Lietuvoje yra nedaug mokslinių tyrimų apie įkalintų asmenų tyčinį savęs žalojimą, susijusį su savižudybės rizika. Užsienio šalių moksliniais tyrimais nustatomos įkalintų asmenų tyčinio savęs žalojimo sąsajos su negatyviomis situacijomis ir depresiškumu yra nevienareikšmės. Įkalintų asmenų tyčinio savęs žalojimo atsiradimui gali būti svarbūs stabilesni asmenybiniai veiksniai, kaip kertiniai įsitikinimai. Tyrimo tikslas. Nustatyti patirtų negatyvių situacijų, depresiškumo ir kertinių įsitikinimų (pagal kognityvinę - elgesio teoriją) sąsajas su nuteistų vyrų tyčiniu savęs žalojimu. Tiriamieji. Tyrime savanoriškai dalyvavo 168 nuteisti vyrai, kalintys Pravieniškių pataisos namuose – atvirojoje kolonijoje. Tiriamųjų amžiaus vidurkis – 29,39 metai. Tyrimo metodai. Duomenys buvo renkami, naudojant: Tyčinio savęs žalojimo skalė – sutrumpinta versija (DSHI-s), Kongityvinės triados skalė (CTI), Depresiškumo skalė (CES-D), Negatyvių situacijų įkalinimo įstaigoje skalė. Taip pat tiriamiesiems buvo pateikiami klausimai apie jų sociodemografinius, kriminogeninius rodiklius bei save žalojantį elgesį praeityje. Tyrimo išvados. Tyčia save žalojusių nuteistų vyrų kertiniai įsitikinimai apie save, pasaulį ir ateitį yra negatyvesni nei savęs nežalojusių nuteistų vyrų. Nuteistų vyrų negatyvesni kertiniai įsitikinimai apie ateitį yra susiję su didesne tyčinio savęs žalojimo tikimybe, atsižvelgus į tyčiniam savęs žalojimui reikšmingus šalutinius veiksnius: tyčinį savęs žalojimą... [toliau žr. visą tekstą] / The number of scientific researches about deliberate self-harm that are associated with the risk of suicide among incarcerated persons is not plentiful. The results of scientific researches in foreign countries about the associations of deliberate self-harm with negative situations and depressiveness among incarcerated persons are not unambiguous. Therefore it might be important more stable personality factors such as core beliefs for the deliberate self- harm of incarcerated persons. Research aim. The aim of the study was to identify the links of experienced negative situations, depressiveness and core beliefs (according to cognitive-behaviour theory) with convicted men’s deliberated self-harm. Research participants. The research included 168 convicted men in Pravieniskes Correction House-Open Prison Colony. The average age of research participants is 29,39. Research methodology. The data was gathered using psychological assessment methods: Deliberate Self-Harm Inventory-short version (DSHI-s), Cognitive Triad Inventory (CTI), The Center for Epidemiologic Studies Depression Scale (CES-D), Negative Situations in Prison Scale. Also was asked about sociodemographic, criminogenic factors and self - harm behaviour in the past. Research conclusions. The convicted men who deliberately self-harmed have more negative core beliefs about themselves, the world and the future than convicted men who do not deliberately self-harmed. The more negative core beliefs about the... [to full text]

A manualised cognitive behavioural therapy (CBT) programme was culturally adapted for use with adult Maori clients with depression who were receiving treatment from Te Whare Marie, a Maori Mental Health service that covers the greater Wellington region. The manual was developed in consultation with local and international literature pertaining to CBT with minority groups and the recommendations of an advisory team. The treatment programme integrated significant Maori concepts with the traditional strategies associated with CBT. The intervention was trialled with 16 Maori clients from Te Whare Marie with a primary diagnosis of depression. Case study and group analysis indicated that the adapted intervention was effective in reducing depressive symptomatology and negative cognition, and increasing general wellbeing in four culturally relevant dimensions. Differences between pre- and post- treatment scores were statistically significant in each of these areas. The intervention did not have a significant impact on the construct of cultural identity. Participants expressed high levels of satisfaction with the treatment, and in general the adaptations were positively received. Treatment was characterised by particularly low dropout rates with 15 of the 16 participants attending seven or more sessions. These results were discussed with reference to their implications for effective delivery of clinical service delivery to Maori consumers of mental health services in New Zealand.

