Thesis (Ed.D.)--Teachers College, Columbia University, 1974. / Typescript; issued also on microfilm. Sponsor: David Goslin. Dissertation Committee: Paul Vahanian. Includes tables. Includes bibliographical references.

This thesis identifies and describes some of the main accounts for health and illness that are current in British culture, placing them within broader contexts of psychological, sociological, traditional, religious and moral discourses; within broader explanatory frameworks; and, by way of an analysis of these ecological aspects, seeks to illuminate our understanding of such accounting. A combination of Q and ethnographic methods were used to elucidate a variety of alternative ways that people "make sense" of health and illness. Three main studies were conducted. The first two investigated accounting for health and illness within a broad framework of accounts as "explanations"; as moral judgements and prescriptions; and as defining meaning. The third study focussed on the external/internal explanatory framework, and demonstrated that accounting is far more complex than the Wallston and Wallston (1981) "Health Locus of Control Construct' would suggest. Some accounts stressed "internality", some "externality", some a combination of both, and others viewed this construct as non-salient. These latter included accounts about personal autonomy, and, importantly, the 'medical model" account. In the thesis overall, among the accounts identified were ones based upon notions of : "the wonders of modern medicine"; "stress"; "the cultural critique'; 'a healthy lifestyle", 'tradition"; "individual autonomy", 'Theism'; and "Willpower". These accounts are assumed to operate both within individual subjectivity and popular discourse, offering people a variety of complementary 'texts' with which to weave narratives, drawing upon different 'texts" according to situational and other demands. Thus accounting is portrayed as an active, thoughtful and sometimes contradictory 'storymaking" activity, and people as competent negotiators of reality.

Colleges in the United States today are facing a mental health crisis. Nearly one-third of students are diagnosed with a mental health condition, which is only aggravated by the stress of college environments. The alarming rate of student suicides indicates a need for increased support from institutions. Despite recent efforts across the nation to improve the accessibility and outreach of existing services, on-campus resources cannot sufficiently meet student needs. As a result, the majority of students suffering from mental and emotional distress are not receiving any form of counseling or treatment. Individuals who live with a serious mental illness are at higher risk for chronic medical conditions and typically have a shorter life expectancy, making treatment for these mental disorders essential to their well-being. Architecture offers an opportunity to influence human behavior and cognition by exposing people to different worlds from their own. This thesis investigates the power of manipulating architectural atmospheres in affecting human perception. Experiencing a space is more than the visual perception of aesthetics and form; it involves the sensory experience of the body to evoke an emotional and physical response (Goodwin). Spatial qualities, like materiality, lighting, color, degree of enclosure and proportioning, contribute to the sensory experience of a space, informing how people feel in it. Manipulating these qualities to produce a sequence of spatial experiences, representative of a range of mental states, can help everyday people empathize with those suffering from mental illnesses, while offering an outlet for those with a mental health condition. / 0 / SPK / specialcollections@tulane.edu

This study used a longitudinal design to investigate the relation between depression and pessimism-related cognitions about the self, world, and future in a clinical sample of psychiatric inpatients. A group of 30 inpatients diagnosed with major depressive illness was compared with a mixed-diagnostic comparison group of 28 inpatients on a measure of syndromal depression, as well as on pessimism-related cognitive measures of self-esteem, perceptions of the benevolence of the world, and hopelessness. All subjects completed the measures at two time points: within four days of admission to an psychiatric inpatient unit, and an average of 13.5 days later. It was expected that the nosologically depressed group would endorse more negative pessimism-related cognitions than the comparison group, that the pessimism-related cognitions would persist beyond remission of depressive symptoms, and that Time 1 cognitions would significantly predict Time 2 depression after controlling for depression at Time 1. Contrary to expectations, groups did not differ on the measure of syndromal depression, nor on the measures of cognitions pertaining to the self and future. Both groups exhibited a significant decline in depressive symptoms over time. Moreover, scores on the pessimism-related cognitive measures changed in concert with scores on the depression measure, and did not predict Time 2 depression. Additionally, significant interactions of group, gender, and time on the measure of syndromal depression, and interactions of group and gender on the cognitive measures, were found. These interactions revealed that men in the nosologically depressed group scored significantly lower than men in the comparison group on the measure of syndromal depression, and endorsed more positive cognitions about the self, world, and future. These findings refute major theoretical postulates regarding depressotypic cognitions, in that pessimism-related cognitions were: (1) not specific to nosological depression; (2) were mood-state dependent, with the exception of cognitions about the world; and (3) did not serve a maintenance function in syndromal depression. Exploratory analyses suggest that for the depressed group only, hopelessness may significantly predict Time 2 depression, and thus serve to prolong depression. The theoretical and clinical implications of all findings are discussed.

