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The handle

http://hdl.handle.net/1887/77746

holds various files of this Leiden University

dissertation.

Author: Schakel, L.

Title: Evaluating the effectiveness of innovative psychological intervention tools in

optimizing health outcomes: A multimethod approach

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6

ŝŶƚĞƌǀĞŶƟŽŶĚŝƌĞĐƚĞĚĂƚŽƉƟŵŝnjŝŶŐ

ŝŵŵƵŶĞĨƵŶĐƟŽŶ͗^ƚƵĚLJƉƌŽƚŽĐŽůĨŽƌ

a randomized controlled trial

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ͮϭϯϰ ŐĂŵĞƐŚĂǀĞƉƌŽǀĞĚĞīĞĐƟǀĞŝŶŝŵƉƌŽǀŝŶŐŬŶŽǁůĞĚŐĞĂŶĚƐĞůĨͲŵĂŶĂŐĞŵĞŶƚƐŬŝůůƐŝŶLJŽƵŶŐ ƉĞŽƉůĞǁŝƚŚĐŚƌŽŶŝĐĐŽŶĚŝƟŽŶƐ;ϮϵͿ͕ĨŽƌĞdžĂŵƉůĞ͕ĂƐǁĞůůĂƐŝŶŝŶĐƌĞĂƐŝŶŐŬŶŽǁůĞĚŐĞĂďŽƵƚ ĚƌƵŐĂŶĚĂůĐŽŚŽůƵƐĞŝŶĂĚŽůĞƐĐĞŶƚƐ;ϱϳͿ͘^ĞƌŝŽƵƐŐĂŵĞƐĐĂŶĂůƐŽŚĂǀĞďĞŶĞĮĐŝĂůĞīĞĐƚƐ ŽŶ ĨĂĐƚŽƌƐ ĐŽŶƐŝĚĞƌĞĚ ŝŵƉŽƌƚĂŶƚ ĨŽƌ Ă ŚĞĂůƚŚLJ ůŝĨĞƐƚLJůĞ ŝŶ ŐĞŶĞƌĂů͕ ƐƵĐŚ ĂƐ ŚĞĂůƚŚLJ ĨŽŽĚ ĐŚŽŝĐĞƐĂŶĚƉŚLJƐŝĐĂůĂĐƟǀŝƚLJ;ϮϴͿ͘^ŽĨĂƌ͕ƐĞƌŝŽƵƐŐĂŵĞƐŚĂǀĞŶŽƚŽŌĞŶďĞĞŶŝŶǀĞƐƟŐĂƚĞĚ ŝŶĐŽŵďŝŶĂƟŽŶǁŝƚŚd͘ƐƚƵĚLJŝŶďƵůŝŵŝĂƉĂƟĞŶƚƐĂŶĚĂƐƚƵĚLJŝŶƉĂƟĞŶƚƐǁŝƚŚĂƐĞǀĞƌĞ ŐĂŵďůŝŶŐĚŝƐŽƌĚĞƌŚĂǀĞƐŚŽǁŶďĞƩĞƌƚŚĞƌĂƉĞƵƟĐŽƵƚĐŽŵĞƐǁŚĞŶdŝŶƚĞƌǀĞŶƟŽŶƐĂƌĞ ĐŽŵƉůĞŵĞŶƚĞĚ ǁŝƚŚ ƐĞƌŝŽƵƐ ŐĂŵŝŶŐ ƚŚĂŶ ŝŶ ƚŚĞ ĐĂƐĞ ŽĨ Ă ƐƚĂŶĚĂůŽŶĞ d ŝŶƚĞƌǀĞŶƟŽŶ ;ϮϳϬ͕ϮϳϭͿ͘dŚƵƐ͕ƐĞƌŝŽƵƐŐĂŵĞƐŵĂLJďĞĂƉƌŽŵŝƐŝŶŐĂĚĚͲŽŶƚŽd͕ĂƐĂŶŝŶŶŽǀĂƟǀĞƚŽŽů ƚŽŵŽƟǀĂƚĞƵƐĞƌƐƚŽŝŶĐƌĞĂƐĞƚŚĞŝƌŬŶŽǁůĞĚŐĞĂŶĚƐŬŝůůƐƌĞŐĂƌĚŝŶŐŚĞĂůƚŚͲƌĞůĂƚĞĚďĞŚĂǀŝŽƌ͘ DŽƐƚƐƚƵĚŝĞƐŽŶƚŚĞĞīĞĐƚƐŽĨƉƐLJĐŚŽůŽŐŝĐĂůŝŶƚĞƌǀĞŶƟŽŶƐŚĂǀĞĨŽĐƵƐĞĚŽŶďĂƐĂůŚĞĂůƚŚ ŽƵƚĐŽŵĞƐ ;Ğ͘Ő͕͘ ŐĞŶĞƌĂů ůĞǀĞůƐ ŽĨ ƉƐLJĐŚŽůŽŐŝĐĂů ĂŶĚ ŝŵŵƵŶĞ ĨƵŶĐƟŽŶŝŶŐͿ͘ dŚĞ Ăŝŵ ŽĨ ƉƐLJĐŚŽůŽŐŝĐĂů ŝŶƚĞƌǀĞŶƟŽŶƐ ŝƐ ƚŽ ĞŶŚĂŶĐĞ ĂŶ ŝŶĚŝǀŝĚƵĂů͛Ɛ ĂďŝůŝƚLJ ƚŽ ĐŽƉĞ ǁŝƚŚ ƉŚLJƐŝĐĂů ĂŶĚƉƐLJĐŚŽůŽŐŝĐĂůƐƚƌĞƐƐŽƌƐĂŶĚĚĂŝůLJůŝĨĞŚĂƐƐůĞƐ͕ǁŚŝĐŚĐĂŶƉƌĞƐƵŵĂďůLJďĞƐƚďĞƐƚƵĚŝĞĚ ďLJĞǀŽŬŝŶŐƌĞĂůͲůŝĨĞĐŚĂůůĞŶŐĞƐƐƵĐŚĂƐŝŵŵƵŶĞĐŚĂůůĞŶŐĞƐ;ŝ͘Ğ͘ŝŶŇĂŵŵĂƚŽƌLJƌĞĂĐƟŽŶƐͿ ĂŶĚ ƉƐLJĐŚŽƉŚLJƐŝŽůŽŐŝĐĂů ĐŚĂůůĞŶŐĞƐ ;ŝ͘Ğ͘ ƐƚƌĞƐƐ ƌĞƐƉŽŶƐĞƐͿ͘ /ŶŇĂŵŵĂƚŽƌLJ ƌĞĂĐƟŽŶƐ ĐĂŶ ďĞ ĞůŝĐŝƚĞĚ ĞdžƉĞƌŝŵĞŶƚĂůůLJ ďLJ͕ ĨŽƌ ĞdžĂŵƉůĞ͕ in vivo or in vitro ƐƟŵƵůĂƟŽŶ ŽĨ ƚŚĞ ŝŵŵƵŶĞƐLJƐƚĞŵ͖ƐƚƌĞƐƐƌĞƐƉŽŶƐĞƐĐĂŶďĞĞůŝĐŝƚĞĚďLJŚĂǀŝŶŐƉĂƌƟĐŝƉĂŶƚƐƉĞƌĨŽƌŵƐƉĞĐŝĮĐ ƉƐLJĐŚŽƉŚLJƐŝŽůŽŐŝĐĂů ƚĂƐŬƐ͘ /Ŷ Ă ƉƌĞǀŝŽƵƐ ƐƚƵĚLJ͕ Ă ƌĞůĂƟǀĞůLJ ƐŚŽƌƚͲƚĞƌŵ ŝŶŇĂŵŵĂƚŽƌLJ ƌĞƐƉŽŶƐĞǁĂƐŝŶĚƵĐĞĚďLJƵƐŝŶŐĂŶin vivoƐƟŵƵůĂƟŽŶǁŝƚŚůŝƉŽƉŽůLJƐĂĐĐŚĂƌŝĚĞ;>W^Ϳ͘dŚĞ ƌĞƐĞĂƌĐŚĞƌƐ ĚĞŵŽŶƐƚƌĂƚĞĚ ƚŚĂƚ Ă ƉŚLJƐŝĐĂů ĞdžĞƌĐŝƐĞ ĂŶĚ ďƌĞĂƚŚŝŶŐ ŝŶƚĞƌǀĞŶƟŽŶ ĚŝƌĞĐƚĞĚ Ăƚ ŽƉƟŵŝnjŝŶŐ ŝŵŵƵŶĞ ĨƵŶĐƟŽŶŝŶŐ ƐŚŽǁĞĚ ƉƌŽŵŝƐŝŶŐ ĞīĞĐƚƐ ǁŚĞŶ ĐŽŵƉĂƌĞĚ ƚŽ ŶŽ ŝŶƚĞƌǀĞŶƟŽŶ ;ϮϳϮͿ͘ ŌĞƌ ƚŚĞ >W^ ƐƟŵƵůĂƟŽŶ͕ ƚŚĞ ƉĂƌƟĐŝƉĂŶƚƐ ǁŚŽ ŚĂĚ ƌĞĐĞŝǀĞĚ ƚŚĞ ŝŶƚĞƌǀĞŶƟŽŶĞdžŚŝďŝƚĞĚƐŝŐŶŝĮĐĂŶƚůLJůŽǁĞƌƉƌŽͲŝŶŇĂŵŵĂƚŽƌLJĐLJƚŽŬŝŶĞůĞǀĞůƐĂŶĚůĞƐƐŇƵͲ ůŝŬĞ ƐLJŵƉƚŽŵƐ ƚŚĂŶ ƚŚĞ ĐŽŶƚƌŽů ŐƌŽƵƉ͘ ŶŽƚŚĞƌ ƐƚƵĚLJ ĞǀĂůƵĂƚĞĚ ƚŚĞ ĞīĞĐƚƐ ŽĨ Ă ƐƚƌĞƐƐ ŵĂŶĂŐĞŵĞŶƚ ƚƌĂŝŶŝŶŐ ŽŶ ŝŵŵƵŶĞ ŽƵƚĐŽŵĞƐ ŝŶ ƉĂƟĞŶƚƐ ǁŝƚŚ ƌŚĞƵŵĂƚŽŝĚ ĂƌƚŚƌŝƟƐ͘ /Ŷ ƌĞƐƉŽŶƐĞƚŽĂƉŽƚĞŶƚƉƐLJĐŚŽƐŽĐŝĂůƐƚƌĞƐƐŽƌ͕ƚŚĞŐƌŽƵƉŽĨƉĂƌƟĐŝƉĂŶƚƐǁŚŽŚĂĚƌĞĐĞŝǀĞĚ ƐƚƌĞƐƐ ŵĂŶĂŐĞŵĞŶƚ ƚƌĂŝŶŝŶŐ ƐŚŽǁĞĚ ĂůƚĞƌĞĚ ĐŽƌƟƐŽů ĂŶĚ />Ͳϴ ůĞǀĞůƐ ĐŽŵƉĂƌĞĚ ƚŽ ƚŚĞ ŐƌŽƵƉǁŚŽŚĂĚŶŽƚƌĞĐĞŝǀĞĚƚƌĂŝŶŝŶŐ;ϭϳϯ͕ϮϳϯͿ͘

