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Insomnia disorder is a debilitating sleep disorder that impacts nearly 10% of Canadian adults. Cognitive Behavioural Therapy for insomnia (CBT-I) is a psychological treatment that targets cognitions and behaviours to improve sleep outcomes. CBT-I has been shown to be an effective treatment for insomnia symptoms; however, little is known about the cognitive and physiological underpinnings of the treatment response. This thesis examines correlates of cognitive, clinical, and biological markers of change across group CBT-I treatment. Specifically, we evaluated: (1) objective and subjective cognitive and psychosocial functioning, (2) discrepancies between objective and subjective measures of sleep, and (3) the relationship between a biological marker of stress and sleep parameters. The first study in this thesis investigated how objective and self-report measures of cognitive functioning, and psychosocial functioning changed across CBT-I. Findings illustrated that changes in self-report cognitive ability and psychosocial functioning were related to the improvements in insomnia symptom severity across treatment. The second study investigated the discrepancy between objectively measured sleep with actigraphy and self-reported sleep variables. Findings showed that the mismatch between objective and subjective sleep parameters decreased early on during the implementation of CBT-I. Additionally, improvement of clinical symptoms was related to a decrease in sleep discrepancies across treatment. In the third study, we examined if there was a relationship between a biological marker of oxidative stress across CBT-I. Results showed that following CBT-I, the biological marker was related to both objective sleep parameters and self-reported symptom improvement. Overall, this thesis demonstrates that in our well-characterized sample of adults with insomnia disorder, group CBT-I was associated with significant post-group changes in cognitive, clinical, and biological factors. This has important implications for the factors that may influence an individual’s treatment response to CBT-I, and thus lead to improvements in tailoring treatments to optimize outcomes for treatment of insomnia disorder. / Dissertation / Doctor of Philosophy (PhD) / Insomnia disorder is a sleep disorder that negatively affects day-to-day-functioning and is associated with poorer mental and health outcomes. Cognitive Behavioural Therapy for insomnia (CBT-I) is an established psychological treatment that focuses on changing sleep behaviours and thinking patterns for improving sleep. This thesis aimed to examine factors that may be related to how CBT-I works to improve sleep with both self-reported and objective measures. We investigated whether cognition (e.g., memory and attention), different measures of sleep, clinical symptoms, and biological factors associated with sleep changed across treatment with CBT-I. Results indicated that several self-reported measures of cognition and sleep improved across CBT-I. Our findings suggest that these variables were related to improvements in sleep following CBT-I. By understanding what factors may be contributing to sleep difficulties and change across CBT-I, we can improve treatment outcomes and better adapt treatment strategies to those struggling with insomnia disorder.

This study investigated the effectiveness of the Triple P Programme to reduce stealing behaviour in three preadolescent children. Using behavioural monitoring and self-report questionnaires, outcome measures included stealing behaviour, parenting practices, parenting efficacy, and parental mental health. A measure of change was also included to identify change points in the therapeutic process. Results suggest that parent training is effective in the reduction of stealing behaviours, as positive changes were found across all the measures employed. This early intervention has the potential to disrupt an antisocial developmental trajectory for children who steal. Limitations of the study and directions for future research are discussed.

Disordered speech has long been recognized as one of the core features of schizophrenia; it is stable across the course of the disorder, and has been identified as a rate limiter of functional outcome (e.g., social skills, scholastic achievement, vocational success). While much of the recent research on thought disorder has focused on the mechanisms behind disordered speech, we have observed a very limited transfer to clinical applications that promote gains in communication skills. The purpose of this study was to evaluate the efficacy of a novel treatment, Structured Therapy for the Enhancement of Purposeful Speech (STEPS), based in behavioural learning principles, to increase goal-directed speech in individuals with schizophrenia. The current study is one of the first to evaluate an intervention specifically aimed at increasing the core symptom of disorganized speech and evaluating change across multiple indicators of discourse. STEPS is based in principles of operant conditioning, wherein sessions take place three times per week for a total of three weeks. In a single-case multiple baseline design, participants (N=3) received positive reinforcement for engaging in goal-directed speech and directive feedback for committing speech errors, thereby increasing or decreasing frequency of that behaviour, respectively. Participants were assessed before, during, and after treatment on a series of thought disorder and speech coherence measures. Primary outcome measures included change in frequency of communication errors within sessions over the course of treatment and severity of thought disorder on standard disorder measures at three assessments points. Participants demonstrated a significant reduction in number of communication errors across unstructured conversations and structured storytelling components such that all participants engaged in significantly more goal-directed communication during treatment sessions compared to baseline performance. Furthermore, all participants were rated as expressing less severe disconnected speech according to a gold-standard measure of thought disorder. Effective communication is central to successful social interactions from building new interpersonal relationships, advocating for oneself to medical professionals, to demonstrating appropriate skills during interviews. The results of this study suggest that this symptom is amenable to change and can be treated in order to promote real-world functional gains. / Thesis (Master, Psychology) -- Queen's University, 2012-08-28 14:24:36.471

