University of Macau / Institute of Chinese Medical Sciences

This study explored the perceptions of post-secondary students and counsellors towards the use of antidepressants and counselling to manage depression. Student depression is increasing and antidepressants appear to be the most frequently used treatment by students. The literature reveals that most depressed students are not accessing campus mental health centres, and counsellors are noting increased severity of illness for those that do seek help. Therefore, in an attempt to gain increased understanding of students who use antidepressants as well as counselling, the student and counsellor perspective is essential. In this study, 10 students and 6 counsellors were interviewed by the researcher. Interviews were digitally recorded and transcribed verbatim. Thematic analysis guided by van Manen’s (1990) hermeneutic phenomenology was used. Overall, the themes identified aim to represent the lived experience of the students who are living with depression and to better assist counsellors in understanding and developing interventions suited to student need. / ix, 129 leaves ; 29 cm

[Truncated abstract] Physical healthcare uses a suite of tools for measuring response to treatment. However, reliable systems of regular patient monitoring are rare in mental healthcare. Mental health services often measure a treatment response from pre- to post- therapy, yet measurement between those occasions is less common. This omission is problematic since arguably there is a need for an alarm system in psychotherapy (Andrews & Page, 2005). A substantial minority of patients do not experience reliable change following treatment, and a small proportion deteriorates (Hansen, Lambert, & Forman, 2002; Newnham, Harwood, & Page, 2007). Without monitoring, it is not always possible to know which patients are progressing poorly. Since the publication of Howard and colleagues' (1996) proposal that patient progress be monitored routinely during therapy and the results fed back to clinicians to direct treatment, this monitoring regime has garnered attention in the United States and Europe (Lambert, 2007; Lutz, et al., 2006). Findings in outpatient psychotherapy have demonstrated that providing real-time feedback on patient progress to clinicians and patients significantly improves clinical outcomes for those patients demonstrating a negative response to treatment (Harmon et al., 2007; Lambert et al., 2001; Lambert et al., 2002). What is not yet apparent is how these processes would generalize to inpatient and day patient (i.e. patients attending hospital for a whole day of treatment) psychiatric care. Inpatients often present with greater severity and are treated in an intensive setting. ... Deviations from this expected pattern would highlight possible differences between inpatient and outpatient care. To develop an appropriate system for monitoring patient progress, it was important to first define clinically significant recovery in inpatient psychiatric care, and provide criteria for clinicians to judge outcome in routine practice (Newnham, Harwood, & Page, 2007). Second, a quick and easy-to-administer system of progress monitoring and real-time feedback was developed to enhance treatment decision making (Newnham, Hooke, & Page, 2009). Third, the system was evaluated to determine clinical effectiveness. Using the World Health Organization’s Wellbeing Index, a program for monitoring patient progress and providing feedback to clinicians and patients was established at Western Australia's largest private psychiatric service. The sample consisted of 1308 consecutive inpatients and day patients whose primary diagnoses were predominantly depressive (67.7%) and anxiety (25.9%) disorders. Feedback to patients and clinicians was effective in reducing depressive symptoms (F (1,649) = 6.29, p<.05) for those patients at risk of poor outcome, but not effective in improving wellbeing (F (1,569) = 1.14, p>.05). The findings support the use of progress monitoring and feedback in psychiatric care to improve symptom outcomes, but raise questions about changes in wellbeing during psychotherapy. The effectiveness study was conducted as a historical cohort trial, consistent with quality improvement efforts, and replication with a randomized controlled design is warranted. Feedback of progress information appears to be an important process within psychotherapy, and further investigation of the means by which clinicians and patients use that information is necessary.

This research report documents the therapeutic intervention undertaken with a 23-year-old Swazi rape victim. The format of this research report takes the form of a case study that follows the principles proposed by Fishman (2005). Its aim is to document the treatment process of an individual of African decent in order to establish whether the treatment model can be effective in clinical settings and in contexts and cultural settings different from that in which it was developed. The Ehlers and Clark (2000) cognitive therapy model for post-traumatic stress disorder (PTSD) was utilised to assess, conceptualise, and treat the case. The client entered therapy three years after being raped for a third time. The case formulation identified factors maintaining the disorder as well as how other traumatic and abusive events earlier in her life influenced her response to the rapes. Data consisted off audio-tape recordings and detailed written synopses of each assessment and therapy session, psychometric measurement instruments and self-report scales completed throughout the intervention, material written by the client, and a research interview conducted by an independent party. She was treated for PTSD and comorbid depression over a period of five months in accordance with the principles described by Ehlers and Clark and a narrative of the treatment process was written. The case narrative in conjunction with quantitative data suggested that this model assisted the client in initiating a healing process. As such the model was found to be both effective and transportable to an African context. Various points of discussion are highlighted, including the challenges of working with PTSD and comorbid major depression, the client-therapist relationship, and that a client and therapist from different cultures, backgrounds, and with different home languages can work together effectively using the Ehlers and Clark model.