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ϭϯϳͮ

6

ƵŶĚĞƌŐŽŶĞ Ă ' ǀĂĐĐŝŶĂƟŽŶ Ăƚ ĂŶLJ ƟŵĞ ƉƌŝŽƌ ƚŽ ĞŶƚĞƌŝŶŐ ƚŚĞ ƚƌŝĂů͖ ĞͿ ŚĂǀĞ ƌĞĐĞŝǀĞĚ ĂŶŽƚŚĞƌ ůŝǀĞ ǀĂĐĐŝŶĂƟŽŶ ĨŽƵƌ ǁĞĞŬƐ Žƌ ůĞƐƐ ƉƌŝŽƌ ƚŽ ƚŚĞ ' ǀĂĐĐŝŶĂƟŽŶ͖ ĨͿ ŚĂǀĞ ďĞĞŶ ƚƌĞĂƚĞĚǁŝƚŚŝŵŵƵŶĞŵŽĚƵůĂƟŶŐĚƌƵŐƐƚŚƌĞĞŵŽŶƚŚƐŽƌůĞƐƐƉƌŝŽƌƚŽĞŶƌŽůůŵĞŶƚ͖ŐͿŚĂǀĞ ;ŽĨŚĂǀĞŚĂĚͿĂĚŝƐĞĂƐĞĂīĞĐƟŶŐƚŚĞůLJŵƉŚŽŝĚŽƌŐĂŶƐ͖ŚͿĂƌĞŬŶŽǁŶƚŽŚĂǀĞĐŽŶŐĞŶŝƚĂů ŽƌĂĐƋƵŝƌĞĚŝŵŵƵŶĞĚĞĮĐŝĞŶĐŝĞƐ͖ŝͿŚĂǀĞƉƐLJĐŚŝĂƚƌŝĐ;^DͲϱͿŽƌƐŽŵĂƟĐĐŽŶĚŝƟŽŶƐƚŚĂƚ ŝŶƚĞƌĨĞƌĞ ǁŝƚŚ ƚŚĞŝƌ ƐĂĨĞƚLJ ĂŶĚͬŽƌ ƚŚĞ ƐƚƵĚLJ ƉƌŽƚŽĐŽů͖ ũͿ ĂƌĞ ƉƌŽĨĞƐƐŝŽŶĂů ƐƉŽƌƚƐ ƉůĂLJĞƌƐ ŽƌƉĞƌĨŽƌŵĞdžƚƌĞŵĞĞdžĞƌĐŝƐĞ͖ŬͿŚĂǀĞĂŚŝƐƚŽƌLJŽĨĞdžĐĞƐƐŝǀĞĚƌŝŶŬŝŶŐŽƌĚƌƵŐƵƐĞ͖ůͿĂƌĞ ĂĐƟǀĞůLJƉĂƌƟĐŝƉĂƟŶŐŝŶŽƚŚĞƌĐůŝŶŝĐĂůƚƌŝĂůƐ͖ŽƌŵͿĚŽŶŽƚŐŝǀĞĐŽŶƐĞŶƚĨŽƌƚŚĞŝƌ'ĞŶĞƌĂů WƌĂĐƟƟŽŶĞƌƚŽďĞŝŶĨŽƌŵĞĚŽĨƚŚĞŝƌ'ǀĂĐĐŝŶĂƟŽŶ͘ dĂďůĞϭ͘^ĐĞĚƵůĞŽĨƐƚƵĚLJĂĐƟǀŝƟĞƐ͘ ^dhzWZ/K sŝƐŝƚ ^ĐƌĞĞŶŝŶŐ ůůŽĐĂƟŽŶ /ŶƚĞƌǀĞŶƟŽŶ period sĂĐĐŝŶĂƟŽŶ

