The aim of this qualitative research project was to investigate the experiences of clients who had received Cognitive Behavioural Therapy (CBT) and Person Centred Therapy (PCT) in primary care. The rationale for the investigation was to inform the assessment and referral process whereby prospective clients are assigned to the two different therapies. A total of 16 clients responded to an invitation to attend an unstructured interview (PCT = 9; CBT = 7) to talk about their experiences of therapy. The resulting transcripts were analysed using Grounded Theory methodology. Transcripts were broken down into meaning units and conceptualised as categories, using the constant comparison method. The categories were integrated, a core category conceptualised and a theory generated. A comparison of the accounts revealed similar and contrasting experiences. The main categories (eg Accessing therapy, Engaging with the therapy) could be organised in the chronological order of the client`s journey through therapy. All participants entered therapy with a particular view of reality. In successful therapy this view changed and they went on to manage their lives in a more constructive way. Participants attributed this change to different elements of the therapy (categorised as It did the trick) which brought about a new understanding (categorised as The key). Where therapy was unsuccessful this did not occur. The mechanism of change was personal to the individual and did not appear to be specific to either therapy. Some of the mechanisms appeared to be consistent with the therapy received (eg. Carrying out tasks, in the CBT group). Others appeared counterintuitive (eg. Putting me straight, in the PCT group). The differences and similarities in the participant`s experiences appeared to be due to the therapist and client`s capacity to respond to each other in order to make the therapy “work.” The Core Category, Reciprocal Responsiveness, was chosen to explain this. The findings also suggest that the ability of the therapist and client to respond to each other will affect the outcome of therapy. The theory was constructed that the outcome of therapy is determined by the occurrence of a sufficient degree of Reciprocal Responsiveness. This study has implications for the assessment process as the findings suggests that, when making a referral, it may be helpful, to take into account the potential client`s activity and responsiveness rather than relying solely on diagnosis. It also contributes to the growing body of literature emphasising the importance of therapist responsiveness to the individual needs of the client, rather than strict adherence to one therapeutic approach. The study is limited to two therapies within primary care. Future studies may consider clients experiences within other settings and with other therapeutic approaches.

This research explores the beliefs and behaviour of individuals who have suffered a traumatic experience, specifically the violent crimes of assault, motor vehicle hijackings and armed robbery. The researcher focuses on the occurrence of residual, subclinical symptoms of PTSD that individuals experience subsequent to the specified violent crimes. By identifying and describing trends in commonalities that exist between research participants’ accounts of such residual, subclinical symptoms the research aims to explore and describe these trends, enabling a common understanding and awareness of the longstanding effects that these experiences have on individuals. The qualitative research design allowed for an exploration aimed at understanding the meaning that individuals ascribe to specific events. Three case studies were examined. The researcher ensured the exclusion of individuals who met the criteria for PTSD by making use of the PCL-S. From this approach a thematic analysis was done using the transcriptions of audiotaped interviews with the participants. The three participants chosen for the study were aged twenty-nine (29), thirty (30) and thirty-one (31) independently. Two of the participants experienced an armed robbery, which were, independently, followed by non-violent crime of housebreaking and theft. A third participant experienced an armed robbery during her early childhood, and an additional crime of aggravated robbery in adulthood. The studied violent crimes had taken place between one year eleven months and six years prior to this study. None of the participants have received therapy following their traumatic experience. Five important findings were identified and discussed. Firstly, some individuals still meet the requirements for a diagnosis of PTSD, even years following their experiences with traumatic events. Secondly, following the experience of a violent crime some individual’s core cognitive schemas regarding themselves, their world and their relationships undergo various changes. Thirdly, some individuals experience numerous posttraumatic symptoms, which are not extensive enough to validate the diagnosis of PTSD, but that affect the individual’s life on a regular basis. Nine symptoms were identified in this study. Fourthly, some individuals may experience additional effects following exposure to violent crimes, e.g. physical illness, that is not classified as posttraumatic symptoms. Fifthly, a few individuals who have been the victim of more than one crime may experience cumulative or diminished effects when one explores the overall effects of revictimisation. Results also indicated that individuals may experiences similar posttraumatic symptoms, but that the presentation of these symptoms are unique and are influenced by an individual’s history, cognitive schemas and the characteristics of the crimes that they have experienced. Finally, these findings explored and described the phenomenon of partial posttraumatic stress disorder in order to expand the understanding of this occurrence. / Dissertation (MA)--University of Pretoria, 2014. / tm2015 / Psychology / MA / Unrestricted

