Idag finns vetenskaplig evidens för att livsstilsförändringar kan sänka blodtrycket hos patienter med hypertoni. Rekommendationer vid behandling av hypertoni är i första hand hälsosamma livsstilsförändringar. Syftet var att belysa faktorer som påverkade patienters följsamhet till livsstilsförändringar vid hypertoni. Metoden som användes var en litteraturstudie. Databearbetning gjordes utifrån 15 vetenskapliga artiklar. Artiklarnas vetenskapliga kvalitet granskades. Därefter analyserades artiklarnas resultatdel och bearbetades för att finna faktorer som kunde påverka patientens följsamhet till livsstilsråd. Fyra kategorier framkom; patientens kunskap och inställning till sin hypertoni, behandlingsprogram och uppföljning, vårdpersonalens kunskap och bemötande samt sociodemografiska och kliniska faktorer. Resultatet visade vikten av att ge råd om livsstilsförändringar till varje patient utifrån den enskildes situation. Vid information är det viktigt att personalen har aktuell kunskap och kan delge den på ett motiverande sätt. För att minska antalet individer med hypertoni bör hälso- och sjukvården i större utsträckning prioritera hälsopromotivt arbete. Utbildning och stöd till personalen krävs för att kunna följa de senaste rekommendationerna som finns för hälsosamma livsstilsval. Studien visar hur betydelsefullt det är för patienter att få utbildning och stöd för att göra positiva livsstilsförändringar. / Today there is evidence based science which shows that lifestyle changes can reduce blood pressure in patients with hypertension. Recommendations for treatment of hypertension are healthy lifestyle changes. The aim was to examine factors that affect patient’s adherence to lifestyle changes when they got hypertension. The method was a literature study.  Data processing was made of 15 science journals. The science qualities of the journals were examined. After that the results in the journals were analyzed to find factors which could affect patient’s adherence to lifestyle changes. Four categories became clear; patient’s knowledge and adjustment to their hypertension, treatment program and follow-up, healthcare personnel’s knowledge and attitude and socio-demographic and clinical factors. The result showed that it is important that right information about lifestyle changes is given from the patient’s own situation. When information is given it is important that personnel have the latest knowledge and can give it in a motivated way. To decrease the number of individuals with hypertension and following diseases, healthcare services should prioritize health promotion. The personnel should receive education and support to be able to follow the latest recommendations there are for healthy lifestyle choices. Education and support is important for patients in their choice of making positive lifestyle changes.

The literature review produced for this thesis systematically analysed qualitative studies of cognitive therapy using a methodology checklist and a meta-synthesis technique. Ten papers which used qualitative analysis to look at clients’ experiences of Cognitive Behavioural Therapy (CBT) met the selection criteria. Seven themes emerged. Three were linked to a therapeutic relationships theme; the trusted listener, power and authority and others like me. Four were linked to the impact of cognitive therapy theme; empowering information, analysing the problem, thinking differently and doing things differently. It was concluded that future research should focus on the components of cognitive therapy and that differences in technique between CBT and Rational Emotive Behaviour Therapy (REBT) should be explored via a qualitative study of clients’ experiences of REBT. A qualitative approach was taken to look at clients’ experiences of REBT. Seven participants were interviewed using a semi-structured interview guide and the resulting transcripts were analysed using interpretive phenomenological analysis. Three themes emerged: one which looked at what it was like to have mental health problems; a second, which looked at clients’ expectations and experiences of the more technical aspects of therapy, and a third which examined the therapeutic relationship. All of the participants appeared to value therapy. However, the extent to which they knew about and used the theory and philosophy of REBT varied greatly. These results suggest that further research needs to be carried out which looks at how people benefit from therapy as clients views may differ from those of therapists. A critical appraisal of the research process was written using the REBT model to reflect the experience of producing the thesis.

Purpose: Describe the Suquamish cultural influences on defining living a life worthwhile and to describe the compatibility of a culturally modified Dialectical Behavior Therapy (DBT) with a Native American community's culture and context. Background: Native Americans experience serious psychological distress, suicide, and substance abuse at higher rates than other racial groups. Studies using DBT found a significant decrease in parasuicidal risk behavior and substance abuse. However, research has not demonstrated that DBT is efficacious or compatible within the Native American culture. Specific Aims: 1) Describe the Native American cultural influences on defining living a life worthwhile. 2) Describe the compatibility between Healthy and Whole, a culturally modified DBT intervention with Native American culture. Methodology: Critical ethnographic study with in-depth interviews (13) and participant observations (10 months) was conducted. Sample was tribal members and clinicians exposed to the Healthy and Whole and tribal members who are identified as knowledgeable regarding tribal tradition. Analyses included semantic domain, taxonomic, and theme analysis for aim1 and compared DBT curriculum to results of aim 1 to accomplish aim 2.Findings: An intergenerational cycle of relational trauma was initiated by structural cultural genocide with systematic abuse and neglect of Native Americans especially children. Relational trauma of abuse and neglect is the source of a variety of maladaptive behaviors. These maladaptive behaviors lead to relational trauma in the next generation. A dual process of maintaining and revitalizing Suquamish cultural values coupled with skills taught in a culturally modified DBT intervention, Healthy and Whole, help Suquamish members live more worthwhile lives and recover from intrapersonal trauma. Implications: Healthy and Whole is a community approach to healing from relational trauma. Healthy and Whole approach to DBT may help other indigenous people live more worthwhile lives and recover from relational trauma and break the cycle because Suquamish cultural values are collectivist and many indigenous peoples share similar values and histories of historical trauma.