M.A. / This action research study explored the development and workings of a monthly, openended depression and anxiety support group based in Johannesburg, Gauteng. Although the growth of mutual-aid groups has escalated over the past three decades, there is little research on support groups created solely for the purpose of servicing depression and anxiety sufferers. Researchers have indicated that support and information at these meetings may prove to be a valuable and effective intervention which helps sufferers come to terms with their condition (Miller, 1987; Stein, Zungu-Dirwayi, Wessels, Berk & Wilson, 1998). The study at hand aimed to elucidate the ways in which the depression and anxiety support group was experienced as helpful, as well as those areas which could be improved to increase the effectiveness of the group system. The support group was examined over an eleven-month period, November 1999 – October 2000, during which time the progress and experiences of three new group members was specifically observed and chronicled. Seven participants, including three members of a support group catering for black depression and anxiety sufferers, were initially sourced and screened for inclusion in the study. Although not intentional, the three subjects that finally fulfilled the criteria for inclusion in the study were all white females attending the Johannesburg support group. Relevant data on the three participants was collected systematically over this period through a process of triangulation. Methods included structured and semi-structured interviews, written reports, questionnaires and participant observation. The grounded theory approach allowed the researcher to work inductively with the data and to discern and explore the connections between elements and patterns that emerged in the analysis. An integration of the research data revealed that the group was primarily helpful to participants through the factors of universality, cohesion, didactic instruction and downward social comparison. Furthermore, the results indicated that participants presenting with prominent avoidant personality disorder (APD), as measured by the Millon Clinical Multiaxial Inventory-II, are likely to strongly value the relief from social isolation that the support group setting affords them, as well as gaining comfort from belonging to and being accepted by a group and improving their interpersonal skills. On the negative front, the group would or could not move beyond a formative, early stage of group development. As a result, its members were either caught in a repetitive cycle of exploring the same territory or lost interest after a relatively short period of time and terminated membership. Based on the findings of this study, it is suggested that members be afforded the opportunity of attending a more advanced therapy group once they feel they have gained the necessary relief from the primary support group. The support group plays a valuable role of reassuring members that they are not alone in their suffering, offering them the learning experience of being accepted by a group and introducing them to group format and protocol. However, once a foundation has been established, it is likely that members would benefit from joining a more advanced group in which interpersonal learning and role modelling is emphasized. Members need an arena where they can explore their behaviour and feelings in depth, and with other members who are functioning at a similar level. It is hoped that the findings of this study will increase understanding of support group functioning, provide suggestions for future research involving APD clients and depression and/or anxiety sufferers in support gr oup settings and make some contribution towards theory-building in this field.

Social (public speaking) anxiety disorder is the most prevalent of all anxiety disorders, and it often impairs social and occupational functioning. Intervention studies indicate that cognitive-behavioral therapy (CBT) is an efficacious treatment for social anxiety. However, access to therapists skilled in CBT for social anxiety is often difficult. In order to respond to the problem of access, the use of videoconferencing for mental health care has developed. No published study has investigated the efficacy of CBT for social anxiety when provided via videoconferencing. The purpose of this study, therefore, was to determine the efficacy of CBT for social anxiety when provided via videoconferencing. A single-case replication design was employed that included a baseline period of 3 weeks, followed by 12 weeks of . treatment, 1-week post-intervention period, and 3-month follow-up. Five participants completed treatment. It was hypothesized that participants would reduce their social anxiety symptoms (i.e., decrease anxiety during speech task, increase duration of speech task, and decrease public speaking anxiety) assessed on standardized measures of social anxiety. Exploratory analyses of changes in self-monitored social anxiety, negative cognitions (public self-consciousness, fear of negative evaluation, internal attributions), working alliance, client satisfaction with treatment, and client comfort with videoconferencing were also performed. Analyses included visual and statistical significance, as well as clinical significance (i.e., endstate functioning, social phobia diagnostic status). The results indicated that