Type D personality refers to the combination of negative affectivity—the tendency to experience negative emotions—and social inhibition, or feeling restrained in social situations. But both traits consist of several more specific facets. Do all of these contribute equally to the risk of adverse cardiac events? To investigate this question, we pooled individual-level data from 1,750 patients with cardiovascular disease across four prospective studies.

Our findings, recently published in the Journal of Psychosomatic Research, revealed a more nuanced picture. Anxious apprehension, one facet of negative affectivity reflecting a tendency to worry excessively, was particularly associated with an increased risk of major adverse cardiac events when combined with social reticence or a lack of social poise. In other words, worrying appeared especially relevant when accompanied by difficulty connecting with others or feeling at ease in social situations. The remaining aspects of negative affectivity showed a different pattern. Dysphoria and irritability were independently associated with a higher risk of cardiac events, regardless of patients’ level of social inhibition. By contrast, none of the social inhibition facets showed a clear independent association with cardiac events.

These findings suggest that the characteristic association between Type D personality and increased riks of adverse cardiac events may be particularly relevant for people who both worry excessively and tend to withdraw from others or feel socially uneasy. More broadly, our study illustrates why it can be valuable to look beyond broad personality traits. Their specific facets and the ways in which these facets interact may provide a more precise understanding of psychological vulnerability in cardiovascular disease.

Early in the movie Titanic, Rose stands at the stern of the ship, overwhelmed by her situation. To outsiders, her life appears privileged—wealth, luxury, status—but she interprets it as a cage, a hopeless future with no escape. Her despair illustrates how our interpretations of situations can shape our emotions and behavior as much as the circumstances themselves. In contrast, Jack’s famous cry—“I’m the king of the world!”—captures the opposite: a moment of expansive, positive interpretation, experiencing possibility, freedom, and connection even in uncertainty. Our study, recently published in Behavior Research and Therapy, similarly examines how people differ in interpreting ambiguous situations—some seeing threat and limitation like Rose, others seeing opportunity and openness like Jack—and how these patterns relate to mental health.

Like the iceberg that challenged the Titanic, our study reveals the hidden depths of psychopathology by showing that beneath everyday interpretations lie powerful patterns that shape well-being. We found that people who tend to interpret ambiguous or complex situations negatively, and who find it difficult to change those initial interpretations, are more likely to carry the so-called p-factor, a general vulnerability for a wide range of mental health problems. Recognizing these thought patterns early could be key to prevention and resilience.

More specifically, difficulty in seeing things in a positive light was tied to social withdrawal, feelings of distance, and struggles in relationships. Just as Rose felt cut off from the people around her, interpreting her life as isolating rather than connected, individuals who habitually view the world through a negative lens may find it harder to sustain closeness and belonging. Supporting people to practice positive reinterpretations—fostering moments more like Jack’s “king of the world” than Rose’s despair—could strengthen social bonds and increase well-being.

Want to learn more? Read our full study here

Did you know surgical procedures are significant contributors to hospital waste and carbon emissions? Orthopedic procedures, like total knee arthroplasty (TKA), generate disproportionately high waste volumes. Optimizing surgical trays containing parts used during orthopedic surgery is an actionable way to reduce this environmental impact.

Together with Pim van Egmond , an orthopedist in the ETZ hospital in Tilburg, we explored if surgical trays in TKA can be reduced by an improved estimation of prosthesis size before the operation. We developed a predictive model using readily available patient data such as sex, height, weight, BMI, and prosthesis side to estimate the required component sizes.

Using this prediction model and reorganizing instrument sets based on predicted size ranges, we achieved a significant reduction in surgical trays. Our best-performing model predicted the appropriate prosthesis sizes with 97.4% accuracy. We estimated that implementation of our approach can lead to 11.2% reduction in the total number of surgical trays used for primary TKA procedures. Such a reduction corresponds to an estimated 1.03 kg CO2eq carbon emission cut and a €29.6 cost reduction per tray.

Our study has now been published in Acta Orthopaedica. We have shown that even small changes in daily orthopedic practice can have a big impact, both ecologically and financially. This is a great step towards more sustainable orthopedic care, not only for the ETZ but also for other hospitals.

Have you ever wondered how childhood trauma can continue to affect behavior later in life? A recent study by Cristina Baroncelli, a PhD candidate whom I supervise, explored the connections between childhood trauma and self-concept clarity—how clearly we see ourselves.

Beyond finding that individuals with more childhood trauma tend to have a more inconsistent and unstable sense of self, we were particularly interested in whether this association could be explained by childhood trauma leading to attachment problems and the development of early maladaptive schemas (EMS)—ingrained negative patterns of thinking and feeling.

We found that difficult childhood experiences are linked to both insecure attachment styles and a less clear sense of self. Importantly, we discovered that three specific EMS—feeling excessively close to someone (Enmeshment), putting others’ needs first (Self-Sacrifice), and feeling at the mercy of authority figures (Subjugation)—serve as bridges between childhood trauma and these later difficulties. For instance, our findings suggest that childhood trauma is associated with a tendency toward these negative schemas, which, in turn, contribute to difficulties in forming secure attachments and developing a stable self-image.

Although our data were collected at a single point in time, preventing conclusions about causality, our findings contribute to a better understanding of these pathways. This insight can be vital for helping individuals who have experienced childhood trauma develop a stronger and more coherent sense of self.

Pregnancy is a transformative journey, not just for the mother but also for the developing baby. To shed light on how maternal mindfulness can play a crucial role in this process, I collaborated with Noor de Waal and colleagues on a recent study published in Early Human Development. The research, involving 408 Dutch women, explored the impact of a mother’s mindfulness on her bonding with her baby and the baby’s social-emotional development.

