Background Regarding adolescence developmental psychopathology and the psychological correlates associated with the onset of severe and enduring mental health in adolescence, this thesis proposes that early attachment related experiences underlie the successful ability to regulate emotions, negotiate interpersonal interactions, assess and utilise social support and develop the necessary mentalizing skills for organizing and understanding both the self and others. Insecure attachment and poor reflective function appear to be linked to clinical samples yet the underlying mechanisms for how these constructs affect adolescent psychopathology and subsequent psychological adaptation have still to be examined. Objectives A quantitative cross sectional design was utilised to investigate the following research questions; 1) Is attachment and reflective function directly and indirectly associated with psychological adaptation to mental health difficulties in adolescence? 2) Do emotion regulation, interpersonal difficulties and social support mediate the effect of attachment and reflective function? Methods 75 participants were recruited from three Tier IV Child and Adolescent Mental Health Services in Edinburgh. They were asked to complete questionnaires measuring the variables of mood, interpersonal difficulties, emotion regulation and social support. The Adult Attachment Interview was administered and coded to ascertain the individual‟s attachment classification and was scored to measure their levels of reflective function when considering their childhood experiences. Structural equation modelling (SEM) was used to analyse the data. Results The emergent clinical picture of this sample was one of adolescents with interpersonal difficulties, moderate distress and poor psychological adaptation. The dominant attachment classification was insecure/ dismissing. The observed level of reflective function indicated that participants could refer to mental states but that these references were not made explicit and their understanding of the intentions of others was likely to be general or superficial. SEM analysis demonstrated that reflective function significantly and directly predicted psychological adaptation but not low mood. In contrast attachment demonstrated a significant indirect path to adaptation, being fully mediated by internally dysfunctional emotion regulation strategies. These maladaptive emotion regulation strategies directly predicted low mood and indirectly predicted psychological adaptation. In terms of the social support construct, the discrepancy between the support desired and the support received directly predicted adaption and partially mediated the relationship between reflective function and and psychological adaptation. Discussion The theoretical implications of the results centred on the importance of investigating the underlying mechanisms of attachment and mentalization in the psychological adaptation of adolescents with severe and enduring mental health difficulties. Emotion regulation, interpersonal difficulties and social support were found to play a significant role in low mood and adaptation thus enhancing the current understanding of psychological distress and chronic difficulties for this population. Further clinical implications were discussed concerning the recommendation of promoting and utilizing a mentalization based approach when working with clinical adolescent populations.

Objectives of the study were to determine an accurate estimate of the rate of Early Trauma (childhood sexual, physical and emotional abuse and emotional and physical neglect) as measured by the CTQ instrument, amongst clients in contact with Mental Health Services in Aberdeen. To investigate the hypothesis that clients in contact with Mental Health Services in Aberdeen who report high levels of Early Trauma (as measured by the CTQ instrument), will have significantly higher levels of psychological distress, (as measured by the SCL-90-R instrument) than clients who report none or low levels of Early Trauma. To estimate the prevalence of personality disorder (as measured by the PDQ-4 instrument) amongst clients in contact with Mental Health Services in Aberdeen. To investigate the hypothesis that there is a significant association between Early Trauma (as measured by the CTQ instrument) and the presence of Personality Disorder (as measured by the PDQ-4 instrument) amongst clients in contact with Mental Health Services in Aberdeen. 136 inpatients at the Royal Cornhill Hospital were surveyed.  The survey used three questionnaires forming a structured interview: The Childhood Trauma Questionnaire (CTQ), Symptom Checklist 90 Revised (SCL-90-R) and The Personality Disorder Questionnaire (PDQ-4). A high percentage (66%) of this inpatient population reported moderate/severe early trauma (ET): males (65%), females (68%), prevalence rates for early trauma were: Emotional Abuse 47% (64 inpatients), Physical Abuse 34% (46 inpatients), Sexual Abuse 34% (46 inpatients), Emotional Neglect 40% (55 inpatients), and Physical Neglect 25% (34 inpatients). Inpatients with high levels of ET did not report higher levels of psychological distress when compared to inpatients with none/low ET for all ET categories. Male inpatients who reported high levels of emotional abuse had significantly higher levels in global severity index values.  Female inpatients regardless of high or none/low levels ET, in all the categories, reported similar symptom levels. 70% of participants have significant personality disturbance: males (78%), females (60%), but only 21% of the participants who have significant personality disturbance have a recorded diagnosis of Personality Disorder (PD). This study shows that ET has a specific effect on males; for males, significant associations were found between PD and emotional abuse and physical abuse.  Males who reported high levels of emotional abuse also had significantly higher levels of overall psychological distress.