two of three hypotheses were supported (i.e., anxiety during speech task reduced and duration of speech task increased over time). At 3-month follow-up, treatment gains were maintained or improved further; 3 participants no longer met the DSM-IV-TR criteria for social anxiety disorder, and 4 participants met criteria for moderate or high level of endstate functioning (i.e., clinical significance). Exploratory analyses revealed that self-monitored social anxiety decreased for 3 of 5 participants, and that a decrease in negative cognitions was associated with a decrease in social anxiety. Working alliance ratings remained high throughout treatment. Satisfaction with videoconferencing decreased over treatment for the participant who did not improve. Generally, comfort with videoconferencing increased over time. The results offer preliminary support for further research about the efficacy of the intervention. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

Thesis (MA)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: Two recent local studies of relapse among individuals who had attended inpatient alcohol rehabilitation programmes in the Western Cape found relapse rates of up to 60%. A high incidence of comorbid anxiety, low self-efficacy and avoidant coping style were principal reasons cited for relapse. The following literary review was undertaken in an effort at better understanding current findings on the comorbid relationship between alcohol abuse/dependency and anxiety, and on dysfunctional coping styles and relapse. It also reviews current literature and theory concerning the treatment of alcoholics using the Relapse Prevention (RP) model of therapy. Based on these findings, recommendations are made for the application of RP to the clinical psychology groups run for alcohol abusing/dependent inpatients at Neuro Clinic D, Stikland Hospital, Western Cape. Relapse Prevention Therapy was selected because of its integrated approach to addressing both substance abuse and the inadequate coping styles that often render people vulnerable to anxiety, depression and relapse. It was also chosen because of the more constructive, less punitive approach it takes to substance dependence/abuse and the issue of lapses and relapse. The recommendations made in this review should not, in any way, be seen as criticism of the existing programme at Neuro Clinic D. They are, essentially, the individual reflections of the author based on the four months he spent conducting clinical psychology groups in the unit and the findings of two local studies that looked at some of the reasons for relapse following treatment in this and other local facilities. The specific focus on the groups run by clinical psychologists should also not be seen as ignoring the important and valuable work done by other professionals in the unit; notably those in psychiatry, nursing, social work, occupational therapy and pastoral care. On the contrary, information gathered by these professionals is vital to the team effort of rehabilitation, and the identification of psychosocial stressors and cognitive patterns that place people at risk of relapse. / AFRIKAANSE OPSOMMING: Twee onlangse plaaslike studies van terugvalonder pasiënte wat binnepasiëntalkoholrehabilitasieprogramme in die Weskaap bygewoon het, het terugvalkoerse van tot 60% gerapporteer. 'n Hoë voorkoms van komorbiede angs, lae sin van self-vermoë en 'n vermydende streshanteringstyl was die hoofredes aangevoer vir die terugval. Die volgende literatuur-oorsig is onderneem in 'n poging tot 'n beter begrip van huidige bevindinge oor die komorbiede verhouding tussen alkoholmisbruik/afhanklikheid en angs, en oor wanfunksionele streshanteringstyle en terugval. Die oorsig beskou ook huidige literatuur en teorie aangaande die behandeling van alkoholiste deur middel van die Relapse Prevention (RP) model (Terugvalvoorkomingsmodel) van terapie. Op grond van hierdie bevindinge word aanbevelings gemaak VIr die toepassing van RP op die kliniese-sielkundegroepe aangebied VIr alkoholmisbruikende/afhanklike binnepasiënte by Neurokliniek D, Stiklandhospitaal, Weskaap. RP is gekies op grond van sy geïntegreerde benadering tot beide substansmisbruik en die onvoldoende streshanteringstyle wat dikwels mense kwesbaar maak vir angs, depressie en terugval. Die model is ook gekies as gevolg van die meer konstruktiewe, minder strafgerigte benadering tot substansafhanklikheid/misbruik en tot val en terugval. Die aanbevelings in hierdie oorsig moet in geen opsig beskou word as kritiek op die bestaande programme in Neurokliniek D nie. Hulle is, in wese, die individuele gevolgtrekkings van die skrywer gebaseer op sy vier maande ondervinding met sielkundegroepe in die eenheid en op die bevindinge van twee plaaslike studies wat ondersoek ingestel het na sommige van die redes vir terugval na behandeling in hierdie en ander plaaslike fasiliteite. Die spesifieke fokus op die groepe wat deur kliniese sielkundiges bestuur word moet ook nie gesien word as 'n geringskatting van die belangrike werk van ander professionele mense in die eenheid nie, in die besonder dié in psigiatrie, verpleging, maatskaplike werk, arbeidsterapie and pastorale sorg. In teendeel, inligting ingesamel deur hierdie mense is lewensbelangrik vir die spanpoging van rehabilitasie, en vir die identifisering van psigo-sosiale stressors en kognitiewe patrone wat pasiënte vatbaar maak vir terugval.

