Indiana University-Purdue University Indianapolis (IUPUI) / In accord with the cognitive model of poor functioning in schizophrenia, defeatist performance beliefs, or overgeneralized negative beliefs about one’s ability to perform tasks, have been linked to poor functional outcomes, cognitive impairment, and negative symptoms in schizophrenia and are a suggested therapeutic target in Cognitive Therapy for Schizophrenia. However, there is a paucity of research investigating these beliefs in schizotypy, or those exhibiting traits reflecting a putative genetic liability for schizophrenia. This study had three aims: to examine whether defeatist performance beliefs 1) are elevated in schizotypy compared to non-schizotypy, 2) are associated with functioning-related outcomes (i.e., quality of life, working memory, negative schizotypy traits), and 3) mediate the relationships between working memory and both negative schizotypy traits and quality of life. Schizotypy (n = 43) and non-schizotypy (n = 45) groups completed measures of schizotypy traits, defeatist performance beliefs, quality of life, and working memory. Results revealed that the schizotypy group reported significantly more defeatist performance beliefs than the non-schizotypy group. Within the schizotypy group, defeatist performance beliefs were significantly positively associated with negative schizotypy traits and significantly inversely associated with quality of life. No associations were observed between defeatist performance beliefs and positive schizotypy traits and working memory. Further, defeatist performance beliefs did not mediate the relationships between working memory and either quality of life or negative schizotypy traits. Findings are generally consistent with the cognitive model of poor functioning in schizophrenia and suggest that defeatist performance beliefs may be an important therapeutic target in early intervention services.

Insomnia is a common health complaint that often becomes a persistent problem. The theoretical frameworks for understanding and treating insomnia have mostly been behavioural, yet the importance of cognitive processes has received greater attention over the years. The overall aim of this dissertation was to expand the knowledge on the processes from the Cognitive Model of Insomnia by investigating them in novel contexts. Study I examined the outcomes from cognitive therapy for insomnia on adolescents. Study II explored the relationship between cognitive processes and the association with remission and persistence of insomnia in the general population. Lastly, Study III investigated if cognitive processes mediated between cognitive behavioural therapy for insomnia (CBT-I) and outcomes of insomnia and depressive severity in a sample of people with insomnia comorbid with depressive problems. The findings show that cognitive therapy for insomnia affected sleep for adolescents, thus this is a promising treatment option for this age group. Further, it was found that cognitive processes distinguished between adults with normal sleep and persistent insomnia. For people with insomnia, elevated sleep-related worry at baseline increased the risk of reporting persistent insomnia later on, whereas a lowering of selective attention and monitoring, and safety behaviours over time increased the likelihood of remission from insomnia. This has clinical implications for insomnia assessment and treatment, as well as theoretical implications, and warrants further research. CBT-I was associated with greater reductions in dysfunctional beliefs and sleep-related safety behaviours compared to control treatment. Dysfunctional beliefs mediated between CBT-I and insomnia severity and depressive severity respectively. This supports the importance of negative thought content in both insomnia and depression.

Insomnia is a common health complaint that often becomes a persistent problem. The theoretical frameworks for understanding and treating insomnia have mostly been behavioural, yet the importance of cognitive processes has received greater attention over the years. The overall aim of this dissertation was to expand the knowledge on the processes from the Cognitive Model of Insomnia by investigating them in novel contexts. Study I examined the outcomes from cognitive therapy for insomnia on adolescents. Study II explored the relationship between cognitive processes and the association with remission and persistence of insomnia in the general population. Lastly, Study III investigated if cognitive processes mediated between cognitive behavioural therapy for insomnia (CBT-I) and outcomes of insomnia and depressive severity in a sample of people with insomnia comorbid with depressive problems. The findings show that cognitive therapy for insomnia affected sleep for adolescents, thus this is a promising treatment option for this age group. Further, it was found that cognitive processes distinguished between adults with normal sleep and persistent insomnia. For people with insomnia, elevated sleep-related worry at baseline increased the risk of reporting persistent insomnia later on, whereas a lowering of selective attention and monitoring, and safety behaviours over time increased the likelihood of remission from insomnia. This has clinical implications for insomnia assessment and treatment, as well as theoretical implications, and warrants further research. CBT-I was associated with greater reductions in dysfunctional beliefs and sleep-related safety behaviours compared to control treatment. Dysfunctional beliefs mediated between CBT-I and insomnia severity and depressive severity respectively. This supports the importance of negative thought content in both insomnia and depression.