Benzodiazepines have been widely prescribed since the 1960s for the management of adverse symptoms related to anxiety, depression, and sleep problems. They were regarded as an efficacious medication when compared with their predecessor, barbiturates. Within 10 years of their introduction, concerns began to be raised regarding their potential to produce dependence and withdrawal symptoms when ceased, including symptoms not present prior to their being prescribed. Subsequent research focussed on establishing effective strategies to ameliorate the adverse symptoms experienced even when the daily intake was slowly reduced. The aim of the work undertaken for this doctorate was to establish whether there was a role for cognitive behaviour therapy (CBT) in benzodiazepine cessation. The initial step in conducting the research for this doctorate was to obtain a detailed understanding of the current state of research on benzodiazepine cessation. Study 1 therefore focussed on establishing the effectiveness of treatment approaches used to assist individuals to cease benzodiazepine use. A Meta-analysis of treatment strategies undertaken in general practice and outpatient settings established that brief intervention resulted in superior cessation rates at post-treatment than routine care. Gradual dose reduction plus CBT was slightly superior to gradual dose reduction alone. However, substitutive pharmacotherapies in combination with gradual dose reduction did not result in a superior outcome to gradual dose reduction alone, and substitutive pharmacotherapy plus abrupt benzodiazepine cessation was less effective than gradual dose reduction. While, providing CBT in conjunction with gradual dose reduction offered a superior outcome than gradual dose reduction alone, current evidence does not identify the CBT strategies that contributed to the superior outcome. The next step in the development of the CBT intervention involved obtaining a deep appreciation of the issues relating to cessation from the perspective of General Practitioners (GPs) and Benzodiazepine Users (BzUs). Accordingly, Study 2 administered semi-structured interviews about benzodiazepine use and its cessation to 28 GPs and 23 BzUs. Responses were analysed using the Consensual Qualitative Research approach, as it enabled comparisons to be made between the views of the two groups of interviewees. The study identified commonality between GPs and BzUs on reasons for commencing use, the role of dependence in continued use, and the importance of lifestyle change in its cessation. BzUs felt there was greater need for GPs to routinely advise patients about non-pharmacological management of their problems and potential adverse consequences of long-term use before prescribing benzodiazepines. Few GPs had assisted a patient to cease use reportedly due to the required time and the expectation of a poor outcome. There was a perception that patients wanted a pharmacological solution to their problems. A critical gap in assessment instruments that are needed for a comprehensive assessment of the outcomes from a treatment trial was identified. In particular, there was no measure of benzodiazepine expectancy or self-efficacy concerning maintenance of benzodiazepine dose reduction. Therefore, Study 3 adapted existing expectancy and self-efficacy measures form other substance domains to verify their applicability to benzodiazepines. Current BzUs (n = 155) were invited to complete two questionnaires either online or via hard copy. Principal component analysis (PCA) of a newly developed Benzodiazepine Expectancy Questionnaire (BEQ) resulted an 18-item, 2-factor scale, while a Benzodiazepine Refusal Self Efficacy Questionnaire (BRSEQ) formed a 16-item, 4-factor scale, Confirmatory factor analysis (CFA) in a second sample (n = 139) confirmed these internal structures, reducing the BEQ to 12 items and the BRSEQ to 14 items respectively. The qualitative study suggested that many GPs would be reluctant to engage in psychological support for benzodiazepine cessation and it was evident that specialist services would be unable to provide substantial support especially in rural and remote areas. Accordingly, it was decided to develop a treatment that was remotely delivered. The initial pilot used a correspondence-based approach, delivered via the postal service. Study 4 comprised a small pilot comparing GP managed gradual dose reduction, plus CBT via mail (M-CBT), which was either delivered immediately (IM-CBT) or after 3 months (DM-CBT). Despite substantial efforts over a 2 year period to recruit GPs and BzUs, only 6 received the allocated intervention. It was decided to trial the intervention as an internet-delivered program to enhance its accessibility to BzUs. Access to the program was promoted through the project website and links from high profile support websites. Study 5 was an uncontrolled trial of internet-based CBT (I-CBT). Access was provided to all newsletters, although, participants were given a suggested sequence for access. Despite placement on the internet and cross-listing on several key websites, the study still only recruited 35 participants (3 of which received the program by mail). Of the 32 undertaking the program via the internet, 21 completed the 3-month assessments and 14 the 6-month assessments. Eight participants reduced their weekly benzodiazepine intake by at least 50%, by 3 months, with five ceasing use at 6 months. A significant increase in self-efficacy, and a decrease in depressive symptoms and dependence were seen. Providing CBT either via mail or the internet assisted some participants to reduce or cease long-term benzodiazepine use. Recruitment to both M-CBT and I-CBT was limited, despite substantial attempts to market the intervention. The studies undertaken for this doctorate make a unique contribution to improving treatment outcomes for people wishing to cease long-term benzodiazepine use. They also provide direction for more extensive studies to definitively establish the nature of effective treatment. The current evidence clearly supports the importance of gradual dose reduction and the role of CBT in further improving treatment outcomes. However, engagement of both BzUs and GPs remains challenging. Remote delivery of CBT via mail or the internet may assist with improving access to CBT, but it does not solve the problem of GP and BzU engagement. An effective system-wide program to address long-term benzodiazepine use will require that incentives for GP involvement (a disincentive for long-term prescription) are in place.

