Understanding how change occurs in psychotherapy is imperative in informing clinical practice. Increasing attention has been given to the role that qualitative research could play in enhancing our understanding of therapeutic change. Although quantitative research suggests that parent-child psychotherapy is effective in facilitating change, no research to date has focused on how parents make sense of their change experience. Interpretative Phenomenological Analysis was used to analyse semi-structured interviews of eight parents who had completed parent-child psychotherapy about their understanding of change. Five master themes emerged which encapsulated participant’s understanding of change. These included constructing a survivor narrative, the experience of being understood enabling further understanding, adjusting expectations and practicing acceptance and feeling empowered to relinquish control. The final theme summarised how despite psychotherapy being conceptualised as a ‘precious’ resource, there was a sense that its limitations could negatively impact participant’s wellbeing. The study concluded that meaningful elements of change were identified from the parents’ experience. Findings were discussed in relation to previous research. Limitations and implications for future research and practice were examined.

There is an emerging interest in the literature base around the use of group singing in dementia care. Although studies indicate positive outcomes, limited research has been carried out from a relational perspective. Additionally, theoretical underpinnings of the reported benefits have yet to be explored. This study aims to investigate the key theoretical mechanisms underlying the experience of group singing. Interview data from seventeen couples who sing together in a group is analysed using grounded theory method. Several key aspects of group singing are presented, namely that the positive experience of the act of singing combined with effective group facilitation enables equal participation and a powerful group effect. A further benefit of new learning and creativity is explored. Implications for clinical practice and possible directions for future research are outlined.

This study explored the application of Weiner’s attribution models of helping behaviour to care staff working with overweight people with learning disabilities. Staff were asked to have a client in mind who was significantly overweight and to complete self-reports of their attributions, affect, optimism and willingness to help the person with their weight. The study found that staff rated their clients’ weight as being attributed slightly more to internal factors than external factors, being low in controllability and high in stability. Staff reported low levels of positive and negative emotion but high levels of sympathy, optimism and willingness to help. No associations were found between attributions or affect and willingness to help. Only optimism was associated with willingness to help. The findings did not support the applicability of Weiner’s attribution models to staff supporting overweight people with learning disabilities. These findings contribute to the inconsistent literature on the applicability of Weiner’s model to staff helping in LD services. Future research should clarify whether willingness to help relates to effective health helping strategies and to explore this further in service contexts. The clinical implications for staff training include enhancing staff’s optimism in health change and providing skills in constructively engaging client’s in healthier behaviours.

Physical activity (PA) during pregnancy is safe for both mother and fetus in the majority of cases, including for women who have undergone in vitro fertilisation (IVF) treatment; however, this population is likely to face unique barriers to PA. Currently, there is a paucity of research exploring the qualitative experiences and decision-making processes surrounding PA for women who have undergone IVF treatment. Eight women, who had undergone successful IVF treatment and given birth within the last two years, participated in semi-structured interviews about their experiences of PA during pregnancy. Interview transcripts were analysed using interpretative phenomenological analysis. Three super-ordinate themes emerged from the data: ‘experiences of loss and opportunities for hope’, ‘navigating risks and obstacles’, and ‘PA can be a valuable part of pregnancy’. Women’s experiences of PA during pregnancy varied. For some, it was a way to keep hold of their active pre-pregnancy selves, for others PA was experienced as a risk to pregnancy, thus influencing the decision-making process. Limitations of the study are considered, as well as implications for clinical practice and directions for future.

Section A provides a critical review of the literature pertinent to children’s imaginary companions, including definitional issues, historical background, and prevalence. Empirical research concerning the characteristics of children who create imaginary companions is presented, followed by an overview of theories attempting to explain the development and functions of imaginary companions. Empirical research investigating the functions of imaginary companions in normative populations is then reviewed, followed by research into the imaginary companions of children from clinical populations. The review concludes by reviewing the literature into the use of imaginary companions as part of psychological therapy. Section B Imaginary companions represent a common childhood developmental phenomenon, to date, largely neglected in the clinical literature. The grounded theory study investigates the functions and therapeutic use of imaginary companions in a clinical population, by interviewing clinicians working therapeutically with young people accessing Child and Adolescent Mental Health Services. Participants were 10 UK clinicians, most practising as child clinical psychologists. Clinicians reported that imaginary companions served a number of fundamental functions, including serving as a communication aide, a secure attachment figure, proving mastery over a child’s world, and acting to maintain stability in the environment, and in a child’s self-image. Imaginary companions were utilised by most clinicians as part of engagement, and to gain insight into young people’s difficulties. Depending on their salience, and congruence with young people’s self-image, imaginary companions were used as therapeutic allies, to aid perspective-taking, and as a way to manage the intensity of interactions with clinicians. Imaginary companions were not therapeutically utilised by a sub-section of clinicians, owing to their perceived low salience, and to clinical risk issues. The findings are discussed in relation to existing theory and research, and methodological limitations, implications for clinical practice, and directions for future research are provided. Section C provides a critical appraisal of the research methodology and findings, and elaborates on clinical implications and future research ideas discussed in Section B.