The bidirectional link between insufficient sleep and the distress related to a parasomnia known as isolated sleep paralysis (ISP) might lead to chronic health effects. The impact of fear-ridden hallucinations related to this REM sleep disorder can be both distressful and embarrassing for individuals often resulting in a reticence to seek help. This quantitative study was guided by a biopsychosocial approach with an integrated theoretical framework. One aim of the study was to determine if fear parameters of ISP (low and high) differ when considering psychosocial factors and sleep quality, based on the Dysfunctional Beliefs and Attitudes About Sleep Scale, the Social Phobia Inventory, the Locus of Control (LOC) subscales, and the Pittsburg Sleep Quality Inventory. Predictive associations between psychosocial factors and subjective sleep quality (SSQ) were also investigated. Retrospective online data from a sample of 159 participants ages 18 and over were analyzed via MANOVA, multiple regression, and independent samples t-tests. Findings from the MANOVA were significant and showed that participants who experience ISP with more fear scored higher on two measures, external other LOC and social phobia. The MANOVA regarding differences in SSQ in relation to psychosocial variables were not significant, and independent sample t-tests did not differentiate fear parameters for DBAS and SSQ (poor sleep was found for both parameters). Providers of therapeutic treatments should take factors of social phobia and external other LOC into account with regards to poor sleep quality for those distressed by ISP. Sleep quality assessments might benefit those who are afraid to disclose about ISP sleep distress, as long term poor sleep can place some at risk for negative health outcomes.

