Donders Institute for Brain, Cognition and Behaviour
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Thesis defense Gwenny Janssen (Donders Series 143)

17 January 2014

Promotors: Prof.dr. J. Eggers, Prof. dr. C. Witteman, copromotor: dr. H. De Mey

Diagnostic assessment of psychiatric patients: A contextual perspective on executive functioning

Executive functioning (EF) is typically involved in realistic goal setting, in organizing our behaviour, executing plans, in evaluating the strategies of choice and reflecting upon their outcome. Although impairmentscan be found in several psychiatric disorders, efforts to evaluate manifestations of executive functioning deficits are hindered by a diffuse conceptualization, complicating diagnosis and treatment. Throughout this thesis it is argued that EF research may benefit from a functional diagnostic approach that examines the contextual nature of problematic behaviours. Functional diagnosis – with its main unit of analysis the clinical relevant (and direct observable) behaviours – aims to relate the neurological underpinnings of psychological processes and behavioural outcome into a conceptual definition of EF. In particular, a behavioural re-examination of the concept of EF (cf. relational frame theory; RFT) was suggested.

Overall, findings indicated that the combined assessment of fine-grained and ecologically valid test-instruments, with evaluative procedures tapping a patients (verbal) ability to select, follow or change problem solving strategies in order to reach a preset goal more systematically, could be successfully used to differentiate populations with (severe) psychiatric illness. Also, with the RFT-based testing and training protocols as outlined in the final chapters of this thesis, we are able to create tailored intervention strategies, that allow us to install valuable compensatory executive competencies necessary for daily life functioning. Based on these results is was argued that the understanding of EF as a product of a specific history of behaviour-environment interactions, can open up a window for the assessment and training of complex human behaviours.