I Sverige beräknas 17 % av befolkningen ha en hörselnedsättning, vilket innebär att det är den vanligaste sensoriska funktionsnedsättningen. Idag finns det en mängd studier som visar att hörselnedsättning är relaterat till sämre psykisk hälsa. Acceptans av sin hörselnedsättning har visat sig vara positivt för hörselnedsatta och samvarierar med hjälpsökande. Acceptance and commitment therapy (ACT) är en transdiagnostisk behandling där psykopatologi antas bero på en hög grad av upplevelsemässigt undvikande och fusion med tankar. Målet i ACT är att öka psykologisk flexibilitet där acceptans är en betydande komponent. Denna explorativa studie undersökte förändringsprocesser i ACT för personer med hörselnedsättning där utfallet var känslomässig och social anpassning för hörselnedsättningen (HHIE-S). De förändringsprocesser som prövades var acceptans (HAQ), som tidigare visat på medierande effekt för ACT, samt två alternativa förändringsprocesser; self-efficacy (HSE-4) och upplevd stress (PSS-4). Behandlingen bestod av åtta internetadministrerade moduler givna med behandlarstöd där veckovisa mätningar av förändringsprocesser och utfall användes. Studiens resultat visar att behandlingsgruppen upplevde marginellt signifikant mindre problem med känslomässig och social anpassning för hörselnedsättningen (HHIE-S). Studiens resultat pekar på att hörselrelaterad acceptans (HAQ) och self- efficacy (HSE-4) medierar behandlingens effekt på deltagarnas känslomässiga och sociala anpassning för hörselnedsättning (HHIE-S). Således tillför denna studie ytterligare belägg för acceptans som förändringsprocess i ACT. Även self-efficacy kan vara en intressant mediator att beakta i fortsatt forskning.

As a whole, eating disorders have been characterised as having the following key features: a persistent over concern with body size and shape; and weight control behaviours such as fasting, exercise, and self-induced vomiting. However, there tends to be a blurred line between those that do and do not meet diagnostic thresholds as the level of psychological distress is comparably similar. This study examined whether psychological inflexibility (from an Acceptance and Commitment Therapy perspective) was associated with eating disorders and whether it mediated the relationship between childhood abuse and invalidation and eating disorders. This was considered to be important because high rates of abuse have consistently been found in this population, yet not everyone goes on to develop an eating disorder. In addition, the role of emotional abuse has been largely neglected. A clinical sample of 190 participants with a clinical or subclinical eating disorder were recruited from eating disorder charities and support forums; they completed a range of questionnaires measuring experiences of abuse and maternal/paternal emotional invalidation in childhood, current levels of cognitive fusion and experiential avoidance and current levels of eating pathology. The sample was split into three groups based on their Eating Disorder Risk Composite scores: elevated, typical and low clinical range. It was found that those in the elevated clinical range (most severe eating pathology) had the poorest emotional processing and significantly higher levels of psychological inflexibility, thought-shape-fusion, depression and anxiety than those in the low clinical range (least severe eating pathology). In terms of predicting current levels of eating pathology, three variables emerged as significant predictors: emotional processing, thought-shape fusion and depression. In terms of predicting current levels of psychological inflexibility, five variables emerged as significant predictors: childhood emotional abuse, emotional processing, thought-shape-fusion, depression and anxiety. The results add novel findings to the literature regarding the role of early experiences on the development of psychological inflexibility, and the role of psychological inflexibility in the maintenance of eating pathology and psychological distress. Clinical implications of these findings in relation to assessment, formulation, intervention and prevention are discussed.

