Clinical perfectionism is characterized by rigidly pursuing unrealistically high standards on which self-worth is contingent and experiencing distress when these standards are not met. Because clinical perfectionism is associated with many psychological diagnoses, understanding how to treat it may help streamline available treatments. The aim of this dissertation was to test the effect of acceptance and commitment therapy (ACT), a cognitive-behavioral therapy, on 53 individuals with clinical perfectionism. Participants in the ACT group received 10 therapy sessions and those in the control group were on a waitlist for 14 weeks. The first study supported the effectiveness of ACT relative to the waitlist control group with respect to perfectionism severity, quality of life, and general symptom distress. The second study showed changes in psychological inflexibility and self-compassion explained improvements in quality of life and concern over mistakes, respectively. It also found a variable effect of baseline psychological inflexibility on response to treatment depending on the outcome tested. In contrast, average self-compassion was generally associated with better outcomes in ACT. Neurological results from the third study suggest receiving ACT was associated with greater cognitive efficiency while performing error-prone tasks and decreased responsivity to emotionally meaningful stimuli. In addition, changes in brain activation were not linked to changes in self-report outcomes. Collectively, this dissertation examined not only the efficacy of an intervention focused on a maladaptive behavioral pattern like clinical perfectionism but also how and for whom such a therapy works.

Trichotillomania is defined as recurrent pulling of one’s hair that results in distress and negative effects on general functioning and quality of life. Estimates of trichotillomania lifetime prevalence generally range from approximately 1% to 3% and it is likely as common as disorders such as obsessive-compulsive disorder and agoraphobia. Yet, quality treatment for trichotillomania is often difficult to find as many mental health professionals are uninformed about the disorder and its treatment. Moreover, mental health services in general are inaccessible to many with estimates suggesting that 96.5 million people do not have access to adequate services. The use of telepsychology has been an effective method for disseminating treatment services for a variety of mental health conditions. However, no research has examined the effectiveness of telepsychology to treat trichotillomania. The current study reports the results of a randomized clinical trial of Acceptance and Commitment Therapy Enhanced Behavior Therapy for the treatment of trichotillomania delivered by way of telepsychology. The study compared an active treatment condition (n = 12) to a waitlist control condition (n = 10). Results showed significant reductions in hair pulling severity from pre- to post-treatment compared to the waitlist condition. Participants in the waitlist condition received the same treatment as participants in the treatment condition following the waitlist period. All participants were then combined to examine overall treatment effects from pre-treatment to a 12-week follow-up. The effect of treatment on hair pulling severity was still significant at follow-up, however the effect was not as strong as at post-treatment. Conversely, the effect on quality of life was maintained and even increased following post-treatment. Additional measures of psychological flexibility, perceived shame, and valued action also saw significant changes from pre-treatment to follow-up. The findings demonstrate that telepsychology is a viable option to disseminate treatment for trichotillomania. Implications, limitations, and future research directions are discussed.

abstract: Excessive gestational weight gain (EGWG) affects 50% of US pregnant women and may be an important contributor to obesity in both the mother and child. Novel strategies to prevent EGWG are needed to reduce the risk of adverse health outcomes for the mother and child. This dissertation presents three manuscripts that 1) propose a novel model to explain how prenatal yoga may prevent EGWG through behavioral, psychological/emotional, and physical factors, 2) test the feasibility and preliminary efficacy of a prenatal yoga intervention to prevent EGWG compared to a pregnancy education comparison group, and 3) qualitatively investigate pregnant women’s experiences participating in a prenatal yoga intervention to prevent EGWG. In manuscript two, 49 women were recruited and randomized to a 12-week prenatal yoga intervention (n=23) or a time-matched pregnancy education comparison group (n=26). A satisfaction survey was administered at post-intervention to assess feasibility outcomes (e.g., acceptability, demand). Mindfulness, emotion regulation, self-awareness, sleep quality, depression, anxiety, and perceived stress were assessed at baseline and post-intervention (12-weeks) and GWG was assessed weekly. Linear mixed models were used to analyze pre-post changes in primary (i.e., GWG during pregnancy) and secondary (i.e., mindfulness, emotion regulation, self-awareness, sleep quality, depression, anxiety, and stress) outcomes. In manuscript three, interviews were conducted with pregnant women who participated in the prenatal yoga intervention (n=13). Interview responses were summarized using an inductive approach to thematic analysis. Findings in manuscript two suggest that prenatal yoga was a feasible method to prevent EGWG with high enjoyment and satisfaction reported among participants. The average number of prenatal yoga sessions attended was 8.84 (SD = 3.85). There was no significant group differences on the rate of GWG or total GWG throughout the intervention and a significant group x time interaction effect for stress (p=.03). In manuscript three, twelve themes were identified among the data and were organized into the following categories (three themes each): 1) experiences of prenatal yoga, 2) prenatal yoga and weight, 3) barriers to prenatal yoga, and 4) facilitators of prenatal yoga. This initial evidence suggests that prenatal yoga has potential as a strategy to prevent EGWG in pregnant women. / Dissertation/Thesis / Embargo form / Doctoral Dissertation Exercise and Nutritional Sciences 2019

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第18516号 / 社医博第57号 / 新制||社医||8(附属図書館) / 31402 / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 川上 浩司, 教授 横出 正之, 教授 佐藤 俊哉 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DGAM

This is the peer reviewed version of the following article: [J Am Geriatr Soc 63:1355–1363, 2015.], which has been published in final form at [doi: 10.1111/jgs.13481]. This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving. / 京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第19642号 / 人健博第34号 / 新制||人健||3(附属図書館) / 32678 / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 三谷 章, 教授 黒木 裕士, 教授 市橋 則明 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第21041号 / 人健博第57号 / 新制||人健||4(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 市橋 則明, 教授 田村 恵子, 教授 万代 昌紀 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

No description available.

