Den psykiska ohälsa hos unga har ökat de senaste åren, framförallt depressioner, ångestsjukdomar och missbruk. Tvångssyndrom är en ångestsjukdom och är en av de fyra vanligaste diagnoserna i Sverige. Det är vanligt att sjukdomen börjar redan i skolåldern. För att kunna förstå elever med Tvångssyndrom och sjukdomens yttringar i skolmiljö, bör lärare ha tillräcklig kunskap för att kunna ge lämpligt stöd. Denna kvalitativa studie syftar till att öka förståelsen för hur tvångssyndromet påverkar skolgången för en individ med denna diagnos, samt ge en ökad bild av vilken kunskap som yrkesgrupper inom elevhälsan besitter. Studien bygger på semistrukturerade djupintervjuer som skildrar fem individers personliga och yrkesmässiga erfarenheter av denna sjukdom. Resultatet ger inblick i tvångssyndromets komplexa karaktär och symptom. Utifrån studiens kvalitativa innehållsanalys formulerades fem kategorier där studiens frekventa och framträdande budskap tas upp: Negativ skolpåverkan, Resursansvar, psykisk ohälsa, kunskapsläge samt behov av stöd. Dessa kategorier kan förstås som att skolgången upplevs vara en svår tid för de drabbade och påverkas direkt och indirekt. Samt att det individuella behovet inte alltid kan tillgodoses på grund av den bristande kunskapen om tvångssyndrom hos skolpersonal. Slutligen sammanfattas studiens framträdande budskap i ett Tema och kan ses som en indiktation och inspirationskälla till vidare forskning inom detta område.

Psykisk ohälsa är något som blir allt vanligare och vanligare i vårt samhälle. Människor mår allt sämre. Att lida av en psykisk sjukdom kan vara oerhört tungt för personen och dennes familj. I vårt samhälle finns fortfarande en stigmatisering kring att lida av en psykisk sjukdom, även om detta har förbättrats de senaste åren. Dock finns en stereotyp bild kvar. Tvångssyndrom (OCD) är ett psykiskt tillstånd som är relativt okänt hos allmänheten. Detta trots att sjukdomen är vanlig. Tillståndet innefattar mycket mer än bara själva tvånget, och kan begränsa personen på många sätt i vardagen. Syftet med denna litteraturstudie var därför att undersöka personers upplevelser av att leva med OCD. För att svara på syftet valdes en kvalitativ metod. Genom systematiska litteratursökningar i databaserna PubMed CINAHL och PsycInfo valdes åtta vetenskapliga artiklar med kvalitativt innehåll ut. Analysen genomfördes med kvalitativ manifest innehållsanalys med induktiv ansats, vilken resulterade i fyra kategorier: att sträva efter kontroll och säkerhet, att hela ens tillvaro påverkas, att vilja vara som alla andra och söka förklaringar och vikten av förståelse och stöd. I resultatet framkom det hur svårt det var att leva ett fungerande liv, vad gäller jobb, skola, familjeliv. Även de mest grundläggande saker kunde bli en stor påfrestning på grund av tvånget och behovet att söka försäkran. Personer med OCD beskrev att samhället inte hade kunskapen samt förståelsen som behövdes. Därför förespråkar författarna till denna studie, ytterligare kunskap inom tillståndet OCD för att som sjuksköterskor kunna arbeta personcentrerat kring dessa personer, för att sprida kunskap i ämnet och få bort den tabubelagda stämpeln.

Excessive Reassurance Seeking (ERS) is an under-researched and poorly understood behaviour that resembles the compulsive behaviours that are typically seen in obsessional problems. ERS can be complex, persistent, extensive, debilitating and may dominate the interactions of those involved. In addition to resembling compulsive checking in Obsessive-Compulsive Disorder (OCD) it may have the effect of transferring responsibility to another person. However, it could be seen as a type of support. Both ERS and support are defined and key questions about these concepts are considered in five studies which examine ERS from the perspectives of non-clinical samples, sufferers of anxiety problems, caregivers and therapists. Study 1 qualitatively examines interpersonal components of ERS in OCD and identified the experience of frustration in caregivers as being particularly pervasive. Study 2 examines the diagnosis specific/transdiagnostic elements of ERS in OCD and health anxiety contrasted with support using mixed methods. Results revealed some limited diagnosis specificity of ERS. Strikingly, people with health anxiety did not seek support; reassurance seeking may be their default response. Study 3 uses a larger sample to quantitatively evaluate therapists’ perception of ERS and its treatment, with results suggesting that there is considerable room for improvement. Study 4 examined therapeutic intervention for ERS in treatment refractory OCD using a single case experimental design; Cognitive Behavioural Treatment (CBT) that focuses on treating ERS had beneficial effects. Study 5 tackled the diagnosis specific/transdiagnostic issues in a questionnaire by considering ERS across different anxiety problems. ERS may represent a final common pathway of multiple processes; some processes appear transdiagnostic; others may indicate disorder specificity. Overall, findings reveal the complexity of ERS and its likely nature as a safety-seeking behaviour which requires attention in treatment. Engendering support as an alternative to reassurance in CBT may be particularly promising.

