An Integrative, Attachment-Based Approach to the Management and Treatment of Patients with Persistent Somatic Complaints

  • Patrick LuytenEmail author
  • Peter Fonagy


Many patients seen in clinical practice present with persistent fatigue and pain-related problems. Although this patient group is very heterogeneous, many of them have difficulties establishing a working relationship with health professionals, which negatively influences their treatment and prognosis. In this chapter, we present a broad, integrative attachment-based approach to the understanding, management, and treatment of these patients. The focus is on three related features of patients presenting with persistent somatic complaints: (a) attachment issues; (b) impairments in (embodied) mentalizing, that is, the capacity to reflect on one’s own embodied self and others; and (c) problems with epistemic trust – the capacity to trust others as a source of knowledge about the world. We also outline the implications of this approach for our understanding, management, and treatment of these patients


Chronic Fatigue Syndrome Attachment Style Borderline Personality Disorder Allostatic Load Attachment Figure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Abbass A, Kisely S, Kroenke K (2009) Short-term psychodynamic psychotherapy for somatic disorders. Psychother Psychosom 78:265–274CrossRefPubMedGoogle Scholar
  2. Abbass A, Nowoweiski SJ, Bernier D, Tarzwell R, Beutel M (2014) Review of psychodynamic psychotherapy neuroimaging studies. Psychother Psychosom 83:142–147CrossRefPubMedGoogle Scholar
  3. Ablin JN, Buskila D, Van Houdenhove B, Luyten P, Atzeni F, Sarzi-Puttini P (2012) Is fibromyalgia a discrete entity? Autoimmun Rev 11:585–588CrossRefPubMedGoogle Scholar
  4. Afari N, Buchwald D (2003) Chronic fatigue syndrome: a review. Am J Psychiatry 160:221–236CrossRefPubMedGoogle Scholar
  5. Afari N, Ahumada SM, Wright LJ, Mostoufi S, Golnari G, Reis V, Cuneo JG (2014) Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis. Psychosom Med 76:2–11PubMedCentralCrossRefPubMedGoogle Scholar
  6. Aggarwal VR, McBeth J, Zakrzewska JM, Lunt M, Macfarlane GJ (2006) The epidemiology of chronic syndromes that are frequently unexplained: do they have common associated factors? Int J Epidemiol 35:468–476Google Scholar
  7. Anda R, Felitti V, Bremner J, Walker J, Whitfield C, Perry B, Dube S, Giles W (2006) The enduring effects of abuse and related adverse experiences in childhood. Eur Arch Psychiatry Clin Neurosci 256:174–186PubMedCentralCrossRefPubMedGoogle Scholar
  8. Annemans L, Wessely S, Spaepen E, Caekelbergh K, Caubere JP, Le Lay K, Taieb C (2008) Health economic consequences related to the diagnosis of fibromyalgia syndrome. Arthritis Rheum 58:895–902CrossRefPubMedGoogle Scholar
  9. Annemans L, Le Lay K, Taeb C (2009) Societal and patient burden of fibromyalgia syndrome. Pharmacoeconomics 27:547–559CrossRefPubMedGoogle Scholar
  10. Arnold LM, Hudson JI, Keck PE, Auchenbach MB, Javaras KN, Hess EV (2006) Comorbidity of fibromyalgia and psychiatric disorders. J Clin Psychiatry 67:1219–1225CrossRefPubMedGoogle Scholar
  11. Bakermans-Kranenburg MJ, Van Ijzendoorn MH, Mesman J, Alink LRA, Juffer F (2008) Effects of an attachment-based intervention on daily cortisol moderated by dopamine receptor d4: a randomized control trial on 1- to 3-year-olds screened for externalizing behavior. Dev Psychopathol 20:805–820CrossRefPubMedGoogle Scholar
  12. Bass C, May S (2002) Chronic multiple functional somatic symptoms. Br Med J 325:323–326CrossRefGoogle Scholar