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

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

睡眠失功能信念在慢性失眠的病理上扮演重要的角色，可能讓個體產生不良睡眠行為與過度睡前激發狀態，進而造成失眠。而癌症相關失眠患者由於其病理的獨特性也可能出現其獨特的睡眠失功能信念，本研究探討在癌症相關失眠的病理機轉中加入癌症相關睡眠失功能信念，是否可較單純一般慢性失眠之睡眠失功能信念對癌症相關失眠有更全面的了解。而癌症相關失眠具有許多不同於一般慢性失眠的要素，其中除了與疾病相關的特殊睡眠失功能信念外，尚有可能與睡眠困擾相關的癌因性疲憊干擾存在。因此，本研究的目的在探討：1）加入癌症相關的睡眠信念之整合睡眠失功能信念與失眠症狀的關聯性是否與單純一般的睡眠失功能信念有所不同；2）其影響路徑是否透過不良睡眠行為與睡前激發狀態影響失眠嚴重度；3）疲憊嚴重度是否使整合睡眠失功能信念對不良睡眠行為的預測力增加。本研究使用問卷調查對混合癌症患者進行各因素的測量後 (N=148)，運用結構方程模型進行路徑與因果分析，研究結果顯示，在疲憊嚴重度較高時，加入癌症相關睡眠失功能信念的整合睡眠失功能信念，其中「對失眠之負向影響預期與擔憂」向度會透過睡前生理激發狀態對「失眠對白天功能影響」程度有正向預測力、而「安眠藥物對疾病影響」向度對「失眠對白天功能影響」程度有負向預測力、不良睡眠行為對「失眠對白天功能影響」程度有正向預測力、一般睡眠失功能信念之預測路徑則多透過認知激發狀態影響；在疲憊嚴重度較低時，「對失眠之負向影響預期與擔憂」向度對「失眠對白天功能影響」程度有正向預測力、「睡眠與健康及病後修復關聯性的信念」向度對「失眠對白天功能影響」程度有負向預測力、「安眠藥物對疾病影響」向度對「睡眠困難」與「主觀痛苦」程度有正向預測力、一般睡眠失功能信念可預測之細項有所減少。研究結果顯示一般睡眠失功能信念會透過睡前認知激發影響失眠嚴重度，而加入癌症睡眠失功能信念後的整合睡眠失功能信念會透過睡前生理激發影響失眠嚴重度，疲憊嚴重度在其中扮演調節變項的角色，疲憊程度高低會使癌症睡眠失功能信念透過不同路徑影響失眠嚴重度。 / Dysfunctional beliefs about sleep play an important role in the pathological mechanism of chronic insomnia. Sleep-related behaviors and presleep arousal may mediate the relationship between the dysfunctional beliefs and severity of insomnia. Since cancer-related insomnia is associated with specific physiological and psychological conditions, there are specific dysfunctional beliefs that might have different influence to patients' sleep. Also, cancer-related fatigue could be closely related to sleep disturbance in cancer patients and demands to be explored. Therefore, the primary purpose of the current study is to explore: 1) whether adding cancer-related dysfunctional sleep beliefs to general dysfunctional sleep beliefs would show different pattern of association with severity of insomnia, comparing to the pattern of general dysfunctional sleep beliefs alone; 2) whether the sleep behavior and presleep arousal mediate the relationship between the dysfunctional beliefs to severity of insomnia in this path of model or not; 3) whether the severity of fatigue is a moderator of the predictibility of combided dysfunctional sleep beliefs to sleep-related behavior. The study recruited 148 mixed cancer diagnosis patients. They were instructed to fill out a package of questionnaires to assess their dysfunctional sleep beliefs, insomnia severity, cancer-related fatigue, etc. Structural equation modeling (SEM) was conducted for path analysis and causality test. Accroding to the result of SEM, presleep arousal was found to be a mediator of the positive association between the beliefs about “expectation and worries of negative consequence of insomnia” and daytime difficulties among subjects with high level of fatigue. Also the beliefs about “harmfulness of hypnotic” have negative predictibility to “daytime difficulty” in these subjects. Sleep behavior, on the other hand, have positive prediction to the “daytime difficulty”. General sleep dysfunctional beliefs showed pathway through presleep cognitive arousal level. For subjects with lower level of fatigue, the beliefs about “expectation and worries of negative consequence of insomnia” have positive association with the “daytime difficulty”. The beliefs about “beliefs about association between sleep and health and recovery from illnesss” were shown to have negative prediction to the “daytime difficulty”. The belief about “hypnotic related to disease” showed positive association with the “sleep difficulty” and associated “distress”. General sleep dysfunctional beliefs had less predictive factors. Based on the results of this study, adding cancer-related dysfunctional sleep beliefs was shown to have different relationship with severity of insomnia compared to general sleep dysfunctional beliefs. General dysfunctional sleep beliefs showed a pathway to insomnia severity through the mediation presleep cognitive arousal level. On the other hand, combided sleep dysfunctional beliefs showed a pathway to insomnia severity through the mediation of presleep somatic arousal level. Furthermore, severity of fatigue is a moderator. Subjets differed in the level of fatigue showed different path from combided dysfunctional sleep beliefs to severity of insomnia.