In this thesis, the evolution of adaptive behaviour in artificial agents is studied. More specifically, two types of adaptive behaviours are studied: articulated and cognitive ones. Chapter 1 presents a general introduction together with a brief presentation of the research area of this thesis, its main goals and a brief overview of the experimental studies done, the results and conclusions obtained. On chapter 2, I briefly present some promising methods that automatically generate robot controllers and/or body plans and potentially could help in the development of adaptive robots. Among these methods I present in details evolutionary robotics, a method inspired on natural evolution, and the biological background regarding adaptive behaviours in biological organisms, which provided inspiration for the studies presented in this thesis. On chapter 3, I present a detailed study regarding the evolution of articulated behaviours, i.e., behaviours that are organized in functional sub-parts, and that are combined and used in a sequential and context-dependent way, regardless if there is a structural division in the robot controller or not. The experiments performed with a single goal task, a cleaning task, showed that it is possible to evolve articulated behaviours even in this condition and without structural division of the robot controller. Also the analysis of the results showed that this type of integrated modular behaviours brought performance advantages compared to structural divided controllers. Analysis of robots' behaviours helped to clarify that the evolution of this type of behaviour depended on the characteristics of the neural network controllers and the robot's sensorimotor capacities, that in turn defined the capacity of the robot to generate opportunity for actions, which in psychological literature is often called affordances. In chapter 4, a study seeking to understand the role of reactive strategies in the evolution of cognitive solutions, i.e. those capable of integrating information over time encoding it on internal states that will regulate the robot's behaviour in the future, is presented. More specifically I tried to understand whether the existence of sub-optimal reactive strategies prevent the development of cognitive solutions, or they can promote the evolution of solutions capable of combining reactive strategies and the use of internal information for solving a response delayed task, the double t-maze. The results obtained showed that reactive strategies capable of offloading cognitive work to the agent/environmental relation can promote, rather than prevent the evolution of solutions relying on internal information. The analysis of these results clarified how these two mechanisms interact producing a hybrid superior and robust solution for the delayed response task.

Cognitive behaviour therapy and interpersonal psychotherapy are the leading treatments for eating disorders. Little is understood regarding their mechanisms of action. The research described in this thesis investigated the purported mechanisms of action of two transdiagnostic versions of these treatments; enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy for eating disorders (IPT-ED). A series of mediation studies were embedded within a randomised controlled trial comparing CBT-E and IPT-ED in a transdiagnostic sample of patients with eating disorders. An analytic strategy using multilevel and structural equation modelling was used to assess for statistical mediation. Three of the key purported mediators of action of CBT-E (regularity of eating, frequency of weighing, and frequency of shape checking) and the key purported mediator of IPT-ED (interpersonal problem severity) were studied. Only regularity of eating demonstrated a strong case for being a mediator of the effect of CBT-E (on frequency of binge eating). The findings were inconclusive regarding other putative mediators of the effect of CBT-E, and for interpersonal problem severity being a mediator of the effect of IPT-ED. Limitations of the research included the non-optimal choice of measures and non-optimal timing of measurements for establishing temporal precedence. Future research should investigate the mediating role of both cognitive (e.g. interpretation of weight) and behavioural processes (e.g. frequency of weighing) in CBT-E, and the role of interpersonal functioning in CBT-E and IPT-ED. Research should use daily, or session by session measurement to better assess the temporal relationship between the purported mediator/s and the outcome/s. Experimental designs comparing dismantled versions of treatment would also help determine the relative effects that different treatment procedures have on treatment outcome/s.