Aus der Einleitung: "Nahezu jeder zweite Deutsche war oder ist akutell regelmäßiger Raucher. Fast ein Viertel - in manchen Altersstufen sogar mehr - aller Adoleszenten und Erwachsenen sind nikotinabhängig oder stark gesundheitsgefährdete "starke Raucher" mit mehr als 20 Zigaretten pro Tag. Fast alle regelmäßigen Raucher wissen zwischenzeitlich, daß Rauchen gefährlich und gesundheitsschädlich ist; jeder zweite Raucher bezeichnet sich sogar selbst als "abhängig. 90% haben bereits mindestens einmal über zumindest einige Tage versucht aufzuhören - ohne Erfolg. [...]"

Einleitung: "Verhaltenstherapie" kommt in ihr zweites Jahr. Zum Start, vor einem Jahr, haben wir Aufgaben, Ziele und Erwartungen formuliert, die in bisher vier Heften der Realitätsprüfung unterzogen wurden. In unserer ersten Jahresbilanz stellt sich die Frage, welche Ziele 1991 schon erreicht wurden und welche 1992 voraussichtlich erreicht werden.

Purpose: The purpose of this study was to determine whether levels of physical activity in people with chronic pain change after participating in a Chronic Pain Management Program (CPMP) at Groote Schuur Hospital (GSH). Methods: A pre-experimental pre-test, post-test study was conducted, consisting of 14 men and women suffering from chronic pain who were referred to a Chronic Pain Management Program (CPMP) from the Chronic Pain Management Clinic at GSH in Cape Town, South Africa. Subjective and objective measuring tools, including pedometry, were used to collect data and non-parametric analysis was conducted to analyse data. Results: 14 participants met the Inclusion criteria. Levels of physical activity changed markedly, but not significantly. Objectively-tested and self-reported physical activity levels changed significantly among participants who took part in a CPMP. Significant improvements in Pain Severity Scores and Pain Interference Scores occurred after the CPMP and there was convergent validity between self-reported and objectively-tested levels of physical activity in those suffering from chronic pain after the CPMP. Conclusion: The Chronic Pain Management Program at Groote Schuur Hospital in Cape Town has shown to improve function and physical activity of those patients living with chronic pain who take part in the CPMP, with function improving significantly, and physical activity nearly doubling in the group being tested who took part in the 5-week long program. The CPMP at GSH should be seen as the beginning of a greater movement towards increasing physical activity in the chronic pain sphere. Research in more public healthcare facilities is needed to increase knowledge around education, pacing and implementation strategies across South Africa.

In South Africa sexual abuse has reached pandemic proportions and continues to increase in the sense that thousands of people are being sexually abused every day and the long term effects of sexual abuse are there to stay. These long term effects are imprinted in the pre-verbal dynamics of the living body and they can appear at any time in the present upon a conscious trigger. This research study seeks to investigate the effectiveness of two therapeutic modalities which are Philophonetics counselling and Trauma Focused Cognitive Behavioural Therapy in the treatment of sexually abused individuals within the South African context. Philophonetics counselling extends the therapeutic conversation into the nonverbal dimension of human communication, which enables the client to go beyond the limitations of verbal expression and access directly feelings, emotions, reactive patterns, old defenses and new potential embedded in the deep layers of the living body. It is a method of exploration, expression, and transformation of inner experiences, since words are limited in the amount of our experience that they convey. Trauma-Focused Cognitive Behavioural Therapy is a type of intervention modality that represents a synthesis of traumasensitive interventions and well established CBT (Cognitive Behavioural Therapy) principles developed from the Cognitive Behavioural school of Psychology.

