Introduction: A review of the literature shows that standard clinical balance measures do not adequately predict fall risk in community-dwelling older individuals. There is significant evidence demonstrating the interactions of fear, anxiety, and confidence with the control of standing posture. Little is known however about the nature of this relationship under more challenging balance conditions, particularly in the elderly. The primary purpose of this work was to evaluate the relationship between fear of falling, clinical balance measures and fall-risk. Methods: Three studies were conducted evaluating the effects of postural threat (manipulated by support surface elevation) and/or cognitive loading (working memory secondary task) on clinical balance performance and task-specific psychological measures. Predictive and construct validity as well as test-retest reliability was evaluated for measures used to assess fear of falling and related psychological constructs . Results: Postural threat resulted in reduced balance confidence and perceived stability as well as increased state anxiety and fear of falling. These changes were significantly correlated to decrements in performance of clinical balance tasks. Neither standard clinical scales of balance and mobility nor generalized psychological measures, alone or in combination, could predict falls in community-dwelling elderly. However, combined scores on selected challenging clinical balance tasks could significantly predict falls. Furthermore, improved predictive precision resulted from having these tasks performed under combined postural threat and cognitive loading. Finally, the inclusion of task-specific psychological measures resulted in further improvements to predictive precision. Psychological measures demonstrated fair to excellent test-retest reliability in both healthy young and independent-living older individuals. Conclusions: Clinical balance tasks performed under more challenging conditions likely better reflect everyday experiences in which a fall is likely to occur. Incorporating easy-to-administer task-specific psychological evaluations and self-reported health estimates with clinical balance assessments might improve the likelihood of correctly identifying community-dwelling individuals at risk for falls. Improved estimates of fall-risk may lead to a reduction in the number of falls experienced in this population, thereby reducing the significant burden of fall-related hospitalizations, treatments and rehabilitation on the individual, families and health care system.

Community notification aims to warn the public when reintegrating sexual offenders represent a significant risk to public safety. However, anxiety and powerlessness are often unintentional side-effects of notification. Fear appeals are persuasive messages that arouse fear of a threat and may include recommended actions for avoiding the threat. This research applied a fear appeal theory, the Extended Parallel Processing Model (EPPM), to community notification web pages. Study 1, a systematic review of existing community notification web pages, informed the development of a traditional web page vignette for Study 2. Study 2 compared the traditional web page format to a high efficacy web page intervention, which comprised educational information on avoiding sexual victimization. The EPPM predicted positive correlations between fear and perceived threat (hypothesis 1), fear and behavioural intentions (hypothesis 2), and perceived efficacy and intentions to adopt victimization prevention behaviours (hypothesis 4) as well as negative correlations between perceived efficacy and maladaptive fear control responses (hypothesis 3). The intervention group was predicted to have higher perceived threat, higher perceived efficacy, be less likely to adopt fear control responses, and more likely to endorse behavioural intentions than the control group (hypothesis 5). Female participants were hypothesized to have higher fear, perceived threat, fear control responses, and behavioural intentions and lower perceived efficacy than male participants (hypothesis 6). The results provide preliminary support for the EPPMs ability to explain reactions to receiving a community notification. Hypotheses 1, 2, and 4 were fully supported and hypothesis 6 was partially supported as females displayed higher fear, perceived threat, and behavioural intentions; however, the intervention was ineffective in producing differences between the intervention and control groups (hypothesis 5). Exploratory regression analyses found gender, education level, previous victimization, parental status, and locus of control were related to the EPPMs variables. Future research should examine the impact of different educational materials and delivery systems (such as interpersonal sources, media, and web-based multi-media) to further examine the application of the EPPM to web-based sexual offender community notification and determine whether it is possible to increase adaptive responses to receiving a community notification by providing educational information.

My thesis is based on a qualitative study in which I have selected six professional teachers in a school in Greater Stockholm, and their views on the phenomenon of conflict management. My questions were the following. How teachers perceive the phenomenon of conflict in the world of school? What strategies do teachers use to resolve conflicts with students? In order to analyze my informants, I have chosen different books that deal with conflict man-agement, policy documents and books on the teaching profession meaning. Through my investigation I found that some teachers used tools and strategies through expe-rience and reflections, and resolve conflicts together or individually. My informants described that there are some teachers how choose to hide and pretend not to see the problem. Other teachers have developed various methods and dared to venture into the conflict and make the conflict as a challenge. Conflict Fear is something that many of my informants mention when some teachers are hid-ing then it is important to work with their own fears in order to develop as a teacher.

Thesis (Ph. D.)--University of North Texas, Aug., 2009. / Title from title page display. Includes bibliographical references.

