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

D.Litt. et Phil. / Although rapid progress was made in the past decade in the development of short term treatment approaches, relatively little attention was given to the treatment of Dysthymic Depression as a separate disorder. It is therefore important that medical doctors and other health professionals recognize this disorder as a separate disorder from Major Depression and adjust their treatment of this disorder accordingly (Keller, 1994). Although Dysthymia is seen as 'n low grade disorder and not as severe as Major Depression, this disorder also has a hampering effect on the quality of the individual's life. It affects relationships with meaningful others, mental and physical well - being as well as productivity (Keller, 1994; Klerman & Weissman, 1992). With the hampering effect on the individual's life, Dysthymic Depression is also costly and is a substantial burden for the family and the community. According to Rupp (1995) appropriate treatment of individuals with affective disorders will be costeffective. , The prevalence of depression in primary care make this disorder an ideal target for treatment-(Robinson, 1995). In this regard, Robinson (1995) mentions that treatment for these disorders is less intensse and'more short term that specialized treatments. In the past few years there have been a.shift from long term treatment strategies to short term structured handbook orientated treatment programs for disorders like depression. Pantalon, Lubetkin & Fishman (1995) emphasize the need for objective and •knowledgeable guides for the treatment of mental disorders. According to these researchers selfhelp books and guides are effective together with cognitive behavioral therapy. The aim of this study was therefore the development of a short term cost effective handbook orientated treatment program for Dysthymic Depression as well as the effectiveness of the treatment program. Antoher aspect of this treatment program that makes it unique, is the exercise component that is incorporated into the program with the cognitive behavioral approach. A group of 23 Dysthymic patients have been evaluated to establish the degree of depression, personality pathology that is present and the course of the therapeutic intervention. This group , received treatment over a period of 8 weeks. A second group of 22 patients served as a control group. The control group received medication and other therapy. The results of this study indicate that not only 'did the intensity of the depression lift, but certain indexes of psychopathology were also reduced. The indexes of psychopathology that indicated an reduction, were the Avoidant, Self-defeating, Schizotypal, Borderline, Anxiety, Somatoform, Dysthymic as well as Major Depression disorders. The effectiveness of the therapy sessions were also monitored over the , period of 8 weeks and indicated a reduction in certain negative factors, namely: Aggression, Anxiety, Fatigue, Sadness and Skepticism. While these factors indicated a reduction in prevalence the following factors indicated an increase in preValence over the 8 therapy sessions: . Surgency, Elation, Concentration, Social Affect, Egotism and Vigor. Although the test sample were relatively small, it is accepted that it was representative of the universum of the Gauteng region where this sample was taken from. From the results obtained from this study it seems that - this handbook orientated treatment program was not only effective for Dysthymic Depression, but also for certain indexes of psychopathology over the 8-week therapy sessions. From the analysis of the components of the therapy sessions, is clear that the model of the Dysthymic individuals showed an improvement with the handbook orientated treatment program.

