This thesis responds to the lack of psychiatric and infrastructural support during the transition from inpatient to outpatient care, and proposes a supportive housing model for patient recovery. It establishes an architecture to support a new model for mental health care using the bio-psycho-social perspective outlined in the psychological research section. Research into different methods of treatment, perception, and current patient infrastructure reveal that the existing framework does not suit the needs of patients caught between the secure levels of care in forensic institutions and those recovered enough to sustain themselves. The psychiatric program is based on the bio-psycho-social perspective outlined in the psychology chapter of the thesis, which will be used to treat patients with schizophrenia, mood disorders and anxiety disorders. The architecture is designed to support this perspective, and is based on the research into perception and the architectural strategies needed in the design of a healing environment: community, security and privacy, patient control including spatial intelligibility, haptic and basic orientation, light, sound and positive distraction. The design is proposed for the Moss Park area in Toronto: where the actual site itself stretches from Dalhousie Street and Queen Street East to Mutual Street and Shuter Street. Its history and current amenities make it an ideal location for a design proposal, though multiple locations are envisioned across the GTA. The design presented in this thesis is envisaged as part of a network of varying care levels: follow-up care, supportive care and comprehensive care. The program for the site will consist of the supportive care programming, which is the middle level of care.

This thesis responds to the lack of psychiatric and infrastructural support during the transition from inpatient to outpatient care, and proposes a supportive housing model for patient recovery. It establishes an architecture to support a new model for mental health care using the bio-psycho-social perspective outlined in the psychological research section. Research into different methods of treatment, perception, and current patient infrastructure reveal that the existing framework does not suit the needs of patients caught between the secure levels of care in forensic institutions and those recovered enough to sustain themselves. The psychiatric program is based on the bio-psycho-social perspective outlined in the psychology chapter of the thesis, which will be used to treat patients with schizophrenia, mood disorders and anxiety disorders. The architecture is designed to support this perspective, and is based on the research into perception and the architectural strategies needed in the design of a healing environment: community, security and privacy, patient control including spatial intelligibility, haptic and basic orientation, light, sound and positive distraction. The design is proposed for the Moss Park area in Toronto: where the actual site itself stretches from Dalhousie Street and Queen Street East to Mutual Street and Shuter Street. Its history and current amenities make it an ideal location for a design proposal, though multiple locations are envisioned across the GTA. The design presented in this thesis is envisaged as part of a network of varying care levels: follow-up care, supportive care and comprehensive care. The program for the site will consist of the supportive care programming, which is the middle level of care.

Contemporary theatre has crossed boldly into therapeutic terrain and is now the site of radical self-exposure. The recent and expanding use of people’s personal stories in the theatre has prompted the need for a robust framework for safe, ethical, flexible and intentional practice by theatre makers. Such a framework is needed due to the risks inherent in putting people’s private lives on the stage, particularly when their stories focus on unresolved difficulties and cross into therapeutic terrain. With this ethical and practical imperative in mind, and in order to create a broader spectrum of ethical risk-taking where practitioners can negotiate blurred boundaries in safe and creative ways, this study draws on relevant therapeutic theory and practice to re-connect therapy and theatre and promote best practice in the theatre of personal stories. In order to promote best practice in the theatre of personal stories (a term I will use to cover the myriad forms of theatre that make use of people’s personal stories), I describe a new framework that synthesises theory and practice from the fields of psychodrama, attachment narrative therapy, and theatre and performance studies. The benefits of this integrative framework for the theatre practitioner are that it promotes safer, more ethical and purposeful practice with personal stories, and encourages more confident and creative artistic expression. The framework provides these benefits because it offers a structured model for decision-making by theatre practitioners who work with personal stories, and suggests ways that the practitioner can explore fresh artistic possibilities with clear intentions and confidence about the boundaries and ethics of the work. The integrated framework has been developed through the grounded theory process of reflective inquiry, using in particular the models of action research, the Kolb experiential learning cycle and applied phronesis. The framework has four elements, which are explored respectively in chapters one to four: 1) History: understanding the roots of the theatre of personal stories in traditions of art, oral history, social activism, theatre and therapy; 2) Ethics: incorporating wide-ranging ethical issues inherent in staging personal stories; 3) Praxis: structuring participatory theatre processes to regulate the level of personal disclosure among participants (a model for structuring practice and regulating personal disclosure is offered — called the Drama Spiral); and 4) Intentions: working with a clear focus on specific intentions — especially bio-psycho-social integration — when working with personal stories. The study concludes, in chapter five, with a critical analysis of two exemplars of practice, examined through the lens of the Drama Spiral.

