Introduction: Current recommendations by National Institute of Clinical Excellence (Technology Appraisal 51) emphasise the need for future research to examine the effectiveness of CCBT across the age span. Kaltenthaler et al. (2008) recommended future research focuses on acceptability of CCBT through using ‘survey and intensive qualitative methods, include the process of initial engagement, continuation versus drop-out, and in those completing, satisfaction or regret undertaking CCBT’ (p.1528). The pilot study by McMurchie (2011) was the first to explore the acceptability and effectiveness of the CCBT package Beating the Blues (BTB) solely with older people. Using qualitative methodology, the aim of the current study was to explore the experiences of older people who, when participating in the pilot study chose to use BTB compared to those who chose to remain with their treatment as usual (TAU). The current study aimed to gain a deeper understanding of the acceptability of BTB as well as factors that influence decisionmaking in terms of uptake to BTB and discontinuation from BTB. Method: Individual semi-structured interviews were carried out with 20 older people who took part in the pilot study (McMurchie, 2011). Participants were in one of three groups, these were: BTB-completers, BTB-discontinuers and TAU. Transcripts were analysed using Interpretative Phenomenological Analysis (IPA) (Smith et al., 2009). Findings: Five master themes emerged from the interviews: Beating the Blues as a Process of Change; Relevance of Beating the Blues to Older People; Challenges of Using Beating the Blues; Motivation to Try Something New and Barriers to Beating the Blues at Time of Uptake. Conclusions: Overall, the master themes reflected the experiences of either “regaining control” or a sense of “hopelessness” when opting whether or not to use BTB in the first instance and to then continue with the treatment. Experiences of using BTB appeared to be linked to the outlook participants had about using a novel treatment with either a sense of hope or impending failure. Participants who chose BTB had a more positive outlook which impacted their ability to manage perceived challenges and work towards recovery. The sense of impending failure seemed to be linked to participants perceiving more barriers to using BTB and struggling to overcome these challenges, resulting in them either declining BTB or feeling they were not benefiting from BTB and therefore discontinuing it.

This thesis follows the research portfolio format and is carried out in part fulfilment of the academic component of the Doctorate in Clinical Psychology at the University of Edinburgh. An abstract provides an overview of the entire portfolio thesis. Chapter One contains a systematic review of published research exploring staff attitudes towards computerized cognitive behavior therapy (cCBT). Chapter Two is an empirical study examining a range of potential predictor variables on well-being outcomes from cCBT. Chapter one is prepared for Behavioural and Cognitive Psychotherapy, whereas chapter two is prepared for submission to the journal, Behaviour Research and Therapy. Both chapters follow the relevant author guidelines. Background: Evidence suggests that computerised cognitive behavioural therapy (cCBT) is both effective and efficacious in treating depression and anxiety. Numerous barriers to its implementation and uptake have been identified, however, including attitudinal variables and high patient attrition rates. Research examining predictors of response from cCBT have tended to adopt the pathological model of distress, focussing on symptom reduction rather than the promotion of well-being. Furthermore, exploration of possible predictors has tended to focus on a narrow range of factors (e.g. age, gender), neglecting key psychosocial variables (e.g. social identification, baseline distress) that could be exerting an effect. Aims: A systematic review examined staff attitudes towards cCBT for depression, anxiety, and comorbid depression and anxiety, focussing on three attitudinal domains: Perceived acceptability of cCBT; staff's self-reported intention to use cCBT in the future, and perceived advantages and disadvantages of cCBT for depression and/or anxiety. An experimental study was subsequently conducted, examining a range of potential predictors on well-being outcomes from a cCBT intervention utilising Beating the Blues. Method: A systematic search across five databases was conducted, followed by manual searches. Strict search criteria were applied, resulting in the identification of 15 studies. These were subjected to quality assessment, data extraction and synthesis. For the empirical study, data from 1354 participants was collected, with subgroup-analyses conducted on those completing measures of life and mental health satisfaction, functioning and well-being. Key potential predictors of interest were level of group identification, baseline distress, and socioeconomic deprivation. Results: Findings from the systematic review indicated that staff held relatively positive attitudes towards cCBT, with some ambivalence emerging in relation to perceived advantages and disadvantages of the intervention. The empirical study obtained significant effects of group identification on life and mental health satisfaction. A mediating impact of group identity on baseline distress emerged, whereas a moderating effect of baseline distress on deprivation was obtained for the functioning model. Discussion: The current findings demonstrated both positive and negative aspects of staff attitudes towards cCBT for depression and/or anxiety, whereas the empirical project established a clear link between social identification, baseline distress, and well-being. Results from both studies are discussed in terms of clinical implications relating to the uptake of cCBT.