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.

The pivotal role of inflated responsibility beliefs in the maintenance and treatment of obsessive-compulsive disorder (OCD) has been clearly demonstrated (Rachman, 1993; Salkovskis, 1998; Shafran, 1997; van Oppen & Arntz, 1994). Yet little is known about the origins of these beliefs, their contribution to a sense of inflated responsibility or the symptoms of OCD, or the contribution of personality to inflated responsibility and to OCD, The aims of this thesis were to investigate a model of the inter-relationships among the personality dimensions of neuroticism and psychoticism, inflated responsibility and OCD, and the origins of inflated responsibility to inflated responsibility and to OCD. In order to achieve these aims, a scale was developed to assess the origins of inflated responsibility based upon the five pathways proposed by Salkovskis, Shafran, Rachman, and Freeston (1999) and the additional domains of guilt, vigilance and thought-action fusion (Shafran, Thordarson, & Rachman, 1996; Shafran, Watkins & Charman, 1996; Tallis, 1994). Eighty-four participants with OCD (age M = 43.36) and 74 control participants (age M =37.14) volunteered to participate in the two studies of this thesis. The aim of Study 1 was to develop and validate a measure of the Origins of Inflated Responsibility (OIR). The results of the first study yielded a 25-ttem scale, the Origins of Inflated Responsibility Questionnaire (OIRQ) with five independent factors: responsibility, strictness, protection from responsibility, critical incidents, and peer blame which demonstrated both internal reliability and temporal stability over a 2-week period. In Study 2, participants also completed the Responsibility Attitudes Scale (Salkovskis, Wroe, Gledhill, Morrison, Forrester, Richards, ct al. (2000) (a measure of inflated responsibility), the Padua Inventory (Sanavio, 1988) (to measure of the symptoms of OCD)y and the Eysenck Personality Inventory-Revised (Eysenck & Eysenck, 1991). Multivariatc Analysis of Variance revealed that the OCD group scored higher on all variables than the control group except for strictness where the groups were not different, and psychoticism where the OCD group scored lower. A series of Multiple Regression analyses revealed that both group and the OIR contributed to inflated responsibility (R2 = .56). When all variables, OIR, inflated responsibility and neuroticism were entered as predictors of OCD, 60% of the variance in OCD was explained however, 49% of the variance was shared by the independent variables suggesting the presence of some underlying construct. Structural Equation Modelling, where all the constructs in the model were examined simultaneously, revealed that neuroticism contributed to the OIR, inflated responsibility and OCD. The OIR were also significant predictors of inflated responsibility and indirectly through inflated responsibility predictive of OCD. The OIR also directly predicted OCD and when the total effects are considered, their contribution was greater than the total effect for inflated responsibility alone. The results of these studies provide good support for the origins of inflated responsibility proposed by Salkovskis et al. (1999), as measured by the OIRQ developed for use in the current thesis. The results also support the contribution of inflated responsibility and neuroticism, as well as the OIR, to OCD, The large amount of variance shared by the OIR, inflated responsibility and neuroticism suggest that there might be some underlying construct, perhaps of a biopsychosocial nature, that requires further investigation for its role in the onset and maintenance of OCD. The clinical relevance of these findings is discussed in terms of early prevention strategies and interventions.

Previous research indicates that pharmaceutically active compounds (PhACs) and endocrine-disrupting compounds (EDCs) are poorly removed during conventional drinking water treatment processes including coagulation; however, removal efficiency increases in the presence of natural organic matter (NOM). Therefore, this project investigates the link between various NOM types with EDC/PhAC removal. Bench-scale coagulation tests were conducted on three different source waters spiked with environmentally relevant levels (nominally 1000 ng/L) of EDCs/PhACs. Two different coagulants were used: polyaluminum chloride (PACl) and aluminum sulphate (alum). NOM was characterized using size exclusion liquid chromatography-organic carbon detection (LC-OCD). Results for Lake Ontario, Otonabee and Grand River water indicate that certain EDCs/PhACs are significantly removed during coagulation while others increase in concentration. Concurrently, particular NOM fractions (biopolymers and humic substances) are also being removed. Solvents used for EDC/PhAC spiking (acetone and acetonitrile) did not affect coagulation, but contributed to low molecular weight neutral and hydrophobic NOM fractions.