Due to the subjective nature of pain and the profound debilitating effects of pain for a growing number of people, there are many challenges to approaching and fully addressing its problems. The traditional biomedical model of health limits its treatment focus to the physical components of pain. Biomedicine provides useful and effective short-term relief of bodily symptoms, but usually cannot cure pain that persists in both mind and body over time. Because chronic pain is often accompanied with discomfort, depression, and other significant life impairments, health researchers have recently conceptualized more comprehensive models to address pain. In the bio-psycho-social-spiritual health model, chronic pain is assessed and treated in the context of a person’s overall quality of life, considering biological, psychological, social, and spiritual health conditions. This movement towards adopting integrative health care models can also provide patient guidance needed for developing inner resources to adapt to pain, as well as recover from and prevent disease. Self-compassion comes from a fertile field of inquiry emerging out of a wider conception of health that includes spirituality. The construct is based on three related components that can assist a person living with pain: (a) being kind to oneself while in pain or suffering, (b) perceiving difficult times as shared human experiences, and (c) holding painful thoughts and feelings with mindfulness, instead of over-identification. Measured using the Self-Compassion Scale, it demonstrates positive associations with a variety of health indicators. However, a direct relationship with chronic pain has not yet been examined. In applying recent research in quality of life (QoL) and self-compassion to a chronic pain patient population, the purpose of this study is twofold: (a) to produce a comprehensive assessment of bio-psycho-social-spiritual QoL conditions (b) to examine differences in QoL with the presence of self-compassion and determine its potential moderating effect on life impairments due to pain. From this project, the QoL conditions that are affected by chronic pain and the moderation effect of self-compassion will be understood better so that more effective treatment and prevention procedures can be developed for people living with pain from long-term disease conditions. / text

In recent years, mental illness in pregnant and postpartum women has become a public health concern. Untreated and undertreated maternal mental illness has a significant negative impact on not only the mother, but also on the baby and family. Further, many women do not seek help or access mental health care due to stigma surrounding mental illness, the unrealistic social expectations of motherhood, and the fear of being judged or rejected. An interpretive descriptive study informed by a feminist perspective was conducted with six postpartum women who sought maternal mental health care services. Semi-structured interviews provided an opportunity to explore women’s experiences of having a maternal mental illness, accessing care, and the role of stigma. Analysis focused on the bio-psycho-social dimensions of their experiences. A shared experience and meaning emerged: self stigma and expectations of motherhood, stigma and infertility, factors influencing self stigma, level of self-efficacy, and treatment satisfaction, engagement and outcome. Findings are discussed with reference to the current literature on maternal mental illness, stigma, and infertility. Findings are conceptualized using Brown’s (2006) Shame Resilience Theory, implications for practice are presented including women’s advice to other women, and recommendations for future research are made.

