To study's primary objective is to establish the effectiveness of a low-threshold guided self-help intervention targeted at improving one's self image in people with anxiety and/or depressive symptoms and low self esteem. We expect to find…
angst; depressie; zelfbeeld; zelfhulp
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head of department of Clinical Psychology at the Vrije Universiteit Amsterdam
The intervention's primary focus is enhancing self-esteem. The primary outcome measure used in this study is the
Rosenberg self-esteem scale (Rosenberg, 1965). This scale includes 10 statements (such as 'generally speaking, I am
content with myself'). The respondent then checks a score on a 4-point scale which indicates the extent to which the
respondent identifies with the statement. Total scores vary from 0 to 30, higher scores indicate higher self esteem. In a
sample of the Dutch population, a mean score of 20.9 was reported with a standard deviation of 4.4. Both international
and Dutch studies report high reliability, validity and internal homogeneity (Cronbach alpha .86; Franck et al., 2008).
The study's secondary focus is establishing whether the intervention is succesful in reducing anxiety and/or depressive symptoms:
1. Anxiety symptoms are measured with the Anxiety subscale of the Hospital Anxiety and Depression Scale (the HADSA). This is a validated 7-item self-report measure of anxiety, with a 4-point scale. Total scores vary from 0 to 21, with higher scores indicating more anxiety symptoms(Spinhoven et al., 1997);
2. Depressive symptoms are measured with the Center for Epidemiological Studies Depression Scale (CES-D). This is a
validated 20-item self report questionnaire, with a 4-point scale. Total scores vary from 0 to 60, with higher scores
indicating more depressive symptoms (Radloff, 1977);
3. In order to establish whether the respondent uses other health care resources and to establish the presence of work
related problems as a consequence of the psychological symptoms, the Tic-P will be administered. This questionnaire is developed by the Institute of Medical Technology Assessment (iMTA) of the Erasmus university and the Trimbosinstitute and has been used in a variety of different studies (van Dam et al., 1998; Hakkaart-van Roijen, 2002; Penninx et al., 2008);
4. Quality of life is increasingly regarded as an important secondary outcome measure. In order to establish quality of life, the RAND-36 will be administered. This is a 36-item self-report questionnaire involving a variety of subscales that portray health-related quality of life (Ware and Sherbourne, 1992).
Recently, a self-help book based on cognitive behavioural techniques targeted at improving one's self image has been
published (de Neef, 2010). In the current study, the effectiveness of the use of this self-help book is studied and
compared to a wait list control group of people with low self esteem and subclinical anxiety and/or depressive
symptoms. Guidance provided to all participants receiving the self-help book entails feedback and aswers to questions
regarding the assignments described in the book.
Recruitment takes place among the general population in the Netherlands.
To study's primary objective is to establish the effectiveness of a low-threshold guided self-help intervention targeted at improving one's self image in people with anxiety and/or depressive symptoms and low self esteem. We expect to find both a significant
improvement of self-esteem (primary outcome measure) and a significant diminshment of anxiety and depression.
1. Pretreatment (T0);
2. Posttreatment 10 weeks after T0(T1);
3. 12 weeks after T1 (T2).
Respondents in the experimental condition are offered the self-help book. The intervention or course entails 6 different
techniques, based on elements from cognitive behavioural therapy. Duration of the intervention may vary from 6 to 10
weeks, depending on the pace of the individual respondent. Guidance by specially trained students and research
assistants is mainly focused on motivating the respondent to work through the entire book, whilst providing feedback
and information in case of any misunderstanding of the assignments described in the book.
Respondents in the control condition are placed on a waiting-list. Throughout the waiting period they do not receive the self-help book, but are free to seek help through the common channels. After the follow-up period of 3 months, they are offered the self-help book, with the same guidance provided by the university.
1. The presence of clinically relevant anxiety and/or depressive symptoms as established by a score of 7 or
higher on the HADS-A and/or a score of 16 or higher on the CES-D;
2. The participant is suffering from low self-esteem as established by administration of the Rosenberg selfesteem
scale (Rosenberg, 1965);
3. The participant is troubled and/or limited by the aforementioned symptoms.
Insufficient understanding of the Dutch language.
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