M.A. / "Stroke is one of the leading causes of death and disability in all races in South Africa" (Fritz & Penn, 1992, p 1). It has devastating effects, and may impact on every aspect of the person's functioning. Research shows that depression is common after stroke, becoming more of a problem with time, and having a greater effect on quality of life than the actual disability (Lezak, 1995). Despite such evidence psychologists have played a very limited role in the rehabilitation of this group. Those with communication problems especially have been excluded from research and therapy, which usually require competence with language to be successful. This study attempts to find an alternative method of research and therapy in order to include this group. Following the model of learned helplessness (Seligman, in, Bleiberg, 1986), it was proposed that the unavoidable, inescapable effects of stroke lead to feelings of helplessness, which are also impossible to escape, and the person soon looses the motivation to attempt to control the situation. This then leads to depression. A method of therapy which breaks this cycle, and allows for the person to experience how their actions do have an effect on their lives is needed. In addition to this, an alternative means of self expression for those with communication difficulties needs to be provided. Art therapy was found to address the problems presented by this group (Dailey, 1984). It has proved useful with other populations that have not been able to benefit from traditional psychotherapy. It becomes an alternative means of self expression for those whose communication ability is compromised. It is accessible to most people, as it only requires the ability to make marks on paper. A theme centred, art therapy approach was therefore chosen for the study. The aims of the study were; to create a therapeutic milieu which allowed for self expression, specifically the expression of emotions, which included all the participants; to investigate the effects of introducing an opportunity for self expression on self concept and group process; and to look at the themes which emerge from the art. The participants were members of a pre-existing support group for stroke survivors. A quasiexperimental design was used. The Draw a Person Test, was administered pre and post intervention. Additional information was gathered using the Beck's Depression Inventory and a demographic questionnaire. This study uses a qualitative method, which includes information regarding the researcher's experience, and is interpreted from the researcher's perspective. It was found that art therapy had a positive effect on self concept. It influenced group process, as participants who were previously marginalised became more central. Numerous themes emerged, some which were specific to individuals, but others that were of relevance to the group as a whole. It proved rewarding for the researcher, both as a therapist and in terms of her relationship with her father who is a stroke survivor with aphasia. Art therapy therefore seems to be a useful tool to be used with this group that has traditionally been excluded from therapy and research. It is suggested that further research would be useful, and suggestions regarding future research are discussed.

Background. A sizable amount of individuals in the community are presented with various kinds of physical and mental health problems which are either undetected, untreated or inadequately treated, due to the limitations on the availability and accessibility of the services in the existing health care system, or to other social and personal reasons. The current study evaluated the effectiveness of a newly developed modality of health-enhancing treatment---the Mindfulness-based Dejian Mind-Body Intervention, as compared to that of a Group Psychoeducational Treatment, in alleviating depressive mood and improving physical health of adult individuals in the community. / Conclusions. Findings of the current study suggest that compared with the Group Psychoeducational Treatment, Dejian Mind-Body Intervention might be more effective in enhancing the emotional and physical health of community individuals presented with moderate to severe depressive mood and/or problems with bowel functioning. / Method. Forty adult volunteers with various degree of depressive mood and physical problems who expressed interest in receiving either Dejian Mind-Body Intervention or Group Psychoeducational Treatment were recruited in the current study. They were matched for gender, age, education and level of depression, and were randomly assigned to either treatment group. / Results. Both the Dejian Mind-Body Intervention and Group Psychoeducation Treatment were effective in bringing about a significant reduction in depressive mood iv among treatment completers. However, differential effectiveness emerged among those presented with moderate to severe depressive mood, where Dejian Mind-Body Intervention resulted in significantly greater treatment-related reduction in depressive mood compared with the Group Psychoeducational Treatment. Besides, Dejian Mind-Body Intervention brought about significant increase in an objective QEEG measure of positive affect, and improvements in physical health (i.e., bowel functioning) that were not evidenced in the Group Psychoeducation Treatment. / Tsui, Jin Ching. / Adviser: Agnes S.Y. Chan. / Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3799. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 62-68). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Text in English / Pharmacological treatment is often required in the management of psychiatric disorders. Non-adherence to medication represents a significant health concern that prevents patients from fully benefitting from their treatment, and can lead to negative consequences for individuals, their families and the healthcare system. The adherence rates to antidepressant medications in a sample of psychiatric outpatients in the Johannesburg Metropolitan district of Gauteng Province were examined. A descriptive survey method was employed to systematically collect data from n=377 patients using a structured, non-clinical questionnaire and the 8-item Morisky Medication Adherence Questionnaire. Variables were analysed using descriptive and correlational statistical methods. Antidepressant adherence rates were reported as 47.7% (low), 31.3% (medium) and 21% (high). These high rates represent a concern in antidepressant treatment, and health care practitioners and health systems must take this into consideration when planning and developing interventions to improve adherence in this area. The current study found significant correlations between antidepressant adherence rates and some medication-, health system- and moderating variables. Based on these findings, interventions that provide appropriate health-related education about treatment and improved social support systems may be effective in addressing antidepressant non-adherence in psychiatric outpatients in this region. / Psychology / M. Soc.Sc. (Psychology)