Purpose: The systematic review explored whether self-management interventions improve patient activation in long-term conditions, and if any improvements are greater than the amount of change experienced by patients in usual care or active control conditions. It also aimed to determine if positive effects on activation are maintained at follow-up. The empirical study sought to explore relationships between patient activation, psychological factors (depression and valued living), perceived clinician empathy, perceived symptom severity, self-management and demographic variables. It also examined whether depression, valued living and perceived clinician empathy are unique predictors of activation, and if activation is a unique predictor of self-management for MS, when relevant confounding variables are controlled for. Methods: For the systematic review, a comprehensive search of multiple electronic databases was conducted to identify intervention research reporting on patient activation outcomes, as measured by the short-form Patient Activation Measure (PAM-13), in people with long-term conditions. For the empirical study, a cross-sectional survey of 118 people with MS explored patient activation, MS symptom severity, valued living, depression, perceived clinician empathy, self-management for MS and demographic factors. Correlation and hierarchical regression analyses were employed to explore relationships between variables. Results: Twenty-five studies were eligible for inclusion in the systematic review, reporting a wide range of long-term conditions. Twenty-one studies (10 RCTs; 1 non-randomised study; and 10 uncontrolled studies) found an improvement in patient activation at post-intervention. Nine studies reported a significantly greater improvement in activation in self-management conditions compared with usual care or an active control at post-intervention. In six out of eight studies, gains in patient activation were maintained in the intervention group at follow-up. However, in four of these six studies, patient activation in the control group also improved over time. Findings from the empirical study suggested that only valued living was a significant predictor of patient activation after controlling for demographic variables and MS symptom severity. Neither depression nor perceived clinician empathy significantly predicted activation. After controlling for valued living, depression and perceived clinician empathy, patient activation independently predicted 5.5% of variance in self-management for MS. Both activation and perceived clinician empathy were significant predictors of self-management for MS. Conclusions: Self-management interventions improve patient activation in long-term conditions compared with usual care or active control. Patient activation gains appear to be maintained longer-term; however, the impact of self-management interventions on activation is unclear due to increases in activation in control groups over time. Valued living is associated with patient activation in MS, while patient activation and perceived clinician empathy are associated with MS self-management. Self-management interventions targeting valued living and the patient-clinician relationship may be effective for addressing low levels of activation in some patients with MS.

Type 2 diabetes is a common condition that is associated with high rates of morbidity, mortality and healthcare costs. Multifactorial management has been shown to be effective in preventing complications and inducing remission or cure of the disease. Despite this, the rate of new cases and the overall burden of the disease remains high. There is a need, therefore, to refocus efforts on strategies to prevent complications in type 2 diabetes. Most of the disease in the UK is now managed in primary care consultations and there is increasing emphasis in health policy on 'making every consultation count'. Accordingly, the overall aim of my thesis is to contribute new knowledge and understanding on the role of the primary care consultation as a strategy in managing and preventing complications of diabetes, with a particular focus on the contribution of patient experiences. Data from the ADDITION-Cambridge and ADDITION-Plus population-based cohorts were used to quantify associations between experiences of primary care consultations measured with the Consultation and Relational Empathy Measure (CARE), and i) cardiovascular (CVD) risk factors, ii) CVD events, iii) all-cause mortality and iv) remission of type 2 diabetes. This was followed by further observational analyses to examine the role of patient health behaviours as a mediator of these associations. Qualitative analysis of semi-structured interviews with practitioners and patients were carried out to further elucidate theory that might explain how primary care consultations relate to the management of diabetes, and to understand the practicalities and barriers in delivering optimal experiences. Social practice theory was then used as a frame of reference to collate findings and contextualise the primary care consultation in managing and preventing complications of diabetes from a wider social perspective. The results of the observational analyses suggest that the primary care consultation may have a small impact on CVD risk factors early in the course of illness (higher levels of high-density lipoprotein cholesterol, lower systolic blood pressure and lower diastolic blood pressure). However, these associations are unlikely to be mediated through patient health behaviours. Over the longer term, consultation experience was significantly associated with the incidence of all-cause mortality; a 40% lower risk of mortality was found in patients with type 2 diabetes who reported better primary care consultation experiences compared to those with poor experiences. Similar trends were observed with CVD events but these were not statistically significant. Consultation experiences were additionally associated with remission of diabetes in adjusted models; 2-3% lower odds of remission with better patient-reported experiences of the consultation according to the CARE measure. The qualitative chapters identified issues around consultation length, relational continuity, face-to-face contact and type of practitioner as important contributors to primary care consultation experience. Moreover, my findings highlighted the difficult balance that needs to be achieved within the consultation between patient experience and disease management, and also between patient-centred and doctor-centred consultations. Further interviews with practitioners emphasised how the wider problems of pressures on the service and increased workloads in primary care are impacting consultation experience. This highlighted competing priorities which could distract from effectively utilising the consultation in diabetes. The final analysis chapter used social practice theory to collate the findings across chapters and suggested that a whole system and societal approach is needed to develop and inform the delivery of effective diabetes strategies. Overall, my thesis suggests that the primary care consultation experience has the potential to be an important strategy in managing and preventing diabetes complications. There are opportunities to more effectively use the consultation in primary care in a way that considers the individual, healthcare system and wider society together. More research is required to establish the causal pathways to explain how these experiences relate to outcomes and to understand what form a future whole system societal intervention might take.