  13. Blom D, Thomaes S, Kool MB, Van Middendorp H, Lumley MA, Bijlsma JWJ, Geenen R (2012) A combination of illness invalidation from the work environment and helplessness is associated with embitterment in patients with fm. Rheumatology 51:347–353CrossRefPubMedGoogle Scholar
  14. Bogaerts K, Millen A, Li W, De Peuter S, Van Diest I, Vlemincx E, Fannes S, Van Den Bergh O (2008) High symptom reporters are less interoceptively accurate in a symptom-related context. J Psychosom Res 65:417–424CrossRefPubMedGoogle Scholar
  15. Bogaerts K, Van Eylen L, Li W, Bresseleers J, Van Diest I, De Peuter S, Stans L, Decramer M, Van Den Bergh O (2010) Distorted symptom perception in patients with medically unexplained symptoms. J Abnorm Psychol 119:226–234CrossRefPubMedGoogle Scholar
  16. Borsini A, Hepgul N, Mondelli V, Chalder T, Pariante CM (2014) Childhood stressors in the development of fatigue syndromes: a review of the past 20 years of research. Psychol Med 44:1809–1823CrossRefPubMedGoogle Scholar
  17. Branco J (2008) Milnacipran for the treatment of fibromyalgia syndrome: a European multicenter, double-blind, placebo-controlled trial. Eur Neuropsychopharmacol 18:S574–S575CrossRefGoogle Scholar
  18. Cassidy J, Kobak RR (1988) Avoidance and its relation to other defensive processes. In: Belsky J, Nezworski T (eds) Clinical implications of attachment. Routledge, LondonGoogle Scholar
  19. Champagne FA, Curley JP (2009) Epigenetic mechanisms mediating the long-term effects of maternal care on development. Neurosci Biobehav Rev 33:593–600CrossRefPubMedGoogle Scholar
  20. Creed F (2007) Cognitive behavioural model of irritable bowel syndrome. Gut 56:1039–1041PubMedCentralCrossRefPubMedGoogle Scholar
  21. Dantzer R, O’Connor JC, Freund GG, Johnson RW, Kelley KW (2008) From inflammation to sickness and depression: when the immune system subjugates the brain. Nat Rev Neurosci 9:46–56Google Scholar
  22. Dendy C, Cooper M, Sharpe M (2001) Interpretation of symptoms in chronic fatigue syndrome. Behav Res Ther 39:1369–1380CrossRefPubMedGoogle Scholar
  23. Diamond D, Stovall-McClough C, Clarkin JF, Levy KN (2003) Patient-therapist attachment in the treatment of borderline personality disorder. Bull Menninger Clin 67:227–259Google Scholar
  24. Dimsdale JE, Creed F, Escobar J, Sharpe M, Wulsin L, Barsky A, Lee S, Irwin MR, Levenson J (2013) Somatic symptom disorder: an important change in DSM. J Psychosom Res 75:223–228CrossRefPubMedGoogle Scholar
  25. Driver C (2005) An under-active or over-active internal world? J Anal Psychol 50:155–173CrossRefPubMedGoogle Scholar
  26. Eisenberger NI, Lieberman MD, Williams KD (2003) Does rejection hurt? An fMRI study of social exclusion. Science 302:290–292Google Scholar
  27. Fischhoff B, Wessely S (2003) Managing patients with inexplicable health problems. Br Med J 326:595–597CrossRefGoogle Scholar
  28. Fonagy P, Luyten P (2009) A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Dev Psychopathol 21:1355–1381CrossRefPubMedGoogle Scholar
  29. Fonagy P, Steele M, Steele H, Higgitt A, Target M (1994) The theory and practice of resilience. J Child Psychol Psychiatry 35:231–257Google Scholar
  30. Fonagy P, Gergely G, Jurist E, Target M (2002) Affect regulation, mentalization, and the development of the self. Other Press, New YorkGoogle Scholar
  31. Fredrickson BL (2001) The role of positive emotions in positive psychology. The broaden-and-build theory of positive emotions. Am Psychol 56:218–226PubMedCentralCrossRefPubMedGoogle Scholar
  32. Gouin J-P, Glaser R, Loving TJ, Malarkey WB, Stowell J, Houts C, Kiecolt-Glaser JK (2009) Attachment avoidance predicts inflammatory responses to marital conflict. Brain Behav Immun 23:898–904PubMedCentralCrossRefPubMedGoogle Scholar