Background: Postpartum Depression (PPD) affects up to one in five mothers. While psychotherapy can effectively reduce symptoms of PPD, it is unclear how PPD treatment affects maternal psychophysiology. Determining physiological changes in response to cognitive behavioural therapy (CBT) could provide insights into the mechanisms underlying effective treatment and/or help predict treatment outcomes. This study examined if treating PPD with CBT led to changes in frontal cortical activity and heart rate variability, two markers of maternal emotion regulatory capacity. Methods: Community-dwelling mothers with PPD (Edinburgh Postnatal Depression Scores ≥10) were randomized to receive nine weeks of group CBT delivered by recovered peers (i.e., those who had previously recovered from PPD) (n=26) or be put on a waitlist to receive the intervention nine weeks later (n=24). Electroencephalographic (frontal alpha asymmetry), electrocardiographic (heart rate variability), and clinical (depression, anxiety) data were collected at baseline and nine weeks later. Results: Participants in both the immediate treatment and waitlist control groups reported moderate levels of depression and anxiety at baseline. After treatment, mothers in the treatment group showed greater improvements in depression (p<0.01, Cohen d=1.22), and anxiety (p<0.005, Cohen d = 1.48), and high-frequency heart rate variability (p<0.05, Cohen d=0.70), but not frontal alpha asymmetry, compared to the waitlist control group. Conclusion: Group CBT for PPD can improve symptoms of depression and anxiety and parasympathetic nervous system function. Future research should attempt to replicate and extend these findings using larger samples, additional biomarkers, and longer periods of follow up. Examining how evidence-based treatments for PPD affect maternal psychophysiology can improve our understanding and potentially predict treatment effects. / Thesis / Master of Science (MSc) / Postpartum depression affects up to one in five mothers in the first year after delivery. When treated promptly with talking therapies (i.e., psychotherapy) such as cognitive behavioural therapy (CBT), many experience significant improvements in their symptoms. However, the changes occurring in the brain and the remainder of the nervous system occurring in response to psychotherapy is not well known. It is important that this is understood so that we can develop more effective treatments and better predict who will respond to different types of treatments. In particular, the role of the frontal lobe of the brain, and the body’s parasympathetic system is poorly understood in the context of PPD. This thesis aimed to examine the impact of CBT on women’s frontal lobe functioning using a measure called frontal alpha asymmetry (FAA) measured via electroencephalography (EEG), and parasympathetic nervous system-based heart rate variability (HRV) using electrocardiography (ECG). In this study, we compared mothers with PPD treated with CBT to those who did not receive this treatment. We found that HRV responded in mothers who received CBT compared to women who were in the control group. No significant changes were found for FAA after treatment. These results suggest that HRV may be explored further as a valid treatment outcome for CBT when provided to women with PPD.

Objective 1: To examine the influence of maternal depression and/ or anxiety on infant, maternal and dyadic FFSF task performance Objective 2: To investigate the changes in infant and maternal FFSF task performance before and after Cognitive Behavioural Therapy (CBT) treatment of maternal depression / Background: Research suggests that postpartum depression (PPD) and postpartum anxiety (PPA) impact both mothers and their infants, leading to adverse behavioural outcomes across the lifespan. The face-to-face still-face (FFSF) task is a validated observational tool used to measure the quality of mother-infant interactions. This thesis aimed to investigate the differences in responses to the FFSF task between dyads consisting of mothers with PPD and/or PPA and healthy dyads. Another goal was to examine whether PPD treatment could improve mother and infant FFSF outcomes. Methods: A systematic search was performed in PubMed/MEDLINE, EMBASE, CINAHL, PsycINFO and Web of Science. Meta-analyses were conducted to examine the differences in infant, maternal and dyadic FFSF outcomes in mothers with PPD, PPA or comorbid PPD and PPA in comparison to healthy control dyads. Second, we examined whether group cognitive behavioural therapy (CBT) for PPD could help improve infant and maternal FFSF outcomes. A case-control design study was conducted with three different assessment points (i.e., pre-CBT treatment, immediately after CBT and three months post-CBT). Results: Meta-analyses suggested that the infants of mothers with PPD display lower levels of positive affect during the play and reunion phases compared to the infants of healthy non-depressed mothers. Also, mothers with PPD may engage less positively with their infants at the reunion phase, and mother-infant dyads affected by PPD show less positive interactive matching during the play phase compared to healthy control dyads. Finally, object/environment engagement was higher in infants of PPA mothers compared to healthy controls at still-face. Conclusion: The results suggest that mothers with PPD and/or PPD (and their infants) may exhibit different interaction patterns compared to healthy dyads. Also, it appears that the benefits of CBT for maternal PPD may extend to their infants through reductions in maladaptive infant withdrawn behaviours to normal, healthy levels. / Thesis / Master of Science (MSc) / Maternal postpartum depression (PPD) and postpartum anxiety (PPA) are the most common mental health complications of birth. Apart from unfavourable effects PPD and PPA have on mothers, it may also impact the mother-infant relationship, leading to adverse infant outcomes. Given the relatively high prevalence of maternal PPD, PPA, and comorbid PPD and PPA, this thesis aimed to examine the differences in how mothers suffering from PPD and/or PPA and their infants coordinate their behaviour, in comparison to healthy mothers and their infants using a validated observational task (face-to-face still-face [FFSF] task). Another goal of this thesis was to investigate whether the benefits of maternal treatment for PPD with cognitive behavioural therapy may extend to infants and improve mother, as well as infant behaviour. These investigations may provide new insights on how maternal PPD and/or PPA affects mother-infant interactions, and consequently, infant socio-emotional development.

