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Syfte: Syftet var att kartlägga effekten av kognitiv beteendeterapi och mindfulness baserad kognitiv terapi hos personer som lider av hypokondri/hälsoångest.Bakgrund: Hypokondri är en undergrupp till somatoforma syndrom, vilket är symtom som inte kan förklaras genom generell medicin. Hypokondri är svårdiagnostiserat och har en underklassificerad term vid namn hälsoångest. Olika behandlingsformer för hypokondri/hälsoångest kan bland annat vara kognitiv beteendeterapi eller mindfulness baserad kognitiv terapi med olika inriktningar.Metod: En litteraturstudie utfördes enligt Goodmans sju steg, där det sista steget exkluderades. Inklusionskriterier var studier som redovisade resultat med deltagare som uppfyllde kriterierna för hypokondri/hälsoångest. Artiklar som krävde en avgift exkluderas från studien. Databassökningar gjordes i PubMed, CINAHL och PsycINFO där tio vetenskapliga artiklar valdes ut och analyserades. Resultat: Behandlingstid var en avgörande faktor för reducering av hypokondri/hälsoångest, där gruppbehandling visade sig ge god effekt. Kognitiv beteendeterapi och mindfulness baserad kognitiv terapi reducerade den negativa synen och attityden på sjukdom och minskade uppmärksamheten över kroppsliga symtom. Konklusion: Graden av hypokondri/hälsoångest minskade med hjälp av kognitiv beteendeterapi, mindfulness baserad kognitiv terapi eller kognitiv terapi. Gruppbehandling gav positiv effekt och visade sig vara kostnadseffektivt för sjukvården. / Aim: The aim was to describe the effect cognitive behavior therapy and mindfulness-based cognitive therapy had on people who suffered from hypochondriasis/health anxiety.Background: Hypochondriasis is a subordinate group to somatoform disorders, which are disorders that cannot be explained by general medicine. Hypochondriasis is difficult to diagnose and has a subordinate term called health anxiety. Mindfulness-based cognitive therapy and cognitive behavioral therapy are different types of treatments for hypochondriasis/health anxiety. Method: A literature study was carried out according to Goodman’s seven steps, the last step was excluded. Inclusion criteria was studies that presented a result of participants who had criteria for hypochondriasis/health anxiety. Payment articles were excluded. Database searches were carried out in PubMed, CINAHL and PsycINFO, where ten scientific articles were chosen, and analyzed. Result: Time of treatment was a substantial factor for reduced hypochondriasis/health anxiety. Treatment in group had a significant effect on treatment outcome. Cognitive behavior therapy, and mindfulness-based cognitive therapy reduced the intrusive image and attitude of being sick, and reduced the attention of bodily symptoms.Conclusion: Hypochondriasis/health anxiety reduced due to treatment. Group treatment had a significant effect on outcome, and showed cost-effectiveness in health care.

Background: Direct-to-consumer (DTC) genetic tests are tests sold directly to consumers, normally without the involvement of healthcare professionals, which aim to provide consumers with their relative genetic risk for various complex diseases. Providers claim that this information will enable and encourage consumers to improve their health behaviour in order to reduce their likelihood of contracting diseases for which they are at an increased genetic risk. However, there are many criticisms and concerns about DTC genetic tests in the literature. Two common concerns are the lack of positive effects, and possible negative effects, that the information generated by the tests may have on consumers health behaviour and health anxiety, and the identified poor quality of information provision on the websites of providers of DTC genetic tests. Although the literature contains some research in these areas it is noticeably limited and occasionally contradictory. Aim and Methods: The aim of the research was to investigate the informational aspects of direct-to-consumer genetic tests, including the provision of information by the companies, consumers information needs and information-seeking behaviour and the effect of the information generated by the tests on health behaviour and health anxiety. The research consisted of three studies: a survey of 275 consumers and potential consumers of DTC genetic tests, in-depth email interviews with 36 consumers of DTC genetic tests and a content analysis of the information provided on all identified providers websites. Results: Positive or neutral changes in health behaviour were identified in a large minority of respondents who had been exposed to genetic risk information, along with the mechanisms by which the information prompted or contributed to change. A minority reported a change in health anxiety, mainly but not exclusively a decrease, with mechanisms again identified. Consumers reported a wide variety of information needs, the most common of which were information to do with the coverage and accuracy of the tests. The provision of information on providers websites varied considerably, both between and within providers, but was generally poor. However, most consumers used other sources alongside these websites, the most common of which was blogs. Conclusions: The results suggest that concerns about possible negative effects of the information generated by the tests are unfounded and that a large minority of consumers have improved health behaviour and decreased health anxiety after purchase. The results also suggest that concern about information provision on providers websites is justified; although this is mitigated by consumers general use of other sources alongside the websites, it is likely that a substantial number of consumers do not have access to enough information to give fully informed consent to the test.