A partir d’une pratique clinique auprès de patients douloureux chroniques dans un centre de la douleur il s’agira de mettre en évidence le rôle joué par des expériences précoces de douleur et leur éventuelle participation au processus de chronicisation de douleurs actuelles pour une catégorie de ces patients. Plus précisément il nous faudra examiner de quelle manière les relations premières de ces sujets avec leurs objets de soin pourraient s’être nouées en partie autour de la perception de douleur. Nous voulons montrer que cette population de patients s’est probablement trouvée très tôt confrontée de différentes manières à des vécus de douleur Pour ce faire nous nous proposons de faire appel de façon préférentielle à un ensemble de travaux et de réflexions développés ces dernières années dans les deux champs que sont d’une part les neurosciences et d’autre part la psychanalyse. Nous terminons par un retour à travers une monographie clinique sur les implications thérapeutiques que peut avoir la prise en compte d’un tel regard sur les avatars de la construction psychique du sujet et ces relations à des expériences ultérieures de douleur. / The subject of this thesis is to show the particular role played by early pain experiences and their possible link to present pain chronicising process for a part of these patients. More precisely, we will review how the first relationships of these subjects to their caregivers could have been partly tied up with pain perception.We want to show how this patients population has been probably very early confronted to pain experiences in different ways.To do so, we will bring up preferentially a set of work and reflection developed throughout these years in both psychoanalysis and neurosciences fields.We end up this work by a return through a clinical monography on therapeutic implications that such an approach can have on the subject psychic construction misadventures and his relationships to further pain experiences.

The goal of this study was to examine if, how, and why sympathy and empathy was created in Nabokov’s two narratives dealing with pedophilia; Lolita and The Enchanter. A large amount of research did exist on this subject regarding Lolita, but not on The Enchanter. Since Nabokov has referred to The Enchanter as a kind of pre-Lolita in the “Authors Note One” in The Enchanter, I thought it would be interesting to see what similar techniques he used to generate sympathy and empathy from the reader in the two books, and to examine if they had any differences regarding the subject. After a close reading of the books, some defining features could be found to be connected to sympathy and empathy. These features had to do with the narration, the form, and the language. The protagonists used these different feature to create a bond with the reader, a bond that is then used to make the reader feel for or/and with the protagonists. Lolita is a longer, more developed, and more comprehensive story than The Enchanter which gives Humbert more time to create and use this bond with the reader. Therefore, Lolita is more likely to generate empathy and sympathy from the reader. If a reader experiences those emotions though, depends on the individual reader. All I have presented in this essay is related to how Nabokov invite empathy and sympathy from the reader when reading Lolita and The Enchanter. That does not mean all readers experience these emotions since it is an individual process that depends on how each reader interprets the narrative.

Institutions of higher learning have required students to take general education courses since such they were conceived and implemented in the 1940s. Requirements vary widely across institutions, but there is a broad consensus that a literature course be required in order to graduate. While these courses feature many types of literature, one literary field is overwhelmingly overlooked: young adult literature. Brigham Young University has recently implemented a young adult literature course that will fulfill a general education requirement. This case study examines the question, "What might be the rationale for including a course in young adult literature as part of the general education curriculum?" The findings of this case study suggest teaching YA literature as a GE course benefits students' emotional and intellectual intelligence. Drawing on observations, interviews, students' work, and students' reflections, analysis concludes that young adult literature has the ability to be used in a university general education class to successfully teach intellectual abilities and to impart and improve emotional intelligence.