This study investigated the effectiveness of the Triple P Programme to reduce stealing behaviour in three preadolescent children. Using behavioural monitoring and self-report questionnaires, outcome measures included stealing behaviour, parenting practices, parenting efficacy, and parental mental health. A measure of change was also included to identify change points in the therapeutic process. Results suggest that parent training is effective in the reduction of stealing behaviours, as positive changes were found across all the measures employed. This early intervention has the potential to disrupt an antisocial developmental trajectory for children who steal. Limitations of the study and directions for future research are discussed.

Postnatal depression (PND) is a serious and debilitating condition that disrupts women's lives at a time when they are already under stress, adapting to the substantial demands having a baby creates. PND is linked with adverse effects on the development of the child and the family system, including poor marital adjustment and elevated levels of depression in male partners. Implications, not only for men's health, but also for the amount and quality of support men can provide for their partners and children are far-reaching. Preventative programmes for the treatment of PND have been widely advocated, but are rare in the literature. Even fewer, are treatment programmes that include male partners. This study compared the efficacy of a structured Cognitive Behavioural Therapy (CBT) programme for the treatment of PND, delivered in 3 different ways, within an Australian semi-rurallcoastal community. Thirty-nine women, diagnosed with PND, completed 10 weeks of either 'individual' (n=9), 'group women only' (n=16) or 'group partners involved' (n=14) intervention and were compared with a control support group (n=7). Pre-intervention, women in the study reported the presence of a number of psychosocial risk factors for PND and almost 20% of the men in this sample were also depressed according to the BDI-II. Partners of the women in the 'group partners involved' treatment completed a 6-week CBT group programme especially designed for men (n=13). Partners of the women involved in the other interventions acted as a control group (n=16). Depression, anxiety, parenting stress, relationship adjustment and social support measures were taken using standardized instruments at pre-intervention, post-test and at 3- and 6-month follow-up. Qualitative information about the experiences of PND and the intervention programme was obtained through focus group interviews. The intervention programme was evaluated by questionnaire by both participants and their general practitioners or allied health professionals who had referred them to the programme. Results indicated that, overall, the 10-week, structured CBT programme was far more effective in treating PND than attending a support group. Over time, group therapy outperformed individual therapy for depression and anxiety. Including partners in intervention meant significantly improved outcomes at 6-month follow-up for depression, anxiety and relationship adjustment for women. When male partners were included, women's social support levels were significantly higher at 3-month follow-up. Post-intervention men who participated in the men's group were significantly less depressed and stressed, and showed higher levels of social support than controls. The intervention programme was rated highly by both participants and referrers for effectiveness and acceptability, with the psychoeducational information and CBT strategies rated as the most useful components. Participants viewed the inclusion of male partners in PND treatment as fundamental and strongly recommended increased community and professional awareness of PND and its consequences. The important implications for clinical practice and resource allocation raised by this study are addressed.