A pre-post-test, quasi-experimental study design with experimental and control groups was carried out in which measures of social climate were used to define and then change a mental health program. Two forms of the Community Oriented Program Evaluation Scale (COPES), which measures ten dimensions of mental health program social climate, e.g., autonomy, program clarity and personal growth, defined the program social climate according to a single taxonomy at three separate test administrations. The definitions were based on views about the program held by staff and clients. Using the COPES Forms, staff and clients defined the program as they saw it, and defined what their ideal program might look like. Systematic feedback about the program social climate was made to a focus group in the experimental site. The feedback resulted in a definition of the program. Review of the test results provided a means for making changes geared at emphasizing programmatic dimensions found to be lacking. New clinical routines were instituted in the experimental site. The post-test results established that the clinical changes significantly improved the worth and quality of the treatment experience. Measures of social climate helped define, then systematically change, a mental health program's social climate. The use of social climate measurement in this evaluation showed that the definitions contributed to its improvement, and its achievement of clinical and programmatic goals.

<p> In the last decade there has been a rise in the availability of consumer focused physical activity and fitness tracking devices. Recently there has been interest in using these devices from the research community for data collection and as part of health behavior interventions. With millions of adults using activity trackers it is necessary to develop an understanding of how they are used, and to what extent different factors may affect physical activity outcomes. </p><p> The current study sought to explore the relationship between behavior change techniques (BCTs) used by long-term users of Fitbit activity tracking devices and change in physical activity over time. In-depth interviews were conducted with participants in order to obtain information about behavior change techniques connected to the use of the Fitbit system. Historical Fitbit data (steps and activity intensity) were also collected. </p><p> Thirty participants were recruited to take part in the study. Based on coding of the in-depth interviews, individuals who are long-term users of physical activity tracking devices were found to use a variety of techniques associated with their engagement with the devices and it&rsquo;s connected applications. On average participants took 9,695 steps (<i>SD</i> = 5,309) and participated in 33.90 minutes of MVPA (<i>SD</i> = 42.90) per day. An exploration of the relationship between technique use and physical activity outcomes using multi-level modeling indicated that there was limited support for the relationship between use of techniques included in the design the Fitbit system and positive change in physical activity over time. No support was found for a positive relationship between the use of additional BCTs not included in the design of the Fitbit system and physical activity outcomes. Additional qualitative analysis demonstrated that individuals think about and use the same techniques in different ways and apply them in different contexts. </p><p> This exploratory study is the first examination of BCT use by individuals who freely choose to use physical activity tracking devices, and provided a proof of concept for a systematic mixed methods approach. Results of the study highlight the importance of understanding context of behavior change technique use in relation to physical activity behavior change.</p>