Predicting who will benefit from what in the treatment of psychiatric disorders is incremental to future development of psychological treatments. In the current study functional magnetic resonance imaging (fMRI) data from participants with social anxiety disorder (SAD) was used to elucidate whether neural responses to negative evaluation could predict treatment response in SAD. Nine weeks prior to Internet- delivered Cognitive Behaviour Therapy (ICBT) onset, participants viewed negative social stimuli directed either at themselves or an significant other during fMRI scanning. Regression analyses including the differential activations for other-referential criticism in contrast to self-referential criticism in the posterior mid cingulate cortex (pMCC) and the lingual gyrus (LG) predicted 34% of treatment change as measured by residual gain scores on the Liebowitz Social Anxiety Scale Self-Report (LSAS-SR) in our sample. The final regression model, combining these measures with behavioural measures, which by themselves explained 27% of the variance, resulted in a model explaining 50% of the variance regarding treatment response. This lends additional support to the notion that further elucidating the neurobiological underpinnings of core processes in SAD, as well as the neural correlates of treatment response to CBT, would be of great value in predicting treatment outcome.

Background: Many women experience childbirth fear to such an extent that it seriously interferes with the woman’s daily life and affects her mental well-being. Aim: The overall aim was to conduct an overview of the midwife-led counselling for childbirth fear in Sweden, to investigate women’s birth preferences and to describe their experiences of treatment on childbirth fear, with focus on midwife-led counselling. Methods: Study I is a cross-sectional study where 43 out of 45 maternity clinics responded to a questionnaire regarding midwife-led counselling. Study II is a longitudinal survey where 889 women participated of whom 70 received counselling. Data were collected by questionnaires in mid-pregnancy, two months and finally, one year after birth. Study III is a randomised controlled study with 258 participating women assessed with childbirth fear. It compares Internet-based cognitive behaviour therapy (ICBT) with midwife-led counselling. Data were collected by questionnaires twice during pregnancy and two months after birth. Study IV is a qualitative interview study using thematic analysis, including 27 women who received midwife-led counselling during pregnancy. Results: Overall, midwife-led counselling was perceived as empowering by the women and increased their confidence when facing birth. The preference for a caesarean section decreased during pregnancy and the majority had a normal vaginal birth but an increase in preference for caesarean section appeared after birth. Half of the women who received treatment for childbirth fear experienced a less than positive birth. Women who had a positive birth experience voiced that the contributing factors were the self-confidence received from counselling and the support from the midwife during birth. Decreased or manageable fear was expressed by the women after counselling and birth, which in turn brought a strengthened confidence for a future pregnancy and birth. Furthermore, major differences exist in counselling for childbirth fear throughout the clinics in Sweden. Conclusion: Midwife-led counselling improved women’s confidence toward giving birth and fear was perceived as manageable. Continuous support is crucial to experience birth as positive. Although women’s preferences for caesarean section did not change over time, few women gave birth with a caesarean section without medial reason.

This research report is a narrative on my encounter with sport psychology. I used the metaphors of “touring” and “journal” to guide the construction of this narrative. Before embarking on my tour with sport psychology, I introduced myself as researcher (chapter 2, journal entry I) and stated the research problem, question and goal(s)(chapter 3, journal entry II). I then went on a tour with sport psychology. I visited a sport psychology museum to learn more about the history of sport psychology (chapter 4, journal entry III) and a sport psychology library to learn more about the field of sport psychology (chapter 5, journal entry IV). I also attended a sport psychology conference to become better acquainted with postgraduate sport psychology training in Psychology Departments (chapter 6, journal entry V). I also visited a sport psychology department at a university in Australia, to witness the delivery of a postgraduate training programme in sport psychology (chapter 7, journal entry VI), as well as a sport centre in South Africa and a sport institute in Australia, to see how and the extent to which sport psychology was practised (chapter 8, journal entry VII). After my tour with sport psychology I took what I had learnt and adapted the MA (Counselling Psychology) programme at the University of Pretoria, South Africa. This led to the programme having three core modules and two elective modules. The core modules are fundamental psychology, counselling psychology and career psychology. The elective modules are: community psychology and sport psychology. The sport psychology module consists of the following courses: sport psychology, sport management, sport sociology and exercise psychology. The Professional Board of Psychology at the Health Professions Council of South Africa approved this module at the end of 2003 (chapter 9, journal entry VIII). Finally, I also looked at the influence of my experience with sport psychology on my identity as a psychologist (chapter 10, journal entry IX). / Thesis (PhD (Psychology))--University of Pretoria, 2006. / Psychology / unrestricted

