This qualitative study investigated the perceptions of exercise among individuals with fibromyalgia. The goal of this research was not to prove that exercise is good for people with fibromyalgia, but rather to gain an understanding of how health practitioners can help fibromyalgia patients adhere to regular physical activity. The research was conducted using three focus groups with people who are treated for fibromyalgia at Medical Consultants in Muncie, Indiana. The groups consisted of current exercisers and non-exercisers. Four themes emerged from the groups that the participants discussed. These themes were, reasons for exercising, barriers to exercise, desired characteristics of an exercise program, and key support personnel helping participants deal with their condition. The information contained within these themes can be used by health practitioners to develop exercise programs that entice fibromyalgia patients to adhere to a regular exercise program. / Fisher Institute for Wellness and Gerontology

Computerized cognitive retraining is a technique for remediation of the cognitive and behavioral changes which follow a traumatic brain injury. The technique utilizes specifically developed computer software which builds on the basic foundations of intellectual functioning. While the injured patient is the target of treatment, the method appeared to have an impact on the patient's family as well. Families of patients who participated in computerized cognitive retraining initially appeared to have fewer difficulties with anxiety, depression, and family problems. They also appeared to be more involved in the patient's treatment than were similar families who had not had this experience.The experiment evaluated the secondary psychological effects of computerized cognitive retraining on the brain injured patient's primary caretaker in the family. The dependent variables studied were perception of family involvement in patient treatment, anxiety, depression and perception of family problems.Subjects were recruited from the outpatient case load of the Psychology Department of Fort Sanders Regional Medical Center in Knoxville, Tennessee and from a local support group for families of patients who have experienced a traumatic brain injury. The injured patients and family members participated in the retraining technique. A total of seventeen patient/family member pairs participated in the study.Subjects participated in either the experimental or control treatments. The experimental group underwent five sessions of approximately one hour in length. The patient and family member worked together during the course of the retraining. Brief counseling followed each session. The treatment group used an Atari 800 computer and Bracy's "Foundations" cognitive retraining software package ( Psychological Software Services, Indianapolis, Indiana). The control group was a waiting list, minimum contact group, whose participation was limited to completion of the pre and posttest materials.Family members in both groups completed pre and posttesting packages. These included: a demographic questionnaire, the "Problem Solving Inventory" (Heppner, 1982a, 1982b), the "State/Trait Anxiety Inventory" (Speilberger, 1983), the "Beck Depression Inventory" (Beck, 1961), and the "Scale of Marriage Problems" (Swenson & Fiore, 1982).The experiment utilized Kerlinger's pretest-posttest control group design (Kerlinger, 1973). Patient/family pairs were randomly selected from the available subject pool. Control or experimental treatment groupings were assigned by stratified random sampling. Data were analyzed by the use of two way analysis of variance with repeated measures on one factor. Throughout the analysis, a level of R < .05 was required to infer statistical significance.The results of this experiment did not support the effectiveness of computerized cognitive retraining as a specific intervention method for the families of brain injured individuals. The findings revealed that there were no statistically significant differences between the control and treatment groups on measures of perception of family involvement, depression, or perception of family problems. The treatment group experienced a statistically significant increase in state anxiety following the experimental treatment. The validity, generalizability and implications for these findings were discussed in light of prior research.Recommendations for further research in the area of family response to computerized cognitive retraining include replication of the study with greater numbers of subjects and more sophisticated evaluation and treatment methodology. It is also suggested that future research address the patient's cognitive level, the utilization of varied retraining protocols specific to the patient's level of function, and premorbid psychosocial factors which may influence the process of cognitive remediation.

This thesis is an enquiry into the psychoanalytic concept of transference. The `transference' refers to a particular kind of relationship that a patient develops towards his therapist and is found, to a greater or lesser degree, in all psychotherapeutic encounters. Psychoanalysis claims that its understanding and handling of the transference relationship provides an unrivalled access into the unconscious mind. Using an historical approach, I examine the pre-history of psychoanalysis from Mesmer to Freud. I then look at the subsequent development within psychoanalysis up to the present, as represented by the school of psychoanalysis known as Object Relations (OR). What I set out to demonstrate, through a critical examination of the psychoanalytic literature, is that the concept of transference does not achieve the epistemological breakthrough for psychoanalysis that is claimed. Firstly I show that the observation connecting transference with the unconscious is by no means a new idea. This connection had already been noted in relation to the concept of the `rapport' developed by Mesmer and his followers some 150 years prior to the advent of psychoanalysis. Secondly I show that the explanation that psychoanalysis gives in terms of the `unconscious phantasies' said to underlie transference, is mistaken. I show that both the formation of transference in terms of ideas about the therapist, and the psychoanalytic interpretation of these ideas in terms of `unconscious phantasy', in fact deny the real nature of the unconscious. This leads me to the development of my central argument against psychoanalysis. Firstly I argue that the real nature of the unconscious is structured around affectivity not ideas. Secondly, I argue that because psychoanalysis misunderstands the real nature of the unconscious, its therapeutic method offers no significant advantage over hypnosis, out of which it directly developed.