  33. Gunnar M, Quevedo K (2007) The neurobiology of stress and development. Annu Rev Psychol 58:145–173CrossRefPubMedGoogle Scholar
  34. Guthrie E, Moorey J, Margison F, Barker H, Palmer S, Mcgrath G, Tomenson B, Creed F (1999) Cost-effectiveness of brief psychodynamic-interpersonal therapy in high utilizers of psychiatric services. Arch Gen Psychiatry 56:519–526CrossRefPubMedGoogle Scholar
  35. Hambrook D, Oldershaw A, Rimes K, Schmidt U, Tchanturia K, Treasure J, Richards S, Chalder T (2011) Emotional expression, self-silencing, and distress tolerance in anorexia nervosa and chronic fatigue syndrome. Br J Clin Psychol 50:310–325CrossRefPubMedGoogle Scholar
  36. Hauser S, Allen J, Golden E (2006) Out of the woods. Tales of resilient teens. Harvard University Press, LondonGoogle Scholar
  37. Hauser W, Bernardy K, Arnold B, Offenbacher M, Schiltenwolf M (2009) Efficacy of multicomponent treatment in fibromyalgia syndrome: a meta-analysis of randomized controlled clinical trials. Arthritis Rheum 61:216–224CrossRefPubMedGoogle Scholar
  38. Heim C, Nater UM, Maloney E, Boneva R, Jones JF, Reeves WC (2009) Childhood trauma and risk for chronic fatigue syndrome: association with neuroendocrine dysfunction. Arch Gen Psychiatry 66:72–80CrossRefPubMedGoogle Scholar
  39. Hill-Soderlund AL, Mills-Koonce WR, Propper C, Calkins SD, Granger DA, Moore GA, Gariepy J-L, Cox MJ (2008) Parasympathetic and sympathetic responses to the strange situation in infants and mothers from avoidant and securely attached dyads. Dev Psychobiol 50:361–376CrossRefPubMedGoogle Scholar
  40. Hudson JI, Pope HG Jr (1996) The relationship between fibromyalgia and major depressive disorder. Rheum Dis Clin North Am 22:285–303CrossRefPubMedGoogle Scholar
  41. Hudson JI, Mangweth B, Pope HG Jr, De Col C, Hausmann A, Gutweniger S, Laird NM, Biebl W, Tsuang MT (2003) Family study of affective spectrum disorder. Arch Gen Psychiatry 60:170–177CrossRefPubMedGoogle Scholar
  42. Hudson JI, Arnold LM, Keck PE Jr, Auchenbach MB, Pope HG Jr (2004) Family study of fibromyalgia and affective spectrum disorder. Biol Psychiatry 56:884–891CrossRefPubMedGoogle Scholar
  43. Insel T, Young L (2001) The neurobiology of attachment. Nat Rev Neurosci 2:129–136CrossRefPubMedGoogle Scholar
  44. Kempke S, Luyten P, Claes SJ, Van Wambeke P, Bekaert P, Goossens L, Van Houdenhove B (2013) The prevalence and impact of early childhood trauma in chronic fatigue syndrome. J Psychiatr Res 47:664–669CrossRefPubMedGoogle Scholar
  45. Koelen JA, Houtveen JH, Abbass A, Luyten P, Eurelings-Bontekoe EH, Van Broeckhuysen-Kloth SA, Buhring ME, Geenen R (2014) Effectiveness of psychotherapy for severe somatoform disorder: meta-analysis. Br J Psychiatry 204:12–19CrossRefPubMedGoogle Scholar
  46. Kool MB, Middendorp HV, Boeije HR, Geenen R (2009) Understanding the lack of understanding: invalidation from the perspective of the patient with fibromyalgia. Arthritis Care Res 61:1650–1656CrossRefGoogle Scholar
  47. Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, Gabriel S, Hirsch R, Hochberg MC, Hunder GG, Jordan JM, Katz JN, Kremers HM, Wolfe F, National Arthritis Data Workgroup (2008) Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part ii. Arthritis Rheum 58:26–35PubMedCentralCrossRefPubMedGoogle Scholar
  48. Lemma A, Target M, Fonagy P (2010) The development of a brief psychodynamic protocol for depression: dynamic interpersonal therapy (DIT). Psychoanal Psychother 24:329–346CrossRefGoogle Scholar