Previous research indicates that pharmaceutically active compounds (PhACs) and endocrine-disrupting compounds (EDCs) are poorly removed during conventional drinking water treatment processes including coagulation; however, removal efficiency increases in the presence of natural organic matter (NOM). Therefore, this project investigates the link between various NOM types with EDC/PhAC removal. Bench-scale coagulation tests were conducted on three different source waters spiked with environmentally relevant levels (nominally 1000 ng/L) of EDCs/PhACs. Two different coagulants were used: polyaluminum chloride (PACl) and aluminum sulphate (alum). NOM was characterized using size exclusion liquid chromatography-organic carbon detection (LC-OCD). Results for Lake Ontario, Otonabee and Grand River water indicate that certain EDCs/PhACs are significantly removed during coagulation while others increase in concentration. Concurrently, particular NOM fractions (biopolymers and humic substances) are also being removed. Solvents used for EDC/PhAC spiking (acetone and acetonitrile) did not affect coagulation, but contributed to low molecular weight neutral and hydrophobic NOM fractions.

Anthropogenic disruptions in the form of hydrological alterations, such as dam construction and the associated water diversions are a cause of much upheaval to local and regional ecosystems. Lake 626 within the Experimental Lakes Area of north-west Ontario, along with its downstream wetlands, 626A and 626B are one such system. Construction of a dam at the L626 inflow has completely restricted water flow, reducing and reshaping the watershed, increasing water retention time, and decreasing outflow into the wetlands. This study investigates the state of each wetland through physical and geochemical characterization during the first year following the diversion. Previous studies have found that hydrological diversions in wetlands can lower water table levels, altering soil chemistry and producing a shift in floral and faunal communities. Ultimate consequences involve significant loss of wetland area through conversion to upland habitat. This provides a model for climatic warming scenarios, wherein sustained drought conditions can produce the same result. Boreal wetlands are surprising fragile ecosystems that store massive quantities of carbon and are at risk of releasing it in such situations. One study showed that an extended summer drought in an otherwise average year with above average precipitation produced losses of 90 g C/m2 over the course of the year. Maintenance of reduced-flow in wetlands 626A and 626B is expected to convert the system into a carbon source and reduce overall wetland area. Radiocarbon dating has revealed that following deglaciation, both 626A and 626B basins were open water wetlands, depositing limnic peat for about 3200 and 1300 years respectively. Each site then transitioned into open sedge dominated fen – 626B to the present and 626A until about 2.5 ka BP when Sphagnum began to develop. Wetland 626B is decidedly an open shrub/sedge fen, supporting Myrica gale, Chamaedaphne calyculata and Carex rostrata / lasiocarpa communities. Wetland 626A is a bog/fen complex, sharing similar communities in the fen areas, but housing a large, centrally located bog of shrub species overlying Sphagnum hummocks. Tritium values in 626A were similar to cosmic background levels, indicating that recharge of basal pore water has not occurred in at least 60 years. Tritium in 626B was much higher, suggesting a substantial difference in hydrology or peat hydraulic conductivity between the basins. Measurement of DOC profiles showed high concentrations in near-surface water, reaching over 80 mg/L, and dropping to about 20 mg/L at maximum depths. An opposite trend was seen for DIC and CH4 profiles which increased concentration with depth (25 – 70 mg/L DIC; 75 – 700 μmol/L CH4). Isotopically however, 13C signatures from basal DIC were more positive while signatures from CH4 were typically more negative (-6 ‰ to +4 ‰ DIC; -57 ‰ to -73 ‰ CH4). Breakdown of DOC by LC-OCD showed high concentrations of humic substances and low molecular weight neutrals. The origin of humic substances in surface water became more pedogenic with increasing distance from the L626 outflow, indicating the influence of decaying wetland vegetation on the DOC of adjacent water. A comparison between contemporary and future characterization of boreal peatlands under drought-like conditions will provide a better understanding of the impacts suffered by wetlands during hydrological alterations. The high sensitivity of wetlands to changing hydrology should also provide a measure for gauging the effects of long term climate warming. This will assist in the development of environmental policies to better govern both the establishment of water diversions and the multitude of other practices leading to climate change.