Neste trabalho foram realizados estudos referentes ao comportamento mecânico e ao contato nata-rocha de dois arenitos da Serra do Espigão, no estado de Santa Catarina, localizados em um trecho de 700m na BR-116 km 108 com histórico de problemas de instabilidade de encostas. No local, observam-se duas formações geológicas, a Formação Rio do Rastro, composta por sedimentos transicionais em pacotes de arenitos e lamitos, e a Formação Botucatu, composta por arenitos eólicos. Neste estudo foram obtidas mais de uma centena de amostras que foram submetidas a análises de lâmina delgada e difratometria de raio X, além de ensaios de granulometria, compressão simples e ensaios CCBT (Composity Cylinder Bond Test). As amostras foram extraídas diretamente da face do talude e também de blocos remanescentes de rupturas no bordo da pista através de uma perfuratriz manual. Para o arenito Botucatu, foram realizados cortes em posição paralela, perpendicular e angular em relação ao plano de estratificação natural da rocha sedimentar. No ensaio de compressão simples avaliou-se a influência da estratificação do arenito Botucatu, bem como a variação na resistência de amostras embebidas e, ainda, a relevância da profundidade amostral na resistência. Os resultados revelaram que a estratificação do arenito Botucatu apresenta forte influência na resistência desta. Para o arenito Rio do Rastro não foram observados planos de estratificação em escala amostral. Ambos os arenitos apresentam considerável queda de resistência ao serem embebidos. Os resultados dos ensaios CCBT puderam ser comparados com ensaios de arrancamento em campo, apresentando valores numéricos muito próximos. A adesão obtida através do ensaio CCBT representa o limite inferior de resistência de contato, podendo ser utilizado diretamente como parâmetro de projeto da adesão nata-rocha. Observou-se em laboratório que o material pulverizado do corte dos corpos de prova compostos tem influência na adesão nata-rocha uma vez que este material promove a colmatação da superfície porosa. As análises de lâmina delgada e difração de raio X contribuíram para a caracterização e identificação geológica dos materiais estudados, bem como para a interpretação dos resultados. / In this research, the grout-rock contact and the mechanical behavior of two sandstones were studied. The samples were collected from a highway cut slope (700m long) at km 108 of BR- 116 from Serra do Espigão in the State of Santa Catarina, which has an history of instability problems. There are two geological Formations: Rio do Rastro Formation, composed of transitional sediment packages of sandstones and mudstones and the Botucatu Formation composed of eolian sandstones. In this work more than one hundred samples were taken for optical thin section microscopy and X-ray diffraction, and tests of grading, uniaxial compression tests and CCBT (Composity Cylinder Bond Test). Samples were taken directly from the slope and also from rock blocks toppled by the road using a portable hand drill. For sampling Botucatu sandstone cuts were made in order to obtain specimens with the natural stratification parallel, perpendicular and angular in relation to its axis. Uniaxial compression test were used to evaluate the influence of these angles of stratification of Botucatu sandstone and the influence of previous soaking. For Rio do Rastro sandstone specimens no bedding planes were observed at the sample scale. The results showed that the Botucatu sandstone strength has a strong influence with respect to its stratification. Both sandstones exhibit considerable loss in strength due to soaking. Pullout field test results which compared well with CCBT. The CCBT results represents the lower limit of rock-grout contact strength and can be used directly as the bond strength design parameter. In the laboratory tests it was also observed that the powdered material resultant from the specimens cutting operations have a considerable influence on the grout-rock bond strength as this material promotes clogging of the porous surface. The grading and the microscopic and diffraction analyses contributed to the characterization and identification of geological materials studied and the results interpretation.