Bakgrund: Inom fysioterapin ser man på individen utifrån ett bio-psyko-socialt perspektiv. ”International Classification of Function, Disability and Health” (ICF) är ett ramverk för att mäta hälsa ur ett bio-psyko-socialt perspektiv. Kunskapen om hur dans som fysisk aktivitet påverkat personer med ryggmärgsskada är bristfällig. Det saknas kvalitativa studier inom området. Syfte: Syftet med studien var att undersöka hur personer med ryggmärgsskada upplever dans ur ett bio-psyko-socialt perspektiv. Metod: Metoden var kvalitativ och induktiv, baserad på semistrukturerade intervjuer med fem informanter: två män och tre kvinnor i åldrarna 21–57 år som dansat i rullstol mellan 2–33 år. Data analyserades med innehållsanalys. Resultat: Informanterna upplevde kroppslig påverkan: Förbättrad styrka, kondition, rörlighet, koordination och balans. Ändrad kroppsuppfattning (fått mer kontakt med kroppen). De hade även fått minskad smärta. De upplevde personlig påverkan: Psykiskt välmående (ökad self-efficacy, förbättrad självkänsla och glädje) samt fysiskt välmående. Dansen hade även varit ångestframkallande. De upplevde att de hade påverkats omgivningsmässigt: Socialt (fått nya vänner, upplevt unik gemenskap och utvecklat socialt samspel). De hade mött acceptans, viss okunskap men fått stöd från närstående. De upplevde påverkan på aktivitets- och delaktighetsnivå: Mer självständig i vardagen (de hade blivit bättre på förflyttningar). Delaktig i samhället (deltar i fler aktiviteter, delaktig i att påverka samhället). Konklusion: Personer med ryggmärgsskada upplever att dans har många positiva effekter bio-psyko-socialt. Fysioterapeuter och andra yrkesverksamma inom vård och omsorg, samt personer med ryggmärgsskada behöver få kunskap om vinsterna av dans som fysisk aktivitet för personer med ryggmärgsskada så att fler kan få del av dansens fördelar. / Background: In physiotherapy you look at the individual through a bio-psycho-social perspective. “International Classification of Function, Disability and Health” (ICF) is an instrument to measure health from a bio-psycho-social perspective. The knowledge about how dance as a physical activity effects people with spinal cord injury is insufficient. Qualitative research in this area is nonexistent.     Purpose: The purpose with the study was to examine people with spinal cord injury’s experiences with dance as a physical activity in a bio-psycho-social manner. Method: The study design was qualitative and inductive, based on semi-structured interviews with five study-participants: two men and three women in the ages 21-57, who had been dancing in wheelchair 2-33 years. The data was analyzed with qualitative content analysis. Results: The participants experienced that dancing had an impact on bodily functions: improved strength, condition, flexibility, coordination and balance. Changes in body perception (more contact with the body). They had also reduced pain. They experienced effects in personal factors: Psychological wellbeing (improved self-efficacy, self-esteem and joy) and physical wellbeing. The dance had also been generating anxiety. They experienced impact on factors involving their surroundings: social (they got more friends, experienced a unique fellowship and developed social interaction skills). They had met acceptance, some ignorance but support from close ones. They experienced impact on their activity and participation: More independent in daily life (they had become better in locomotion). Participating in the community (participating in more activities, participating in having an impact on the community). Conclusion: People with spinal cord injury experience that dancing has many positive outcomes on bio-psycho-social factors.  Physiotherapists and other professionals in health care, and people with spinal cord injury need to get knowledge about the profits of dance as a physical activity for people with spinal cord injury so that more people can take part of the benefits of dancing.