Psychological distress is common during pregnancy. The objective of this thesis was to evaluate the effectiveness of antenatal cognitive behavioural based treatments in reducing psychological distress in pregnant women. A systematic review was undertaken of randomised controlled studies utilizing antenatal cognitive behavioural based treatment in reducing anxiety and stress compared to treatment as usual. Eleven papers were identified through a systematic search of databases using predefined criteria comparing intervention groups to treatment as usual in pregnant women with anxiety or stress. The systematic review revealed preliminary evidence for the effectiveness of cognitive behavioural based treatment with several studies noting changes over time in anxiety and stress; however, only a few studies reported intervention effects when compared to control. While the systematic review results suggest that a small number of cognitive behavioural based interventions may be effective in reducing anxiety and stress during pregnancy compared to treatment as usual, confidence in these findings is limited due to methodological limitations such as lack of follow-up, high attrition rates and difficulties with generalisability. The evidence base is currently insufficient and further research which utilises a robust methodology is needed before any reliable conclusions can be drawn. An empirical study was conducted to examine the effectiveness of a brief, single-session stress reduction programme introducing cognitive behavioural techniques aimed at reducing general anxiety, other pregnancy related distress and improving general well-being and pregnancy outcomes. Twenty-nine participants with clinically significant levels of anxiety were recruited to the empirical study from the local maternity hospital. Participants completed measures of general anxiety, pregnancy related anxiety, general well-being and childbirth experience. The control was derived from a historical dataset where 37 participants were matched for baseline anxiety levels. The empirical study demonstrated significant reductions in general anxiety; however, similar findings were also observed in the control group. Significant reductions were observed with pregnancy related anxiety and women also reported their childbirth experience similarly regardless of delivery type. Although our findings were not significant when compared to control, our recruitment design resulted in good return rates following birth. Further studies using sophisticated study design with use of robust control group are required.

Cognitive models of Social anxiety disorder (SAD) routinely discuss the cognitive biases (e.g., attentional, interpretation, memory) that contribute to thinking about oneself negatively before, during, and after social or performance situations. However, these models do not mention other impacts of negative self-evaluations - including negative evaluations of others - even though cognitive case formulations often include beliefs about oneself, others, the future, and the world. Importantly, CBT for SAD does not always lead to optimal subclinical symptoms at the end of treatment; suggesting that our most evidence-based treatments require modifications. Few studies have experimentally examined the presence of negative evaluations of others within social anxiety, which has led to inconsistent understanding about whether people with social anxiety demonstrate negative evaluations of others. These conflicting findings are even more complicated by no study examining if the negative self-evaluations that are commonly reported by people with SAD cause negative other-evaluations, and vice-versa. I outline two studies in this dissertation where I aimed to understand the relationship (or lack thereof) between negative self-evaluations and negative other-evaluations and its cognitive, behavioural, and emotional consequences. In Study 1, I randomly assigned an unselected sample (N = 152) to provide no-, medium-, or high-evaluations of a videotaped anxious person. Participants also took part in a 10- minute conversation task with a confederate posing as another participant. I measured social anxiety symptoms, state anxiety and electrodermal activity across four-time points, and several measures related to self- and other-evaluations. Overall, my manipulation was effective as participants responded to the subsequent other-evaluations in the way I anticipated. Despite this, I found no differences between conditions on most of my primary self-evaluation outcomes. However, I observed that participants in the high-evaluation condition demonstrated poorer memory recall. In Study 2, I randomly assigned an unselected sample (N = 169) to receive positive, ambiguous, or negative false-feedback following a conversation task with a confederate. My manipulation was effective, and again, I found no differences between conditions on my primary other-evaluation outcomes. Participants in the negative-feedback condition reported greater state anger following the negative evaluation for the remainder of the study, compared to participants in the other conditions. Ultimately, evaluations of others were less problematic than I initially expected. Because I did observe cognitive and emotional consequences of this self-other process, these findings could have important implications for further refinement of SAD models and treatments using Cognitive Behavioural Therapy.

The effectiveness of a Group CBT programme for Social Phobia was assessed using 18 participants recruited from a routine practice setting. Therapy was based on CBT techniques as practiced routinely by the clinical practice, and were not modified for the study by factors such as strict exclusion criteria and adherence to rigid manualised treatments. Pre- to post-treatment effect sizes compared favourably with those reported in a meta-analysis (Taylor, 1996). The findings provide support for the accessibility and effectiveness of group CBT techniques for Social Phobia in field settings. While some individuals within the sample experienced dramatic improvement, some remained severely impaired even at post-treatment. The results of Hierarchical Multiple Regressions indicated that lower levels of pre-treatment depression severity, higher levels of attendance, and greater homework compliance, were predictive of more improvement on some, but not all, measures of outcome. Implications for treatment are discussed.