Binge-eating disorder (BED) is characterized by recurrent objective binge eating that occurs in the absence of compensatory behaviors to prevent weight gain. As the most common eating disorder emerging in youth, BED co-occurs with increased eating disorder and general psychopathology, impaired quality of life, and obesity [1]. Despite its clinical significance, there is a dearth of treatment studies in adolescents [1, 2]. Regarding cognitive-behavioral therapy (CBT), the most well-established treatment for adults with BED [2], one pilot randomized-controlled trial (RCT) in 25 adolescent girls with objective binge eating suggested superiority to wait-list (WL) in achieving binge-eating abstinence through 6 months following randomization and in improving eating disorder psychopathology, but not in reducing binge eating or standardized body mass index (BMI; kg/m2) [3]. Other CBT-related RCTs documented efficacy of Internet-based, weight loss-oriented self-help versus WL [4] and no differences in dialectical behavior therapy versus weight management [5]. Based on this preliminary evidence, the aim of the BEDA (Binge Eating Disorder in Adolescents) study was to provide a confirmatory test of the efficacy of CBT in adolescent BED. It was hypothesized that CBT will be superior to WL in improving binge eating, associated psychopathology, and quality of life, but not BMI, with long-term maintenance of effects.

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.

(in English): A total of 62% of the Czech adult population currently suffer from overweight or obesity (BMI over 25). Overweight problems are mostly caused by bad eating and exercising habits. The web application Self-Coaching with cognitive behavioral therapy elements helps overweight or obese users to gradually change their bad habits. The objective of the research part of the thesis is to evaluate the effect of a 5-week use of the web application Self-Coaching and to find out whether or not this effect changes if the users are provided with a virtual intervention of an instructor trained in a cognitive behavioral approach to obesity treatment. I evaluated the percentage of weight loss as compared to the initial body weight, the energy and nutritional balance of the diet, vegetable intake, physical activity, the number of days of using the application and the use of the psychological section of the application (psycho-coaching). Weight loss was the identified main effect of the web application Self-Coaching. After five weeks, the users lost on average 2.5% of their initial weight. The intervention of the instructor helped to increase the number of days, for which the users used Self-Coaching.

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Equine Assisted Therapy is, from a social work perspective, a relatively unexplored arrangement of therapy in which the horse is part of the treatment. This study illustrates the equine therapist’ experiences of Equine Assisted Cognitive Behavioural Therapy (EA-CBT) and Equine Assisted Therapy (EAT) up against people suffering from mental health issues. The research questions are: How do we use horses as a part of the treatment up against people with mental health issues? What components can be identified as a central part of the treatment in Equine Assisted Therapy? The empirical material was collected by using hermeneutic approach and qualitative semi-structured interviews with three practicing equine therapists. The main result showed that horses are used as therapeutical co-workers, as well as a metaphor for the individuals’ emotions. The horses take a significant part of the patients’ sense of coherence (KASAM) as well as the patients’ mentalization, especially through emotional understanding and communication. Furthermore, the result indicate that the horse is as an important link in the encounter between therapist and patient. The analysis was based on an analytic method, in which the empirical material is the starting point of coding and creating themes. The central conclusions were that the horse play a significant role in the promotion of the humans’ ameliorative mental health. It does not only play role for the mental health issues, but also for the patients’ conduction after the treatment.

Meeting the psychological needs of the culturally and linguistically different has always posed challenges to mental health providers. The Haitian community in South Florida has been one such group for whom mental health services have been less than readily available. Some reasons include a lack of trust from the community, a pejorative cultural framework of mental health services, as well as, a lack of competent Haitian Creole speaking therapists armed with culturally congruent therapeutic skills. These present as challenges for community based-agencies attempting to meet the mental health needs of this population. It is even more problematic for humanitarian voluntary agencies (VOLAG) that sponsor refugees and support them throughout their resettlement efforts. Additionally, the 2010 earthquake has given rise to gender based violence disproportionally impacting women and girls (Amnesty International, 2011) who are now seeking safe haven in the U.S. and particularly South Florida. Tasked with assisting in the resettlement of Haitian refugees/asylees/parolees, many psychologically affected by pre and post migration traumas, these agencies must find unique solutions to help their clients toward the ultimate goal of resettlement, self-sufficiency (Stenning, 1996). This Applied Clinical Project (ACP) showcases a community-university partnership with a VOLAG. Participatory Action Research (PAR) protocol was used as an explorative tool to learn from stakeholders about the efficacy of incorporating Solution-Focused Group Therapy (SFBT) in a resettlement integrative program for Haitians. Results will also contribute to the future development of a toolkit to support family therapists in adapting their western trainings to provide culturally and linguistically competent mental health services.