Background: Depressive and anxiety symptoms are prevailing among transitional aged youth (TAY) putting this population at high risk for lifelong mental illness as these disorders track through adulthood. Heavy social media use (SMU) is prevalent among TAY, which is concerning given it is associated with emotional distress in the form of depression and anxiety, with evidence that unfavourable social comparisons may be a primary mechanism. However, most research is cross-sectional in nature, highlighting the need for experimental studies to provide a greater understanding of how SMU impacts mental health and social comparisons. Accordingly, the primary aim of this study was to examine whether reducing SMU to 1 hour/day reduced depressive symptoms in distressed TAY. Secondary objectives included the examination of intervention effects on anxiety symptoms, and whether social comparison mediated the relationship between SMU reduction and reduced depressive and anxiety symptoms. Exploratory objectives included examining the intervention effects on individuals with greater/lesser emotional distress at baseline. Design and Methods: A randomized controlled trial was used to assign 218 (77% female) TAY (aged 17-25 years) to either the intervention group (n=116) or the control group (n=102). The intervention group was instructed to reduce smartphone-based SMU to a maximum of 1hr/day while the control group had no SMU restrictions. Study duration included 1-week baseline period followed by a 3-weeks intervention period; and mental health outcome measurements were taken at baseline and 4-weeks. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CESD-10), and anxiety symptoms were measured using the Generalized Anxiety Disorder scale (GAD-7), while social comparison was measured using the Technology-Based Social Comparison and Feedback-Seeking subscale (SCFS), which is a subscale of the Motivations for Electronic Interaction Scale (MEIS). Results: Analysis of variance (ANOVA) revealed the intervention was successful in limiting SMU, evidenced by a significant group x time interaction showing a greater reduction of SMU in the intervention group compared to the control group (p <.001, parital ηₚ²=.286). Simple effects showed that intervention participants spent less time in SMU than controls at week two (79.8min (45.6) vs 186.8min (98.21), p < .001), week three (75.97min (53.78) vs 189.67min (84.38), p < .001), and week four (76.01min (57.48) vs 188.8min (94.94), p <.001). There was good adherence to submitting screenshots (94%) and this did not differ by group at baseline (p = 0.474) or during the 3-week intervention period (p = 0.834). ANOVA also revealed a significant group x time interaction showing a greater reduction for the intervention group compared to the control group at week 4 in depressive symptoms (p= .019, partial ηₚ²= .025) and anxiety symptoms (p = .015, partial ηₚ²= .027), but groups did not differ on changes in social comparison (p= .593, partial ηₚ²= .001). Three-way interactions showed that relative to controls, SMU reduction produced a greater reduction in anxiety symptoms for those with high baseline scores (p = .008, partial ηₚ²= .032) compared to those with low baseline scores, whereas this three-way interaction was not significant for depressive symptoms (p = .438, ηₚ²=.003). Conclusion: Our data suggest that reducing SMU to approximately 1hr/day may be a feasible, inexpensive and effective therapeutic component that should be considered in the overall management of anxiety and depressive symptoms in TAY with emotional distress, a vulnerable population for lifelong mental illness.

This study investigates the prevalence of peri-operative anxiety and the effective management of intra-operative anxiety during awake surgery. Plastic and vascular surgical patients were selected for the study as many procedures performed within these specialities are performed under local or regional anaesthesia. The study consists of two distinct stages. The first stage was a postal survey of patients (n=213) who had undergone awake plastic, renal access or carotid surgery up to two weeks previously, in order to determine retrospectively the prevalence of peri-operative anxiety. The second stage of the study was a randomised controlled trial of interventions for the effective management of intra-operative anxiety in patients (n=128) having undergone the same surgical procedures described in stage one. The interventions tested in stage two were handholding and an anxiety management package involving a relaxation technique and a procedural information leaflet, against a ¿usual care¿ control. The findings from stage one of the study suggest that peri-operative anxiety prevalence is low, although unacceptable levels of anxiety are seen to elevate during the intra-operative phase. The RCT in stage two demonstrated that intra-operative anxiety was no more effectively managed by the interventions tested than by usual care alone. The validity and reliability of retrospective anxiety measurement was investigated by comparing anxiety scores from stage one with contemporaneous and post-hoc anxiety scores from stage two and found to be an accurate measure of anxiety experienced at the time of the event.

Symptomatic spinal disorders affect a large proportion of the population and are associated with substantial morbidity, social burden, and economic impact. Spine surgery interventions can provide excellent results in carefully selected patients whose symptoms fail to improve with non-operative management, but an evidence-based approach is paramount to optimize outcomes and rigorous standards of health research methodology are critical to avoid misleading conclusions. This thesis aimed to investigate and apply modern innovations in health research methodology to the field of spine surgery. It consists of seven chapters divided between three sections: randomized controlled trials, observational studies, and systematic reviews and meta-analyses. By applying the findings of each chapter, clinicians, researchers, and other evidence users can advance the credibility of future research and enhance the care of patients with spinal disorders. / Thesis / Doctor of Philosophy (PhD)