Abstract Student-athletes are viewed as the epitome of health due to their physical appearance and talent set; however, it is their psychological health that needs significant attention (Etzel, 2006). Psychosocial stressors such as the pressures and demands of being a student and athlete as well as the demands and expectations of the coach have significant impact on the student-athlete’s mental health and well-being (Beauchemin, 2014; Cleary et al., 2011; Lafrenière et al., 2011; Mageau & Vallerand, 2003; Watson, 2005). The purpose of this research is to investigate any correlation between student-athletes’ perceptions of coaching leadership behaviors and the symptoms associated with disorders such as anxiety, depression, suicidality, and substance abuse. The Leadership Scale for Sport (Chelladurai & Saleh, 1980) and the Symptom Assessment Measure instruments are used in this study. An exploratory analysis determined the reliability and construct validity of the instruments. Thirty-three student-athletes from a non-football Division I university engaged in the study, with twenty-eight completing some or all portions of study. All participants are between the ages of eighteen and twenty-four. A linear regression analysis demonstrated no relation between the independent variable, student-athlete perception of coaching leadership behaviors and the dependent variable, symptoms associated with anxiety, depression, suicidal behavior, and substance abuse mental health disorders, (F=.52, p=.49, R2=.061, and Beta coefficient was -0.248). Gender differences is not determined due to the skewed sample consisting of eighty five percent female and fifteen percent male. Though the linear regression analysis indicates no relation between the dependent and independent variable, supplemental contextualization was given to additional questions asked on the Symptoms Assessment Measure. These findings provide evidence that student-athletes perceive that their coach’s leadership behaviors do have influence on their mental health. This reinforces reports that coaches do wield power over their athletes and their influence is related to student-athletes’ psychological well-being (Horn, 2008; Locke et al., 2012; Stebbings et al., 2012).

Appendices were not supplied with the digital version of the thesis but are available in the print version. / The present research includes two studies. Study I was based on the research finding that exposure to nuclear radiation and other toxic chemicals results in those who were exposed not only believing their health to be affected, but experiencing significant and chronic stress. It was hypothesised that ongoing stress for New Zealand’s nuclear test veterans resulting from the inability to adapt to their past nuclear exposure would result in them experiencing greater depressive symptomatology, poorer perceived health, and poorer perceived memory performance than a control group. Psychological profiles of 50 nuclear test veterans and 50 age-matched Control participants were obtained through postal survey and face-to-face interview, using the Geriatric Depression Scale, Medical Outcomes Study Short Form-36, and the Memory Assessment Clinics Self-Rating Scale. As predicted, the nuclear veterans exhibited more depressive symptoms, and perceived their health and memory performance to be poorer than the Control group. A stress theory framework is applied to help conceptualise the experience of the nuclear veterans, and to provide an explanation for their lower scores and consequent poorer functioning. Through the pathway of poor perceived health leading to anxiety, health anxiety was considered a form of chronic stress the nuclear veterans were experiencing. Consequently, Study II aimed to examine whether Acceptance and Commitment Therapy (ACT) could be usefully applied to relieve this anxiety. Most psychotherapeutic approaches have been developed for problems that have an "irrational" or "pathological" foundation. However, these approaches often fit poorly with psychological distress that stems from cognitions that are reality-based and may need to be accepted rather than changed, such as in the case of nuclear exposure-related health anxiety. ACT may be particularly useful in these situations in which cognitive change is not warranted. Study II examined the use of ACT with 5 NZ nuclear test veterans (of either Māori or Pākehā descent) experiencing moderate to high levels of health anxiety. Results of self-report measures administered at baseline, during treatment, post-treatment, and at 6-week follow-up indicated varying results amongst these men. One participant showed clinically significant post-treatment reductions in health anxiety, experiential avoidance, and general psychological distress that were maintained at follow-up. Two participants showed clinically significant post- vi treatment reductions in health anxiety, experiential avoidance, and distress, despite not engaging in therapy as they did not wish to make changes. For the same reason, a fourth participant chose not to engage in therapy, despite high baseline scores on all measures, and showed no improvement during or after therapy. The fifth participant had low baseline scores on all measures, maintaining these throughout therapy, and at follow-up. Results are explained in terms of cohort and gender effects, with suggestions for adapting ACT with NZ older adults, particularly males. Implications for the utility of ACT with toxic exposure populations, older adults, and various cultures are discussed.