<p> Anxiety and behavior disturbances are a significant problem for geriatric residents living in a facility. Currently treatment for these symptoms is pharmacological. While medications are necessary in some cases, significant uncomfortable side effects can result. The availability of effective treatments that are non-pharmacological allows nurses to offer an alternative option for these symptoms. The purpose of this project was to investigate animal-assisted therapy (AAT) and the effects this therapy has on anxiety and behavioral symptoms for geriatric patients living in a facility. A four week study was conducted with adult subjects age 55-85 who were diagnosed with anxiety or behavior symptoms and live in a facility. A dog was utilized for the therapy. Evidence suggests the effectiveness of AAT for a multitude of disease states and medical conditions. Use of ATT in this study revealed several behavioral changes for individual participants.</p>

<p> Adolescent treatment has come to rely on behavioral correctives with an emphasis on autonomy. This emphasis neglects the importance of healing the relational capacity in order to build internalized security. Addressing insecure attachments enables adolescents to transform their internal working model established in their early life experiences, potentially enabling them to move forward confidently in the relational world ahead of them. Utilizing both hermeneutic and heuristic methodology, this thesis considers existing research and theory combined with personal experience to examine the far-reaching effects of attachment styles and the neurological and therapeutic importance of right-brain attunement as the basis of emotional healing. This thesis also explores traumatizing practices in residential adolescent treatment, which may be more aligned with business models instead of optimum clinical models. The cultural collective unconscious is considered as operating from patriarchal principles, emphasizing obedience and punishment over building both trust and relationality.</p>

<p>Research over many decades has considered how physical activity affects mental health and how physical activity is perceived and utilized by mental health professionals in the treatment of clients. Findings suggest that physical activity is useful for decreasing symptoms of some disorders, improving mood, and improving cognitive functioning. Further, mental health professionals generally endorse the topic of physical activity as relevant and useful in the mental health context. However, mental health professionals do not generally address client physical activity. Among other concerns, mental health professionals believe that addressing physical activity with clients could have a negative impact on the client?s perception of the counseling process. This study investigated whether addressing client physical activity with college students participating in an intake counseling session influenced client ratings of the session or client ratings of the counseling relationship. There were no significant differences found in client ratings of the counseling session or counseling relationship when physical activity was addressed. The results of this study can be used in making decisions about addressing the topic of physical activity in the mental health context.

<p> The aim of the present study was to generate a set of therapy suggestions specifically for use in the treatment of creative individuals diagnosed with bipolar disorder. In order to achieve this end, the author collected information from bodies of literature that focused on three general research areas: (a) the relationship between bipolar illness and creativity, (b) the treatment of bipolar individuals, and (c) psychotherapy treatment of creative individuals. The information gleaned from these three areas was synthesized and used to inform the general treatment suggestions. This study examined several of the existing approaches to the treatment of bipolar disorder and provided suggestions for ways in which those treatments could be tailored for use with creative clients who are diagnosed with bipolar disorder. Effective psychiatric and psychological (i.e., psychotherapeutic) interventions have been developed for the treatment of individuals diagnosed with bipolar disorder, though additional research can be conducted to better understand how these interventions can be adapted to improve outcomes with certain clinical subgroups. Creative individuals with bipolar disorder reflect one such subgroup, and it is hoped that the suggestions for therapeutic adaptations contained within this dissertation begin to draw more attention to an under-researched group.</p>