abstract: This study investigated the relation between Sensory Processing Sensitivity (SPS) temperament and depression, and whether such a relation might be further influenced by the indirect effects of parenting environment and empathic personal distress. A moderated mediation model was proposed to explain the underlying relations among SPS, depression, parenting environment and empathic personal distress. That is, greater levels of SPS temperament might predict higher levels of empathic personal distress, which then leads to increasing likelihood of experiencing depression. Moreover, it was predicted that this mediation relation might be significantly stronger under a less positive parenting context. The present study recruited 661 participants from a U.S. university and implemented questionnaires in an online survey. There was a significant main effect of SPS temperament in predicting empathic personal distress and depression, such that the more sensitive individuals reported higher empathic personal distress and depression. There also was a significant main effect of parenting environment on depression, where more positive parenting was associated with less depression. Empathic personal distress was found to partially mediate the relation between SPS and depression. That is, the association between SPS and depression could be partially explained by empathic personal distress. However, parenting environment did not moderate the main effect of SPS temperament on depression, the main effect of SPS on empathic personal distress, or the mediation model. / Dissertation/Thesis / Masters Thesis Psychology 2019

The purpose of this study was to test the hypothesis that the hearing distressing voices simulation training, Developing Empathy for the Lived Experience of Psychiatric Disability: A Simulation of Hearing Distressing Voices (HDVS), developed by Patricia E. Deegan, Ph.D., will affect counseling students’ empathy for clients diagnosed with schizophrenia, as measured by the Jefferson Scale of Empathy – Health Professions Students version (JSE-HPS). The experimental design was a quasi-experimental, one-group, pre-test/ post-test, and the Jefferson Scale of Empathy – Health Professions Students version was used to measure empathy. A total of 55 participants were drawn from a convenience sample of master’s counseling students from CACREP-accredited programs in southern Louisiana and Chicago, Illinois. A two tailed, paired samples t-test revealed that there was a significant difference (pM=116.11, SD=9.76) and post-test empathy scores (M=121.85, SD=8.9). This study suggests the HVDS is an effective tool to assist counseling students with developing empathy, decreasing stigmatizing attitudes, and avoiding disempowerment and marginalization within the counseling relationship.

The United States has a long-standing history of appropriating Indigenous representations for the use of mascots in athletics. Despite protest by Indigenous groups against this practice, professional athletics teams continue to appropriate Indigenous representations as mascots. The National Congress of American Indians produced a public service announcement (PSA), Proud to Be (PTB), to elicit support from the general public for changing the name/mascot Redskins. The purpose of the proposed research is to experimentally examine the effects that PTB has on support among Non-Indigenous participants, as function of political alignment. We considered two competing outcomes: The Counterproductive Hypothesis predicts the more conservative participants are, the less supportive they will be of changing the Redskin name/mascot, especially after watching the PTB rather than two control PSAs (directed at ending the word retard or reducing texting and driving). We also expect that the more conservative participants are, the less supportive they will be of either “name change” campaign, especially the one that corresponds with the PSA they view. Alternately, The Effective Hypothesis predicts if the PSA induces empathy among viewers, it could elicit support independent of political perspective. That is, participants will be supportive of changing the Redskin name/mascot after watching PTB rather than either control PSA. This effect will occur through the effects of PTB on increased empathy (specific to the target group). Preliminary analyses provide support for the Effective Hypothesis: Regardless of political perspective, participants experienced increased empathy for Indigenous People after viewing PTB, which led to increased support for the message promoted by Proud to Be.

