A meta-analysis of the effectiveness of Cognitive Behavioural Therapy (CBT) for adult depression was conducted. Twenty-nine studies were identified from 1988 to 2004 that met selection criteria. Comparisons to no treatment, antidepressant medication, behaviour therapy, and other psychotherapies were made using Hedges' d corrected for sample size. Results indicated a clear superiority of cognitive therapy (CT) and CBT over wait-list or no treatment conditions, and slightly larger effect sizes for CT/CBT over pharmacological and other psychotherapeutic treatments for depression. As tests of homogeneity were not met for the pharmacotherapy and other psychotherapy conditions, the results should be interpreted with caution. About equal effect sizes were found between CT/CBT and Behavioural Therapy. Effect size was significantly related to format of treatment (with group therapy achieving a larger effect size than individual therapy format) and type of research trial (with larger effect sizes yielded for efficacy than effectiveness trials). Length of therapy, measured in weeks, was also significantly related to better outcome in CT/CBT. These results confirm that CT and CBT are excellent options for the treatment of adult depression.

Pain is one of the most prevalent symptoms in patients with advanced cancer and, according to anecdotal evidence, perhaps the most feared. Surprisingly, fear of pain has been the subject of little research within cancer care. On the other hand, there is a large literature in the area of chronic non-malignant pain that is relevant to this issue. It suggests that fear of pain contributes to pain severity and to limitations in daily activities in various populations with chronic non-malignant pain. However, little is known about the extent to which such findings might generalize from patients with chronic nonmalignant pain to those with chronic cancer pain. Therefore, this research examined the extent to which fear of pain is associated with functional limitations in patients with advanced cancer. In particular, this study compared patients with chronic cancer and non-cancer pain on measures of fear of pain and other related constructs. The primary objective was to investigate, among patients with chronic pain due to advanced cancer, the relationships between fear of pain, catastrophizing, anxiety sensitivity, depression, physical symptoms, pain severity, and limitations in function. A secondary objective was to compare the relationship observed in cancer patients to those observed in patients experiencing chronic non-malignant pain. A total of 235 patients with chronic pain were recruited (117 patients with advanced cancer who received a referral for pain management and 118 patients with a primary complaint of chronic non-malignant pain). Participants completed self-report questionnaires. Findings revealed similarities between the groups for fear of pain, catastrophizing, anxiety sensitivity, physical symptoms, and limitations in function; however, they differed on level of depression and pain severity. Fear of pain and catastrophizing independently predicted disability in both groups; fear of pain predicted pain severity in patients with non-malignant pain. Catastrophizing predicted pain severity in both groups. Fear of pain mediated the relationship between anxiety sensitivity and limitations in function. This study provides an empirical perspective on fear of pain and other psychological constructs among patients with advanced cancer; it integrates the literature on cancer and non-cancer chronic pain, and confirms the value of psychological adjuncts to pain management in cancer.

The purpose of this dissertation was to use a multidimensional approach to explain choking, via an incorporation of dispositional and situational variables to expand on Baumeister and Showers' (1986) initial conceptualization of choking. This objective was achieved through a series of four studies using the Self-Determination Theory (SDT). In Study 1 (n = 268) we created a taxonomy of pressure contexts using an online survey. Autonomous sport motivation predicted a positive perception of performance under pressure. Study 2 (n = 138) consisted of a laboratory experiment using a 2 (high vs. low motivation) x 2 (self-awareness manipulation) by 3 (performance on basketball arcade game trials) mixed-factorial design. Results revealed that as pressure to perform increased, performance decreased. Participants in the self-awareness condition performed significantly worse than their counterparts. We unexpectedly found that high self-determined participants performed significantly worse across ail three trials compared to low self-determined participants. Study 3 (n = 34) was conducted with swimmers competing at the Canadian Olympic Trials. We found significant relationships between sport motivation and performance whereby autonomous sport motivation was negatively associated with performance decrements in participants' most important events. Study 4 (n = 40) consisted of an online survey with athletes to explore quantitative and qualitative differences between perceived best and worst performances using a within-participant design. In line with SDT, in descriptions of their best performances, participants reported focusing on the task itself, being less distracted, and simply enjoying what they were doing. In contrast, participants' emphases were on being distracted by their environmentlothers, too much/not enough motivation, and lacking confidence/increased anxiety in descriptions of their worst performances. Overall, this program of research extends the original criteria of choking using SDT. Results emphasize the importance of studying skilled athletes and provide insight into the situational variables that increase pressure (e.g., self-awareness, goals, focus). Future research should focus on further developing an integrated model of choking using SDT as a theoretical framework with skilled athletes evaluated over time in order to determine specific dispositional and situational variables that increase the likelihood of choking under pressure.

