Para avaliar se ocorreriam mudanças cognitivas, sensoriais, comportamentais e emocionais positivas duradouras em mulheres submetidas à psicoterapia cognitivo-comportamental em grupo em relação à fibromialgia, foram selecionadas 36 doentes do sexo feminino, 18 formando o grupo experimental e 18 o grupo comparativo. O grupo experimental foi submetido a 10 sessões em grupo de psicoterapia cognitivo-comportamental. Os resultados foram comparados e analisados qualitativamente, o que permitiu a elaboração da representação social da mulher com fibromialgia / In order to evaluating if the cognitive-behavioral group psychotherapy would provide cognitive, sensorial, behavioral, emotional, lasting and positive changes in women with fibromyalgia, in comparison to those who had not been submitted to this intervention, thirty-six women participated in this study; eighteen formed an experimental group and eighteen, a comparative group. The experimental group underwent ten sessions of cognitive-behavioral psychotherapy. The recollected data had been compared and analyzed qualitatively, which allowed elaborating the social representation of the woman with fibromyalgia.

研究背景 / 雖然靜觀減壓療法(MBSR)近來備受關注， 但在香港中國人群中尚缺乏可靠量表測定其靜觀能力，而且也罕有研究評估MBSR在家庭護理者心理健康方面的作用。 / 研究目的 / 本研究有兩個目的：第一，在香港社區人群和臨床患者中驗證中文版《五面靜觀能力問卷》（FFMQ-C），並設計簡潔版中文問卷 （FFMQ-SF）；第二，使用隨機對照研究（RCT）評估MBSR在緩解家庭護理者抑鬱症狀等方面的療效。 / 對象與方法 / 在問卷驗證研究中，招募了230名社區成人和156名廣泛性焦慮患者（GAD）。重測信度和內部一致性信度用於檢驗可信度。驗證性因素分析（CFA）則用於檢驗結構效度。 / 在RCT中，141位符合納入和排除條件的家庭護理者被隨機分配至靜觀減壓組和對照組（提供健康教育自學材料）。抑鬱症狀是本研究的主要指標，使用流行病學研究中心憂鬱量表（CESD）測定。得分在16以上的被定為疑是抑鬱症，CESD下降50%則被定為臨床好轉。次要研究結果包括焦慮，自我效能，靜觀能力和生活品質等。參與者需在研究開始之前，幹預結束之時和三個月隨訪之後自行填寫問卷。數據分析採用意向性研究方法。 / 研究結果 / FFMQ-C的重測信度為0.88，內部一致性在社區人群為0.83，在GAD患者為0.80。CFA證實了問卷的五因數結構 （NNFI 0.94, CFI 0.95, RMSEA 0.076 (0.063-0.086)）。FFMQ-SF包括20個條目，具有良好的效度和信度。 / 在RCT中，靜觀減壓組 （n=70）的退出率明顯低於對照組 （n=71）（12.9% vs 26.8%, p= .039）。靜觀減壓組CESD的下降程度在幹預結束之時（-6.72 ± 6.38 vs -2.85 ± 4.82, p= .001），和三個月隨訪之後（-4.70 ± 6.32 vs -1.39 ± 8.52, p=.001）都比對照組更加顯著。靜觀減壓組較對照組有更多人獲得臨床好轉的，無論在幹預結束之時（35.3% vs 4.7%, OR (2.29, 54.51)），還是在三個月隨訪之後（23.5% vs 7.0%, OR (1.00, 16.90)）。靜觀減壓組在焦慮症狀緩解、自我效能提高和靜觀能力增加等方面均較對照組有更顯著的改變。 / 研究結論 / FFMQ-C和FFMQ-SF都能可靠並準確的檢測香港中國人群的靜觀能力。 / MBSR能有效減少護理者的焦慮、抑鬱症狀，提高自我效能和靜觀能力，在香港社區中有良好的可行性和接受性。 / Introduction / Mindfulness-based stress reduction (MBSR) program has been receiving increasing attention in recent years. However, no questionnaires were validated to measure “mindfulness in Hong Kong Chinese adults. In addition, few studies have been conducted to examine the effectiveness of MBSR on mental wellbeing of family caregivers. / Objectives / The first part of this thesis aimed to validate the Chinese version of Five Facet Mindfulness Questionnaire (FFMQ-C) in Hong Kong and to develop a short form scale (FFMQ-SF). The second part of the thesis aimed to evaluate the effectiveness of MBSR in reducing depressive symptoms among family caregivers in Hong Kong Chinese adults. / Subjects and Methods / In the first part of the thesis, 230 community adults and 156 patients with clinical diagnosis of generalized anxiety disorder (GAD) were recruited. Both test-retest and internal consistency reliability were used to examine the reliability of FFMQ-C, while confirmatory factor analyses (CFA) were used to examine the structure validity of FFMQ-C. / In the second part of the thesis, 141 caregivers, who met the inclusion/exclusion criteria, were randomly assigned to either the 8-week MBSR group or the control group (self-learning booklets on mental health and stress management). The Center for Epidemiologic Studies Depression Scale (CESD) was used to measure the depressive symptoms as the primary outcome. A score of CESD above 16 was used to identify the clinically significant depression and a 50% or more reduction in CESD was regarded as clinical improvement. The secondary outcomes included anxiety, self-efficacy, mindfulness and quality of life and so on. All the outcome measures were self-administrated at baseline, post-intervention and 3-month follow-up. Intention-to-treat analyses were used to test the group effects of MBSR on outcome measures. / Results / The test-retest reliability of FFMQ-C was 0.88, and Cronbach's