This study used an interdisciplinary approach to examine an intervention for reducing public speaking state anxiety. A quasi-experiment was conducted to determine if a multiple-exposure treatment technique (TRIPLESPEAK) would help to attenuate public speaking anxiety. The treatment group reported experiencing significantly less state anxiety during their post-test presentation than did the control group. This lead to the conclusion that exposure therapy can be used to help students enrolled in basic communication classes begin to overcome their fear of speaking in front of an audience. Follow-up analysis of the treatment group's reported anxiety levels during all five presentations (pre-test, Treatment Presentation 1, Treatment Presentation 2, Treatment Presentation 3, and post-test) revealed an increase in anxiety from the last treatment presentation to the post-test presentation. In order to explore this issue, Shannon's entropy was utilized to calculate the amount of information in each speaking environment. Anderson's functional ontology construction approach served as a model to explain the role of the environment in shaping speakers' current and future behaviors and reports of anxiety. The exploratory analysis revealed a functional relationship between information and anxiety. In addition, a qualitative study was conducted to determine which environmental stimuli speakers perceived contributed to their anxiety levels. Students reported experiencing anxiety based on four categories, which included speaker concerns, audience characteristics, contextual factors and assignment criteria. Students' reports of anxiety were dependent upon their previous speaking experiences, and students suggested differences existed between the traditional presentations and the treatment presentations. Pedagogical and theoretical implications are discussed.

This study examined the effects of test anxiety reduction strategies on U.S. Air Force allied health care students and had a fourfold purpose. The first was to estimate the extent of student test anxiety in allied health care students. The second was to determine the predictors of student test anxiety. The third was to determine if the Student Learning Center provides an effective method of reducing test anxiety in the subjects. The final purpose was to recommend areas for future research.

The problem of this study was to investigate the effectiveness of systematic desensitization on test anxiety, general anxiety, and attitude toward school among fifth-grade elementary-school children.

Introduction: Posttraumatic stress disorder (PTSD) is a disabling psychological disorder that affects about 7% of adults in the United States. PTSD and its symptoms have consistently been shown to have an inverse relationship with exercise participation. The strongest reported associations have been between high intensity exercise, and the hyperarousal and avoidance symptom clusters. Importantly, resistance training (i.e., weight lifting) is thought to have beneficial effects for several conditions that commonly co-occur with PTSD, such as anxiety, depression, and poor sleep quality. However, no studies have examined the effects of high intensity resistance training on PTSD symptoms. Purpose: This study sought to examine the effects of a 3-week high intensity resistance training program on the PTSD hyperarousal and avoidance symptom clusters, sleep quality, anxiety, and depression symptoms in anxious adults who screened positive for PTSD. Additionally, this study explored potential mechanisms of action (e.g., cognitive appraisal, perceived exertion, acute changes in affect, arousal, and distress) between exercise and PTSD. Methods: Thirty trait anxious individuals who screened positive for PTSD were randomly assigned to either a 3-week high intensity resistance training intervention, or a 3-week time-matched attention control group, while blocking for gender. Both groups were required to attend 3 on-site sessions per week, for 3 weeks (i.e., 9 total sessions). Each resistance training session consisted of a 5-minute warm-up, 20 minutes of high intensity resistance training, and a 5-minute cool-down. Each control session consisted of a brief 30-minute educational video on topics not relating to exercise or PTSD. Changes in PTSD symptoms, sleep quality, anxiety and depression were analyzed using repeated measures ANOVA, and potential mechanisms of action were explored with a series of longitudinal mixed-effects