Objectives: To assess the feasibility and effectiveness of an online 1-day cognitive behavioural therapy (CBT)-based workshop in the prevention of postpartum depression (PPD) Methods: In Study 1, data was analyzed from a cohort of 38 birthing parents in the form of a pre-test-post-test pilot study. The ability to develop a 1-day prevention intervention, with feasible study design, recruitment, and retainment strategies that was acceptable to participants was assessed and effect sizes were preliminarily measured in preparation to develop a future full-scale randomized control trial (RCT). In Study 2, a parallel-group RCT was utilized to examine a new group of 124 participants split into either the experimental or control group. Participants received the workshop plus treatment as usual (TAU; experimental group) or TAU alone (control), Major depressive disorder (MDD) diagnosis, levels of PPD symptoms, anxiety, social support, mother-infant relationship quality, and infant temperament was assessed at one, two, and three months postpartum. Results: In Study 1, a 1-day prevention intervention for PPD that was deemed acceptable to study participants was successfully developed. The online 1-day CBT-based workshops for preventing PPD were feasible in terms of study design based on participant recruitment speed and retention rate. In Study 2, trial recruitment was stopped after 25% of the expected sample size was recruited as fewer than 10% of participants in either group developed MDD at three months postpartum. Data were collected up to three months postpartum in those already enrolled. Among all enrolled participants (n=124), a trend toward larger reductions in EPDS scores was seen in the experimental group at two months postpartum (p=0.06). Participants with baseline Edinburgh Postnatal Depression Scale Score ≥7 in the experimental group showed larger, statistically significant reductions in PPD and anxiety at two months postpartum. Conclusion: The studies in this thesis suggest that the 1-day online CBT-based workshop could have potential as an intervention for preventing PPD in birthing parents considered higher-risk. Keywords: Postpartum depression, pregnancy, perinatal care, prevention and control, cognitive behavioural therapy, mental disorders / Thesis / Master of Science (MSc) / Postpartum depression is an ideal disorder for prevention due to its high prevalence, clear window for intervention (pregnancy), and easily identifiable risk factors. The objective of this thesis was to determine whether an online 1-day CBT-based workshop, was feasible for participants and whether it was effective in preventing PPD. In the first study the ability to design a 1-day intervention, as well as the feasibility of its study design, recruitment and retention strategies on participants were assessed. In the second study its effectiveness at preventing PPD was examined. We found that our 1-day workshop was feasible for participants and showed promise in preventing PPD in higher-risk samples. This research can provide guidance for future preventive interventions to improve outcomes for birthing parents at risk of developing PPD.