Le Trouble de Stress Post-Traumatique (TSPT) fait suite à l’exposition à un ou plusieurs événement(s) traumatique(s) et se caractérise par un ensemble de symptômes : flashbacks, cauchemars, comportements d’évitement, altération négative de la cognition et de l’affect, hyper-vigilance et perturbation du sommeil (American Psychiatric Association, 2013). La récente considération de ce trouble dans la sphère publique a mis en lumière l’intérêt sociétal d’agir en amont auprès des professionnels exposés à ce type d’évènements dans le cadre des fonctions de leur métier, tels que les professionnels spécialisés en milieu montagneux (lieu où les conditions sont dangereuses et imprévisibles), qui sont particulièrement exposés à des évènements traumatiques (Weinbruch & Nordby, 2010) et ont par conséquence plus de risque de développer un TSPT que la population générale.Le but visé par l'objectif de ces travaux de thèse a été d’explorer des pistes d’actions à suivre pour renforcer les capacités de résilience chez des professionnels à risques afin de prévenir au plus tôt le TSPT. A travers une approche intégrative et processuelle du développement du TSPT basée sur une perspective biopsychosociale, nous avons étudié un ensemble de facteurs impliqués dans l’apparition et/ou le maintien de ce trouble que nous avons par la suite intégrés à la construction, l’évaluation et l’implémentation d’une action de prévention.Les résultats des études menées en laboratoire et sur le terrain ont permis de dégager l’implication d’un ensemble de facteurs tant spécifiques que généraux (i.e., flexibilité du coping, mécanismes de régulations physiologiques, sens de la mission). Nous pouvons conclure que ce trouble est la résultante de processus translationnels biopsychosociaux marqués par une forte interconnexion entre la psychologie et la physiologie, et l’environnement social professionnel qui modifie l’expression et la visibilité du TSPT. Cette thèse a permis de construire de premiers éléments pour une action de prévention basée sur une vision intégrative et multifactorielle et d’en mesurer l’efficacité dans une démarche fondée sur la preuve. En conclusion, ces travaux ouvrent la voie de la prévention primaire du TSPT professionnel dans une vision intégrative. / Post-Traumatic Stress Disorder (PTSD) follows exposure to one or more traumatic events and is characterized by a set of symptoms: flashbacks, avoidance, negative cognitive and affect changes, hyper-vigilance and sleep disturbance (American Psychiatric Association, 2013). The recent consideration of this disorder in the public sphere has highlighted the societal interest in acting upstream with professionals exposed to this type of event as part of their professional duties. The Auvergne Rhône-Alpes region has populations of professionals specialized in mountain environments (dangerous and unstable with sudden changes in weather conditions), who are particularly exposed to traumatic events (Weinbruch & Nordby, 2010). As a result, they are more likely to develop PTSD than the general population.The aim of this thesis work was to provide elements to establish the lines of action to be adopted to improve the resilience capacities of at-risk professionals in order to prevent PTSD in the early stages. Through an integrative and processual approach to PTSD development focused on a biopsychosocial perspective, we studied a set of factors involved in the development and/or persistence of this disorder and coupled with the construction, evaluation and implementation of preventive action.The results of the laboratory and on-site studies revealed the involvement of a set of both specific and general factors (i.e., coping flexibility, physiological regulatory mechanisms, meaning of the mission). We can thereby conclude that this disorder is the result of a translational interaction defined by strong interconnection between psychology and physiology, and by the socio-professional environment that modifies the expression and visibility of this disorder. This thesis proposed new elements to prevent professional TSPT, based on an integral and multifactorial vision with an evidenced-based approach. In conclusion, these studies are the first to address primary prevention of PTSD with an integrative approach.