  49. Lieberman MD (2007) Social cognitive neuroscience: a review of core processes. Annu Rev Psychol 58:259–289CrossRefPubMedGoogle Scholar
  50. Lovell RM, Ford AC (2012) Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol 10:712–721.e4CrossRefPubMedGoogle Scholar
  51. Luyten P, Abbass A (2013) What is the evidence for specific factors in the psychotherapeutic treatment of fibromyalgia? Comment on “is brief psychodynamic psychotherapy in primary fibromyalgia syndrome with concurrent depression an effective treatment? A randomized controlled trial”. Gen Hosp Psychiatry 35:675–676CrossRefPubMedGoogle Scholar
  52. Luyten P, Van Houdenhove B (2013) Common and specific factors in the psychotherapeutic treatment of patients suffering from chronic fatigue and pain disorders. J Psychother Integr 23:14–27CrossRefGoogle Scholar
  53. Luyten P, Van Houdenhove B, Cosyns N, Van Den Broeck AL (2006) Are patients with chronic fatigue syndrome perfectionistic – or were they? A case–control study. Pers Individ Diff 40:1473–1483CrossRefGoogle Scholar
  54. Luyten P, Kempke S, Van Houdenhove B (2009) Treatment of chronic fatigue syndrome: findings, principles and strategies. Psychiatry Investig 5:209–212CrossRefGoogle Scholar
  55. Luyten P, Mayes LC, Fonagy P, Van Houdenhove B (2015) The interpersonal regulation of stress: a developmental framework. Manuscript in preparationGoogle Scholar
  56. Luyten P, Kempke S, Van Wambeke P, Claes SJ, Blatt SJ, Van Houdenhove B (2011) Self-critical perfectionism, stress generation and stress sensitivity in patients with chronic fatigue syndrome: relationship with severity of depression. Psychiatry Interpers Biol Processes 74:21–30CrossRefGoogle Scholar
  57. Luyten P, Fonagy P, Lowyck B, Vermote R (2012a) The assessment of mentalization. In: Bateman A, Fonagy P (eds) Handbook of mentalizing in mental health practice. American Psychiatric Association, Washington, DCGoogle Scholar
  58. Luyten P, Mayes LC, Target M, Fonagy P (2012b) Developmental research. In: Gabbard GO, Litowitz B, Williams P (eds) Textbook of psychoanalysis, 2nd edn. American Psychiatric Press, Washington, DCGoogle Scholar
  59. Luyten P, Van Houdenhove B, Lemma A, Target M, Fonagy P (2012c) An attachment and mentalization-based approach to functional somatic disorders. Psychoanal Psychother 26:121–140CrossRefGoogle Scholar
  60. Luyten P, Van Houdenhove B, Lemma A, Target M, Fonagy P (2013) Vulnerability for functional somatic disorders: a contemporary psychodynamic approach. J Psychother Integr 23:14–27CrossRefGoogle Scholar
  61. Luyten P, Beutel M, Shahar G (in press) Functional somatic disorders. In: Luyten P, Mayes LC, Fonagy P, Target M, Blatt SJ (eds) Handbook of psychodynamic approaches to psychopathology. Guilford Press, New YorkGoogle Scholar
  62. Maher-Edwards L, Fernie BA, Murphy G, Nikcevic AV, Spada MM (2012) Metacognitive factors in chronic fatigue syndrome. Clin Psychol Psychother 19(6):552–557CrossRefPubMedGoogle Scholar
  63. Malouff JM, Thorsteinsson EB, Rooke SE, Bhullar N, Schutte NS (2008) Efficacy of cognitive behavioral therapy for chronic fatigue syndrome: a meta-analysis. Clin Psychol Rev 28:736–745CrossRefPubMedGoogle Scholar
  64. Maunder RG, Hunter JJ (2008) Attachment relationships as determinants of physical health. J Am Acad Psychoanal Dyn Psychiatry 36:11–32CrossRefPubMedGoogle Scholar
  65. Maunder RG, Lancee WJ, Nolan RP, Hunter JJ, Tannenbaum DW (2006) The relationship of attachment insecurity to subjective stress and autonomic function during standardized acute stress in healthy adults. J Psychosom Res 60:283–290CrossRefPubMedGoogle Scholar