Neste trabalho foram realizados estudos referentes ao comportamento mecânico e ao contato nata-rocha de dois arenitos da Serra do Espigão, no estado de Santa Catarina, localizados em um trecho de 700m na BR-116 km 108 com histórico de problemas de instabilidade de encostas. No local, observam-se duas formações geológicas, a Formação Rio do Rastro, composta por sedimentos transicionais em pacotes de arenitos e lamitos, e a Formação Botucatu, composta por arenitos eólicos. Neste estudo foram obtidas mais de uma centena de amostras que foram submetidas a análises de lâmina delgada e difratometria de raio X, além de ensaios de granulometria, compressão simples e ensaios CCBT (Composity Cylinder Bond Test). As amostras foram extraídas diretamente da face do talude e também de blocos remanescentes de rupturas no bordo da pista através de uma perfuratriz manual. Para o arenito Botucatu, foram realizados cortes em posição paralela, perpendicular e angular em relação ao plano de estratificação natural da rocha sedimentar. No ensaio de compressão simples avaliou-se a influência da estratificação do arenito Botucatu, bem como a variação na resistência de amostras embebidas e, ainda, a relevância da profundidade amostral na resistência. Os resultados revelaram que a estratificação do arenito Botucatu apresenta forte influência na resistência desta. Para o arenito Rio do Rastro não foram observados planos de estratificação em escala amostral. Ambos os arenitos apresentam considerável queda de resistência ao serem embebidos. Os resultados dos ensaios CCBT puderam ser comparados com ensaios de arrancamento em campo, apresentando valores numéricos muito próximos. A adesão obtida através do ensaio CCBT representa o limite inferior de resistência de contato, podendo ser utilizado diretamente como parâmetro de projeto da adesão nata-rocha. Observou-se em laboratório que o material pulverizado do corte dos corpos de prova compostos tem influência na adesão nata-rocha uma vez que este material promove a colmatação da superfície porosa. As análises de lâmina delgada e difração de raio X contribuíram para a caracterização e identificação geológica dos materiais estudados, bem como para a interpretação dos resultados. / In this research, the grout-rock contact and the mechanical behavior of two sandstones were studied. The samples were collected from a highway cut slope (700m long) at km 108 of BR- 116 from Serra do Espigão in the State of Santa Catarina, which has an history of instability problems. There are two geological Formations: Rio do Rastro Formation, composed of transitional sediment packages of sandstones and mudstones and the Botucatu Formation composed of eolian sandstones. In this work more than one hundred samples were taken for optical thin section microscopy and X-ray diffraction, and tests of grading, uniaxial compression tests and CCBT (Composity Cylinder Bond Test). Samples were taken directly from the slope and also from rock blocks toppled by the road using a portable hand drill. For sampling Botucatu sandstone cuts were made in order to obtain specimens with the natural stratification parallel, perpendicular and angular in relation to its axis. Uniaxial compression test were used to evaluate the influence of these angles of stratification of Botucatu sandstone and the influence of previous soaking. For Rio do Rastro sandstone specimens no bedding planes were observed at the sample scale. The results showed that the Botucatu sandstone strength has a strong influence with respect to its stratification. Both sandstones exhibit considerable loss in strength due to soaking. Pullout field test results which compared well with CCBT. The CCBT results represents the lower limit of rock-grout contact strength and can be used directly as the bond strength design parameter. In the laboratory tests it was also observed that the powdered material resultant from the specimens cutting operations have a considerable influence on the grout-rock bond strength as this material promotes clogging of the porous surface. The grading and the microscopic and diffraction analyses contributed to the characterization and identification of geological materials studied and the results interpretation.

Neste trabalho foram realizados estudos referentes ao comportamento mecânico e ao contato nata-rocha de dois arenitos da Serra do Espigão, no estado de Santa Catarina, localizados em um trecho de 700m na BR-116 km 108 com histórico de problemas de instabilidade de encostas. No local, observam-se duas formações geológicas, a Formação Rio do Rastro, composta por sedimentos transicionais em pacotes de arenitos e lamitos, e a Formação Botucatu, composta por arenitos eólicos. Neste estudo foram obtidas mais de uma centena de amostras que foram submetidas a análises de lâmina delgada e difratometria de raio X, além de ensaios de granulometria, compressão simples e ensaios CCBT (Composity Cylinder Bond Test). As amostras foram extraídas diretamente da face do talude e também de blocos remanescentes de rupturas no bordo da pista através de uma perfuratriz manual. Para o arenito Botucatu, foram realizados cortes em posição paralela, perpendicular e angular em relação ao plano de estratificação natural da rocha sedimentar. No ensaio de compressão simples avaliou-se a influência da estratificação do arenito Botucatu, bem como a variação na resistência de amostras embebidas e, ainda, a relevância da profundidade amostral na resistência. Os resultados revelaram que a estratificação do arenito Botucatu apresenta forte influência na resistência desta. Para o arenito Rio do Rastro não foram observados planos de estratificação em escala amostral. Ambos os arenitos apresentam considerável queda de resistência ao serem embebidos. Os resultados dos ensaios CCBT puderam ser comparados com ensaios de arrancamento em campo, apresentando valores numéricos muito próximos. A adesão obtida através do ensaio CCBT representa o limite inferior de resistência de contato, podendo ser utilizado diretamente como parâmetro de projeto da adesão nata-rocha. Observou-se em laboratório que o material pulverizado do corte dos corpos de prova compostos tem influência na adesão nata-rocha uma vez que este material promove a colmatação da superfície porosa. As análises de lâmina delgada e difração de raio X contribuíram para a caracterização e identificação geológica dos materiais estudados, bem como para a interpretação dos resultados. / In this research, the grout-rock contact and the mechanical behavior of two sandstones were studied. The samples were collected from a highway cut slope (700m long) at km 108 of BR- 116 from Serra do Espigão in the State of Santa Catarina, which has an history of instability problems. There are two geological Formations: Rio do Rastro Formation, composed of transitional sediment packages of sandstones and mudstones and the Botucatu Formation composed of eolian sandstones. In this work more than one hundred samples were taken for optical thin section microscopy and X-ray diffraction, and tests of grading, uniaxial compression tests and CCBT (Composity Cylinder Bond Test). Samples were taken directly from the slope and also from rock blocks toppled by the road using a portable hand drill. For sampling Botucatu sandstone cuts were made in order to obtain specimens with the natural stratification parallel, perpendicular and angular in relation to its axis. Uniaxial compression test were used to evaluate the influence of these angles of stratification of Botucatu sandstone and the influence of previous soaking. For Rio do Rastro sandstone specimens no bedding planes were observed at the sample scale. The results showed that the Botucatu sandstone strength has a strong influence with respect to its stratification. Both sandstones exhibit considerable loss in strength due to soaking. Pullout field test results which compared well with CCBT. The CCBT results represents the lower limit of rock-grout contact strength and can be used directly as the bond strength design parameter. In the laboratory tests it was also observed that the powdered material resultant from the specimens cutting operations have a considerable influence on the grout-rock bond strength as this material promotes clogging of the porous surface. The grading and the microscopic and diffraction analyses contributed to the characterization and identification of geological materials studied and the results interpretation.