The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file. Title from PDF of title page (University of Missouri--Columbia, viewed on Dec. 18, 2009). Thesis advisor: Dr. Devoney Looser. Includes bibliographical references.

The purpose of this cross-sectional, secondary data analysis was to explore, non-modifiable (stable) trait factors and modifiable (transient) state factors associated with fear of recurrence (FOR) in breast cancer survivors. Antecedent trait factors included demographic, clinical, social/behavioral factors, postulated mediator state factors included pain, fatigue, sleep disturbances, depression, state anxiety and perceived stress, and FOR was the outcome variable. The study used baseline data from an R-21 NCI funded (grant #R21CA109168) randomized control trial that examined the effects of mindfulness based stress reduction in early stage breast cancer recovery. Instruments from this study for antecedent variables (trait factors) included a Demographic and Clinical History Form, STAI; instruments used for mediator variable (state factors) included CES-D, STAI, PSS and MDASI subscales for pain and fatigue, sleep; the instruments used for the outcome variable FOR - CARS overall fear and nature of worry. The study sample included 82 women within 18 months post breast cancer treatment (stage 0, I, II, III). The Theoretical Model for psychosocial nursing research was used as a heuristic framework to examine the associations between trait factors and state factors and their mediating effects on FOR. Aim 1 explored the relationship between the antecedent (trait) variables associated with FOR (CARS overall fear and CARS nature of worry) using Pearson's and Spearman's correlations and analysis of variance (ANOVA). The findings revealed a negative association between age and FOR, CARS overall fear (r = -.236, p = .033) and FOR, CARS nature of worry (r = -.269, p = .015). Trait anxiety was positively associated with FOR, CARS overall fear (r = .433, p = .000) and FOR, CARS nature of worry (r = .358, p < 0.001). Race/ethnicity, education, marital status, employment, exercise, cancer stage, cancer treatment, exercise, smoking, drinking, hormone use and family history of breast cancer were not associated with FOR. Aim 2 explored the relationship between postulated mediator (state) variables, such as pain, fatigue, sleep disturbances, state anxiety, depression, perceived stress associated with FOR (CARS overall fear and CARS nature of worry) using Pearson's correlations. Findings revealed that depression (r = .347, p = .001), state anxiety (r = .467, p < 0.001), perceived stress (r = .365, p = .001) were positively associated with FOR, CARS overall fear of recurrence, and that pain (r = .220, p = .047), fatigue (r = .247, p = .025), state anxiety (r = .369, p = .001), and perceived stress (r = .410, p < 0.001) were positively associated with FOR, CARS nature of worry. Aim 3 used a mediation analysis (bootstrapping method) to examine the indirect effects of the statistically significant modifiable mediator state factors on the statistically significant antecedent trait factors and FOR (CARS overall fear and CARS nature of worry). With trait anxiety as the antecedent variable, state anxiety was indirectly associated (a mediating variable) with FOR, CARS overall fear (β = .1381, 95% CI = .0053 - .3050, p = .0299). Similarly, with a composite age/trait anxiety antecedent variable, state anxiety was indirectly associated (a mediating variable) with FOR, CARS overall fear (β = .5579, 95% CI = .1201 - 1.1669, p = .0157). Perceived stress and depression did not mediate the relationship between age and trait anxiety and concerns about recurrence overall fear. With trait anxiety as the antecedent variable, perceived stress was indirectly associated (a mediating variable) with FOR, CARS nature of worry (β = .5474, 95% CI = .0178 - 1.3298, p = .0294). Similarly, a composite age/trait anxiety antecedent variable, perceived stress was indirectly associated (a mediating variable) with FOR, CARS nature of worry (β = 2.0375, 95% CI = .1136 - 4.5976, p = .0495). Pain, fatigue and state anxiety did not mediate the relationship between age and trait anxiety and FOR nature of worry. This study suggests that breast cancer survivors who are anxious at baseline and report a current state of anxiety or perceived stress may be at higher risk for fears of breast cancer recurrence. Understanding the individual patient characteristics such as age, history of anxiety and current status of perceived stress or anxiety and the relationship with fears of recurrence allow nurses to offer individualized interventions for patients at greatest risk for psychological distress.