L'adolescence est une période importante de la vie caractérisée par des changements majeurs psychologiques et comportementaux qui ont été théoriquement et empiriquement reliés aux changements dans l'environnement social. Les différents milieux de vie des adolescents leur offrent un «terrain de jeu» pour explorer, tester, développer et intégrer des compétences cruciales nécessaires à l’interaction sociale, comme les comportements prosociaux. À l'adolescence, les relations entre pairs deviennent plus saillantes et plus importantes qu’a toute autre période de la vie. Au-delà des contextes familial et scolaire, les adolescents consacrent beaucoup de temps à différentes activités avec des pairs. Parmi ces activités, nous nous sommes focalisées sur la participation à des activités extrascolaires qui sont considérés comme un milieu de vie important dans le développement positif des adolescents.Le premier objectif de cette thèse était de mieux comprendre le rôle des milieux de vie dans l'empathie et les comportements prosociaux à l'adolescence. Nous avons développé et examiné un modèle théorique intégratif des relations entre les caractéristiques positives et négatives des milieux de vie (famille, classe et groupe de pairs extrascolaire), la perception par les adolescents des comportements prosociaux dans chacun de ces milieux de vie et de leurs propres comportements prosociaux, en tenant compte du rôle médiateur de l'empathie.Le deuxième objectif était de mieux comprendre les relations longitudinales bidirectionnelles entre l'empathie et les comportements prosociaux à l'adolescence, en mettant un accent particulier sur les processus internes à la personne.Enfin, le troisième objectif était de mieux comprendre les trajectoires de développement de l’empathie et des comportements prosociaux des adolescents en prenant en compte leur participation à des activités extrascolaires.Nous avons conduit un recueil de données longitudinales à 3 vagues avec un intervalle d’un an. Les adolescents ont répondu à des questions concernant les caractéristiques des trois milieux de vie, les comportements prosociaux dans chacun d’eux, leur participation extrascolaire, ainsi que leur empathie et leurs comportements prosociaux.Nos résultats suggèrent que les caractéristiques des groupes de pairs extrascolaires et de la famille (en particulier les plus négatives) et la perception de leurs comportements prosociaux jouent un rôle majeur dans les comportements prosociaux des adolescents via l'empathie à l'adolescence. Ils montrent également que l’empathie est un prédicteur des comportements prosociaux et que les trajectoires de développement de l’empathie et des comportements prosociaux à l’adolescence sont différentes chez ceux qui participent à des activités extrascolaires où on n’observe pas de trajectoire développementale décroissante comparé à ceux qui n’y participent pas.En utilisant une seule approche théorique dans trois milieux de vie différents, nous avons pu saisir les caractéristiques communes et spécifiques de la famille, du groupe-classe et des groupes de pairs extrascolaires, qui ont une influence sur les comportements prosociaux des adolescents. De plus, prendre en compte les différences entre les individus et les processus de développement intra-individuels, l’hétérogénéité des trajectoires développementales concernant l’empathie et les comportements prosociaux à l’adolescence est essentiel pour saisir l’interaction complexe entre la famille, la classe, le groupe de pairs extrascolaire, l’empathie et le développement prosocial / Adolescence is a significant period in life that is characterized by major changes that have been theoretically and empirically related to changes in social environments. Adolescents different living environments offer the “playground” to explore, to test, to develop and integrate social cues and crucial abilities that are necessary for social interaction, such as prosocial behaviours. During adolescence, peer relationships become more salient and prominent than in any other period in life. Away from the family and the school context, adolescents spend a large amount of time in activities with peers. Among these activities we focused on extracurricular activity participation, that have been conceptualised as an important developmental context of adolescents’ livesThe first aim of this dissertation was to provide more insight into the role of living environments in relation to empathy and prosocial behaviours in adolescence. We developed and examined an integrative model of the relations between positive and negative living environment features, adolescents’ perceptions of prosocial behaviours across the three contexts (family, class and extracurricular peer group) and their own prosocial behaviours, taking into account the potential mediating role of empathy.The second aim was to provide more insight into the bidirectional longitudinal relations between empathy and prosocial behaviours during adolescence, with a special focus on the within-person processes.Finally, the third aim of this dissertation was to provide more insight into adolescents’ prosocial behaviours and empathy developmental trajectories considering extracurricular activity participation.This dissertation used data from a 3-Wave longitudinal study gathered during the three years of the PhD with data collected at one-year intervals. Adolescents answered questions concerning the features of the living environment, their peer group’s and parents’ prosocial behaviours, extracurricular activity participation, and their own empathy and prosocial behaviour.Our findings suggest that extracurricular peer group features, family features (particularly the negative ones) and extracurricular peer group and parents’ prosocial behaviours play a major role in adolescents’ prosocial behaviours via empathy in adolescence.Therefore, we found that empathy is a driver of prosocial behaviours. We also identified that latent class growth for empathy and prosocial behaviour were different in the extracurricular activity group for which there was no downward trend trajectory over time compared to the non-extracurricular group.Using one approach across three living environments allowed us to capture the common and specific features of the family, school and extracurricular peer group contexts that influence adolescents’ prosocial behaviours. Furthermore, our results highlighted the need to acknowledge the between person differences and the within-person processes of development. Moreover, it is important to consider the heterogeneity of developmental trajectories concerning empathy and prosocial behaviours during adolescence if we want to capture the complex interplay between family, class, extracurricular peer group, empathy and prosocial development.

This research focuses on obsessive-compulsive disorder (OCD) and how games focused on making the player feel empathy (empathy games) can increase the public’s general knowledge of the disorder. The disorder is currently commonly misunderstood and is not always taken seriously, something that potentially could hurt those with OCD. The stigma surrounding OCD sometimes makes people avoid getting the help they need, making them suffer in silence. The objective of the research was to define several game design principles that suggests what a developer should focus on when making an empathy game about OCD with the purpose to inform the general public. This was done by analyzing several scientific articles discussing either OCD or empathy games, and concluding the most important parts from them into game design principles. Four game design principles were found; target audience, reality, clarity, and includation. These have not been tested in a practical setting, but can possibly serve as guidelines when making an empathy game focusing on OCD.