Depression and anxiety are common in patients with coronary heart disease (CHD). As well as reducing health related quality of life, psychological problems can be a barrier to recovery and to making the necessary lifestyle changes to prevent worsening of cardiac health. A report on cardiac rehabilitation services in South East London (Marks & Filer, 2005) identified gaps in the services provided: not all CHD patients receive psychological support. Reviews of psycho-educational programmes in cardiac rehabilitation (Dusseldorp 1999 and Bennett & Carroll 1994) have found that group interventions can be effective in reducing emotional distress, targeting risk factors and increasing active coping. Cognitive behavioural techniques such as goal setting and evidence checking have been found to be effective when working with CHD patients (Lewin 2002). A psycho-education session based on cognitive behavioural techniques was designed and delivered to CHD patients as part of their usual Phase III cardiac rehabilitation programme in 3 hospitals in South East London. Two types of session were delivered: one individualised and interactive, the other generic and didactic in style. The format and content of the intervention is outlined in a manual and the same manual was used to deliver the session each time. All patients received a written handout summarising the session. Patients were randomly allocated to the control or intervention group. Outcomes were measured by HADS, Dartmouth COOP and a behavioural questionnaire before and after the session. Results showed high levels of patient satisfaction with the intervention in terms of usefulness and feeling comfortable and accepted in the group format. There was no significant difference in HADS scores over time, or between groups. This project is a case study for the complexities of carrying out research with limited resources in the setting of the NHS and highlights the role of practice-based evidence.

The following case study presents the therapeutic work carried out with a client experiencing chronic pain specifically osteoarthritis. The case study depicts counselling work carried out which is considered to be relevant to the DPsych portfolio i.e. chronic pain and Jeffrey Young's schema therapy (Young, 1990, 1991), and aspects ofthe therapeutic relationship. The study seeks to demonstrate how a cognitive behavioural therapy (CBT) assessment can be carried out in conjunction with assessing early maladaptive schemas (Young, 1990, 1991), as proposed by the schema therapy model. The study draws on the theory ofcognitive and behavioural therapy and schema therapy models, in relation to assessing chronic pain and pain coping strategies. The client presented has been anonymised and given the name M. The process oftherapy will be described including aspycts oftreatment plans, difficulties and supervision. Finally, a reflective summary describes the experiential process of being a CBT practitioner.

No description available.

No description available.

Four studies were conducted in order to investigate the way people construe their most stressful and traumatic experiences. Personal constl1,lct theory was the main theoretical approach used in all studies but the thesis also drew upon social const~ctionist perspectives. In study one, a clinical sample of people diagnosed with PTSD (n = 36) was tested using repertory grids and questionnaires. The study tested the viability of the personal construct model of PTSD (Sewell et aI, 1996). Results did not support the model and a new personal construct model was proposed. In study two, an investigation into a number of methodological issues relating to the hierarchical-classes analysis (HICbAS), as applied to PTSD conceptualizations within the personal construct model, was conducted. Results revealed that its use in the analysis of repertory grid data was based on flawed assumptions. Corrective suggestions were proposed and the TUCKER-HICLAS software was introduced in order to improve the analysis of repertory grid data. In study three, a student sample (n = 114) was divided into groups according to some personality traits (high/low anxiety, repression, dissociatIon, thought suppression). The students completed repertory grids using as elements life events, including the most stressful event of their lives, and consequently their patterns of construing these events were compared between them as well as with the patterns found among the PTSD ' , patients from Study One. Results were counterintuitive in the sense that it was found that the low anxious group was the most similar to the PTSD group. A model based on the concepts of anticipation and epistemic control was proposed to account for the findings. In study four, an asylum seeker and refugee sample (n = 5) diagnosed with PTSD was interviewed and asked to complete repertory grids. Results showed that this population tends to construe their traumas in terms of constructs expressing social relations rather than psychological states, as commonly found among non-refugee people. Central to their construing of trauma was found to be the concept of 'limbo'. The psychosocial effects of limbo were explored through the anthropological concept of liminality. It was propose'd that issues of functionality should be incorporated into the diagnosis and treatment of trauma among asylum seekers and refugees as well as the general population.

No description available.

No description available.

I assessed common mental disorder (CMD) and its association with gender disadvantage among young women in two defined catchment areas (with contrasting socio-economic circumstances) in each city. Socio-economic status is a risk factor for CMD, and may confound or modify the effect of gender disadvantage, hence the stratified sampling. Female gender disadvantage cannot be measured directly, but is a well recognized phenomenon and has important effects across the life course. I used five proxy indicators; 1) no older brother at the time of birth (as a proxy for male preference), 2) limited parental bonding (low care and high overprotection), 3) low educational attainment 4) adverse marital circumstances (early age at marriage and low satisfaction) and 5) subjective perception. Recruitment and interviewing of 525 women aged 20-35 was completed with 98% response rate. 57% were married. The prevalence of CMD (SRQ score >=8) ranged from 26% (high SES Rawalpindi) to 83% (low SES Islamabad). Perception of parental preference for males, low care, less education, early age at marriage and low marital satisfaction were, as hypothesised, strongly correlated. I have found strong effects of all of the indicators of gender disadvantage (other than birth order) upon risk for CMD, independent of SES. I found strong evidence to support the main hypothesis of an independent association between low care and increased risk for CMD. However, for this risk factor the effect was modified by SES being significantly stronger among those living in higher SES districts.

No description available.

No description available.