<p>Endometrial cancer (EC) is one of the most common forms of cancer among women, and the rate of disease is expected to increase significantly in the next several years. Ethnically diverse EC survivors may be at increased risk for comorbidities or cancer recurrence because of lower physical activity participation and higher rates of obesity. A systematic review of physical activity interventions for overweight and obese female cancer survivors was conducted. The first study was a cross-sectional study, which assessed the differences between 62 active and inactive Bronx EC survivors for body mass index (BMI), quality of life and physical activity behavioral variables. The second study of this dissertation was a wait-list controlled trial for 28 obese to determine the feasibility of a 12-week physical activity intervention in this population. The primary findings from the systematic review were that center-based physical activity interventions were feasible and led to an increase in physical activity for overweight and obese female cancer survivors. The first study found that 65% of the sample was obese, and 47% reported being physically active. The Active group reported significantly higher quality of life of the Functional Assessment of Cancer Therapy ? Endometrial questionnaire (FACT-En: 154 ? 13 vs. 145 ? 20, d=0.57, p<0.05), compared to the Insufficiently Active group. BMI was 3.3 kg?m-2 lower in the active group (d=0.40, p=0.057). The active group also reported higher walking self-efficacy, barrier self-efficacy and outcome expectations (p<0.05). In the third study, adherence to the physical activity intervention was 60%, and the dropout rate was modest, indicating that the intervention was feasible. Participants who completed the program had significantly greater increase in six-minute walk test distance (+22 meters) and quality of life (+10 points) compared to the control p<0.05). These studies show that this population has an elevated need for physical activity interventions that can promote the adoption of physical activity. Physically active EC survivors have better health and employ in more behavioral processes than their Insufficiently Active counterparts. A 12-week physical activity intervention was feasible and supports the potential effectiveness of a physical activity interventions

<p> Preliminary studies suggest that martial arts participation may benefit children with Autism. Following on existing pilot studies, this investigation conceptualized mixed martial arts in terms of Applied Behavior Analysis and considered the impact of a mixed martial arts program designed for children with Autism on children's focus, attention, motor control, and social skills. This study followed two boys with Autism over the course of six weeks. Multiple behavioral observations, parent interviews, and instructor interview were conducted; Child Behavior Checklist and Gilliam Autism Rating Scale-2 were administered. One child, new to the program, evidenced dramatic gains in social skills, physical ability, respect, and overall attitude. A second child, participating in the program for more than a year, maintained previous gains in these same areas throughout the intervention. Results suggest that boys with Autism may benefit from participation in mixed martial arts training. Discussion considers advantages of martial arts over traditional behavior therapy for children with Autism, such as reduced cost, availability in most areas of the United States, and less stigmatization than a treatment setting.</p>

<p> Almost every athlete will experience at least one sport related injury (SRI) during his or her career in sport. Because of these injuries, there is often a period of time that the athlete is removed from play and forced to complete a rehabilitation program. In order to enhance this rehabilitation process, researchers have investigated various mental skills used by athletes to enhance their recovery process. Two of the areas that research has reviewed in terms of injury rehabilitation have been imagery and self-efficacy. However, there is a lack of research in which an imagery education intervention has been implemented to see how athletes in a rehabilitation program respond in terms of their imagery use, levels of self-efficacy, and speed of recovery. Therefore, this study investigated the use of an imagery education program, and its effect on athletes' imagery use, self-efficacy and rehabilitation time. This was done through the use of the Athletic Injury Imagery Questionnaire-2 (AIIQ-2) and the Athletic Injury Self-Efficacy Questionnaire (AISEQ). Due to a high attrition rate in participation, inferential statistics were not able to be conducted in order to truly assess the effectiveness of the imagery education program. However, other conclusions were drawn based on the completion rates and various variables that may have affected those rates. The study found that female, freshman were most likely to complete the entire study, while male juniors were least likely to complete the requirements of the study. </p>

<p> Although breast cancer is typically considered a disease that affects women at an older age, younger women are also impacted by breast cancer. Additionally, current literature suggests that women who are diagnosed at a younger age face greater challenges adjusting to breast cancer survivorship. Young survivors are often in the midst of starting their career, beginning a family, and planning for their future. Thus, a cancer diagnosis drastically interrupts these plans. This study examined the relationship between different variables that are commonly studied in young breast cancer survivorship. Women were eligible if they were diagnosed between the ages of 19-45 years, were post-treatment at the time of the study, and first-time survivors of breast cancer. Participants were recruited from social media websites, online support and advocacy group, and cancer centers across the United States. Participants completed an online survey. This study examines the structure of the hypothesized latent variables included in a proposed structural model of psychosocial adjustment to breast cancer survivorship. Two of the four hypothesized latent factors were supported by the data, and a revised structural model of psychosocial adjustment to young breast cancer survivorship is provided. Follow-up research should examine the structural model and determine the most important factors in predicting young breast cancer survivors' quality of life and life satisfaction. </p>