<p> The purpose of the current study was to test the effects of participation in a <i>treatment grief choir</i> vs. <i> standard care grief group</i> (verbal) on bereaved persons&rsquo; perceived grief, coping, energy, social support and health and to examine the experiences of those participating in both groups. In this mixed-methods study, the results from the qualitative phenomenological focus groups were used for explaining and interpreting the findings of the Randomized Control Trial (RCT). Within the RCT, five people completed the <i>treatment grief choir</i> and four completed the <i>standard care grief group</i> (<i> N=9</i>). A repeated-measures ANOVA was employed to detect any statistical significance among the adult grievers. A significant within-subjects effect was found in both groups for the Numeric Rating Scale (NRS) start-of-session grief, NRS end-of- session grief, Hogan Grief Reaction Checklist (HGRC), and NRS end-of-session coping measures. These results indicate that both groups showed significant improvement over time in these areas. A between-subjects effect was found for the NRS end-of-session grief and for the Multidimensional Scale of Perceived Social Support (MSPSS) with the <i>standard care grief group</i> scoring significantly better over time than the <i>treatment grief choir</i>. Finally, one interaction effect was found for the NRS end-of-session health scores at week sixteen, with a significant gain for the <i>standard care grief group</i>. </p><p> For the qualitative portion of this study, five members of the <i> treatment grief choir</i> and three of the four members from the <i> standard care grief group</i> participated in separate focus group interviews. A seventeen-step analysis of the interview data was employed to discover meaningful descriptions and experiences while maintaining validity and integrity of the process. The following categories emerged from the analysis of the <i> treatment grief choir</i> interview: The Grief Choir Did Help; Songs were Important in Grief; Making Musical Connections Helped; Interactions with Grievers were Valued; The Music Therapists Influenced the Experience; and Gained Insights about Grief. The following categories emerged from the <i> standard care grief group</i>: Standard Care Did Help; Timing and Composition of Group Mattered; Standard Care was a Complex Experience; and The Experience of Being in Research. Recommendations for future grief choirs and standard care grief groups are discussed.</p>

<p> This thesis project explores the chronic issue of untreated mental illness as a social problem within the context of the County of Santa Barbara California&rsquo;s mental health public policy decision making process. As the county&rsquo;s Board of Supervisors considers implementation of the California Legislature&rsquo;s Assembly Bill AB1421, which provides for Assisted Outpatient Treatment, it is essential that the board fully consider the issues, community perspectives and impact. Funding to be requested in the following grant proposal is to be used for interventions providing an educational forum focusing on diverse stakeholder perspectives in order to develop implementation recommendations. Actual submission and/or funding of the grant were not required for the completion of this project. An assessment of current research establishes both that untreated mental illness is a serious social problem with high costs to the individual and communities, as well as the importance of community involvement in the development of public policy.</p>

<p> Text messaging may offer a useful tool for shaping psychotherapy homework compliance. Patients may send text messages to report compliance and psychotherapists may respond with text messaged verbal praise. In this analog study, the effects of text message reporting and reinforcement on homework compliance behavior were examined. Ninety-four college students, who agreed to attend two lectures about stress management, were asked to complete a daily, five-minute online relaxation exercise between lectures. Participants were randomly assigned to one of three conditions. In one group, they were not asked to report on completion of the exercise. In the second group, they were asked to report their daily completion of the exercise via text message. They did not receive responses. In the third group, they were asked to send text message reports and they also received text message responses containing praise. Compliance was measured through objective monitoring of online relaxation exercise use. It was expected that receiving text messaged praise would lead to greater homework compliance. It was also anticipated that simply being asked to send text message reports would improve compliance. As predicted, homework compliance was significantly greater in the group that received text messaged praise. However, significant differences were not found between the other two groups. Rapport did not differ between the groups and there was no relationship found between rapport and compliance. Based upon these results, it was concluded that text message reporting with reinforcement may be helpful in improving psychotherapy homework compliance.</p>

<p> Literature has widely documented the link between stress and serious physical and mental health consequences (e.g., depression, heart disease, Alzheimer&rsquo;s Disease, cancer). Women in middle-adulthood face a number of commingling stressors that may exacerbate their existing stress levels and place them as a higher risk of developing stress-related health issues. For example, in middle-adulthood women experience biological/hormonal changes (i.e., menopause, increased cortisol response to stressors), neural changes (i.e., cognitive declines), changes in skin function and appearance (i.e., wrinkles, sagging), as well as assuming multiple challenging roles (i.e., caregiver, employee, spouse). Due to the gravity of the effects of stress, there has been an increased need for a deeper understanding of stressors that women in middle&ndash;adulthood face and an increased need to target those specific stressors in an attempt to ameliorate their negative effects. In this context, the research reported here focused on developing a curriculum to conduct a one-day workshop for women in middle-adulthood in order to provide a deeper understanding of the various types of stress (e.g., hormonal/biological, age-related appearance changes, discrimination, gender role strain, multiple roles, cultural expectations, finances, etc.) experienced by women in middle-adulthood and providing culturally congruent stress reduction interventions. The development of the curriculum used to conduct a workshop is targeting women between the ages of 45 and 65 who are experiencing significant levels of stress and who wish to expand their knowledge of stressors and repertoire of stress reduction/management strategies. The curriculum was reviewed by two doctoral level mental health professionals who rated the content, strengths, and weaknesses of the curriculum. Their feedback was incorporated into a compilation of suggestions and future directions for the curriculum.</p>