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The improvement in cancer remission rates in children and adolescents due to advances in cancer treatment and therapy has led to the development of guidelines that address long-term follow up for survivors of childhood cancers. Adolescents often experience negative emotions related to the fear of uncertainty about long-term survival after cancer remission, yet often report feelings of hope and optimism for the future more than adult cancer survivors. The purpose of this study was to understand the role of self-efficacy and coping in adolescents after remission of cancer. A secondary purpose was to analyze which coping strategies supported long-term survival goals after cancer remission in adolescent populations. A systematic literature review was conducted from the following online databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature On-line (MEDLINE), Education Resources Information Center (ERIC), and PsycInfo. Selected articles included those published between 2000-2016 that were written in English and were peer-reviewed. The results of the study revealed that most adolescents with cancer remission do not experience long term psychosocial issues related to their cancer diagnosis and treatment. However, a large percentage of adolescent cancer survivors report intermittent depression, suicidal ideation and a lower quality of life due to survival after remission. The literature indicates that multiple, integrative forms of behavioral therapy: cognitive, psychosocial, and family based treatment models, help to enhance long term quality of life in adolescent cancer survivors. Strategies that use positive coping methods and improve self-efficacy related to long term survival after remission have demonstrated improvement in psychosocial behaviors in adolescents and promote a better outlook on planning for the future. Future research that analyzes the most effective coping skills to practice after cancer remission and that optimize self-efficacy related to long term survival can positively influence quality of life for adolescent cancer survivors.

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Social anxiety disorder is the fourth most prevalent mental disorder in the US. Over the past several decades, psychotherapeutic, specifically cognitive behavioral, and pharmacologic approaches have been found efficacious for social anxiety disorder. A number of meta-analyses have been conducted since 1995 examining the efficacy of cognitive behavioral therapy (CBT) and/or pharmacotherapy for social anxiety disorder. Though there have been numerous trials in the past decade, no meta-analysis examining both psychotherapy and pharmacotherapy for social anxiety disorder has been published since 2001. For the present study, a comprehensive literature search produced 93 publications featuring 94 controlled trials (N = 11,503), which were included in the final analyses. We found a moderate to large effect size for all active treatments compared to control conditions. Significant heterogeneity among treatment effects was evident, largely accounted for by true variation between effects, versus standard error. Examination of potential study characteristic moderators indicated that treatment type (CBT, medication, combination), analysis type (intent-to-treat vs. completer), funding source, type of screening interview, type of treatment clinic (academic or private), version of diagnostic criteria, type of social anxiety sample (generalized social anxiety disorder only vs. mixed sample of generalized and specific social anxiety disorder) and type of inclusion/exclusion criteria related to other anxiety disorders were significant moderators. Publication type, inclusion/exclusion criteria related to depression and substance abuse/dependence, and full sample comorbidity with another disorder were not. Treatment type was no longer a significant moderator once control condition was accounted for. In psychotherapy trials, self-exposure (as compared to all other types of CBT) and psychotherapist training were significant moderators, whereas variables corresponding to treatment modality and delivery were not. Medication class and specific drug type were significant moderators for pharmacotherapy studies comparing an active treatment to a control condition. Head-to-head comparisons, which included trials comparing active treatments, indicated no differences between psychotherapy, medication, and the combination of the two. Further, social anxiety treatment had moderate to large effects on depression and quality of life. / Psychology

The increasing evidence of the organizational demands encountered by sports performers provides a fertile ground for research. There is now a requirement to move beyond describing the organizational stressors that performers encounter in order to understand the complex appraisal and coping processes that athletes engage in when experiencing organizational stress. This thesis aimed to conduct a detailed examination of these processes in high-level sport performers. Chapter 2 describes a narrative review of the extant appraisal literature that has examined the roles of situational and personal influences on appraising. In order to generate a detailed understanding of this literature, the review includes findings from the general, occupational, organizational, and sport psychology literatures. This review was instrumental in determining the direction of the research described in later chapters. Chapter 3 aimed to narrow the focus of the thesis to organizational stress transactions in sport performers and therefore, describes a diary study that explored swimmers appraisals of organizational stressors. The findings of this study provided insight into the complex process of appraisal and suggested that appraisals are related to the situational property of the stressor encountered. In addition, the results pointed to the importance of exploring the coping strategies that athletes use to manage organizational stressors in future research. Chapter 4 describes a narrative review of the literature that has examined athletes ways of coping with organizational stressors. Due to the limited sport psychology research in this area and in order to extend current knowledge in sport, prominent findings from the organizational and occupational psychology domains were considered. Chapter 5 was designed to extend the findings of Chapter 3 and the existing literature by examining the coping strategies that swimmers use in response to organizational stressors. This chapter highlighted the complexity of coping and suggested that appraisal mechanisms are linked to the coping family employed. Chapter 6 aimed to take a more complete approach to examining organizational stress transactions by exploring various components of stress transactions. The study presented in this chapter suggested that the appraisal an athlete makes is influential in determining the performance outcome that they will experience. Collectively, the chapters described above highlighted appraising as the pivotal element in stress transactions and established a rationale for the cognitive-behavioral based intervention that is described in Chapter 7. The study presented in Chapter 7 aimed to alleviate some of the negative outcomes of organizational stress by optimizing sport performers appraisals. The findings suggested that cognitive restructuring was a useful technique for achieving this aim. The program of research presented in this thesis suggests that appraising is the pivotal element of organizational stress transactions in sport and that appraising can be optimized in order to alleviate the negative emotional and performance outcomes of maladaptive appraisals. In addition, the research highlights the importance of considering the situational properties of stressors, the complexity of coping, and the relationships between components of stress transactions in future research. Further, the findings presented within this thesis suggest that future research should aim to make methodological and measurement advances and examine, in detail, performers appraisal and coping processes.