Problème : Les stratégies d’exposition traditionnelle (in vivo et en imagination) habituellement utilisées pour traiter l’anxiété liée à la santé ne sont pas toujours utilisables avec les aînés en perte de mobilité ou ayant des troubles cognitifs. L’immersion en réalité virtuelle (RV) peut représenter une solution alternative, mais aucune étude n’a testé son utilité auprès de personnes âgées qui s’inquiètent à propos de leur santé. Objectif et hypothèses : Déterminer si une salle d’attente d’hôpital virtuelle génère de l'anxiété (mesurée par deux réactions physiologiques : rythme cardiaque et conductance cutanée) chez les personnes âgées souffrant d’anxiété sous-clinique liée à la santé. H1 : les participants anxieux (peu importe leur âge) auront des réactions physiologiques plus élevées (vs niveau de base ou T1) que les participants non anxieux durant l’immersion dans la salle d’attente. H2 : comparativement aux personnes âgées anxieuses, les jeunes anxieux auront des réactions physiologiques significativement plus importantes (vs T1) durant l’immersion dans la salle d’attente. Méthode : Les réactions physiologiques de quatre groupes (n = 30) de jeunes (18-35 ans) et de personnes âgées (65 ans et plus) avec ou sans anxiété sous-clinique liée à la santé ont été comparées avant (T1) et durant (T3) une séance d’immersion dans un salle d’attente virtuelle. Pour s'assurer que les réactions physiologiques n'étaient pas causées par le simple fait d’être exposé à un environnement virtuel, les participants ont été exposés à un environnement virtuel neutre (T2) entre ces deux temps de mesure. Des analyses multi-niveaux ont été effectuées pour tester les deux hypothèses. Résultats : Les participants anxieux ont vu leur rythme cardiaque augmenter de façon significativement plus importante (vs groupe non anxieux) pendant l’immersion (T2: β = 8.77, p=0.045; T3: β = 9.73, p=0.03), mais aucune différence significative entre les deux groupes n’a été observée sur la conductance cutanée (T2: β = 0.30, p = 0.70; T3: β = 0.47, p = 0.55). Par ailleurs, la fréquence cardiaque des participants anxieux n’a pas augmenté de façon significative entre le T2 (environnement neutre) et le T3 (salle d’attente) (β = -0.04, p = 0.97). Enfin, comparativement aux participants âgés anxieux, les jeunes participants anxieux n'ont pas connu d'augmentation significativement plus importante de leur fréquence cardiaque (T2: β = 1.92, p = 0.83; T3: β = -1.51, p = 0.87) et de leur conductance cutanée (T2: β = -0.65, p = 0.65; T3: β = -0.79, p = 0.58) durant l’immersion. Conclusion : La salle d’attente virtuelle ne fait pas plus physiologiquement réagir les personnes âgées qui s’inquiètent au sujet de leur santé que l’environnement virtuel neutre. Puisque cette étude pilote a été réalisée auprès de participants ayant des inquiétudes sous-cliniques au sujet de leur santé, d’autres recherches sont nécessaires afin de tester l’utilité de la salle d’attente virtuelle auprès de population clinique. / Problem: Traditional exposure strategies (in vivo and imaginal) commonly used to treat health anxiety are not always applicable to seniors with mobility loss or cognitive difficulties. Virtual reality (VR) immersion may be an alternative solution, but no studies have tested its usefulness with seniors who are concerned about their health. Objective and hypotheses: To determine whether a virtual hospital waiting room generates anxiety (measured by two physiological reactions: heart rate and skin conductance) in elderly people suffering from subclinical health anxiety. H1: Anxious participants (regardless of age) will have higher physiological reactions (vs. baseline or T1) than non-anxious participants during immersion in the waiting room. H2: Compared to anxious elderly individuals, anxious young people will have significantly greater physiological reactions (vs T1) during immersion in the waiting room. Method: The physiological reactions of four groups (n = 30) of young adults (18-35 years of age) and seniors (65 years of age and older) with or without subclinical health anxiety were compared before (T1) and during (T3) an immersion session in a virtual hospital waiting room. To ensure that physiological reactions were not caused simply by being exposed to a virtual environment, participants were exposed to a neutral virtual environment (T2) between these two measurement times. Multi-level analyses were carried out to test both hypotheses. Results: Anxious participants experienced a significantly higher increase in heart rate (vs. non-anxious group) during immersion (T2: β = 8.77, p=0.045; T3: β = 9.73, p=0.03), but no significant difference between the two groups was observed on the skin conductance measure (T2: β = 0.30, p = 0.70; T3: β = 0.47, p = 0.55). In addition, the heart rate of anxious participants did not increase significantly between T2 (neutral environment) and T3 (waiting room) (β = -0.04, p = 0.97). Finally, compared to anxious elderly participants, anxious young individuals did not experience a significantly greater increase in their heart rate (T2: β = 1.92, p = 0.83; T3: β = -1.51, p = 0.87) and skin conductance (T2: β = -0.65, p = 0.65; T3: β = -0.79, p = 0.58) during immersion. Conclusion: The virtual waiting room does not generate more physiological reactivity in older individuals with health concerns than the neutral virtual environment. Since this pilot study was conducted with participants with subclinical health anxiety, further research is needed to test the usefulness of the virtual waiting room with clinical populations.