published_or_final_version / Psychiatry / Master / Master of Philosophy

Cancer has long been a prevalent illness in Hong Kong which caused tremendous stress on patients and their families. This study examined the cognitive process and behavioral efforts which related to cancer patients’ subjective well-being. Three hypotheses were proposed. First, higher internal locus of control over the cause of illness was hypothesized to relate to poorer subjective well-being through maladaptive coping. Second, higher internal locus of control over the course of illness may result in better subjective well-being through adaptive coping. Third, higher levels of hope may relate to better subjective well-being through adaptive coping. Ninety-eight patients with different types of cancers were recruited in this study. The results showed that internal locus of control over the cause of illness was not directly related to subjective well-being. The relationship between internal locus of control over the course of illness and social/family well-being was fully mediated by adaptive cognitive-behavioral coping and social and activity-engagement coping respectively in two separate mediation analyses. The relationship between levels of hope and social/family well-being was partially mediated by social and activity-engagement coping, while levels of hope significantly associated with social/family, emotional, functional and overall well-being. The study findings enhance understanding of close relationship between cognitive process and behavioral efforts in enhancing cancer patients’ adjustment to the illness. / published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

Comorbid chronic insomnia was found highly prevalent in breast cancer patients. It also persisted through survivorship. Negative emotions upon diagnosis and during the course of cancer treatment might complicate the underlying mediating factors between stress and insomnia found in non-cancer population. Cognitive Behavioural Therapy (CBT) has been evidenced in improving insomnia. With the appreciation of Mindfulness training in improving cognitive flexibility and rumination, a novel treatment approach integrating CBT and mindfulness—Mind-Body Intervention (MBI) was developed. 　　　There were three objectives in the research. Firstly, prevalence data on insomnia and clinical profile of Hong Kong Chinese breast cancer survivors were obtained. Secondly, the mediating roles of negative emotions, hyperarousal, pre-sleep arousals in the relationship between perceived stress and insomnia were examined. Thirdly, the effects of CBT and MBI for breast cancer survivors with insomnia were investigated. 　　　In the first study, 1049 women who survived from non-metastatic breast cancer were invited to complete a survey on stress, mental health, arousals and insomnia. Those who met psychophysiological insomnia were invited to participate in the second study, which was a multisite randomized controlled trial. The 73 participants were allocated to CBT (n=24), MBI (n=27) or waiting list control, WLC (n=22). Both treatments were five weekly-session group therapies. Outcomes on insomnia, mental health, arousals, dysfunctional beliefs, quality of life and mindfulness, were obtained on baseline, post-treatment, 3-month and 6-month follow-ups. 　　　Results of the first study revealed 34.6% of the participants suffered from clinical insomnia, while 15.1%, 27.4% and 12.8% endorsed moderate to extremely severe depression, anxiety and stress respectively. Duration of insomnia was correlated with insomnia severity. Hyperarousal was found moderating cognitive ore-sleep arousal and anxiety, these in turn, together with depression mediated the relationship between perceived stress and insomnia severity. Results of the second study supported the hypothesis both CBT and MBI improved insomnia and other psychological symptoms, while WLC did not. After treatment, significant decreases of 59 and 67 minutes of total wake time per night were found for CBT and MBI respectively. Sleep efficiency values significantly increased in CBT (12.2%) and MBI (12.7%). Moderate to large effect sizes and clinically significant differences were found in most sleep and psychological variables. Generally, CBT produced larger effect sizes than MBI on post-treatment. The therapeutic gains were found sustaining through 3-month to 6-month follow-ups in both treatments. However, the effect sizes of CBT were on the declining trend, while those of MBI were more stable. 　　　The results suggested that insomnia and anxiety were frequently experienced in breast cancer even after completing the medical treatments. The longer the survivors suffered from insomnia, the higher the severity was found. In additional to the cognitive pre-sleep arousal, the important mediating roles of depression and anxiety imply that insomnia treatments should incorporate strategies designed to help in decreasing rumination/worry before bedtime and improving mental health conditions. The findings also provided initial evidence for the efficacy of MBI as a viable treatment for insomnia. More vigorous randomized controlled trial and the long-term efficacy could be further studied. / published_or_final_version / Clinical Psychology / Doctoral / Doctor of Psychology