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Research into doctor patient communication and their roles is reviewed. Two series of semi-structured interviews with general practitioners (e.p.e) and patients separately are reported. In the first, 4 g. p. s each selected 6 patients for 3 groups; terminally ill with knowledge, terminally ill without, and chronic controls. Content analysis of patient transcripts revealed differences in frequency of utterances classed as showing knowledge. Differences between groups and qualitative analysis of all interviews, verified g.p.s’ categorisation. Knowledge was not simply absent or present, since all groups show awareness, but differ in the degree to which the nature of illness is openly acknowledged. One g.p. reported routinely informing patients, but others did not, although agreed this is occasionally appropriate. A typology of methods g.p.s and patients use to control information exchange is proposed. g.p.s' role formulations appear to underpin their reported communicative behaviour. 22 g.p.s were interviewed in the second series. Again they were asked to select patients, but few did this within the time allotted: therefore analysis focused upon g.p.s. Content analysis of interviews splits g.p.s into "informers" and "non informers". Qualitative analysis of g.p.s’ reported communication strategies suggests that underlying this simple dichotomy is a continuum from revelation through passive response to concealment. Strategies are implemented by various tactics; e.g. euphemism, uncertainty, denial, evasion, prompting questions. Differences in reported intentions and behaviour are interpreted by recourse to g.p.s' descriptions of their role during terminal care. Those who conceal attempt to maintain the Parsonian curative physician role and are reluctant to classify patients as terminal. Those who reveal try to abandon this role for one modelled on that of counsellor. Nearly all experience role ambiguity and attempt to resolve this in ways predicted by role theory.

This thesis identifies systematically the domains of positive consequences of illness and details the development of a measure of the positive consequences of illness- the Silver Lining Questionnaire (SLQ). Further aims of the thesis include the use of the SLQ as a predictor of health outcome and an investigation of the prevalence and correlates of positivity in illness. The first study questioned 55 people about their positive experiences of illness and uncovered 17 themes. In the second study a pilot questionnaire based on these themes was administered to the participants of the first study and an additional sample of cancer and chronic respiratory patients. Refinements to the questionnaire resulted in a 38-item measure of positivity. In study 3, the SLQ's properties of reliability and responsiveness to change were confirmed in a sample of chronic respiratory and cardiac patients in a rehabilitation setting. This study also found that positivity increased following rehabilitation. In study 4, the SLQ was used to predict the health outcome of patients with chronic fatigue syndrome. Finally, study 5, investigated the prevalence of positivity amongst respiratory patients varying in illness severity and found no significant difference between patient groups in the expression of positivity. This study identified extraversion and a sense of spirituality and religiosity as correlates of positivity. This thesis thus addresses a previously neglected field of research and presents a more comprehensive measure of positivity than existing measures. This thesis also addresses previously unanswered questions regarding the prevalence and correlates of positivity and also the potential for increasing positivity. Finally, the implications of positivity in illness for health management are highlighted.

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This research examines Hemodialysis patients' psycho-social characteristics and predictors of quality of life and compliance at a small rural hospital. Sixty-four patients from the hemodialysis unit at Renfrew Victoria Hospital in Renfrew, Ontario, and a satellite unit at St. Francis Memorial Hospital in Barry's Bay, Ontario, were assessed using the Social Work Patient Profile, Perceived Quality of Life and Compliance Indices. Bivariate correlation and multiple regressions were conducted on psychosocial, physical and mental health variables to determine if they correlated, and could be predictors of, social worker and nurses' perceptions of patients' quality of life and compliance. / Findings support multiple correlations between variables. Younger age, recreation, family support, self driving to dialysis, dementia, diabetes as the cause of chronic kidney failure (CKF), and other as the cause of CKF were significant individual predictors of social work quality of life score. Significant individual predictors for the nurses' quality of life scores were dementia, glomeruloneph, compliance, level of education, and polycystic kidney disease as the cause of CKF. The statistically significant risk factors for nurses' quality of life were lower levels of education and dementia. The four psychosocial variables that predicted compliance to treatment, suggested that there was increased compliance for patients who had recreation and family support, and increased risk factors with age and lower levels of education.