This study aims to explore the extent to which participating in a Mindfulness-Based Stress Reduction (MBSR) programme may result in shifts in people’s relationship with time, notably whether they become more present-focussed. The eight week MBSR programme advocates mindfulness, which is defined as paying attention on purpose in the present moment without judgement, as a way of reducing stress. The programme has been available in East London since 2009. A case study of eight MBSR programme participants’ experiences using narrative analysis was conducted. Narrative psychology and social constructionism provided the theoretical basis in which our storied lives are located in culturally inscribed narratives, with specific discourses around time and stress. Time discourses tend to pressurise people to believe that it is better to go about daily life at a fast pace, which requires significant hurrying and rushing with pervasive senses of time urgency. Stress discourse locates stress management within individuals. One-on-one semi structured interviews were held so that participants could reflect on their experience of time and the present moment orientation of the programme. Participants’ perceived a shift in how they experienced time with greater awareness of being present-focussed and they identified stress reduction benefits, which included feeling calmer, less panicked and more self-accepting. However, some of the participants maintaining the formal mindfulness practices like the body scan, meditation and mindful movement after the programme often proved difficult, as they were drawn back into their dominant narratives around time which were characterised by busyness, productivity and time scarcity.

This study investigated the relationship among anxiety, depression, and sleep disturbances and the treatment of these three disorders through neurotherapy. Research suggests that these conditions commonly co-occur in the general population and that central nervous system (CNS) arousal may play a primary role in the development and maintenance of these disorders. Several recent studies suggested that neurotherapy, a biofeedback-based treatment for CNS dysregulation, might be an effective treatment for comorbid conditions, particularly the ones of interest here, depression, anxiety, and sleep disturbances. This investigation used a clinical case-series design to assess pre/post neurotherapy changes on objective measures of anxiety, depression, and sleep and to determine whether changes in anxiety and depression then predict improvements in sleep quality. Data for 23 participants (10 males) were obtained from files of adults (Mage = 40.22 years, SD = 16.20) who received at least 15 neurotherapy sessions (M = 47.83 sessions, SD = 22.23) the University of North Texas Neurotherapy Lab. Matched pair t-tests revealed that symptoms of sleep disturbance, depression, and anxiety showed significant improvements following neurotherapy. Neurotherapy treatment effect sizes generally ranged from moderate to large (d = .414 - .849). Multiple regression analysis found that changes in self-reported anxiety symptoms, but not depressive symptoms, predicted observed improvements in sleep quality (adjusted R2 = .26). Last, the implications and limitations were discussed in relation to neurotherapy practice and the associated research.

Indiana University-Purdue University Indianapolis (IUPUI) / Depression in African American (AA) adolescents is a prevalent mental health problem, can result in serious concurrent and long-term effects, and is associated with health disparities due to underutilization of mental health services. Initiatives to reduce disparities among depressed AA adolescents require a greater understanding of the experience of depression from their own point of view. The purpose of this dissertation was to generate a comprehensive theoretical framework that describes how AA adolescents experience depression throughout adolescence. The information gained about how AA adolescents understand and manage depressive symptoms, and in some cases seek and use mental health services will contribute to initiatives to reduce behavioral health disparities. This dissertation project was composed of two components. The first component was an integrative review of studies that explored associations between adolescent coping responses and depression. The integrative review summarized and integrated research from the past ten years that examined coping techniques of depressed adolescents. It revealed that the use of active coping strategies plays an important role in recovery from depression. The second component was a grounded theory study which included a sample of 22 community-based AA young adults (ages 18-21) and 5 clinic-based AA adolescents (ages 13-17). During semi-structured interviews, participants described their experiences with depression as adolescents. In addition, a timeline was constructed that included major events related to the unfolding of depression, including treatment seeking, which occurred during adolescence. Data generated from the grounded theory study were analyzed and resulted in two qualitatively derived products. The first is a typology titled Being With Others that depicts interaction patterns of depressed AA adolescents with people in their lives. The five categories in the typology are keeping others at bay, striking out at others, seeking help from others, joining in with others, and having others reach out. The second product is a theoretical framework titled Weathering through the Storm that describes how depression in AA adolescents unfolds over time. The five phases of the framework are labeled enduring stormy weather, braving the storm alone, struggling with the storm, finding shelter in the storm, and moving out of the storm.