Previous research describes co-morbid substance use disorders and eating disorders as a complex issue. Research on collaboration between Swedish addiction treatment facilities and Swedish eating disorder care is scarce. The aim of this Bachelor thesis is to analyze and understand how professionals in addiction care and professionals in eating disorder care experience collaboration regarding people with comorbid substance use disorders and eating disorders. The approach of this study is hermeneutic. The bio-psycho-social model and Collaboration Theory are used for data analysis. The data consists of nine semi-structured interviews with professionals working in either regional eating disorder care or municipal addiction care or in an independent addiction treatment facility. The informants work in different Swedish municipalities and regions having varying occupations. Some work in social services, others in medical care. Our results show varying experiences of collaboration among the informants. Some informants think collaboration works well whilst others see room for improvement. Poor collaboration is described by some informants as due to organizational prestige or bureaucracy. Some informants emphasize that referrals between different care units lead to long wait times for the patients/clients during which nobody takes responsibility for the patient, whose health may worsen. The professionals use different strategies, treatments, and methods to treat and recognize comorbidity and to collaborate with other care units. Joint care planning, reaching a consensus and having a holistic viewpoint are methods that the informants use. The informants have different views on which disorder that precedes the other, and also on which treatment is best suited for this type of comorbidity. Several professionals believe that the addiction should be treated primarily. According to the professionals, prerequisites for collaboration are: established contact with other collaborative parties, the knowledge and accessibility of other professionals, patient consent and motivation. An exchange of knowledge at an organisational level is requested, regarding subjects such as collaboration and comorbidity. / Tidigare forskning visar att samsjuklighet i form av missbruk och ätstörning är ett komplext problem. Forskning om samverkan mellan missbruksvård och ätstörningsvård i Sverige är dock ett relativt outforskat område. Denna intervjustudie syftar till att analysera och förstå hur professionella inom missbruksvården och professionella inom ätstörningsvården upplever samverkan gällande personer med samsjuklighet: missbruk och ätstörning. Studien antar en hermeneutisk ansats, det biopsykosociala perspektivet samt samverkansteori används för att analysera empirin. Empirin består av nio semistrukturerade intervjuer med professionella inom regional ätstörningsvård, kommunal missbruksvård och ett fristående behandlingshem. Informanterna arbetar i olika kommuner och regioner samt har olika yrkesbakgrund inom bland annat socialtjänst eller hälso- och sjukvård. I studien framgår de professionellas samverkanupplevelse, arbets- och behandlingssätt av personer med samsjuklighet i form av missbruk och ätstörning. Därtill framgår vilka förutsättningar som enligt informanterna bör ligga till grund för att upprätta samverkan kring klientgruppen. Resultaten visar att de professionellas erfarenheter och upplevelse av samverkan varierar. Att samverkan fungerar väl respektive om samverkan behöver förbättras lyfts fram. Dålig samverkan på grund av prestige eller i form av en byråkratisk klyfta mellan kommun och region identifieras av några informanter. Vissa informanter framhåller att remisskickande mellan vårdenheter leder till långa väntetider, där klienten eller patienten ”bollas runt”. Under väntetiden kan den vårdsökande fara illa. De professionella använder olika arbetssätt och strategier för behandling, för att fånga upp samsjuklighet och för att inleda samverkan. Gemensam vårdplan, samsyn och helhetssyn är några arbetssätt de professionella utgår ifrån. Informanterna har olika syn på vilket sjukdomstillstånd som föregår det andra och ser även olika på vilken behandling som lämpar sig bäst för denna typ av samsjuklighet: flera anser att missbruket bör behandlas först. Upplevda förutsättningar för samverkan är upprättade kontakter med annan samverkanspart, professionellas kunskap, tillgänglighet samt patientens samtycke, initiativtagande och motivation. Organisatorisk kunskapsöverföring om samverkan och samsjuklighet efterfrågas.

