behavioral data (BPM-P) were available of respectively 39 and 31 participants. Results showed no significant difference with regard to ASD characteristics over time. However, the COVID-19 pandemic resulted in an increase in emotional and behavioral problems. Parents reported an increase in internalizing, externalizing, and attention problems. Boys seem to be particularly vulnerable to develop more internalizing problems.
This longitudinal study has two aims: (1) Investigate the impact of COVID-19 on behavior problems... more This longitudinal study has two aims: (1) Investigate the impact of COVID-19 on behavior problems of children with ASD as compared to children from the general population. (2) Examine to what extent parental mental health and social connectedness are related to resilience of children with ASD during COVID-19.
The COVID-19 pandemic presents each of us with a challenge, but it can be particularly demanding ... more The COVID-19 pandemic presents each of us with a challenge, but it can be particularly demanding for children and adolescents with ASD. ASD is a developmental disorder, which is characterized by limitations in social communication, as well as repetitive behavioral patterns, limited interests and activities. Current circumstances rely heavily on the capacities in which many children and adolescents with ASD already experience problems, specifically in terms of social contact and coping with change. Due to COVID-19 we expect that many children and adolescents with ASD, given the diagnostic characteristics and frequent comorbid problems, will experience more stress, anxiety, depression, loneliness, and a deterioration in functioning. We also anticipate that they will have difficulty with the constantly changing information surrounding the virus. Further, we expect that parents of children with ASD, who must take on extra care responsibilities and differing roles in addition to their ow...
Psychotherapy research is characterized by a quest for evidence-based treatment. Systematic numer... more Psychotherapy research is characterized by a quest for evidence-based treatment. Systematic numerical comparison by means of randomized controlled trials is held as objective methodology resulting in evidence on efficacy of psychological treatments. In this pursuit, numbers are taken as speaking for themselves. However, I argue that the assumed procedural objectivity does not yield objectivity of evidence resulting from the method of choice. This discussion I base on the analysis of a clinical case example from our own mixed method psychotherapy research, in which the numbers could speak for themselves, yet the conclusion does not at all.
Achtergrond De American Psychological Association erkent ruim 320 evidence-based treatments (EBTs... more Achtergrond De American Psychological Association erkent ruim 320 evidence-based treatments (EBTs), op basis van treatment manuals die wetenschappelijk effectief zijn bevonden. Zowel klinisch als beleidsmatig worden behandelprotocollen toenemend omarmd als garantie voor kwaliteitszorg. In de klinische praktijk klinkt echter kritiek op de toepasbaarheid in individuele therapie. In dit paper gaan we de empirische evidentie na voor de meerwaarde van behandeling op basis van een behandelprotocol. Methode In een systematisch literatuuronderzoek onderzochten we vier hypothesen die gesteund zouden moeten worden voor geprotocolleerd behandelen als factor in behandeleffectiviteit: geprotocolleerde behandeling (1) is effectiever dan treatment-as-usual en (2) dan syndroomspecifieke niet-geprotocolleerde behandeling, (3) heeft een grotere effect size en (4) wordt gemedieerd door manual adherence. Resultaten Er werd nauwelijks empirisch onderzoek gevonden waarin geprotocolleerde met niet-geproto...
This dissertation is focused on the validity of “the data” that are collected in psychotherapy re... more This dissertation is focused on the validity of “the data” that are collected in psychotherapy research for the purpose of evidencing treatment efficacy. In the ‘Evidence Based Treatment’ (EBT) paradigm, researchers rely on the so-called ‘gold standard methodology’ to gather sound and trustworthy evidence, which increasingly influences the organization of mental health care worldwide (Kazdin & Sternberg, 2006). In the gold standard, data are collected by quantified self-report measures, to assess the presence and severity of symptoms before and after treatment. When the pre-post difference is larger for a group of people that received the treatment of interest and a group of people who received no or an alternative treatment (Chambless & Ollendick, 2001), the treatment of interest is called effective. In this methodological procedure, researchers tend to assume that when this gold standard methodology is conducted properly, “the data” will speak for themselves. However, when evidenc...
European Journal of Psychotherapy & Counselling, 2021
Analysis of single cases represents an essential strategy for developing our understanding of par... more Analysis of single cases represents an essential strategy for developing our understanding of paradoxical outcome and illusory mental health. Based on findings from both practice-based and randomized controlled outcome studies, 35-40% of clients fail to improve over the course of psychotherapy.We examined the prevalence of failure cases in the Single Case Archive, a database that includes more than 3000 psychotherapy case studies from a variety of ISI-ranked journals. We found that only 4% of these studies describe any form of failure in treatment. Thematic analysis of the titles and abstracts of failure case studies revealed that the majority did not focus on investigating the nature or meaning of failure but were primarily interested in other theoretical and practical matters. We propose a number of explanations for this apparent publication bias in case study research and discuss implications for further research.
Aim “All have won, and all must have prizes,” - so the dodo bird verdicts the statistical indiffe... more Aim “All have won, and all must have prizes,” - so the dodo bird verdicts the statistical indifference between ‘evidence based’ types of psychotherapy. Evidence is understood as the result of randomized controlled (RCT) research. This ‘golden standard’ design requires samples that are homogeneous with regard to symptom(s) - following from the statistical assumptions in central tendency statistics. Symptom specific measures are used to select patients scoring above cut-off, resulting in samples characterized by tight and simple symptom patterns. Whereas the external validity of this procedure is heavily critiqued, I study the internal validity of a priori methodological assumptions in RCT efficacy research. In this paper, I address the clinical and epistemic plausibility of sample selection by a quantified symptom measure for depression, the BDI-II, which was found to be a reliable screening measure for Major Depressive Disorder. Method In a pilot study on our mixed method psychother...
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Papers by Femke Truijens