The overall aim of the present thesis was to examine long-term psychological distress following cancer during adolescence and to develop a tailored psychological intervention to reduce cancer-related distress experienced by young survivors of adolescent cancer that was feasible and acceptable. Study I adopted a longitudinal design, assessing health-related quality of life (HRQOL) and symptoms of anxiety and depression among adolescents diagnosed with cancer from shortly after diagnosis (n=61) up to 10 years after diagnosis (n=28). Findings suggest that development of HRQOL and anxiety and depression is not linear and whilst the majority adjust well, a subgroup report long-term elevated distress. In Study II, experiences of cancer-related psychological distress were explored using unstructured interviews. Participants described cancer treatment as a mental challenge, felt marked and hindered by the cancer experience, and struggled with feelings of inadequacy and insecurity, existential issues, and difficulties handling emotions. Study III was a preliminary investigation of individualised cognitive behavioural therapy (CBT), alongside the identification and conceptualisation of cancer-related concerns using cognitive-behavioural theory. Significant difficulties with recruitment were encountered. Participants reported cancer-related concerns conceptualised as social avoidance, fear and avoidance of emotions and bodily symptoms, imbalance in activity, and worry and rumination. In Study IV, the acceptability and feasibility of an internet-administered CBT based self-help intervention (ICBT) for young persons diagnosed with cancer during adolescence was examined using an uncontrolled design and embedded process evaluation. The study protocol for Study IV was included in this thesis along with preliminary findings demonstrating significant difficulties with recruitment. Overall, findings suggest that whilst the majority of survivors of adolescent cancer adjust well over time a subgroup report elevated levels of distress and a range of distressing cancer-related experiences. A number of cancer-related difficulties were identified in Study II and III, which may be used to inform the development of future psychological treatments for the population. Preliminary investigation of the psychological interventions examined within this thesis further highlights the need for future development work to enhance the feasibility and acceptability of psychological support for the population.

Background: Psychological perfectionism, from a clinical perspective, started to be a topic of interest for cognitive behavioural clinicians at the beginning of the 1950s. Whilst many studies have identified perfectionism as a pivotal motivator in different conditions of neurosis, the exact nature of its interactions remains unclear. In the research community there is still a debate as to whether there is such a thing as good perfectionism, and there remains no consensual theory of psychopathological perfectionism. Aims: The aim of the study was to investigate why the nature of the phenomena remains a contentious issue, and to develop a robust theory of psychopathological perfectionism, within a cognitive behavioural framework, which will find general acceptance. From the literature review this appears to be the first qualitative study to develop such a theory. Method: Substantive grounded theory was developed within a framework of methodical hermeneutics which, it is argued, is capable of generating formative theory. 20 volunteers who came forward in response to advertisements became participants in semi-structured interviews using a post classic qualitative methodology, from which emerging data became the basis of categories leading to the development of the theory, and functions of the phenomena. Results and Conclusions: The study sets out reasons why there remains an impasse amongst researchers and clinicians about the condition of psychopathological perfectionism. A parsimonious theory of pathological perfectionism has been developed, the constructs of which are just necessary and sufficient to describe the condition. The developed theory makes a contribution to theories proposed prior to 1990 and to contemporary research. However as with all theories it is necessarily provisional, so that its usefulness is in need of further research and development. Psychopathological perfectionism has only two constructs, namely a demand to achieve perfectionism in at least one idiosyncratic sphere, which is in response to a core schema of conditional worth. A number of symptoms or functions of psychopathological perfectionism have also been identified, and there are suggestions as to how the condition develops and is maintained to the detriment of the sufferer. The study synthesizes over fifty years of theory and research into the phenomena. The developed theory and its symptoms or functions have important implications for clinical interventions, training, and for further psychological and psychosocial research. These implications are discussed.