The central question of this study was to examine the moral orientation and the role of self in subject generated moral dilemmas for information on the developmental and cultural forces contributing to the etiology and maintenance of eating disorders in college women. The research was based on the theories of Carol Gilligan (1982, 1988, 1990). Twelve women identified as bulimic by therapists and twelve women with no eating disorder were administered the BULIT-R and the moral conflict and choice interview. A Guide to Reading Narratives of Moral Conflict and Choice for Self and Moral Voice provided the framework for analyzing the the interviews. Using Chi squares to analyze the data, no significant differences were found between the two groups on presence, predominance, and alignment of the moral voices of care and justice or on relationship framework, although a trend toward the bulimic sample aligning both with the justice and care orientations was noted. The bulimic sample expressed one or more of the vulnerabilities of care and both care and justice significantly more often than the comparison sample. No difference was found for expression of self care, though the quality of self care expressed was different. Subjects from the bulimic sample mentioned self care in conjunction with self-preservation, while subjects in the comparison group mentioned self-care as an ordinary consideration in conflicts. A significant difference was found between the two groups on mention of a problematic relationship with father, with bulimics describing an emotionally distant relationship with father more often. Finally, the quality of the conflicts described by bulimics tended to be more critical to self than those described by the comparison sample. Results were related to what Gilligan (1990) calls the biggest challenge of the adolescent female: how to integrate inclusion of self with inclusion of others. Disturbances in relationships within the family resulted in the women from the bulimic sample having difficulty with this task. Two coping styles were identified: role reversal and hostile avoidant (Salzman, 1990). The relevance of these coping styles to bulimia was discussed. Implications for therapy were reviewed and recommendations were made for future research. / Graduation date: 1992

Background: With the increasing incidence in stroke and the resultant high prevalence of residual disability resources are not adequately meeting the needs of the patients. Furthermore patients continue to express dissatisfaction with their care. New interventions are being developed and evaluated. However, when offered these new interventions, patients may refuse or not participate fully. A stroke workbook intervention was developed through a line of research examining the role of perceived control in recovery. During the randomised controlled trial (RCT) evaluating its efficacy patients failed to fully participate in the activities proposed in the workbook. Why, when there is such a dearth of treatment available, do stroke patients not fully participate in or adhere to the interventions offered? Methods: Three studies were conducted, a predictive study using the intervention group of the RCT exploring the demographic, clinical and psychological factors predicting adherence; a predictive study using one of the intervention groups from a larger 2x2 RCT to examine the predictors of adherence to an easier intervention (video); and a third longitudinal study examining the efficacy of an even simpler intervention (letter) on increasing adherence to the video. The theoretical framework of Leventhal's Self Regulation Model was used to develop the letter intervention and to explain the findings. Results: Five types of adherence behaviours emerged from the three studies, all with their own difficulties of definition, measurement and their individual predictor variables. Gender, impairment and illness representations were all predictive of adherence. An easier intervention promoted adherence especially for men and the more impaired. Women appeared to adhere more readily to the complex intervention. These gender differences may be associated with illness representations. A theoretical-based letter does not increase adherence per se but may increase the amount of adherence to an easier intervention. Conclusion: Adherence behaviour is not one type of behaviour and is associated with measurement difficulties. The Self-Regulation model appeared to offer some logical explanations to the findings. The findings have clinical implications and could possibly be associated with patients' satisfaction with care.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

No description available.

published_or_final_version / abstract / toc / Nursing Studies / Master / Master of Nursing in Advanced Practice