Fibromyalgia Syndrome (FMS) is a disease of unknown etiology that affects up to 3 million Canadians, or 2-10% of the general population (Carruthers & van de Sande, 2005). Acceptance-based behavioural therapy (ABBT) is a relatively recent approach to treating human suffering in general and chronic pain in particular (Hayes, Strosahl, & Wilson, 1999; McCracken, 2005). ABBT treatments have been shown to effectively treat pain, pain-related anxiety, depression, and other behavioural measures of disability (McCracken, 2005; McCracken, Vowles, Gregg, & Almada, 2010; Pear & Simister, 2016, p. 160). In-person treatments can place significant burden on patients and the overall health-care system. Outcomes for online programs can be similar to those for in-person treatment while allowing for increased flexibility for both patients and professionals (Ritterband & Tate, 2009; Strecher, 2007). The current study extended a pilot study (Shay, Tkachuk, Simister, Bailly, & Skrabek, 2011), modifying the previous treatment to a 6 unit program that could be delivered online. Sixty-one participants completed the study, being randomly assigned to an online ABBT plus treatment-as-usual (online ABBT + TAU) group or a treatment-as-usual alone (TAU) group. All participants completed a series of self-report measures at baseline, at post-treatment, and at a 3-month follow-up. Linear mixed modelling supported significant differences between the groups in favour of the ABBT + TAU treatment group on the primary outcome measure (Fibromyalgia Impact Questionnaire-Revised (FIQ-R); F (2, 52.82) = 20.10, p < .0001) following treatment. The online ABBT + TAU group also had significantly greater improvements in depression, pain, acceptance, perceived helplessness, and kinesiophobia. Increased acceptance mediated the effects of treatment on improvements in FMS quality of life and FMS impact, while reduced helplessness mediated the effects of treatment on improvements in level of reported pain. Comments and subjective ratings of improvement were consistent with the quantitative results. Participants rated mindfulness (contact with present moment experience) as the most useful treatment unit. / February 2016

Midwives experience both occupational and organisation episodes of work-related psychologicl distress. As the wellbeing of health professionals is linked with the safety and quality of care, these episodes of distress should be met with adequate support. Midwives can be reluctant to speak openly about episodes of work-related distress. Additionally, they may not be able, or prefer not to access, face-to-face support. As such, an online intervention may be one option that midwives turn to when seeking support, as it can provide confidential and flexible access to support. This research makes a case for the development of an online interevention, designed to effectively support midwives in work-related psychological distress. Firstly, a narrative literature review integrates contemporary research to build an overview of the nature, prevalence, and origin, of work-related psychological distress in midwifery populations. A critical literature review then explores some of the ethical considerations in relation to providing midwives with anonymous and confidential online support. This review concludes that the provision of anonymity and confidentiality online would ensure the greatest benefit overall to the greatest number of people using and working within maternity services. A systematic mixed-methods literature review then concludes that there are currently very few targeted interventions designed to support midwives in work-related distress, none of which are currently delivered online. Moreover, this review identifies insufficient high-quality research to comprehensively understand which particular interventions or techniques could deliver effective support to midwives in work-related psychological distress. Lastly, a multi-stakeholder Delphi study is presented to establish consensus in relation to the content development, design and delivery of an online intervention to support midwives and/or student midwives in work-related psychological distress. In this case, an expert panel prioritised confidentiality and anonymity, along with 24-hour mobile access, effective moderation, an online discussion forum, and additional legal, educational, and therapeutic components. Consensus also supported the inclusion of a simple user assessment to identify people at risk of either causing harm to others or experiencing harm themselves, in order to direct them to appropriate support. The impact of any future intervention of this type will be optimised by utilising the findings from this Delphi study throughout the intervention development process. Furthermore, as the ethical, practical and evidence based arguments for the development of an online intervention designed to support midwives in work-related psychological distress have now been formed, it will be important to build and rigorously test this intervention in response to the identified gaps in research. This thesis demonstrates that there is a case for the development of an online intervention designed to support midwives in work-related psychological distress. Future research will require feasibility studies, pilot studies and adequately powered randomised controlled trials in order to sercure the evidence base for any new online support for this professional population.

Over the next thirty years, Alzheimer’s disease rates will increase alongside global aging. To handle the anticipated increase in demand, knowledgeable and skilled dementia caregivers are in need throughout the long-term care spectrum. Online training programs have emerged as a viable and convenient platform to educate both formal and informal caregivers. The first and second study systematically reviewed online dementia training programs and evaluated the CARES® Dementia Basics Training Program among formal and informal caregivers. The first study is a systematic review of online dementia-based training programs for both formal and informal caregivers conducted using the Preferred Reporting Items for Systematic Reviews (PRISMA) method. Methodological quality of the final sample (N=15) was assessed by the Cochrane Collaboration Back Review Group criteria. Results of the systematic review suggests that online interventions improve the condition and preparedness of caregivers, but future evaluations should consider study designs with multiple time points, control groups, and content that is personalized and interactive. In the second study, an evaluation of the online CARES® Dementia Basics Program among formal and informal caregivers was performed. The sample (N=233) included respondents from the states of OR, WA, CA and IL over three time points. Results indicate baseline differences in education, race, and caregiver type and a modest improvement in knowledge among both formal and informal caregivers. Recommendations are provided for future development and evaluation of online interventions.