Anxiety disorders, including social anxiety disorder (SAD) and posttraumatic stress disorder (PTSD) are common and disabling conditions. Largely based on animal and pharmacological studies, both the serotonergic and substance P/neurokinin-1 (SP/NK1) systems have been implicated in their underlying pathology. However, only few neuroimaging studies have directly assessed these neurotransmitter systems in human sufferers of anxiety disorders, and none have addressed possible between-systems relationships. The overall aim of this thesis was to study possible neurochemical alterations associated with anxiety disorders. To this end, three studies using positron emission tomography (PET) for in-vivo imaging of the brain serotonergic and SP/NK1 systems in patients with SAD and PTSD were conducted. The radiotracers [11C]5-HTP, [11C]DASB, and [11C]GR205171 were used to index serotonin synthesis rate, serotonin transporter (SERT) availability, and NK1 receptor availability respectively. In Study I, patients with SAD relative to controls exhibited enhanced serotonin synthesis rate and serotonin transporter availability. Serotonin synthesis rate in the amygdala was positively related to social anxiety symptom scores. Study II demonstrated increased NK1 receptor availability in the amygdala in patients with SAD relative to controls. In Study III, patients with PTSD showed elevated NK1 receptor availability in the amygdala as compared to controls. SERT availability in the amygdala was negatively related to PTSD symptom severity, a relationship that was moderated by NK1 receptor levels. The regional overlap between SERT and NK1 receptor expression was altered in patients with PTSD, with reduced overlap linked to more severe symptoms. Collectively, the findings are consistent with the view that serotonin in the amygdala induces rather than reduces anxiety and links exaggerated anxiety to an overactive presynaptic serotonin system. In addition, the involvement of the SP/NK1 system in stress and anxiety, as suggested by animal studies, was demonstrated in two common human anxiety disorders. Finally, PTSD symptomatology is better accounted for by interactions between the serotonergic and SP/NK1 systems in the amygdala than by each system separately. In conclusion, this thesis supports that both the serotonergic and SP/NK1 systems in and of themselves, but also interactively, may be important contributors to anxiety symptomatology.

The amygdala, a small structure located deep bilaterally in the medial temporal lobe, is the key structure for the emotional processing and storage of memories associated with emotional events, especially fear. The structure has also been shown to enable humans and animals to detect and respond to environmental threats. Fear conditioning became the main model to examine the neural substrates of emotional learning in mammals and specifically in rats’. With the fear conditioning method, researchers can tests rats’, responses to aversive stimuli during the delivery of a cue and then measure how the responses change after learning of the association between the stimuli and the cue. After learning of the two stimuli, the delivery of a cue alone will prompt a fear response in the rats. The fear response can also be elicited by placing the rats in the same chamber in which the aversive stimuli has previously been experienced, which depends on both the amygdala and the hippocampus. Where the amygdala stores the memories of stimulus related to fear, the hippocampus seems to hold all the fear memories in relation to contextual information about the stimulus. The aim of this paper will be to make a comprehensive overview of internal neural processes of both the amygdala and hippocampus and the interaction between the two structures during fear conditioning, to see how the structures separately work to overlap emotion and memory processes.

Vi åldras på flera sätt, biologiskt, psykologiskt och socialt. Rädsla för att ramla, en pågående oro för att ramla och som leder till undvikande av aktiviteter man fortfarande kan göra, finns hos många äldre och påverkar dem på flera sätt. Rädslan kan leda till inaktivitet som i sin tur leder till ensamhet och nedstämdhet. Syftet med studien är att beskriva äldre personers egen erfarenhet av att uppleva rädsla för fall och dess konsekvenser. En kvalitativ studie har gjorts där fem personer har intervjuats. Intervjuerna och analysen av dem är gjorda utifrån en fenomenologisk metod. Vid analysen framkom tre huvudkategorier: Oro för konsekvenserna av ett fall, Strategier för att undvika fall samt Saknad. Äldre personer som upplever en rädsla för fall undviker vissa aktiviteter. De upplever också en saknad efter aktiviteter de tidigare utfört men nu slutat med. De har strategier för att hantera sina rädslor. Det är viktigt att inte se äldre som en homogen grupp och att vid rehabilitering ta hänsyn till olika faktorer som person, miljön personen vistas i, aktiviteter de utför eller önskar utföra och känslan av delaktighet. / We age in different ways, biologically, psychologically and socially. Fear of falling which means a lasting concern about falling which leads to an avoiding of activities that the person still has a capability to do. This can cause inactivity that eventually leads to loneliness and depression. The aim of this study is to describe older peoples own experiences to live with fear of falling and its consequences. A qualitative study was done where five older people were interviewed. The interviews and analyses were done using a phenomenological method. At the analysis three main categories were found: Concern about the consequences of a fall, Strategies to avoid a fall and A feeling of missing. Older people with fear of falling avoid some activities. There is a feeling that they miss some activities they have previously done but don't do any longer. They have strategies to handle their fears. In rehabilitation it is important not to see the elderly as an homogeneous group. It is also important to consider different factors such as the person, the environment in which the person lives, activity and feeling of involvement.

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