Computerised Cognitive Behavioural Therapy (CCBT) has been recommended for patients in the National Health Service (NHS) Primary Care across the United Kingdom for management of mild to moderate anxiety and depression. This approach also promises financial savings, and may fill the gap between demand and supply of face-to-face therapy. Studies have shown that CCBT is feasible and effective. However, dropout rates can be as high as 86%, but the reasons remain unclear and the information available is limited. This thesis explores factors that may impact on the usability and user experience of this computer-mediated therapy. Espousing the “real world” research philosophy and widely used methods in the Human-Computer Interaction (HCI) field for usability evaluations, four studies using a mixed-methods design were conducted. Study I was an online usability survey, which investigated if usability evaluations had been conducted for CCBT applications. Two versions of questionnaires were sent to four CCBT software developers and ten authors of randomised controlled trials. The categories and responses of the questionnaires gathered from five respondents were reviewed and summarised. The findings suggested that usability evaluations for CCBT were still in their infancy when compared to other healthcare interventions to which HCI approaches have been widely applied. Study II was a usability Heuristic Evaluation (HE) conducted with four expert evaluators to assess two different CCBT applications’ interfaces (MoodGYM and Living Life to the Full) against the self-designed usability heuristics for their compliance. The findings revealed numerous usability issues. Major problems related to navigation and inconsistency of the interfaces were identified. These could be rectified to enhance the user experience. Study III focused on other factors besides usability that might have an influence on the effective use of CCBT. Perceptions of service providers who were involved in both decision-making about CCBT availability and supporting its use were gathered. Nine service providers at different NHS organisations were interviewed. The interviews were analysed using techniques from Grounded Theory (GT). The findings suggested that the practitioners’ attitudes towards CCBT might have affected its service delivery. Four categories from the data analysis were identified: (1) shaping behaviour, (2) implementing and delivering, (3) making an appropriate referral, and (4) technology/CCBT packages - advancing with time. A conceptual model was also generated, “building support around CCBT”: a road-map that could address some of these issues. Study IV examined patients’ perceptions and acceptance of a CCBT application (Beating the Blues), its usability and the user experience, and also whether the user characteristics (e.g. computer experience (CE) and computer self-efficacy (CSE)) had any influence on patients’ use of this technology. A mixed-methods approach was utilised with a sample of 33 participants. Face-to-face and email interviews were conducted. Feedback was also gathered from a usability questionnaire and think-aloud protocol with seven participants selected from the sample. The data were analysed using Thematic and Saliency Analysis to uncover themes. Descriptive statistics were used to describe data from questionnaires. Two overarching themes from the interviews were identified: (1) access to CCBT services, and (2) perceptions and attitudes towards CCBT. Both themes revealed issues which might have significantly impacted on patients’ engagement with CCBT. Numerous flaws were also discovered in the application’s design and functionality (e.g. navigation, aesthetics, relevance of content, and inflexibility). However, the results from CE and CSE questionnaires suggested that participants were confident in using this technology. The four studies provided an in-depth understanding of factors that affect the usability and user experience of CCBT and possible reasons for the high attrition rates. The implications of this research point to the need for health policymakers to focus on the current implementation issues and on how best to deploy this treatment therapy to patients. Further development of CCBT is pivotal to its success, in particular, expanding contexts of use and increasing usability evaluations. Keeping users interested and engaged will improve treatment efficiency, completion rates and will achieve better clinical outcomes.

No description available.