The present study is an investigation of the relationships between pubertal timing, peer and romantic relationships, and delinquent and risk-taking behaviour in a sample that included youth heavily involved in such behaviours. Ninety-nine youth, males and females aged 13 to 19, were recruited through public advertisements (Community Group) and community agencies who serve youth involved with the justice system (Justice Group) to participate in the study. Youth were interviewed individually to assess peer relationships, romantic relationships, delinquent behaviour and drug use, and completed questionnaires to assess pubertal development, sexual behaviour, relations with opposite-sex peers and social desirability response bias. In order to determine the relationship between pubertal timing and involvement with delinquent peers on the one hand, and the behaviours of interest on the other, standard regression analyses were conducted. It was found that pubertal timing did not account significantly for any of the variance in delinquency, drug use, or sexual behaviour scores with one minor exception. For males, both involvement with delinquent peers and pubertal timing were significant predictors of sexual behaviour variety scores, such that late pubertal timing and greater association with delinquent peers were associated with higher sexual variety scores. Gender comparisons, investigated via a series of ANCOVAs, found that males reported engaging in a greater variety of delinquent behaviours and a greater frequency of delinquent behaviours across their lifetime than did females. Males also reported an earlier age of onset of delinquent behaviour, by approximately 2 years. However, there was no gender difference in past year frequency of delinquent behaviour, nor on any of the indices of drug use and sexual behaviour. Justice Group Females reported significantly greater mean age differences (2.45 years) between their romantic partners and themselves in comparison to the three other participant groups.

Cette étude s'intéresse à la notion d'une continuité entre les expériences de l'éveil et du rêve, dans le contexte de la grossesse et du post-partum. Des recherches antérieures ont suggéré que les rêves de la grossesse refléteraient les préoccupations de l'éveil et pourraient meme faciliter le dépistage des femmes à risque de dépression lors du post-partum. La présente étude poursuit cette exploration avec des raffinements méthodologiques et un échantillon plus important. Les principaux objectifs sont de mieux cerner l'impact de la grossesse et du post-partum sur le contenu des rêves, ainsi que de clarifier la relation entre les rêves et les symptômes dépressifs et anxieux de l'éveil. Cent quarante-trois femmes enceintes agées entre 20 et 34 ans ont complété un journal de rêves et des questionnaires sur les symptômes dépressifs et anxieux de l'éveil et ce, à trois moments entre le deuxième trimestre et le mois suivant l'accouchement. Les données de comparaison de 125 femmes non enceintes ont quant à elles été extraites de la banque de rêves d'une étude normative sur les rêves des Canadiens. Les analyses statistiques ont démontré que plus de la moitié des rêves de la grossesse et du post-partum comprenaient des références à la grossesse et à la maternité, alors que ces éléments étaient très rares dans le groupe de comparaison. Par ailleurs, les rêves reflétaient les caractéristiques propres aux périodes prénatale et post-natale, avec plus de références à la grossesse dans la première période, et plus d'éléments associés à la maternité dans la seconde période. Contrairement à nos attentes, les femmes enceintes et les femmes non enceintes ne se sont pas distinguées quant au contenu négatif de leurs rêves. Finalement, les symptômes dépressifs étaient associés à un contenu négatif accru dans les rêves, tant durant la grossesse que lors du post-partum, alors qu'une telle relation n'a pas été clairement observée avec les symptômes anxieux. Ces résultats suggèrent que les expériences marquantes et chargées d'émotions sont propices à se transposer dans les rêves. À travers l'analyse de rêves, cette étude offre également un regard nouveau sur l'expérience psychologique de la grossesse et de la maternité.