Through his personal spiritual growth process and Jesus’ teachings and life, Paul became acutely aware of the vast differences between Prophetic Judaism and the Mystical Traditions in relation to the Temple Cult and Temple-ism in general. Paul’s own “history of religion” centred on Abraham’s Covenant as the first and preferred, unmediated, spiritual and universal model, against Moses’ priestly mediated cultic system designed basically for Jews. Therefore, Paul follows Jesus teachings and mission to “rip the dividing curtain” of the Jerusalem Temple (Heb 6:19, 20); so that all nations can be reconciled to God (Eph 2:11-18). Jesus re-negotiated “a new and better covenant” of God’s mercy through repentance to all. Cultic “regulations” and Jewishness as being a special “religious”, covenantal “qualification” is now outdated and rather were now dangerous myths in Paul’s new religion. Paul knew that bridging concepts and new interpretations of metaphors will have to be part of the transition. God did not need a final special blood cultic sacrifice; to the contrary, only some people needed one so that they can make the mental transition from a cultic religion to a spiritual and personal religion.To Paul, God was the unknown Father and the Essence of all creation and Jesus-Christ was their leader and master or lord. In the mystical sense however, “Christ” represented the real Spiritual essence of mankind; the image of God in mankind. The core of Paul’s soteriology is his growth and participational aspects which constitutes the salvation process and are closely linked. The salvific process starts in the first phase with conversion from cultic Temple-ism and weaning from cultic and ethnic “laws” through the teaching of, and participation in, the spiritual growth process of the “physical” Jesus while the Spirit within us is awakening. The latter heralds the start of the “second” mature spiritual phase of the resurrected and vindicated Christ; sensitising our conscience as our moral identity and source of internal motivation from the real Self; one lives intuitively from loving-kindness; you honour this Gift in your earthly vessel with a fitting response to life. The behavioural element is central and an absolute necessity in the salvific process and he never views it as being secondary. Christianity will have to revise simplistic “faith” to salvation dogmas and broaden its functional scope by again honouring the second personal and authentic spiritual growth phase to be able to manifest a better Kingdom with the aid of Human Beings. / Systematic Theology and Theological Ethics / D.Th. (Systematic Theology)

Through his personal spiritual growth process and Jesus’ teachings and life, Paul became acutely aware of the vast differences between Prophetic Judaism and the Mystical Traditions in relation to the Temple Cult and Temple-ism in general. Paul’s own “history of religion” centred on Abraham’s Covenant as the first and preferred, unmediated, spiritual and universal model, against Moses’ priestly mediated cultic system designed basically for Jews. Therefore, Paul follows Jesus teachings and mission to “rip the dividing curtain” of the Jerusalem Temple (Heb 6:19, 20); so that all nations can be reconciled to God (Eph 2:11-18). Jesus re-negotiated “a new and better covenant” of God’s mercy through repentance to all. Cultic “regulations” and Jewishness as being a special “religious”, covenantal “qualification” is now outdated and rather were now dangerous myths in Paul’s new religion. Paul knew that bridging concepts and new interpretations of metaphors will have to be part of the transition. God did not need a final special blood cultic sacrifice; to the contrary, only some people needed one so that they can make the mental transition from a cultic religion to a spiritual and personal religion.To Paul, God was the unknown Father and the Essence of all creation and Jesus-Christ was their leader and master or lord. In the mystical sense however, “Christ” represented the real Spiritual essence of mankind; the image of God in mankind. The core of Paul’s soteriology is his growth and participational aspects which constitutes the salvation process and are closely linked. The salvific process starts in the first phase with conversion from cultic Temple-ism and weaning from cultic and ethnic “laws” through the teaching of, and participation in, the spiritual growth process of the “physical” Jesus while the Spirit within us is awakening. The latter heralds the start of the “second” mature spiritual phase of the resurrected and vindicated Christ; sensitising our conscience as our moral identity and source of internal motivation from the real Self; one lives intuitively from loving-kindness; you honour this Gift in your earthly vessel with a fitting response to life. The behavioural element is central and an absolute necessity in the salvific process and he never views it as being secondary. Christianity will have to revise simplistic “faith” to salvation dogmas and broaden its functional scope by again honouring the second personal and authentic spiritual growth phase to be able to manifest a better Kingdom with the aid of Human Beings. / Systematic Theology and Theological Ethics / D.Th. (Systematic Theology)