day Testday Follow up

dŝŵĞƉŽŝŶƚ Week 0 Week 4 Week 4-10 Week 10 Week 10 Week 14

EZK>DEd͗ ůŝŐŝďŝůŝƚLJƐĐƌĞĞŶ y /ŶĨŽƌŵĞĚĐŽŶƐĞŶƚ y ůůŽĐĂƟŽŶ y /EdZsEd/KE^͗ /ŶƚĞƌǀĞŶƟŽŶĐŽŶĚŝƟŽŶ y ŽŶƚƌŽůŽŶĚŝƟŽŶ y ^^^^DEd^͗

Heart rate measure y y y

Serum blood sample y y y y

Heparin blood sample y y y

DĞĚŝĐĂůƐĐƌĞĞŶŝŶŐ ƋƵĞƐƟŽŶŶĂŝƌĞ y D/E/WƐLJĐŚŝĂƚƌŝĐŝŶƚĞƌǀŝĞǁ y

IGRA test (Interferon Gamma Release Assay y

HIV test y sĂĐĐŝŶĂƟŽŶ y WƐLJĐŚŽƉŚLJƐŝŽůŽŐŝĐĂů stress tasks y ^ĂůŝǀĂƐĂŵƉůĞƐ y y y y ,ĞĂƌƚƌĂƚĞ͕,ĞĂƌƚZĂƚĞ Variability and Skin ŽŶĚƵĐƚĂŶĐĞ>ĞǀĞůƐ

y y y

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ĚĞtŝƚĂŶĚZĂĨĂĞůŝĚĂƌƌĂŽĨĞůŌhŶŝǀĞƌƐŝƚLJŽĨdĞĐŚŶŽůŽŐLJĨŽƌƚŚĞŝƌŚĞůƉŝŶĚĞƐŝŐŶŝŶŐĂŶĚ ĚĞǀĞůŽƉŝŶŐƚŚĞƐĞƌŝŽƵƐŐĂŵĞsŝĂEŽǀĂ͘dŚĞĂƵƚŚŽƌƐĂůƐŽĂĐŬŶŽǁůĞĚŐĞƌ͘D͘͘^ŚĞƌǁŽŽĚͲ ^ŵŝƚŚĨŽƌŐŝǀŝŶŐƚŚĞƉƌŽĨĞƐƐŝŽŶĂůĂĚǀŝĐĞŽŶƚŚĞŶŐůŝƐŚ͘

©sŝĂEŽǀĂŝƐĚĞǀĞůŽƉĞĚďLJ>ĞŝĚĞŶhŶŝǀĞƌƐŝƚLJ͕,ĞĂůƚŚDĞĚŝĐĂůĂŶĚEĞƵƌŽƉƐLJĐŚŽůŽŐLJhŶŝƚŝŶ

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