Introduction The prevalence of depressive symptoms in persons with heart failure is higher than in age- and gender-matched populations not suffering from heart failure. Heart failure in itself is associated with an unpredictable trajectory of symptoms, a poor prognosis, high mortality and morbidity, and low health-related quality of life (HrQoL). With the addition of depressive symptoms to heart failure the negative health effects increase further. Though the negative consequences of depressive symptoms in heart failure are well known, there is a knowledge gap about the course of depressive symptoms in heart failure and about how to effectively manage these symptoms. Pharmacological treatment with serotonin reuptake inhibitors has not been able to demonstrate efficacy in persons with heart failure. In a few studies, cognitive behavioural therapy (CBT) delivered face-to-face, has demonstrated effects on depressive symptoms in persons with heart failure. However, currently there are barriers in delivering face-to-face CBT as there is a lack of therapists with the required training. As a solution to this, the use of Internet-based CBT (ICBT) has been proposed. ICBT has been shown to be effective in treatment of mild and moderate depression but has not been evaluated in persons with heart failure. Aim The overall aim of this thesis was to describe depressive symptoms over time and to develop and evaluate an ICBT intervention to treat depressive symptoms in persons with heart failure. Design and Methods The studies in this thesis employ both quantitative (Studies I, II and III) and qualitative (Studies II and IV) research methods. The sample in Study I (n=611) were recruited in the Netherlands. The participants (n=7) in Study II were recruited via advertisements in Swedish newspapers. Studies III and IV used the same cohort of participants (Study III n=50, Study IV n=13). These participants were recruited via an invitation letter sent to all persons who had made contact with healthcare services in relation to heart failure during the previous year, at the clinics of cardiology or medicine in four hospitals in southeast Sweden. Study I had a quantitative longitudinal design. Data on depressive symptoms was collected at baseline (discharge from hospital) and after 18 months. Data on mortality and hospitalisation was collected at 18 and 36 months after discharge from hospital. Study II employed three differentBehind the Screen2patterns of design, as follows: I) The development and context adaptation of the ICBT program was based on research, literature and clinical experience and performed within a multi-professional team. II) The feasibility of the program from the perspective of limited efficacy and function was investigated with a quantitative pre-post design. III) Participants’ experience of the ICBT program was investigated with a qualitative content analysis. Data on depressive symptoms was collected pre and post intervention. The time used for support and feedback was logged during the intervention, and qualitative interviews were performed with the participants after the end of the intervention. Study III was designed as a randomised controlled trial. A nine-week ICBT program adapted to persons with heart failure and depressive symptoms was tested against an online moderated discussion forum. Data on depressive symptoms, HrQoL and cardiac anxiety was collected at baseline (before the intervention started) and after the end of the intervention (approximately 10 weeks after the start of the intervention). Study IV had a qualitative design to explore and describe participants’ experiences of ICBT. The participants were recruited from within the sample in Study III and all had experience of ICBT. Data collection occurred after the ICBT program ended and was carried out using qualitative interviews by telephone. Results The mean age of the samples used in this thesis varied between 62 and 69 years of age. Concerning the symptom severity of heart failure, most persons reported New York Heart Association (NYHA) class II (40-57%) followed by NYHA class III (36-41%). Ischaemic heart disease was the most common comorbidity (36-43%). The vast majority had pharmacological treatment for their heart failure. Six percent of the persons in Study I used pharmacological antidepressants. In Studies II and III, the corresponding numbers were 43% and 18% respectively. Among persons hospitalised due to heart failure symptoms, 38% reported depressive symptoms. After 18 months, 26% reported depressive symptoms. Four different courses of depressive symptoms were identified: 1) Non-depressed 2) Remitted depressive symptoms. 3) Ongoing depressive symptoms. 4) New depressive symptoms. The highest risk for readmission to hospital and mortality was found among persons in the groups with ongoing and new depressive symptoms. A nine-week ICBT program consisting of seven modules including homework assignments on depressive symptoms for persons with heart failure was developed and tested. The RCT study (Study III) showed no significant difference in depressive symptoms between ICBT and a moderated discussion forum. Within-group analysis of depressive symptoms demonstrated a significant decrease of depressive symptoms in the ICBT group but not in the discussion forum group. The participants’ experience of ICBT was described in one theme: ICBT- an effective, but also challenging tool for self-management of health problems. This theme was constructed based on six categories: Something other than usual healthcare; Relevance and recognition; Flexible, understandable and safe; Technical problems; Improvements by live contact; Managing my life better. Conclusion After discharge from hospital, depressive symptoms decrease spontaneously among a large proportion of persons with heart failure, though depressive symptoms are still common in persons with heart failure that are community dwelling. Depressive symptoms in persons with heart failure are associated with increased risk of death and hospitalisation. The highest risks are found among persons with long-term ongoing depressive symptoms and those developing depressive symptoms while not hospitalised. ICBT for depressive symptoms in heart failure is feasible. An intervention with a nine-week guided self-help program with emphasis on behavioural activation and problem-solving skills appears to contribute to a decrease in depressive symptoms and improvement of HrQoL. When ICBT is delivered to persons with heart failure and depressive symptoms the participants requests that the ICBT is contextually adapted to health problems related to both heart failure and depressive symptoms. ICBT is experienced as a useful tool for self-care and something other than usual healthcare. ICBT also requires active participation by the persons receiving the intervention, something that was sometimes experienced as challenging.