<p>Historically, the horse has in many ways been important to human beings. Today, Equine Assisted Therapy is a form of treatment in which the horse is used as a tool from the treatment of the client. Supported Equine therapy has a therapeutic purpose and may vary depending on the patient's needs and the professionals work competence. Various studies show that animals have a positive impact on people. The aim of our study was to explore how Equine Assisted Therapy is used within the practical fields of social work in Sweden. We wanted to  illustrate how professionals in different social work settings utilize this form of treatment. Based on our purpose we have chosen to use a qualitative approach in which we interviewed five professionals who work with Equine Assisted Therapy as treatment method in various activities. In our results, we present the strengths and weaknesses according to the professionals; which approach they consider relevant and how a treatment session might look like.</p><p> </p>

Hintergrund. Für die durch wiederkehrende Essanfälle gekennzeichnete Binge Eating-Störung (BES) wurde die Kognitive Verhaltenstherapie (KVT) als Behandlungsmethode der Wahl etabliert. Zum Psychotherapieprozess, welcher das Therapieergebnis beeinflusst, ist jedoch wenig bekannt. Fragestellung. Da Untersuchungen zum Prozessaspekt der therapeutischen Adhärenz Unterschiede zwischen Patienten eines Therapeuten sowie zwischen verschiedenen Therapeuten belegen, soll der Einfluss von Patienten- und Therapeutenmerkmalen auf die therapeutische Adhärenz geprüft werden. Methode. In einer prospektiven, multizentrischen, randomisiert-kontrollierten Behandlungsstudie zum Wirksamkeitsvergleich von KVT und Internet-basierter angeleiteter Selbsthilfe (INTERBED) wurde die therapeutische Adhärenz in der KVT durch unabhängige Rater erfasst. Patienten- und Therapeutenmerkmale wurden mittels Interview und Selbstbericht erhoben. Ergebnisse. Soziodemografische Merkmale wie ein geringeres Bildungsniveau der Patienten und weibliches Geschlecht der Therapeuten wurden als signifikante Prädiktoren einer höheren therapeutischen Adhärenz identifiziert. Störungsspezifische Merkmale der Patienten waren nicht mit der therapeutischen Adhärenz assoziiert. Therapeutenmerkmale wie ein geringerer Ausbildungsgrad, eine geringere erlebte therapeutische Kompetenz und höhere Erwartungen sowie ein höheres emotionales Wohlbefinden der Therapeuten sagten eine höhere therapeutische Adhärenz vorher. Diskussion. Die etablierte hohe therapeutische Adhärenz erschien unabhängig vom Patienten, während einige Therapeutenmerkmale als Prädiktoren identifiziert wurden. Ungünstige Einflüsse auf die therapeutische Adhärenz bedürfen weiterer Erforschung und einer stärkeren Berücksichtigung in der Ausbildung von Therapeuten. / Background. Cognitive-behavioral therapy (CBT) has been established as the treatment of choice for binge-eating disorder (BED) which is characterized by recurrent binge eating episodes. However, only little is known about the impact of the psychotherapeutic process on treatment outcomes. Objectives. While studies concerning the process aspect of therapist adherence found differences between patients from one therapist as well as differences between therapists, the impact of patient and therapist characteristics on therapist adherence will be investigated. Methods. In a prospective multicenter randomized-controlled trial comparing CBT to Internet-based guided self-help (INTERBED), the therapist adherence to CBT was determined by independent raters. Patient and therapist characteristics were obtained via interview and self-report questionnaires. Results. Sociodemographic characteristics including lower education in patients and female sex in therapists were identified as predictors of higher therapist adherence. Disorder-specific characteristics of patients were not associated with the therapist adherence. Therapist characteristics including less postgraduate therapist training, lower self-rated therapeutic competence, and higher expectations as well as higher emotional well-being of therapists predicted higher therapist adherence. Conclusions. The high level of therapist adherence was mostly independent from patients, while some therapist characteristics were identified as predictors. Adverse impacts on therapist adherence should be investigated further and might be considered in therapeutic training.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.

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