alpha was 0.83 in the community sample and 0.80 in the GAD sample. CFA showed adequate model fit for correlated five-factor structure (NNFI 0.94, CFI 0.95, RMSEA 0.076 (0.063-0.086)). A 20-item FFMQ-SF was developed and showed sufficient reliability, validity and psychometric property. / In the second part of the thesis, the MBSR group (n=70) showed significantly lower attrition rate than the control group (n=71) (12.9% vs 26.8%, p= .039). Participants in the MBSR group reported significantly greater reduction in CESD compared to the controls immediately post-intervention (-6.72 ± 6.38 vs -2.85 ± 4.82, p= .001) and at 3 months post-intervention (-4.70 ± 6.32 vs -1.39 ± 8.52, p=.001). MBSR group had a significantly larger proportion of participants with clinical improvement than the control group immediately post-intervention (35.3% vs 4.7%, OR (2.29, 54.51)) and at 3 months post-intervention (23.5% vs 7.0%, OR (1.00, 16.90)). Significant group effects of MBSR were also shown on the reduction of anxiety symptoms, the improvement in self-efficacy, and the increase in mindfulness. / Conclusions / The FFMQ-C and FFMQ-SF are reliable and valid instruments to measure mindfulness in Hong Kong Chinese adults. / MBSR is a feasible and acceptable program to effectively reduce psychological symptoms, and to improve mindfulness and self-efficacy among adult caregivers in Hong Kong Chinese. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Hou, Jing. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 102-122). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / Abstract (English) --- p.i / Abstract (Chinese) --- p.iii / Acknowledgements --- p.v / List of Contents --- p.vii / List of Tables --- p.xi / List of Figures --- p.xiii / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1. --- Background of the study --- p.1 / Chapter 1.1.1. --- Validation of the Chinese Version of the Five Facet Mindfulness Questionnaire for Adults in Hong Kong --- p.1 / Chapter 1.1.2. --- Evaluation of the effectiveness of MBSR on mental health among caregivers in Hong Kong --- p.2 / Chapter 1.2. --- Objectives --- p.4 / Chapter 1.3. --- The structure of the thesis --- p.5 / Chapter Chapter 2 --- Literature review on the impact of caregiving and the interventions for caregivers --- p.7 / Chapter 2.1. --- Definition of caregiver --- p.7 / Chapter 2.2. --- Global view of caregivers --- p.7 / Chapter 2.3. --- Care burden --- p.8 / Chapter 2.3.1. --- Introduction of Care burden --- p.8 / Chapter 2.3.2. --- The measurements of care burden --- p.9 / Chapter 2.3.3. --- Social determinants of care burden --- p.12 / Chapter 2.3.4. --- The impacts of caregiving on caregivers’ physical and psychological health --- p.18 / Chapter 2.4. --- Interventions for caregivers --- p.20 / Chapter 2.4.1. --- Psychosocial interventions --- p.21 / Chapter 2.4.2. --- Support and information --- p.21 / Chapter 2.4.3. --- Respite care --- p.21 / Chapter 2.4.4. --- Technology-based interventions --- p.22 / Chapter Chapter 3 --- Rationales of the study --- p.23 / Chapter 3.1 --- What’s mindfulness? --- p.23 / Chapter 3.2. --- How is mindfulness applied? --- p.24 / Chapter 3.2.1. --- Mindfulness-based stress reduction (MBSR) --- p.24 / Chapter 3.2.2. --- Mindfulness-based cognitive therapy (MBCT) --- p.25 / Chapter 3.2.3. --- Dialectical behavior therapy (DBT) --- p.25 / Chapter 3.2.4. --- Acceptance and commitment therapy (ACT) --- p.26 / Chapter 3.3. --- Reviews on the effectiveness of MBSR --- p.27 / Chapter 3.4. --- The use of MBSR among caregivers --- p.29 / Chapter 3.5. --- Limitations of current studies --- p.31 / Chapter 3.6. --- Why in Hong Kong? --- p.31 / Chapter Chapter 4 --- Validation of a Chinese Version of the Five Facet Mindfulness Questionnaire for Adults in Hong Kong, and Development of a Short Form --- p.33 / Chapter 4.1. --- Background --- p.33 / Chapter 4.2. --- Methods --- p.35 / Chapter 4.2.1. --- Preparation of Chinese version of FFMQ --- p.35 / Chapter 4.2.2. --- Participants and procedure --- p.35 / Chapter 4.2.3. --- Measures --- p.36 / Chapter 4.2.4. --- Data analysis --- p.38 / Chapter 4.3. --- Results --- p.40 / Chapter 4.3.1. --- Reliability --- p.41 / Chapter 