  66. McEwen BS (2007) Physiology and neurobiology of stress and adaptation: central role of the brain. Physiol Rev 87:873–904CrossRefPubMedGoogle Scholar
  67. Mikulincer M, Shaver PR (2007) Attachment in adulthood: structure, dynamics and change. The Guilford Press, New YorkGoogle Scholar
  68. Mikulincer M, Dolev T, Shaver PR (2004) Attachment-related strategies during thought suppression: ironic rebounds and vulnerable self-representations. J Pers Soc Psychol 87:940–956CrossRefPubMedGoogle Scholar
  69. Miller GE, Chen EY, Zhou ES (2007) If it goes up, must it come down? Chronic stress and the hypothalamic-pituitary-adrenocortical axis in humans. Psychol Bull 133:25–45CrossRefPubMedGoogle Scholar
  70. Neumann ID (2008) Brain oxytocin: a key regulator of emotional and social behaviours in both females and males. J Neuroendocrinol 20:858–865CrossRefPubMedGoogle Scholar
  71. NICE (2007) Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and management of CFS/ME in adults and children. Clinical Guideline 53. National Institute of Health and Clinical Excellence, LondonGoogle Scholar
  72. Oldershaw A, Hambrook D, Rimes KA, Tchanturia K, Treasure J, Richards S, Schmidt U, Chalder T (2011) Emotion recognition and emotional theory of mind in chronic fatigue syndrome. Psychol Health 26:989–1005CrossRefPubMedGoogle Scholar
  73. Pae CU, Luyten P, Marks DM, Han C, Park SH, Patkar AA, Masand PS, Van Houdenhove B (2008) The relationship between fibromyalgia and major depressive disorder: a comprehensive review. Curr Med Res Opin 24:2359–2371CrossRefPubMedGoogle Scholar
  74. Pedrosa Gil F, Scheidt CE, Hoeger D, Nickel M (2008a) Relationship between attachment style, parental bonding and alexithymia in adults with somatoform disorders. Int J Psychiatry Med 38:437–451CrossRefPubMedGoogle Scholar
  75. Pedrosa Gil F, Weigl M, Wessels T, Irnich D, Baumuller E, Winkelmann A (2008b) Parental bonding and alexithymia in adults with fibromyalgia. Psychosomatics 49:115–122CrossRefPubMedGoogle Scholar
  76. Powell DJH, Liossi C, Moss-Morris R, Schlotz W (2013) Unstimulated cortisol secretory activity in everyday life and its relationship with fatigue and chronic fatigue syndrome: a systematic review and subset meta-analysis. Psychoneuroendocrinology 38:2405–2422CrossRefPubMedGoogle Scholar
  77. Rasting M, Brosig B, Beutel ME (2005) Alexithymic characteristics and patient-therapist interaction: a video analysis of facial affect display. Psychopathology 38:105–111CrossRefPubMedGoogle Scholar
  78. Reeves W, Jones J, Maloney E, Heim C, Hoaglin D, Boneva R, Morrissey M, Devlin R (2007) Prevalence of chronic fatigue syndrome in metropolitan, urban, and rural Georgia. Popul Health Metr 5:5PubMedCentralCrossRefPubMedGoogle Scholar
  79. Rimes KA, Chalder T (2010) The beliefs about emotions scale: validity, reliability and sensitivity to change. J Psychosom Res 68:285–292CrossRefPubMedGoogle Scholar
  80. Rudich Z, Lerman SF, Gurevich B, Weksler N, Shahar G (2008) Patients’ self-criticism is a stronger predictor of physician’s evaluation of prognosis than pain diagnosis or severity in chronic pain patients. J Pain 9:210–216CrossRefPubMedGoogle Scholar
  81. Rudich Z, Lerman SF, Gurevich B, Shahar G (2010) Pain specialists’ evaluation of patient’s prognosis during the first visit predicts subsequent depression and the affective dimension of pain. Pain Med 11:446–452CrossRefPubMedGoogle Scholar
  82. Sattel H, Lahmann C, Gundel H, Guthrie E, Kruse J, Noll-Hussong M, Ohmann C, Ronel J, Sack M, Sauer N, Schneider G, Henningsen P (2012) Brief psychodynamic interpersonal psychotherapy for patients with multisomatoform disorder: Randomised controlled trial. Br J Psychiatry 200:60–67CrossRefPubMedGoogle Scholar
