Bipolar disorder is characterized by episodes of mania and depression and serious suicidal risks. Recent studies reported high mental imagery susceptibility (general use of imagery in daily life and emotional impact of prospective imagery) in euthymic bipolar patients. This thesis aims to: a) replicate these findings in patients at different phases of bipolar disorder and with varying degrees of bipolarity, and b) explore how mental imagery susceptibility, ruminative processing, and behavioural approach system (BAS) sensitivity interact to amplify mood symptoms. Chapter 1 provides an overview of current theories of mood amplification and recurrence in bipolar disorders. Chapter 2 details the local validation of scales used in the thesis. Chapter 3 (Study 1) investigated whether mental imagery susceptibility, positive rumination and BAS sensitivity were elevated in remitted bipolar I disorder compared with major depressive disorder and non-psychiatric controls. Results suggested that these cognitive variables were elevated in remitted bipolar I disorder. Positive rumination also interacted with positive prospective images to predict bipolarity. Chapter 4 (Study 2) found that these cognitive variables were elevated in bipolar I disorder during manic and euthymic phases, compared to major depression. Further, the number of positive prospective images predicted recovery status and manic symptom severity. Chapters 5, 6 and 7 report that, compared with people without bipolar spectrum conditions, these cognitive characteristics were elevated in sub-threshold bipolar disorder (Study 3), individuals with high bipolar risks based on a behavioural paradigm (Study 4), and individuals with high familial risk (Study 5). Studies 3-5 confirmed that positive and negative prospective images interacted with rumination to amplify hypomanic and depressive symptoms respectively. Chapter 8 (Study 6) showed that suicidal flash-forwards function as a psychological escape from perceived entrapment and defeat in suicidality. Based on these findings, Chapter 9 proposes novel imagery-based techniques for targeting problematic imagery in bipolar disorders.

The medical model has been criticised for its failure to attend to individuals' experience of illness and the meaning they attribute to illness. HIV / AIDS has challenged its adequacy and brought the question of meaning in illness into sharp focus. This study aimed to understand what it means to live with HIV by exploring the fantasies, images and metaphors that make up the depth of such an experience. Phenomenology was deemed the appropriate approach, as it assigns epistemological significance to metaphor and ontological primacy to the lifeworld. An interview guide was fashioned from existing phenomenological literature and in-depth interviews were conducted with eight HIV -infected individuals. Five protocols were selected to constitute the study. In addition, an audio tape recording of one individual's metaphorical dialogue with HIV was obtained and transcribed. The three protocols with the richest content of imagery and metaphor were subjected to phenomenological explication. The remaining two protocols were used to support and clarify emergent meaning. A phenomenological explication of the data revealed a number of salient metaphors and themes. Upon being diagnosed with HIV, individuals were confronted with a socially and institutionally prescribed understanding of the disease; HIV as synonymous with AIDS and immediate death, HIV as sexual deviance, and HIV as myth. These metaphors influenced their conceptualisation and handling of HIV. Individual embodied metaphors included: embodying a heart of stone to live with HIV and perceiving HIV as a punishment from God, a demon from the Devil, a death sentence and a torture. Affectively, the experience of HIV was constituted as fear of physical disfigurement and exposure, anxiety, vulnerability, anger, betrayal, injustice and isolation. In a process of resolution and transformation, individuals imbibed positive metaphors with which to continue living with HIV. In order to cope with HIV, individuals seemed to negotiate a metaphorical space in which to dwell with their virus. This entailed establishing some form of dialogue with HIV or a Higher Power. This study revealed that metaphorical thinking about HIV /AIDS has a powerful impact on individuals' embodiment of their world. Metaphor is also an effective means Clf conveying and eliciting meaning in the experience of illness. Based upon these findings, it was suggested that metaphor be a prime focus for future research endeavours.

In this study the role played by metaphor in psychotherapy is investigated. Issues discussed, included the formulation of a definition of metaphor as well as an adequate theory of metaphor. The place metaphor holds in thought and learning; as well as how it has found its expression within some psychotherapeutic traditions are also discussed. The primary aim of the dissertation is to illustrate the versatility of metaphor, enabling it to be a significant and powerful tool in the hand of the psychotherapist. The application of various forms of metaphor is illustrated through case studies which offer a discussion of how the specific type of metaphor had been applied in psychotherapy. In conclusion, some recommendations are made with regard to further research within the fields of psychotherapy and neuropsychology. / Psychology / M.A. (Clinical Psychology)