4.3.2. --- Validity --- p.42 / Chapter 4.3.3. --- Cross-validation --- p.45 / Chapter 4.3.4. --- Confirmatory factor analysis --- p.46 / Chapter 4.3.5. --- Development of short version of FFMQ (FFMQ-SF) --- p.46 / Chapter 4.3.6. --- Evaluation of the FFMQ-SF --- p.47 / Chapter 4.4. --- Discussion --- p.50 / Chapter 4.5. --- Limitations --- p.53 / Chapter 4.6. --- Conclusions --- p.54 / Chapter Chapter 5 --- A Randomized Control Trial of MBSR among Family Caregivers - Subjects and Methods --- p.55 / Chapter 5.1. --- Study design --- p.55 / Chapter 5.2. --- Recruitment --- p.55 / Chapter 5.3. --- Retention --- p.56 / Chapter 5.4. --- Inclusion criteria and exclusion criteria --- p.57 / Chapter 5.5. --- Randomization, concealment and blinding --- p.58 / Chapter 5.6. --- Intervention group --- p.58 / Chapter 5.7. --- Instructors --- p.60 / Chapter 5.8. --- Settings --- p.61 / Chapter 5.9. --- Control group --- p.61 / Chapter 5.10. --- Outcomes and measures --- p.61 / Chapter 5.10.1. --- Primary outcome (depression) measure --- p.61 / Chapter 5.10.2. --- Secondary outcome measures --- p.62 / Chapter 5.10.3. --- Other measures --- p.65 / Chapter 5.11. --- Sample size calculation --- p.65 / Chapter 5.12. --- Statistical analyses --- p.66 / Chapter 5.12.1. --- Baseline comparison --- p.66 / Chapter 5.12.2. --- Effectiveness of MBSR --- p.66 / Chapter 5.12.3. --- Correlations among the changes of variables --- p.67 / Chapter 5.12.4. --- Medical services utilization --- p.67 / Chapter 5.12.5. --- Sensitivity analyses --- p.68 / Chapter Chapter 6 --- A Randomized Control Trial of MBSR among Family Caregivers - Results --- p.69 / Chapter 6.1. --- Recruitment and study flow --- p.69 / Chapter 6.2. --- Baseline characteristics --- p.69 / Chapter 6.3. --- Attrition and compliance --- p.74 / Chapter 6.4. --- Analyses of primary outcome - depressive symptoms --- p.75 / Chapter 6.5. --- Analyses of secondary outcome measures --- p.80 / Chapter 6.5.1. --- Anxiety --- p.80 / Chapter 6.5.2. --- Caregiver self-efficacy --- p.81 / Chapter 6.5.3. --- Mindfulness --- p.82 / Chapter 6.5.4. --- Other secondary outcome measures --- p.83 / Chapter 6.6. --- Correlations of changing scores between mindfulness and other outcomes --- p.83 / Chapter 6.7. --- Correlations of change scores between CESD and other outcomes (not including FFMQ) --- p.86 / Chapter 6.8. --- Analyses of medical services utilization --- p.87 / Chapter 6.9. --- Adverse effects of MBSR --- p.88 / Chapter 6.10. --- Per protocol analyses --- p.89 / Chapter Chapter 7 --- A Randomized Control Trial of MBSR among Family Caregivers - Discussion --- p.90 / Chapter 7.1 --- Discussion --- p.90 / Chapter 7.1.1. --- Effects of MBSR on depression --- p.90 / Chapter 7.1.2. --- Effects of MBSR on anxiety --- p.91 / Chapter 7.1.3. --- Effects of MBSR on mindfulness measured by Five Facet Mindfulness Questionnaire --- p.92 / Chapter 7.1.4. --- Effects of MBSR on caregiver self-efficacy --- p.92 / Chapter 7.1.5. --- Attrition and compliance --- p.93 / Chapter 7.1.6. --- Relationship between practice time and mindfulness --- p.93 / Chapter 7.1.7. --- Relationship between mindfulness and other psychological outcomes --- p.94 / Chapter 7.1.8. --- Effects of MBSR on perceived stress and health related quality of life --- p.95 / Chapter 7.1.9. --- Effects of MBSR on medical service utilization --- p.96 / Chapter 7.1.10. --- Self-rated effectiveness and acceptability --- p.96 / Chapter 7.1.11. --- Adverse effects of MBSR --- p.96 / Chapter 7.2. --- Strengths --- p.97 / Chapter 7.3. --- Limitations --- p.97 / Chapter 7.4. --- Implications and recommendations for further study --- p.98 / Chapter 7.5. --- Conclusions --- p.99 / Reference --- p.102

The aim of this research study was achieved by providing support for the effectiveness and the transportability of the Ehlers and Clark (2000) cognitive therapy model for the assessment and treatment of PTSD. Furthermore, the contextual factors which were important in this case were investigated and documented. However, research within the social sciences will inevitably produce various limitations due to the unique individuals and dynamic phenomena that are studied.