regression models. Results: Participants were 73.3% female, with a mean age of 29.1 years (SD = 7.4), and 63.3% identified as a racial minority. Groups did not significantly differ at baseline. There was a Time*Group interaction for hyperarousal symptoms (F = 4.7, p = .04, η2 .18), demonstrating a significantly larger reduction in hyperarousal symptoms for the resistance training group (d = -1.84) relative to the control (d = -1.13). The Time*Group interaction for avoidance symptoms was not significant (F = 1.7, p = .20, η2 = .08); however, the effect size of resistance training was larger (d = -2.71) than the control (d = -1.16). There was a significant Time*Group interaction for sleep quality (F = 4.7, p = .04, η2 = .19), demonstrating greater improvements in global sleep quality for resistance training (d = -1.06) relative to the control (d = -.15). However, there was no significant effect of Time on PTSD-related sleep disturbances (F = 3.0, p = .1, η2 = .13) nor was there a significant Time*Group interaction (F = .09, p = .80, η2 < .01). Similarly, Time*Group interactions for anxiety (F = 3.5, p = .08, η2 = .14) and depressive symptoms (F = 2.7, p = .12, η2 = .11) were not significant. However, resistance training had a large effect on anxiety (d = -.81), and small effect on depression symptoms (¬d = -.41). Regarding the potential mechanisms of action, changes in cognitive appraisal significantly predicted changes in PTSD symptoms during the resistance training intervention (b = 7.1, SE = 2.9, p = .02). Similarly, changes in perceived exertion during exercise was a significant predictor of PTSD symptoms over the 3-week intervention period (b = -3.1, SE = 1.2, p = .01). However, changes in affect, arousal, and distress did not significantly predict changes in PTSD (p’s >.05). Conclusion: This is the first randomized attention-controlled trial testing the effects of high intensity resistance training on PTSD symptoms. The overall results support the hypothesis that resistance training can beneficially affect PTSD symptoms and its commonly co-occurring conditions, such as poor sleep quality. Future adequately powered studies are warranted.

Orientadores: Maria Cristina Volpato, Francisco Carlos Groppo / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-11T23:02:37Z (GMT). No. of bitstreams: 1 Gamba_CarlaGoncalves_M.pdf: 490335 bytes, checksum: a284d83f154dafb6d75ba007f7de4dda (MD5) Previous issue date: 2008 / Resumo: A importância do controle da ansiedade está bem estabelecida na literatura, porém há poucas publicações a respeito de sua aplicação em serviço público de saúde. Assim, o objetivo deste trabalho foi comparar dois protocolos farmacológicos de controle da ansiedade em um serviço de atendimento odontológico público. Dentre os usuários do serviço odontológico da rede SUS do município de Vassouras, RJ, que apresentavam necessidade de tratamento odontológico, foram selecionados 103 voluntários com necessidades especiais ¿ PNE, ou doença crônica não transmissível - DCNT, classificados como ASA II, os quais foram submetidos a exodontia de dentes superiores, em estudo randomizado cruzado, sob 3 condições: 1. Midazolam (foram sedados 30 minutos antes do atendimento com 7,5mg de midazolam por via oral), 2. N2O/O2 (foram sedados com a mistura óxido nitroso/oxigênio durante atendimento), e 3. Sem sedação (foram atendidos sem sedação farmacológica). Foram avaliados os seguintes parâmetros: pré-operatório: grau de ansiedade; pré, trans e pós-operatório: pressões arteriais sistólica e diastólica, freqüências cardíaca e respiratória e saturação de oxigênio; pós-operatório: grau de controle de dor e a percepção sobre a ansiedade do paciente pelo cirurgião-dentista que realizou o procedimento odontológico e pelo voluntário. Também foram avaliados o volume de anestésico utilizado, o custo e o tempo dispendido no atendimento e a preferência do cirurgião-dentista e do voluntário com relação às sessões. De acordo com a variável estudada foram aplicados os testes Qui-Quadrado, Friedman, Mann-Whitney e Kruskal-Wallis (a = 0,05). Foram observados emprego de menor volume de solução anestésica e menores valores para as pressões arteriais sistólica e diastólica, freqüências cardíaca e respiratória nas sessões com sedação farmacológica (p<0,05). Os voluntários apresentaram menor (p<0,0001) ansiedade (auto-relato e relato pelo dentista) nas sessões com sedação. A maioria dos dentistas (88%) e dos voluntários (75%) preferiu a sedação com