The field of cognitive neuroscience has benefited greatly from multimodal investigations of the human brain, which integrate various tools and neuroimaging data to understand brain functions and guide treatments for brain disorders. In this dissertation, we present a series of studies that illustrate the use of multimodal approaches to investigate brain structure and function, brain connectivity, and neuromodulation effects. Firstly, we propose a novel landmark-guided region-based spatial normalization technique to accurately quantify brain morphology, which can improve the sensitivity and specificity of functional imaging studies. Subsequently, we shift the investigation to the characteristics of functional brain activity due to visual stimulations. Our findings reveal that the task-evoked positive blood-oxygen-level dependent (BOLD) response is accompanied by sustained negative BOLD responses in the visual cortex. These negative BOLD responses are likely generated through subcortical neuromodulatory systems with distributed ascending projections to the cortex. To further explore the cortico-subcortical relationship, we conduct a multimodal investigation that involves simultaneous data acquisition of pupillometry, electroencephalography (EEG), and functional magnetic resonance imaging (fMRI). This investigation aims to examine the connectivity of brain circuits involved in the cognitive processes of salient stimuli. Using pupillary response as a surrogate measure of activity in the locus coeruleus-norepinephrine system, we find that the pupillary response is associated with the reorganization of functional brain networks during salience processing. In addition, we propose a cortico-subcortical integrated network reorganization model with potential implications for understanding attentional processing and network switching. Lastly, we employ a multimodal investigation that involves concurrent transcranial magnetic stimulation (TMS), EEG, and fMRI to explore network perturbations and measurements of the propagation effects. In a preliminary exploration on brain-state dependency of TMS-induced effects, we find that the propagation of left dorsolateral prefrontal cortex TMS to regions in the lateral frontoparietal network might depend on the brain-state, as indexed by the EEG prefrontal alpha phase. Overall, the studies in this dissertation contribute to the understanding of the structural and functional characteristics of brain network systems, and may inform future investigations that use multimodal methodological approaches, such as pupillometry, brain connectivity, and neuromodulation tools. The work presented in this dissertation has potential implications for the development of efficient and personalized treatments for major depressive disorder, attention deficit hyperactivity disorder, and Alzheimer's disease.

COVID-19 continues to have a major impact on US health and society. Robust research on the epidemiology of acute and post-acute COVID-19 remains fundamentally important to informing policy makers, scientists, as well as the public. This dissertation reports on the development of a large, diverse, United States general population-based meta-cohort with standardized, prospective ascertainment of SARS-CoV-2 and COVID-19, integrated with comprehensive pre-pandemic phenotyping from 14 extant cohort studies. Meta-cohort data were used to investigate risk and resilience factors for incident severe (hospitalized or fatal) and non-severe COVID-19 and correlates of time-to-recovery from SARS-CoV-2 infection. Results support the major acute and post-acute public health impact of COVID-19 and the vital role of modifiable (e.g., obesity, diabetes, cardiovascular disease) and non-modifiable (e.g., age, sex) risk factors for adverse COVID-19 outcomes. Findings suggest that standard primary care interventions—including obesity and cardiometabolic disease prevention and treatment, depression care, and vaccination—remain fundamental to COVID-19 risk mitigation among US adults. Given its longitudinal design and comprehensive pre-pandemic and pandemic-era measurements, the meta-cohort is well suited to support ongoing work regarding the public health impact of SARS-CoV-2 infection, COVID-19, post-acute sequelae, and pandemic-related social and behavioral changes across multiple health domains.