This qualitative study was aimed at examining which therapeutic attitudes and procedures it is possible to find regarding obsessive-compulsive disorder (OCD), to see if there are any specific factors that crystallizes as particularly important for this disorder. A total of ten therapists with different background and experiences concerning OCD participated in the study where semi-structured interviews was used to collect the data. To analyze the data thematic analysis was used. Three main-themes grew from the analysis, which were all related to the study’s overall purpose. The first main-theme was general therapeutic attitudes. Under this theme, there are two sub-themes, personal characteristics of the therapist and degree of knowledge. The second main-theme, therapeutic approaches regarding OCD, also includes two sub-themes, degree of therapeutic distinctiveness and specific treatment interventions. The third main-theme was the treatment results components. This theme also includes two sub-themes, therapeutic factors and choice of method. In the participants’ stories about which therapeutic attitudes and procedures that are important regarding the treatment of people suffering from OCD, several factors became visible. These are connected to a general therapeutic attitude across diagnosis, such as warmth, empathy, and the ability to form an alliance, in addition to several therapeutic factors which are important to OCD specifically, such as experience and maturity, and being creative. The participants also emphasizes to a large degree ERP as the first choice in regards to treatment. Specifically for this study is that one participant emphasizes ACT as the preferred treatment intervention, where ERP did not result in a satisfactory treatment outcome.

Two decades of research on obsessive-compulsive disorder (OCD) has helped us develop a strong understanding of why obsessions are often followed by the performance of a compulsive act. What we have understood less well is why that act is repeated, even though it often results in an increase, rather than decrease, in discomfort. Emergent research on compulsive checking implicates a number of beliefs—including perceived responsibility, perceived harm, need for certainty, and beliefs about one’s memory— that may influence behavioural parameters (e.g., check duration) of checking episodes. Furthermore, it has also been suggested that the act of compulsive checking may recur in part because of a self-perpetuating mechanism in which checking has paradoxical effects on these beliefs. Finally, some researchers have proposed that attentional focus (e.g., focus on threat) during checking may be related these paradoxical outcomes. At present, these ideas are mostly speculative, in part because there have been so few detailed studies of the actual phenomenology of compulsive rituals. The purpose of the present research was to gather phenomenological data on compulsions as performed by a clinical sample under ecologically valid conditions. Study 1 extended emergent research suggesting that compulsions may persist because the act of checking has a number of ironic effects on beliefs. Individuals with a diagnosis of obsessive-compulsive disorder (OCD) and anxious controls (AC) completed a naturalistic stove task in our laboratory kitchen. Participants were fitted with portable eyetracking equipment and left on their own to boil a kettle, turn the stove off, and check to ensure that the stove is safe before leaving the kitchen. Surrounding the stove were household items that are “threatening” (e.g., matches) or “non-threatening” (e.g., mugs). Ratings of mood, responsibility, harm (severity, probability) and memory confidence were taken pre- and post-task and a portable eyetracker was used to monitor attention throughout the stove task. We examined the relations between behavioural indices (check duration, attentional focus) and pre- and post-task ratings of responsibility, perceived harm, mood, and memory confidence. Although we found that OCD (as compared to AC) participants took significantly longer to leave the kitchen after using the stove, we found no evidence that stronger pre-task ratings of responsibility, perceived harm, or memory confidence were associated with longer check duration. However, we found some evidence of an ironic effect whereby greater check duration was associated with greater perceived harm and decreased certainty about having properly ensured the stove was off. Of note, these ironic effects were not unique to participants with OCD, but were also observed in the AC group. With respect to the eyetracking data, we found minimal evidence linking threat fixations and beliefs in participants with OCD. In contrast, a number of interesting relations emerged in the eyetracking data of our anxious control participants. For AC participants, a greater proportion of time spent looking at the stove was associated with greater post-task sense of responsibility for preventing harm, greater post-task harm estimates, decreased certainty (about having ensured the stove was off), and decreased confidence in memory for the task. In Study 2, individuals with a diagnosis of OCD completed a structured diary of their compulsions as they occurred naturally over a three˗day period. Participants recorded the circumstances leading to each compulsion and reported on the acts involved in the compulsive ritual, the duration and repetitiveness of the ritual, and the criteria used to determine completeness of the ritual. The findings of this study suggest that unsuccessful compulsions (i.e., compulsions in which certainty was not achieved) were associated with a longer duration (trend), more repetitions, a higher standard of evidence, and offered little in the way of distress reduction. These findings are discussed within the theoretical context of cognitive˗behavioural model of obsessive˗compulsive disorder and clinical implications are offered.