Para avaliar se ocorreriam mudanças cognitivas, sensoriais, comportamentais e emocionais positivas duradouras em mulheres submetidas à psicoterapia cognitivo-comportamental em grupo em relação à fibromialgia, foram selecionadas 36 doentes do sexo feminino, 18 formando o grupo experimental e 18 o grupo comparativo. O grupo experimental foi submetido a 10 sessões em grupo de psicoterapia cognitivo-comportamental. Os resultados foram comparados e analisados qualitativamente, o que permitiu a elaboração da representação social da mulher com fibromialgia / In order to evaluating if the cognitive-behavioral group psychotherapy would provide cognitive, sensorial, behavioral, emotional, lasting and positive changes in women with fibromyalgia, in comparison to those who had not been submitted to this intervention, thirty-six women participated in this study; eighteen formed an experimental group and eighteen, a comparative group. The experimental group underwent ten sessions of cognitive-behavioral psychotherapy. The recollected data had been compared and analyzed qualitatively, which allowed elaborating the social representation of the woman with fibromyalgia.

O efeito da reabilitação neuropsicológica foi verificado em uma amostra de 16 pacientes com diagnóstico de doença de Alzheimer leve e moderado. Após ensaio clínico aberto com rivastigmina por 4 meses, os pacientes foram divididos em três grupos: sessões em grupo, individual e em casa com o cuidador. Os três grupos realizaram o mesmo protocolo de reabilitação, e antes e depois das 22 semanas de tratamento foram avaliados pelos mesmos instrumentos. Os resultados indicaram que as sessões em grupo são mais eficientes para sintomas psiquiátricos; individual para atividades da vida diária; e em casa, dependendo do perfil do paciente e do cuidador, pode ser uma alternativa de tratamento / The effect of a neuropsychological rehabilitation was tested in a sample of 16 patients with mild and moderate Alzheimer disease. After an open trial with rivastigmine for 4 months, they were divided in 3 groups: group sessions, individualized and at home with a caregiver. All 3 groups fulfilled the same rehabilitation protocol, and just before and after the 22 week period of treatment, all patients were evaluated using the same instruments. The results of the study indicated that group session are more effective for psychiatric symptoms, individualized sessions for activities of daily living training and at home training, depending on the patient's and caregiver's profiles, can be an option for treatment of these patients

O efeito da reabilitação neuropsicológica foi verificado em uma amostra de 16 pacientes com diagnóstico de doença de Alzheimer leve e moderado. Após ensaio clínico aberto com rivastigmina por 4 meses, os pacientes foram divididos em três grupos: sessões em grupo, individual e em casa com o cuidador. Os três grupos realizaram o mesmo protocolo de reabilitação, e antes e depois das 22 semanas de tratamento foram avaliados pelos mesmos instrumentos. Os resultados indicaram que as sessões em grupo são mais eficientes para sintomas psiquiátricos; individual para atividades da vida diária; e em casa, dependendo do perfil do paciente e do cuidador, pode ser uma alternativa de tratamento / The effect of a neuropsychological rehabilitation was tested in a sample of 16 patients with mild and moderate Alzheimer disease. After an open trial with rivastigmine for 4 months, they were divided in 3 groups: group sessions, individualized and at home with a caregiver. All 3 groups fulfilled the same rehabilitation protocol, and just before and after the 22 week period of treatment, all patients were evaluated using the same instruments. The results of the study indicated that group session are more effective for psychiatric symptoms, individualized sessions for activities of daily living training and at home training, depending on the patient's and caregiver's profiles, can be an option for treatment of these patients