The United States Supreme Court decision in the Roe v. Wade (1973) case provides women with a right to privacy and the liberty to make decisions concerning their reproductive lives. With this, women who become pregnant are offered the right to choose between keeping their pregnancy and terminating the pregnancy by way of abortion. Since Roe v. Wade (1973), many women have exercised their reproductive liberties, as evidenced by the termination of over 60 million pregnancies via legal abortion in the United States. Still, secrecy among women with a history of abortion remains a common phenomenon. Studies conducted on abortion and reasons for abortion are innumerable and literature on reasons women keep abortion secret are readily available. However, research lacks in the area of examining the lived experience of women with history of abortion secret. Thus, this research examines this phenomenon from women’s lived experiences and the effects of the secret on their relationship(s) when kept from at least one person(s) with whom the post-abortive women are/were in relationship. Purposive sampling was used to select five female participants for this study. To examine participants’ lived experience with abortion secret history as it relates to its effects on relationship(s), the researcher employed qualitative method Interpretative Phenomenological Analysis (IPA) in conjunction with Bowen Family Systems Theory approach. Seven superordinate themes emerged from the data analysis: self-sacrifice, emotional aftermath of abortion secret; secrecy as protection; dance of anxiety; effects on relationships; generational experiences; and, finding freedom. The collaborative use of IPA and Family Systems Theory provided an understanding of participants’ experiences, the effects of the secret on participants, as well as their emotional systems. The data collected added to the limited research available on this phenomenon providing space for post-abortive women’s secrecy experience to be heard.

No description available.

No description available.

Psykisk ohälsa är något som har stort inflytande på människors dagliga rutiner där de drabbade kan sakna motivationen för att hålla sig till sina vardagliga uppgifter. På marknaden finns det idag appar som ska motivera användare till att ta hjälp och skapa nya rutiner. Hos dessa appar fattas det dock önskvärda funktioner eller så ligger de bakom en betalvägg vilket kan göra att man tappar motivationen till att använda apparna. UX- och UI-design kan vara väldigt viktigt för att användare ska kunna skapa nya användningsrutiner, speciellt vid appar för psykisk ohälsa. Vi har därför skapat en app-prototyp, med inspiration från analysmetoden kognitiv beteendeterapi (KBT), som har en UX- och UI-design som ska uppmuntra till rutinskapande och vara lättillgänglig. För att validera vårt arbete samt utveckla vår gestaltning har vi haft ett flertal itereringstester, samtal med psykologer och kuratorer samt utfört anonyma användartester. Undersökningens resultat visar att applikationer för kontinuerligt bruk uppmuntrar till rutinskapande och användning via enklare funktioner samt en estetiskt tilltalande UI-design. / Mental illness is something that has a big influence on people's everyday routines where the affected person may lack the motivation to abide by their daily tasks. On today's market there are apps which are for motivating users to get help and make new routines, but there is a lack of desirable features or they’re behind a paywall which can affect the motivation to use the apps. UX- and UI-design can be very important for the making of routines for users, especially when it comes to apps for mental illness. Therefore we have created an app-prototype, with inspiration from Cognitive Behavioral Therapy (CBT), which has an UX- and UI-design that will encourage routine making and be more available. To validate our work and develop our design we have had several iteration tests, conversations with psychologists and social workers, and anonymous user tests. The result of the study shows that applications for continuous usage encourage new routines and utilization through simplified features and an aesthetically pleasing UI-design.