N2O/O2. O tempo de atendimento foi menor (p<0,05) na sessão com midazolam, sem diferença entre as demais (p>0,05). O custo da sedação é menor com uso de midazolam. Conclui-se que ambos os protocolos de sedação farmacológica foram eficazes em reduzir a ansiedade dos voluntários e promoveram atendimento com melhor controle dos parâmetros cardiocirculatórios. A sedação com midazolam pode ser mais vantajosa em serviço público, nas Unidades Básicas de Saúde (atendimento de baixa complexidade), considerando-se o menor tempo dispendido no atendimento e menor custo operacional, enquanto que a via inalatória poderia ser utilizada nos Centros de Especialidades Odontológicas para atendimento de média complexidade. Devido a importância do controle de ansiedade em pacientes com necessidades especiais, as Coordenações de Saúde Bucal deveriam optar pela capacitação de toda a rede para o uso de protocolos de controle da ansiedade. / Abstract: The importance of anxiety control is well established in the literature, but little is published about its application in public health facilities. The aim of this study was to compare two pharmacologic anxiety control protocols in a public health facility. Hundred and three ASA II subjects (controlled chronic diseases and patients with special needs) from the public dental service of Vassouras, RJ, were submitted to maxillary tooth extraction under the following conditions: 1. Midazolam (sedated with 7.5mg midazolam p.o. 30 min before dental treatment), 2. N2O/O2 (sedated with nitrous oxide/oxygen during dental treatment), and 3. (treated without pharmacologic sedation). The systolic and diastolic blood pressures, respiratory and heart rates and oxygen saturation were evaluated before, during and after dental treatment. The anxiety level was evaluated before each treatment; the perceptions about the dental treatment (anxiety and pain control) by the subject and the dentist who performed the treatment were evaluated at the end of each dental treatment. The volume of local anesthetic, cost and time for the procedures in each session were also evaluated. The subjects and dentists were asked what was the preferred session. The results were submitted to Chi-square, Friedman, Mann-Whitney and Kruskal-Wallis according to the parameter studied (a = 0.05). Less anesthetic volumes and lower values of systolic and diastolic pressures, and respiratory and heart rates were observed in the sessions with pharmacologic sedation (p<0.05). The volunteers presented lower (p<0.0001) anxiety levels (self evaluation and evaluation by dentist) in the sessions with pharmacologic sedation. The N2O/O2 sedation was preferred by most of the dentists (88%) and volunteers (75%). Less time (p<0.05) was expended in the midazolam session with no difference between the two other sessions (p>0.05). The cost of midazolam sedation was lower than that of N2O/O2 sedation. Both pharmacologic sedation protocols were able to reduce the anxiety of the volunteers with a better control of the cardiovascular parameters during the sessions than the observed in the session without pharmacologic sedation. Due to the lower cost and less treatment time offered by midazolam sedation this can be advantageous in public health service. The inhalation sedation with N2O/O2 could be used in public health facilities for medium complexity dental treatment. Public health dental professional should be qualified to offer anxiety control especially to medically compromised patients. / Mestrado / Odontologia em Saude Coletiva / Mestre em Odontologia em Saúde Coletiva

Orientadores: Francisco Carlos Groppo, Maria Cristina Volpato / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-11T23:06:54Z (GMT). No. of bitstreams: 1 Caldas_LuizAlbertoFerrazde_M.pdf: 491019 bytes, checksum: 2cca83d7a350bc6ea47bd322cb57f1ba (MD5) Previous issue date: 2008 / Resumo: Foi objetivo deste estudo, avaliar a eficácia e a viabilidade da técnica de sedação por via inalatória com a mistura N2O/O2, no atendimento odontológico público. O estudo foi aberto, com 100 voluntários (54 homens e 46 mulheres), adultos, com idades compreendidas entre 18 e 50 anos, realizado no serviço de urgência do Hospital Universitário Severino Sombra, no município de Vassouras. Todos apresentaram quadro de pulpite aguda irreversível em dentes superiores. A dor (escala de 11 pontos em caixa - E11) e a ansiedade (auto-declaração) dos sujeitos foram quantificados previamente ao procedimento. Os sujeitos foram divididos