In this study the role played by metaphor in psychotherapy is investigated. Issues discussed, included the formulation of a definition of metaphor as well as an adequate theory of metaphor. The place metaphor holds in thought and learning; as well as how it has found its expression within some psychotherapeutic traditions are also discussed. The primary aim of the dissertation is to illustrate the versatility of metaphor, enabling it to be a significant and powerful tool in the hand of the psychotherapist. The application of various forms of metaphor is illustrated through case studies which offer a discussion of how the specific type of metaphor had been applied in psychotherapy. In conclusion, some recommendations are made with regard to further research within the fields of psychotherapy and neuropsychology. / Psychology / M.A. (Clinical Psychology)

M.Tech. / OBJECTIVE: The aim of this study was to determine the extent of the benefit of combining psychological intervention, in the form of guided imagery, with spinal manipulative therapy, in the treatment of mechanical chronic lower back pain. The guided imagery functioned to address the psychosocial factors playing a role in the experience, maintenance and exacerbation of chronic pain (Turk, Swanson & Tunks, 2008), while the chiropractic spinal manipulative therapy functioned to address the dysfunctional biomechanics which cause the biological and neurological aspects of the chronic pain. DESIGN AND METHODOLOGY: 30 subjects between the ages of 18 and 40, presenting to the University of Johannesburg Chiropractic day clinic with chronic lower back pain, participated in the trail. They were randomly divided into 2 groups, which both underwent 6 treatments. During the initial consultation, both groups had their lumbar range of motion measured with the digital inclinometer, and were asked to complete the Oswestry Pain and Disability Index (Appendix G), Numerical Pain Rating Scale (Appendix H), and Perceived Stress Scale (Appendix I). This was followed for group A by spinal manipulative therapy to the restricted segments. Group B was treated with spinal manipulative therapy and a guided imagery session, performed by a registered psychologist. The participants were instructed on how to perform the guided imagery on their own, and were asked to perform it at home 3 times per week for the duration of the treatment. During the 2nd consultation, both groups received spinal manipulative therapy, and their progress was noted throughout on a SOAP note. During the 3rd consultation, both groups again had their lumbar range of motion measured, and were asked to complete the Oswestry Pain and Disability Index, Numerical Pain Rating Scale, and Perceived Stress Scale. Treatment followed as per the initial consultation for both groups. During the 4th and 5th consultations, both groups received spinal manipulative therapy. During the final consultation, both groups were again treated with spinal manipulative therapy, followed by lumbar range of motion measurements, and final completion of the Oswestry Pain and Disability Index, Numerical Pain Rating Scale, and Perceived Stress Scale. RESULTS: There was a statistically significant improvement in overall lumbar range of motion for both groups throughout all degrees of freedom respectively. It is interesting to note that both in extension as well as rotation the inter-group measurements were statistically significantly different at treatment outset, but due to greater improvement in group B over group A, became statistically comparable on completion of the trials. There was also a significant overall improvement and decrease in subjective symptoms of perceived pain, disability and stress for both groups, and the Numerical Pain Rating Scale also demonstrated a statistically significant improvement in results, due to greater improvement of group B over group A. CONCLUSION: The subjective and objective results between participants of the same group, demonstrated that both spinal manipulative therapy alone, as well as spinal manipulative therapy in conjunction with guided imagery was effective in treating chronic mechanical lower back pain. When comparing results between the two groups, the combined protocol group showed statistically significant improvement above the purely chiropractic group in 3 out of 6 objective measures, and 1 out of 3 subjective measures. There is thus limited evidence as to the advantage of combining guided imagery with the chiropractic treatment protocol of chronic mechanical lower back pain, however unfortunately not sufficient evidence to draw a definitive conclusion.

Measures of pain tolerance and threshold were obtained for 100 male and female subjects in a pretest treatment posttest experiment using the cold pressor test. Subjects were divided into five treatment groups with an equal representation of males and females in each group. In addition each group was divided into high and low locus of control, resulting in a 2 X 5, locus of control-by—treatment, experimental design. Treatment groups received one of the following five sets of instructions: prescribed pleasant imagery, prescribed angry imagery, self-generated pleasant imagery, self-generated angry imagery, and expectancy control. Credibility checks were obtained on all groups, and an ANOVA revealed no significant differences in credibility ratings among the groups.

The present study investigated the influence of a brief, intensive biofeedback-assisted imagery training regimen on psychological, physiological and neuroendocrinological measures of pain and stress in injury related chronic pain patients. The subjects were 36 patients (myelography examcandidates) who were assigned to the imagery or wait-list control group by order of referral presentation and to formulate equivalent groups.