Orientador: Irene Sales de Souza / Resumo: Esta pesquisa teve como objetivo geral, propor e operacionalizar ações no sentido de provocar reflexões e mudanças na posição do sujeito educador no trabalho do ensinar e aprender de um grupo de 72 agentes educacionais, de 15 creches de Franca, e melhorar a qualidade de vida destes e das crianças. Também buscou analisar as repercussões sob a ótica das agentes educacionais durante e após a realização do Projeto Solidariedade: a creche como espaço de sociabilização. Trata-se de uma pesquisa-ação que seguiu a perspectiva de análise quanti-qualitativa. A coleta de dados e informações foi efetivada através de entrevistas semi-dirigidas, dinâmicas de grupo, questionários semi-estruturados, observações, desenhos acompanhados de explicações elucidativas sobre seus significados e formulários. Para a análise qualitativa utilizamos a análise do discurso. Esta pesquisa-ação trouxe novas perspectivas na vida pessoal e no trabalho das agentes educacionais na educação com crianças de zero a sete anos: 1) A escuta diferenciada, atendendo à singularidade de cada uma foi valiosa para melhorar a auto-estima das agentes educacionais e seus trabalhos na educação com as crianças, possibilitando a criação de um espaço onde as crianças puderam falar de seus desejos e anseios, acalmando-as e facilitando a aprendizagem. 2) As agentes educacionais reconheceram a importância do trabalho de equipe multiprofissional e interdisciplinar na visão bio-psico-social da organização da criança e de seu papel nesta estruturação. 3) As agentes educacionais observaram melhoras nos relacionamentos familiares, com as colegas de trabalho, com as coordenadoras e com os familiares das crianças nas creches. Constatamos que a classe é mal remunerada, tem uma formação profissional insuficiente, ...(Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The general target of this paper is to propose and to perform actions aiming to arouse reflections and attitude changes of the educator in the work of teaching and learning of a group of 72 educational agents, of 15 day nurseries from Franca, and to improve their and the children quality of living. It has also targeted to analyse the repercussion under the point of view of the educational agents during and after the performance of the Solidarity Project: the day nursery as a socialization space. In fact it is a research-action that followed the perspective of quanti-qualitative analysis. The data collection and information was done through semi-directed interviews, group dynamics, semi-structured questionnaires, observations, draws followed by elucidative explanations about their meanings and forms. The speech analysis was used for the qualitative analysis. This research-action brought new perspectives for the personal and professional life of the educational agents in the eucational process with children aged from zero to seven years: 1) The distinct listening, in compliance with the peculiarity of each one of them was worthy to improve the self-esteem of the educational agents and their educational labour with the children, making possible the creation of a space where the children could speak of their wishes and longings making them calmer and the learning process easier. 2) The educational agents recognized the importance of the multiprofessional and interdisciplinary team work in the bio-psycho-social view of the organization of the child and her role in this structuration. 3)The educational agents noticed improvements in the familiar relationships, with the workmates, with the coordinators and with families of the day nursery children. We verified that the category earn low salaries,...(Complete abstract, click electronic access below) / Doutor

Magister Psychologiae - MPsych / Globally, and especially in Sub-Saharan Africa the advent of HIV and AIDS has created new inequalities within already challenged health care systems. Chronic illnesses have often been associated with increased prevalence of psychological symptoms. Both national and international studies have found a strong association between psychiatric morbidity and HIV and AIDS. Furthermore, studies have found that social support contributes to positive adjustment of individuals infected with HIV and provides a buffer against the effects of anxiety. The aim of this study was therefore to examine anxiety and social support in adults diagnosed with HIV or AIDS at a public health clinic in the Western Cape. The objectives in relation to the aim were: (1) To determine the prevalence of anxiety in adults diagnosed with HIV or AIDS. (2) To determine the degree of social support, as a component of quality of life,in adults diagnosed with HIV or AIDS. (3) To examine the relationship between anxiety and social support in adults diagnosed with HIV or AIDS. The broad theoretical framework that guides this study is the bio-psycho-social model. A cross-sectional design was used in which 70 participants were recruited using a purposive sampling method. Participants were assessed using well-validated self-administered questionnaires: Hospital Anxiety and Depression Scale(HADS) and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). Data were analysed using the Statistical Package for the Social Sciences (SPSS) version 17.1. Correlational and inferential statistics were conducted. The findings of this study indicated that participants in this study had higher levels of anxiety (28%) when compared to the general population (15.8%). Participants in this study, indicated a 59% enjoyment and satisfaction with social support, which indicates satisfaction with social support some of the time. There was however no significant relationship between anxiety and social support in this study. HIV intervention efforts should include screening HIV positive individuals for the presence of psychiatric symptoms. Interventions should also include encouraging HIV positive individuals to maintain and expand their social networks.