Attachment injuries occur as a result of aversive interpersonal events in which a partner is betrayed, or abandoned during a critical moment of need for support and care, and as such, relational trust is seriously violated (Johnson, Makinen, & Millikin, 2001). The incident creates long-lasting emotional injuries and ruptures the couple's attachment bond. An indelible imprint is left on the relationship when the incident becomes a marker for the other's dependability and trustworthiness. An injured partner's recollection of the injurious incident often triggers a traumatic reaction in-session (Johnson et al., 2001). Within Emotionally Focused Couple therapy (EFT), such injuries are often the cause of therapeutic impasses, moments in which the therapeutic process is halted (Johnson et al., 2001; Millikin, 2000). The Attachment Injury Resolution Model (AIRM) has been developed to specifically address these impasses. The clinical process of repair within the AIRM is also akin to a forgiveness and reconciliation process in couple therapy. The articles in this dissertation contribute to both theoretical and empirical knowledge about how clients change as they resolve an injury and therapist behaviors that facilitate this change process. In the first article, which is theoretical in nature, attachment theory is used to shed light on the nature of partner's emotional responses post-injury, and the process of relational repair and renewal in the aftermath of an injury. The forgiveness and reconciliation process is placed within the context of attachment. Healing attachment injuries involves emotionally processing the deep hurts, fears, anger and sadness related to the rupture of an attachment bond. Restoring emotional accessibility and responsiveness to these emotional expressions is viewed as crucial to the forgiveness and reconciliation process. This process facilitates the renewal of an emotional connection and restores relational trust in the aftermath of the injury. This article also builds upon previous scholarly efforts by placing the AIRM within the context of the theory of change in EFT, which includes a synthesis of experiential, systemic, and attachment theory (Johnson, 2004). EFT clinical theory provides a systematic framework to explain how couple clients change as they resolve an attachment injury. Unprocessed emotion responses related to an injurious incident evolve into rigid, emotional signals and negative interaction patterns that block emotional engagement related to the injury. Partners engage in a predictable and constricted manner of emotional processing when caught in an injury-specific negative interaction cycle (i.e., pursue-withdraw). An injury-specific cycle may emerge as a consequence of the injury or reinforce a pre-existing negative, rigid interaction cycle in the relationship and contribute to attachment insecurity. Emotional engagement related to the injury is thus impeded (Johnson, 2004). Client change involves shifts in emotional processing of the injurious incident. In terms of the client change process, the first four stages of the AIRM involve a de-escalation of an injury-specific cycle. Injured partners are supported to unpack secondary emotion responses (i.e., anger, hostility, feelings of betrayal) and de-escalate negative interaction cycles to potentially access and explore deeper, more primary emotions (i.e., fears of abandonment, loss, sadness) related to the rupture of the bond caused by the injury. Client change leading to attachment injury resolution is captured in subsequent steps in an injury-specific softening event. The injured partner increasingly risks more vulnerable emotion and need expression to an increasingly accessible and responsive withdrawn partner. Reparation of the ruptured bond requires that the offending partner be emotionally accessible and responsive to these primary emotional experiences and attachment needs related to the injury (Johnson et al., 2001). The offending partner's responsiveness serves as a traumatic antidote, and marks the completion of a new bonding event in the relationship, which promotes greater relational trust. Article 2 presents empirical findings from a psychotherapy process study of the AIRM. A task analytic research methodology (Greenberg, 1991) has guided numerous research studies in both the development (Millikin, 2000) and empirical substantiation of the AIRM in both process (Makinen & Johnson, 2006; Naaman, Pappas, Makinen, Zuccarini & Johnson, 2005) and outcome research studies (Makinen & Johnson, 2006). According to this methodological framework for clinical model development (Greenberg, 1991), ongoing empirical investigations of the AIRM was warranted. Three research objectives were identified for the study found in Article 2. The first objective was to enrich previous knowledge about the client change process by enriching empirical description of the client change process. The second objective of this study was to validate the AIRM. The third objective of this study was to identify therapist behaviors associated with client performance tasks at each stage of the model. (Abstract shortened by UMI.)

The current state of knowledge makes it necessary to consider other theoretical frameworks to account for symptom presentation and treatment outcomes for women with an eating disorder (ED). Attachment theory is a theoretical framework that could playa central role in our understanding and treatment of EDs. This thesis consists of two studies that examine the role of adult attachment in understanding: (1) ED symptom expression and treatment outcome among a sample of women with anorexia nervosa restricting subtype (ANR), AN binge purge subtype (ANB) or bulimia nervosa (BN), and (2) group treatment processes among women with ANR, ANB, BN and eating disorder not otherwise specified (EDNOS) receiving treatment in day hospital group-based program with rolling admissions. In the first study women diagnosed with ANR, ANB, or BN completed an attachment scale pre-treatment, and ED symptom scales pre-treatment (N = 243) and post-treatment (N = 157). A comparison sample of 126 non-ED women completed attachment scales on one occasion. Those with EDs had significantly higher attachment insecurity than non-ED. ANB was associated with higher attachment avoidance compared to ANR and BN, and higher attachment anxiety compared to BN. Higher attachment anxiety was significantly related to greater ED symptom severity and poorer treatment outcome across all EDs even after controlling for ED diagnosis. In the second study women (N= 264) diagnosed with an ED completed attachment scales pre-treatment, ED symptom scales pre- and post-treatment, and group climate scales weekly during treatment. Engaged group climate increased and Avoidance group climate decreased across weeks of treatment. Engaged group climate growth was associated with improved ED symptoms post-treatment. Higher attachment avoidance at pre-treatment was related to lower Engaged group climate at week 1, and was related to a greater impact of the group on the individual's experience of group engagement. Overall, attachment dimensions substantially contribute to our understanding of ED symptoms and treatment outcome. Addressing attachment insecurity when treating those with EDs may improve treatment outcomes. Furthermore, clinicians might improve group processes and outcomes by tailoring interventions to individuals' attachment avoidance when treating women for EDs.