Mindfulness, the practice of being present and non-judgmental, was related to increased maternal-infant bonding both before and after birth. Mothers who practiced mindfulness reported stronger emotional connections with their babies and perceived their infants as having fewer social-emotional problems. The study highlights that adopting a non-judgmental attitude during pregnancy can foster positive feelings towards the baby, leading to better outcomes in the first year of life. This suggests that mindfulness interventions could be beneficial for expectant mothers, helping them to bond more deeply with their babies and support their infants’ emotional well-being.

In essence, this research underscores the importance of mental well-being during pregnancy, not just for mothers but for their babies too. Mindfulness could be a simple yet powerful tool to promote healthier, happier families.

To shed light on the significant role psychosocial distress plays in heart disease, I collaborated with Paula Mommersteeg and others in our recently published study in the International Journal of Cardiology. This decade-long study monitored 546 patients with non-obstructive coronary artery disease (NOCAD), a condition characterized by symptoms of ischemia without major coronary blockages, affects many individuals, especially women.

Our findings revealed that 19% experienced major adverse cardiac events (MACE) within the 10-year follow-up, including heart attacks or cardiac-related deaths. Interestingly, women had a lower risk of these events compared to men.

Key findings highlighted that fatigue, low positive mood, and physical limitations were significant predictors of MACE. Surprisingly, factors like anxiety, hostility, and Type D personality did not show a strong correlation with adverse outcomes. While depressive symptoms initially appeared predictive, their impact diminished after adjusting for other health and lifestyle factors.

These insights emphasize the importance of addressing psychosocial distress in heart disease management. Interventions aimed at improving mood and reducing fatigue could potentially enhance patient outcomes. Understanding these dynamics can help healthcare providers develop more holistic treatment plans, ultimately improving the quality of life for those affected by NOCAD.

In the social and behavioral sciences, researchers often measure not directly observable (latent) variables like religiosity, cultural norms, and well-being, with questionnaires consisting of multiple questions to measure each latent variable. However, researchers often face challenges when analysing such data due to the measurement error and skewness in questionnaire item scores. My recent commentary in the journal Religion, Brain & Behavior sheds light on why these issues should not be ignored.

Measurement Error: When researchers use the mean or sum of item scores to represent latent variables, they assume these scores are error-free. This assumption can lead to attenuation bias, where the true associations between variables are underestimated. This bias is particularly problematic when testing interaction effects that are often used in social science to determine if one variable influences the magnitude of an association between two other variables.

Skewness: Psychological questionnaire scores are often not normally distributed, with high or low scores being more common than average scores. For instance, certain populations tend to generally score high on wellbeing or low on questions measuring suicidal ideation. Using statistical models that assume normality can result in biased parameter estimates. The computer simulations in my commentary paper show that ignoring skewness can further increase the negative bias in estimated effects that results from ignoring measurement error.

To properly estimate relations between latent variables measured with skewed and ordinal item scores, I recommend using Categorical Structural Equation Modeling (CATSEM). This approach is essential for researchers aiming to draw valid conclusions from their data, especially when estimating interaction effects. By addressing these issues, researchers can enhance the reliability and validity of their findings, ultimately contributing to more robust psychological research.

In today’s fast-paced world, many people suffer from stress, but what if mindfulness could help us better manage those symptoms? To delve deeper into the effects of Mindfulness-Based Stress Reduction (MBSR) on our physiological responses to stress, I collaborated on a recent study led by Ivan Nyklicek, published in the journal Mindfulness.

The study included 58 Dutch participants who underwent an 8-week MBSR program. We measured their heart rate and brain activity before and after the program while recalling a stressful event. Participants reported feeling less negative overall, and their heart rate variability—a sign of better stress management—increased. However, changes in brain activity were less clear and require future research.

Our findings suggest that while MBSR can improve general feelings of well-being and heart health, its impact on brain responses to stress might be more complex. The study highlights the potential of mindfulness to enhance our mental and physical health, though more research is needed to fully understand its effects on the brain.

During times of distress, our attachment system drives us to seek reassurance through closeness, but how we manage this need can vary significantly based on whether we have an avoidant or anxious attachment style. A recent study by Francisco Steenbakkers, one of the PhD students I supervise, explored this dynamic during the COVID-19 pandemic, focusing on how attachment styles influenced interpersonal distance preferences.

During the COVID-19 pandemic, we asked 168 Dutch participants, aged 18 to 71, to participate in a computerised social experiment. We measured their preferred interpersonal distance when approaching another person and when being approached by another person. Participants also reflected on how they would have responded pre-pandemic. We additionally asked participants to respond to various psychological questionnaires, including measurements of attachment style.

Findings revealed that individuals scoring high on attachment avoidance preferred and estimated larger interpersonal distances, consistent with previous research. Interestingly, no significant associations were found for attachment anxiety. Participants generally preferred greater distances when being approached rather than when approaching others, and these distances were larger during the pandemic compared to pre-pandemic times.

These results underscore the impact of attachment avoidance on distancing behavior, particularly during social threats like the COVID-19 pandemic. The study suggests that while attachment avoidance clearly influences how we manage physical proximity, the role of attachment anxiety remains complex and warrants further investigation.

I am incredibly grateful and honoured to receive this year’s best PhD dissertation prize from Tilburg University. Many thanks to my supervisors Prof. Jelte M. Wicherts, Dr. Wilco Emons, Dr. Nina Kupper, and the late Prof. Johan Denollet for their guidance and support. I would also like to congratulate all other prize winners. More information about their theses can be found here. A digital version of my dissertation can be found here.