As the structure of the American family changes, it is becoming more common for children to be raised by their grandparents. In fact, over the past 40 years, there has been a 50% increase in grandparent-headed homes in the US (Ellis and Simmons, 2014). Custodial grandparents, who provide primary caregiving responsibilities for their grandchildren, often become responsible for their grandchildren due to distressing situations and report many social-emotional, physical, and psychological difficulties (e.g., Hayslip and Kaminski, 2005). Additionally, children of custodial grandparents have been found to have significantly more emotional and behavioral problems than non-custodial grandchildren (Smith and Palmieri, 2007). The main parenting resource for this population is often support-groups, which often do not provide needed assistance with discipline and behavior management. The overall purpose of this study was to adapt Parent Child Interaction Therapy (PCIT) to custodial grandparents, using a consumer-oriented approach. The study was completed in three discrete stages. During Stage 1, qualitative interviews with custodial grandparents were completed to collect further information about custodial grandparents' experience parenting their grandchildren, use of parenting resources, and opinion of parenting strategies and PCIT. Findings from this stage indicated that custodial grandparents were amenable to PCIT procedures, but experienced significant barriers in accessing parenting services. Due to these barriers, a service delivery adaptation was developed and an online intervention was created (Stage 2) to transcend treatment barriers. Finally, during Stage 3, this online intervention was tested in a small single-subject design pilot study. Multiple metrics supported the feasibility, accessibility, satisfaction, and initial treatment efficacy of this intervention. All participants demonstrated clinically significant reductions in at least two symptom measures and reported satisfaction with the online intervention. Overall, results provide preliminary support for the use of online interventions to teach PCIT strategies and support future research on online interventions for this population. / Ph. D. / The overall purpose of this study was to adapt Parent Child Interaction Therapy (PCIT) to custodial grandparents, using a consumer-oriented approach. The study was completed in three stages. During Stage 1, interviews with custodial grandparents were completed to collect further information about custodial grandparents’ experience parenting their grandchildren, use of parenting resources, and opinion of parenting strategies and PCIT. Findings from this stage indicated that custodial grandparents were amenable to PCIT procedures, but experienced significant barriers to accessing parenting services. Due to these barriers, a service delivery adaptation was developed, and an online intervention was created (Stage 2) to transcend treatment barriers. Finally, during Stage 3, this online intervention was tested in a small pilot study. Multiple metrics supported the feasibility, accessibility, satisfaction, and initial treatment efficacy of this intervention. Overall, results provide preliminary support for the use of online interventions to teach PCIT strategies and support future research on online interventions for this population.

No description available.

E-mental health and home treatment are treatment approaches that have proven to be effective, but are only slowly implemented in the German health care system. This paper explores the attitudes toward these innovative treatment approaches. Data was collected in two large, non-clinical samples representative of the German population in spring 2020 (N = 2,503) and winter 2020/2021 (N = 2,519). Statistical associations between variables were examined using two-tailed tests. Binary and multinomial logistic regressions were performed to predict attitudes toward online-based treatment concepts and home treatment approaches. Only few (<20%) people preferred online-based treatment approaches, while a larger proportion (~50%) could imagine being treated at home. Overall, younger subjects were more open to online-therapy approaches, while people with lower education preferred more often a traditional therapy setting. Acceptance of online-therapy did not raise significantly during the first months of the COVID-19 pandemic. When different online-based treatment options were available, the probability of accepting home treatment significantly increased with increasing levels of therapeutic support. Further promotion of acceptance for online-therapy and home treatment seems to be necessary. In the future, more information on innovative treatment approaches should be actively provided.

Clinical and subclinical eating pathology are common, especially among female undergraduates. Such problems are often chronic and associated with a range of negative medical and psychological outcomes. Thus, it is important to develop effective prevention programs to reduce eating disorder risk. Numerous studies suggest that dissonance-based prevention programs are the most successful in reducing eating disorder risk factors, however, such programs might not be convenient for students limited by scheduling restraints or geographic proximity. Further, some students may be reluctant to attend such groups due to lack of anonymity. One way to address these potential barriers is to adapt dissonance-based programs for online use. However, no extant studies have examined the feasibility of this mode of delivery for dissonance-based programs. The current study examined the effectiveness of an online dissonance-based program, and compared it with traditional face-to-face delivery and assessment-only control conditions. It was hypothesized that: 1) online and face-to-face dissonance programs would produce comparable results; and 2) both of these active treatments would yield improvements in eating disorder outcomes (e.g. reduced thin ideal internalization, body dissatisfaction, dieting, negative affect, and eating disorder symptoms) compared with an assessment-only control condition. Results partially supported the original hypotheses. Modified intent-to-treat analyses (MITT) indicated that participants in both the face-to-face and online intervention groups showed less body dissatisfaction at post-intervention assessment compared to assessment only participants. Further, when analyses were conducted using a non-intent-to-treat (non-ITT) approach (examining only the outcomes of participants who completed the intervention), significant post-intervention differences were observed for all outcome variables. Specifically, individuals in both intervention groups showed lower thin-ideal internalization, body dissatisfaction, restraint, negative affect, and fewer eating disorder symptoms compared to assessment only participants. This study indicates that there may be some promise in adapting dissonance-based eating disorder prevention programs for online use. Future studies should continue to refine online adaptations of such programs and examine the effects of such programs with different populations.