  83. Sbarra DA, Hazan C (2008) Coregulation, dysregulation, self-regulation: an integrative analysis and empirical agenda for understanding adult attachment, separation, loss, and recovery. Pers Soc Psychol Rev 12:141–167CrossRefPubMedGoogle Scholar
  84. Schattner E, Shahar G, Abu-Shakra M (2008) “I used to dream of lupus as some sort of creature”: chronic illness as an internal object. Am J Orthopsychiatry 78:466–472CrossRefPubMedGoogle Scholar
  85. Sicras A, Rejas J, Navarro R, Blanca M, Morcillo A, Larios R, Velasco S, Villarroya C (2009) Treating patients with fibromyalgia in primary care settings under routine medical practice: a claim database cost and burden of illness study. Arthritis Res Ther 11:R54CrossRefGoogle Scholar
  86. Spaeth M (2009) Epidemiology, costs, and the economic burden of fibromyalgia. Arthritis Res Ther 11:117PubMedCentralCrossRefPubMedGoogle Scholar
  87. Stonnington CM, Locke DEC, Hsu C-H, Ritenbaugh C, Lane RD (2013) Somatization is associated with deficits in affective theory of mind. J Psychosom Res 74:479–485CrossRefPubMedGoogle Scholar
  88. Subic-Wrana C, Beutel ME, Knebel A, Lane RD (2010) Theory of mind and emotional awareness deficits in patients with somatoform disorders. Psychosom Med 72:404–411CrossRefPubMedGoogle Scholar
  89. Tak LM, Rosmalen JGM (2010) Dysfunction of the stress responsive systems as a risk factor for functional somatic syndromes. J Psychosom Res 68:461–468CrossRefPubMedGoogle Scholar
  90. Thomas H, Else G, Barbara T, Francis C (2009) Psychodynamic interpersonal therapy and improvement in interpersonal difficulties in people with severe irritable bowel syndrome. Pain 145:196–203CrossRefGoogle Scholar
  91. Van Houdenhove B, Luyten P (2007) Fibromyalgia and related syndromes characterized by stress intolerance and pain hypersensitivity: do we need a new nosology? Curr Rheumatol Rev 3:304–308CrossRefGoogle Scholar
  92. Van Houdenhove B, Luyten P (2008) Customizing treatment of chronic fatigue syndrome and fibromyalgia: the role of perpetuating factors. Psychosomatics 49:470–477CrossRefPubMedGoogle Scholar
  93. Van Houdenhove B, Luyten P, Kempke S (2013) Chronic fatigue syndrome/fibromyalgia: a “stress-adaptation” model. Fatigue Biomed Health Behav 1:137–147CrossRefGoogle Scholar
  94. Van Koulil S, Effting M, Kraaimaat FW, Van Lankveld W, Van Helmond T, Cats H, Van Riel P, De Jong AJL, Haverman JF, Evers AWM (2007) Cognitive-behavioural therapies and exercise programmes for patients with fibromyalgia: state of the art and future directions. Ann Rheum Dis 66:571–581PubMedCentralCrossRefPubMedGoogle Scholar
  95. Waller E, Scheidt CE (2006) Somatoform disorders as disorders of affect regulation: a development perspective. Int Rev Psychiatry 18:13–24CrossRefPubMedGoogle Scholar
  96. Watkins LR, Maier SF (2005) Immune regulation of central nervous system functions: from sickness responses to pathological pain. J Intern Med 257:139–155CrossRefPubMedGoogle Scholar
  97. Wessely S, White P (2004) There is only one functional somatic syndrome. Br J Psychiatry 185:95–96CrossRefPubMedGoogle Scholar
  98. Wirtz PH, Siegrist J, Rimmele U, Ehlert U (2008) Higher overcommitment to work is associated with lower norepinephrine secretion before and after acute psychosocial stress in men. Psychoneuroendocrinology 33:92–99CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Faculty of Psychology and Educational SciencesKU LeuvenLeuvenBelgium
  2. 2.Research Department of Clinical, Educational and Health PsychologyUniversity College LondonLondonUK

Personalised recommendations