背景: 近代不少西方的實證心理治療方法都開始採納東方源來已久的身心治療，來醫治常見的情緒病，例如：抑鬱症，效果最為顯著。這個發展趨勢正好回應現存醫療制度及資源的限制，或其他社會文化及個人所造成的障礙。本研究旨在檢視一種促進身心健康的中國禪宗身心治療方法 － 以「德建身心療法」對比於 「認知行為治療法」及「等候對照組」，在治療一羣抑鬱症患者的抑鬱情緒、腦功能的改善及其身体健康等的療效。 / 研究方法: 在一個精神科門診部內，研究員召集了75 名成人的抑鬱症患者。他們都是有不同程度的抑鬱情緒或身體健康問題，同時有興趣參加為期十節的「德建身心療法」或「認知行為治療法」。 在對照基本資料後 (如年齡、學歷、抑鬱程度，初患或復發) ，他們被隨機分派到「德建身心療法」、「認知行為治療法」或「等候對照組」中。治療前及治療後，抑鬱症患者都會接受情緒、腦功能、健康狀況及腦電波的評估。 / 結果: 整體而言，相對於「等候對照組」，「德建身心療法」及「認知行為治療」更有效地減低患者的抑鬱症狀。此外，「德建身心療法」更帶來一些其他組別所末見的療效；包括有效地提昇患者的專注力、記憶、執行功能、腸道功能及睡眠質素。再者、研究亦發現「德建身心療法」的參加者，在有關正面情緒和專注力的兩個客觀量化腦電波(QEEG)指數上有顯著的攀升。意外地，在短短的十星期後「德建身心療法」參加者使用抗抑鬱药的份量亦有效地減少。 / 總結: 本研究的結果顯示中國的禪宗身心治療方法 －「德建身心療法」在治療抑鬱症患者的情緒捆纏、腦功能失衡、睡眠及腸道功能、提升正面情緒及專注力的量化腦電波指數都有明顯的功效。 / BACKGROUND: There are growing interests and encouraging findings of adapting and developing Mind-Body Intervention into evidence-based group treatment for common mental disorders such as depression. The advancement is a partial response to the limitations on the availability and accessibility of the existing treatment in the current health care system for depression, and/or a partial response to the socio-cultural and personal reasons in different communities. The present study aimed to evaluate the effectiveness of a newly developed Chinese Chan-based treatment the Dejian Mind-Body Intervention (DMBI), as compared to the groups of Cognitive-behavioural Therapy (CBT) and Wait-list control, in alleviating depressive mood and improving physical health of adult depressive patients. / METHOD: Seventy-five patients with the diagnosis of Major Depressive Disorder were recruited in the current study. They were stratified for age, education, level of depression, course of illness before random assignment to receive either 10-session DMBI or CBT, or placed on a wait-list. Pre-post measurements included primary outcome measures on psychiatrists’ rating and self-evaluated mood scores (HRSD and BDI) and secondary outcome measures on performance in different neuropsychological assessment (Executive function, Attention, Memory). The three groups also compared among different sleep (SOL, TST, and WASO), gastrointestinal parameters as well as neurophysiological QEEG indices. / RESULTS: Both the DMBI and CBT groups demonstrated significant reduction in depressive psychopathology after intervention. However, the DMBI group but not the CBT or Wait-list control groups demonstrated significant improvement in attention, verbal memory, executive function, gastrointestinal health and overall sleep quality. Besides, Dejian Mind-Body Intervention brought about significant increase in objective QEEG measures of positive affect and attention that were not evidenced in the other two groups. Participants in the DMBI group also demonstrated significant reduction in the use of anti-depressant after the end of 10-week treatment. / CONCLUSIONS: Findings of the current study suggested that a Chinese Chan-based Dejian mind-body intervention has positive effects on improving the mood and health conditions of individuals with depression. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Wong, Yun Ping. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 79-109). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; some appendixes also in Chinese. / ABSTRACT --- p.iii / CHINESE ABSTRACT --- p.v / ACKNOWLEDGEMENTS --- p.vii / TABLE OF CONTENTS --- p.ix / LIST OF TABLES --- p.x / LIST OF FIGURES --- p.xii / LIST OF APPENDICES --- p.xiii / LIST OF FIGURES --- p.xii / Chapter CHAPTER I: --- INTRODUCTION --- p.1 / PURPOSES OF THE PRESENT STUDY --- p.26 / Chapter CHAPTER II: --- METHODS --- p.29 / Chapter CHAPTER III: --- RESULTS --- p.47 / Chapter CHAPTER IV: --- DISCUSSION --- p.68 / GENERAL DISCUSSION --- p.70 / CLINICAL IMPLICATIONS --- p.76 / LIMITATION AND SUGGESTIONS FOR FUTURE DIRECTION --- p.77 / REFERENCES --- p.79 / TABLES --- p.110 / FIGURES --- p.124 / APPENDICES --- p.128