em dois grupos: G1 - sedação por via inalatória e G2 (controle) - nenhuma forma de sedação. A anestesia local foi feita pela injeção infiltrativa de 1.8 ml de uma solução de lidocaína a 2% com epinefrina 1:100.000. A pressão arterial sistólica e diastólica (PAS e PAD), a saturação de oxigênio (SpO2), a freqüência cardíaca (FC) e respiratória (FC) foram monitorados antes do atendimento, no momento em que o voluntário se sentava à cadeira odontológica, logo após a anestesia, 10 minutos após a anestesia e após encerrar os procedimentos. O tempo de atendimento (TA) foi medido a partir do posicionamento na cadeira odontológica e do fim do procedimento clínico, quando uma nova E11, o conforto e a opinião sobre a técnica (operador e voluntário) foram avaliados. Nos pacientes do G1 foram aplicados três testes de avaliação Trieger em três momentos distintos: antes do início da sedação, durante a sedação, e após o término da sedação. OBS.: O resumo na integra poderá ser visualizado no link ou texto completo da tese digital. / Abstract: The aim of the present study was to evaluate the conscious sedation performed by nitrous oxide/oxygen (N2O/O2) at the dental public service. The study was open, with 100 subjects (54 male and 46 female), adults, from the dental emergency service¿ of Severino Sombra University-Hospital, in the Vassouras city. All subjects presented irreversible-acute pulpitis in at least one maxillary tooth. The pain (11 box scale ¿ E11) and the anxiety (auto-declaration scale) were both measured previously the treatment. The subjects were than divided into two groups: G1 ¿ conscious sedation and G2 (control) ¿ no sedation. Local anesthesia (LA) was performed by infiltration of 1.8 ml 2% lidocaine with 1:100.000 epinephrine. Systolic and diastolic blood pressure (PAS e PAD), oxygen saturation (SpO2), cardiac (FC) and respiratory (FC) frequencies were monitored before the dental procedures, when the subject was sit on the chair, right after LA, 10 minutes after LA and after the end of the dental procedures. The time for dental procedures (TA) was measured from the moment when the subject was sit on the dental chair and at the end of the dental procedure. Note: the complete abstract is avaiable with the link or full eletronic digital theses or dissertations. / Mestrado / Saude Coletiva / Mestre em Odontologia

M.A. / In accordance with literature indications that have established the need for psychotherapeutic outcome assessment instruments to determine the effects of psychotherapy, an exploratory and comparative study was conducted with anxiety disorder clients in private practice settings. The purpose of the study was to verify the recommendations made in the literature for the use of an idiographic method of outcome assessment (the Dyad Grid), as opposed to typically applied normative methods (the IPAT Anxiety Scale). The nature of the suggestions concerning the application of an idiographic method of outcome assessment, required the development of a theoretical framework which integrated the assessment procedure in an explanatory manner. To this end, the personal construct psychology view of anxiety was discussed in relation to repertory grid technique and prior outcome assessment research conducted with the Dyad Grid. On the basis of the personal construct approach to anxiety, a pre-test post-test research design was used to establish the utility of the Dyad Grid to discriminate between beneficial and nonbeneficial psychotherapy outcomes with anxiety disorder clients. The outcome results of the Dyad Grid assessments were compared with the results obtained from the IPAT Anxiety Scale, in conjunction with qualitative post-therapeutic ratings of benefit, or a lack of benefit, made by the client and therapist. The findings obtained on the basis of 14 case-studies are encouraging. The Dyad Grid displayed a statistically significant level of agreement with the client and therapist ratings of therapeutic outcome (onetailed, p = 0,05), whereas the IPAT Anxiety Scale did not. Though limited to a sample of convenience, and subject to an idiographic methodological bias, the discussion of the results indicated that the study provides support for the use of idiographic procedures as an alternative to nomothetic methods of outcome assessment. It is concluded that the initial success of the Dyad Grid in assessing psychotherapy outcome as beneficial or non-beneficial warrants further investigation with a large sample research design.