Appendices were not supplied with the digital version of the thesis but are available in the print version. / The present research includes two studies. Study I was based on the research finding that exposure to nuclear radiation and other toxic chemicals results in those who were exposed not only believing their health to be affected, but experiencing significant and chronic stress. It was hypothesised that ongoing stress for New Zealand’s nuclear test veterans resulting from the inability to adapt to their past nuclear exposure would result in them experiencing greater depressive symptomatology, poorer perceived health, and poorer perceived memory performance than a control group. Psychological profiles of 50 nuclear test veterans and 50 age-matched Control participants were obtained through postal survey and face-to-face interview, using the Geriatric Depression Scale, Medical Outcomes Study Short Form-36, and the Memory Assessment Clinics Self-Rating Scale. As predicted, the nuclear veterans exhibited more depressive symptoms, and perceived their health and memory performance to be poorer than the Control group. A stress theory framework is applied to help conceptualise the experience of the nuclear veterans, and to provide an explanation for their lower scores and consequent poorer functioning. Through the pathway of poor perceived health leading to anxiety, health anxiety was considered a form of chronic stress the nuclear veterans were experiencing. Consequently, Study II aimed to examine whether Acceptance and Commitment Therapy (ACT) could be usefully applied to relieve this anxiety. Most psychotherapeutic approaches have been developed for problems that have an "irrational" or "pathological" foundation. However, these approaches often fit poorly with psychological distress that stems from cognitions that are reality-based and may need to be accepted rather than changed, such as in the case of nuclear exposure-related health anxiety. ACT may be particularly useful in these situations in which cognitive change is not warranted. Study II examined the use of ACT with 5 NZ nuclear test veterans (of either Māori or Pākehā descent) experiencing moderate to high levels of health anxiety. Results of self-report measures administered at baseline, during treatment, post-treatment, and at 6-week follow-up indicated varying results amongst these men. One participant showed clinically significant post-treatment reductions in health anxiety, experiential avoidance, and general psychological distress that were maintained at follow-up. Two participants showed clinically significant post- vi treatment reductions in health anxiety, experiential avoidance, and distress, despite not engaging in therapy as they did not wish to make changes. For the same reason, a fourth participant chose not to engage in therapy, despite high baseline scores on all measures, and showed no improvement during or after therapy. The fifth participant had low baseline scores on all measures, maintaining these throughout therapy, and at follow-up. Results are explained in terms of cohort and gender effects, with suggestions for adapting ACT with NZ older adults, particularly males. Implications for the utility of ACT with toxic exposure populations, older adults, and various cultures are discussed.

L’objectif de cette recherche était de tester les effets de la thérapie de l’acceptation et de l’engagement (ACT) sur les étudiants en première année de la Faculté d’ Éducation, Burapha Université, Thaïlande, en développant un programme de développement des compétences émotionnelles grâce à la pleine conscience et de l’accompagnement et du conseil (MBECC) adressé aux participants. 130 d’étudiants de première année ont passé le test Thaï d’ Intelligence Émotionnelle et le test d’échelle d’évaluation de la pleine conscience (MAAS test). 18 étudiants ont été sélectionnés et répartis en 3 groupes: le Marathon MBECC, le Bref MBECC et un groupe de contrôle via une procédure d'échantillonnage aléatoire simple. Le protocole de recherche a suivi un protocole expérimental de recherche avec pré test, post- test et test de suivi, un mois après les interventions et leurs comparaisons respectives avec un groupe de contrôle. Les données ont été statistiquement analysées en utilisant une analyse multivariée des variances (procédure MANOVA). Les résultats de recherche démontrent que le programme Marathon MBECC et le programme Bref MBECC ont amélioré les scores moyens en capital émotionnel à la phase post-test et de suivi (significatif : p < .05) plus que le groupe de contrôle au post-test et de suivi. Les programmes Marathon et Bref ont amélioré les scores moyens en KE du groupe expérimental sans différence significative entre les 2 groupes, à la phase post-test et suivi. Finalement, les scores moyens et le niveau d’évaluation de la pleine conscience n'ont pas significativement affecté les scores moyens des étudiants en KE. / The purpose of this study was to study the effects of Acceptance and Commitment Therapy (ACT) on emotional capital (EK) of the freshmen students of the Faculty of Education, Burapha University, Thailand, by using the Mindfulness Based Emotional Competencies Counseling (MBECC) program. 130 freshmen students completed the Thai Emotional Intelligence Screening Test (Thai-EI) and the Mindful Attention Awareness Scale (MAAS). Then, 18 freshmen students were divided into 3 groups: the Marathon MBECC, the Brief MBECC, and the control group by simple random sampling according to the score of Thai-EI and MAAS. The research design was a pretest–posttest control group design, including follow-up testing after 1 month. The data were statistically analyzed by utilizing a multivariate repeated measures analysis of variance. The research results demonstrated that the Marathon MBECC and the Brief MBEC enhanced the sample’s EK scores at the post-test and follow-up phase significantly (p < .05) more than the control group’s mean scores. The Marathon MBECC and the Brief MBECC increased the mean scores on EK of the experimental group with no significant differences between the 2 groups, at the post-test and follow-up phase. Finally, the scores on level of dispositional mindfulness did not significantly affect the students’ scores on EK.