P-hacking can be described as a more or less deliberate, explorative approach to data analysis with a flexible/opportunistic search space and the reporting of primarily statistically significant findings. This leads to inflated type-1 error rates and to bias in reported estimates in the scientific literature. This thesis aims to describe how p-hacking can be manifested in academic research and to illustrate how bias due to p-hacking is expected to affect the veracity of published findings using two specific examples from the literature. This thesis also argues that when evaluating published findings in the current academic environment, we should assume a priori that biases due to p-hacking and publication bias are present. The thesis used Monte Carlo simulations and systematic reviews of the literature in two specific fields: the proposed associations between exposure to night work and breast cancer in women, and between job strain and coronary heart disease. A general model and mathematical framework to predict expected bias from p-hacking was developed, and can be used for  a priori defined protected inferences of any published finding, under explicit assumptions of various levels of p-hacking. The model indicated a close to 100% chance of demonstrating a false positive association in larger studies, but also showed that even minimal p-hacking results in substantial bias in estimates. The literature review identified large flexibility in the analytical process, allowing for the final model to be picked from a large pool of available models, with an implied search space of thousands of estimates. Some of the specific observations made here could be used to argue evidence for high risk of p-hacking and publication bias in the reviewed literature: None of the 17 reviewed studies on job strain and coronary heart disease reported the proper estimate of the job strain interaction (chapter 6) and our analysis showed that the proper estimate would not have been statistically significant in any of the studies (chapter 7). One study described a data driven approach with an implied search space of at least 502 models, where adjusting for confounding did not reduce the strength of the association, as would be expected, but instead increased its strength so it fell above the threshold for statistical significance (chapter 5). One study was based on a speculative and marginally significant estimate after arbitrarily restricting the analysis to a subgroup, when estimates on the full group were available and indicated a non-significant association (chapter 5). Statistical power analyses on research into night work and breast cancer indicated that statistically significant findings were over-represented in the literature (p≈.001) suggesting the presence of bias from p-hacking or selective publishing of significant findings (chapter 5). The findings also suggest that previously reported estimates in meta-analyses was likely to represent prevailing bias in the two fields reviewed here. A bias-adjusted meta-analysis on the job strain model and coronary heart disease with a total of 462,220 subjects and 6,836 CHD events indicated no support for the job strain interaction (RR=1.00; 95% CI: 0.88--1.14). In addition, it did not show an increased risk due to high job demand (RR=1.03; 95% CI: 0.97--1.11) but it did confirm previously reported risks due to low job control (RR=1.11; 95% CI: 1.03--1.20).

Every year, approximately 3000 people die as the result of physical trauma in Sweden (Gedeborg, Chen, Thiblin, & Byberg, 2012). Many of these deaths occurs outside of the hospital and are preventable, including some caused by hemorrhage. One hemorrhage control device is the tourniquet which can be used in a civilian pre-hospital setting. The effects of stress on a laypersons tourniquet application ability is unknown and to date only one study have examined the effects of stress on tourniquet application in a military population (Schreckengaust, Littlejohn, & Zarow, 2014). The purpose of this study was to investigate how the performance of two first aid interventions, tourniquet application and cardiopulmonary resuscitation (CPR), is affected by stress in immediate (layperson) and first (professional) responders. A total of 55 participants followed a brief educational program about hemorrhage control. Their ability to apply a tourniquet and perform CPR was tested in a calm classroom scenario and a stressful scenario, which consisted of paintball fire and an obstacle course. Stress was assessed through subjective reports of stress, physiological heart rate and heart rate variability measurements, and subjective workload and with a secondary task. The results showed differences of elicited stress reaction between the conditions and groups. Tourniquet and CPR performance was moderately affected by stress. Participants across all groups experienced more stress reactions during the stressful scenario, and laypersons did experience more stress reactions than professional first responders. In conclusion, the method did make participants experience more stress reactions in terms of psychological, physiological and performance adaptations in the stressful scenario. However, the results need to be replicated and a list of suggested improvements are given, such as: examining the fidelity of the scenarios, validating the tourniquet application assessment method, and examining the relationship between tourniquet application performance and self-assessed performance.

Psykoterapeutisk behandling har traditionellt utvärderats med diagnosspecifika skattningsskalor. Syftet med psykoterapi ses alltså som besvärsminskning. Denna metod kan vara problematisk eftersom items i skalorna inte alltid är relevanta för patienten, och denna syn på psykoterapi inte är kompatibel med KBT som metod. Ett alternativ till att mäta besvär är att istället se till patientens mål och utvärdera terapin utifrån dessa. Ett sådant sätt att mäta kan ha flera fördelar; vara mer relevant för den enskilda patienten, ha en terapeutisk effekt i sig självt, ge en riktning åt terapin, ge kriterier för utvärdering samt vara mer kompatibelt med KBT. Dock saknas kunskap om relationen mellan minskning av besvär och uppfyllelse av terapimål under psykoterapi. I denna studie undersöks relationen mellan besvärsminskning och måluppfyllelse under behandling session för session. Data samlades in från nio behandlingar, och resultaten visade som förväntat en negativ korrelation mellan besvärsminskning och måluppfyllnad. Ingen tydlig trend kunde ses i vilket mått som förbättrades först. Ett starkare samband fanns mellan livskvalitet och måluppfyllelse än mellan livskvalitet och besvärsminskning. / <p>Psykoterpeutexamensuppsats</p>

Arbetsprestation som inte går ut över anställdas hälsa är viktigt ur etthållbarhetsperspektiv. Tidigare forskning har visat att anpassning avden psykosociala arbetsmiljön kan främja mental hälsa ocharbetsprestation. En del studier har även visat att individens personligaresurser har betydelse för arbetsprestation och mental hälsa. Syftet medföreliggande studie var att utöka förståelsen för hur olika psykosocialaarbetsmiljöfaktorer tillsammans med personliga resurser relaterar tillarbetsprestation och mental hälsa. Data baseras från en enkätstudie avtjänstemän (N=237) som sedan analyserades med en hierarkisk multipelregressionsanalys. Resultaten visade att en hög autonomi ochpersonliga resurser var positivt relaterade med arbetsprestation ochmental hälsa. Höga kvalitativa arbetskrav visade sig vara negativtrelaterad med mental hälsa och arbetsprestation. Dessa resultat kanbidra till ökad förståelse för hur organisationer kan arbeta för att uppnåhållbar prestation.

För att uppnå en hög prestation på företag satsas miljontals kronor på ledarskapsutveckling varje år. Det huvudsakliga syftet med dessa är att utveckla medarbetarna genom sina chefer. Trots detta glöms medarbetarperspektivet ofta bort när dessa insatser utvärderas. Studiens syfte är därför att undersöka medarbetarnas upplevelser av sina chefer efter att de hade genomgått en ledarskapsutveckling på XY Energy Organization (fiktivt namn). En förstudie låg till grund för intervjuguiden till datainsamlingen. Fallstudien bestod av tolv (n=12) kvalitativa semistrukturerade medarbetarintervjuer som sedan analyserades tematiskt. Detta gav författarna möjligheten att jämföra medarbetarnas upplevelse med ledarskapsutvecklingens struktur. Resultatet visade att medarbetarna upplevde insatsen som positiv både när är det kommer till sina chefers ledaregenskaper och företagets organisationskultur. Den positiva medarbetarupplevelsen kan förklaras genom att ledarskapsutvecklingen lade stor vikt vid medarbetarperspektivet och att individanpassa insatsen till cheferna. Den var även omfattande, långsiktig, anpassad till det vardagliga arbetet och utgick från ett aktivt lärande. Förbättringsområden hade varit att följa upp insatsen bättre efteråt, samt att förbättra organisationens intranät för att utveckla kommunikationen inom organisationen ytterligare.