This study discusses the assessment and treatment of a 21-year old male who had suffered multiple traumas, which had culminated in the death of his younger brother. He presented with Acute Stress Disorder. The literature review examines a diverse range of theorists and discourses, that have addressed the psychological consequences of trauma and highlights the complexity of the phenomena involved. The case study, located in the South African context, aims to sensitise the reader to the unique dilemmas facing each trauma survivor, and serves to highlight specifically those areas, which are pertinent and further more contribute significantly to the recovery process. The case narrative consists of a detailed synopsis of the therapy process, extracted from the session record notes documented at the time. Several other sources of information, including contributions from the participant, were used to verify and validate the accuracy of the data included. The narrative is written in a style that conveys the intensity of the nature of trauma work and the manner in which both patient and clinician are frequently confronted with very difficult emotional work. Finally the discussion examines the case narrative through the use of a set of carefully selected hermeneutic questions. These focused on (I) key concepts from the work of Robert Lifton who highlights the existential dimensions of the impact of trauma; (2) the role of the image in encapsulating the complex traumatic and post-traumatic experience of the survivor as well as facilitating the emotional processing of the trauma is examined; (3) the contribution to the process of therapy of aspects of the therapeutic relationship; and (4) the concept of recovery in relation to the question of what constitutes 'trauma work'. In conclusion, several meta-theoretical issues related to trauma, the strengths and weaknesses inherent to the research and relevant future areas of research are highlighted.

The purpose of this study was to investigate the effects of music and imagery versus imagery only interventions on inducing relaxation and reducing nausea and emesis in cancer patients undergoing chemotherapy treatment. Specifically, this study explored an adaptation of the Bonny Method of Guided Imagery and Music (BMGIM). Approximately 280 patients were interviewed, 43 began data collection procedures, and 20 of these individuals completed the study. Three dependent measures (heart rate, nausea, and emesis) were collected both before and after each of six intervention sessions. Experimental treatment conditions were guided imagery with music (MI) or without music (IO), alternated across the sessions. As part of the experimental treatment, participants were also encouraged to listen to music at home, i.e., to listen twice daily to CD recordings for relaxation. One recording contained a script for relaxation with music in the background, and the other contained only a script for relaxation. Moreover, after the fourth and sixth week of being in the study, the participants responded to a satisfaction survey on their perception on the benefits of MI and IO intervention. A follow-up telephone interview was conducted with each participant nine days after completion of the study. Regression analysis was used to examine factors relating to the frequency of nausea and emesis as well as heart rate. A Pearson correlation coefficient was used to examine the relationship between the extent to which patients utilized the CD for relaxation at home and the amount of improvement experienced. Descriptive analyses were employed to examine participants' responses to their perceptions of the benefits of imagery only and music with imagery interventions (i.e., to the Participant Satisfaction Survey). Results indicated a statistically significant decrease on post-heart rate for MI as well as for IO interventions. There were no statistically significant differences in heart rate, nausea, or emesis between the two experimental interventions. However, there was a significant decrease in the frequency of nausea and emesis over time, i.e., across the six-weeks of treatment. The Pearson correlation indicated no significant relationship between the times participants listened to the CD and the outcomes of nausea and emesis. Self-reports from the participants indicated that the guided imagery with music, both within the experimental intervention sessions as well as at home, seemed to be very beneficial in inducing relaxation for these particular cancer patients.

This study explored the impact of three psychological interventions over seven weeks - goal setting (GS), GS and imagery (IM), and GS and mindful self-compassion (MSC) - on 20 athletes' (Mage = 16.75 years) pain, cognitive appraisal, depression reinjury anxiety, psychological readiness to return to sport, and range of motion (ROM). IM and GS interventions have demonstrated initial effectiveness; however, no study has examined MSC in relation to post-ACL recovery. All athletes experienced significant decrease in pain (F(2) = 97.30, p = .000) from Week 1 to Week 7 and a significant increase in ROM from Week 2 to Week 7 (F(1) = 77.93, p = .000). All athletes experienced significantly higher depression at Week 1 compared to both Week 2 and Week 7 (F(2) = 9.01, p = .001), and significantly higher difficulty coping with their injury at Weeks 1 and 2 compared to Week 7 (F(2) = 6.32, p = .005). There were no statistically significant effects found between the intervention groups at Weeks 1, 2, and 7. However there were moderate effect sizes between interventions which suggest MSC and IM could help athletes cope with their injury during the first few weeks after surgery, and GS may contribute towards less depression at seven weeks post-surgery. Limitations include small sample size, low power, and use of self-report measures. Results have implications for orthopedic surgeons, physical therapists, and health professionals working with athletes recovering from serious sport injury.