Partant des theories de Hoskins ainsi que des Hone et Mercure, nous avons voulu dans cette etude, a l'aide de l'etude clinique de cas d'un couple, verifier: (a) si les valeurs des partenaires sont a la base de la polarite D-S/A dans leur relation et quelles sont ces valeurs; (b) si la clarification de ces valeurs par les conjoints et l'evolution de celles-ci peuvent favoriser entre eux une dynamique relationnelle plus fonctionnelle. En consequence, parmi cinq couples en therapie et ayant passe le test Dominance-Accommodation Scale de Hoskins (1986), nous avons selectionne un dont le score accusait dans leur relation une forte predominance de la dynamique D-S/A. Ce couple fut suivi en therapie par une therapeute du Centre de counseling de l'Universite saint Paul et a participe a 16 entrevues cliniques etalees sur 7 mois. Trois semaines apres ces entrevues, les conjoints passerent a nouveau le test Dominance-Accommodation et nous donnerent une entrevue de recherche sur leurs valeurs et la dynamique D-S/A dans leur relation. (Abstract shortened by UMI.)

Certains déficits de l'attention/hyperactivité sont associés à une activité anormalement élevée des ondes cérébrales thêta combinée à un ralentissement de l'activité bêta. Conséquemment, certains traitements visent la réduction des ondes thêta et l'augmentation des ondes bêta. Un enregistrement subliminal auditif qui semble réduire l'activité thêta (Sub/Alpha) a récemment été développé et testé de façon préliminaire au niveau clinique. Ce traitement présent, l'avantage d'être facile à insérer dans les activités quotidiennes et il offre ainsi la possibilité d'être incorporé à des approches multi-modales déjà établies. De plus, il s'avère être trés économique. Notre étude a comparé l'efficacité de Sub/Alpha à celle d'un enregistrement de bruit rose, tous deux utilisés quotidiennement pendant cinq semaines (n = 11 pour chaque groupe). Un électro-encéphalogramme et un test sur ordinateur de la capacité d'attention, le Test of Variables of Attention (TOVA), ont été administrés à sept reprises. Il y avait une semaine d'intervalle entre les mesures. Les résultats démontrent une différence significative sur les mesures de thêta, bêta1 et du ratio T/B, pendant la présentation de Sub/Alpha comparée à celle du bruit rose. On ne remarque aucune différence significative entre l'écoute de Sub/Alpha et du bruit rose à la maison, sur les mesures de thêta, bêta1 et du ratio T/B, à moyen terme. Les résultats n'indiquent pas de différence significative sur les mesures du TOVA (omission, commission, temps de réponse et variabilité du temps de réponse), pendant la présentation de Sub/Alpha comparée à celle du bruit rose. Et finalement, on ne remarque aucune différence significative entre l'écoute de Sub/Alpha et du bruit rose à la maison, sur les mesures du TOVA à moyen terme. Pour les deux groupes il n'y a pas de changement entre la premiére et la derniére session de l'étude.

Cette these vise a preciser les enjeux logiques de la recherche qui mene a la decouverte de nouveaux agirs psychotherapeutiques. Nous procedons d'abord a une recension des ecrits dans le domaine de la philosophie de la technologie, ou les problematiques traitees s'averent particulierement pertinentes. Le consensus le plus important dans ce champ est celui qui porte sur la distinction fondamentale entre la demarche de la technologie d'une part et celle de la science d'autre part, bien que les auteurs different grandement quant a leurs avis respectifs sur la nature des rapports qu'entretiennent science et technologie. Afin de preciser les enjeux logiques sous-jacents, nous proposons un modele de la decouverte des agirs. Notre modele distingue deux types de recherche: la recherche centree-sur-le-savoir et la recherche centree-sur-le-pouvoir. Notre modele met en evidence l'utilisation des connaissances dans le but de generer des agirs et sur l'utilisation des agirs pour generer des connaissances. Nous posons deux facons de concevoir la decouverte d'un agir. La premiere facon consiste a concevoir un agir comme le produit d'une application d'une theorie ou de connaissances scientifiques. La seconde consiste a considerer la genese d'un nouvel agir comme le produit d'un processus de nature inductive. Ce deuxieme cheminement permet de mettre en place des theories technologiques. En nous basant sur ce modele, nous proposons des criteres de demarcation pour repertorier les differents types de recherche, en l'occurrence la recherche scientifique fondamentale, la recherche scientifique appliquee et la recherche technique. Finalement, le modele de la decouverte des agirs est applique a la recherche avec incidence sur la psychotherapie. Suite a une recension des ecrits dans le domaine de la recherche sur la psychotherapie, la recherche actuelle est examinee afin de faire ressortir les enjeux logiques qui lui sont sous-jacents. Les enjeux epistemologiques de la recherche actuelle sont reformules a la lumiere du nouveau modele de la decouverte d'un agir.