Bakgrund: För att halitosis ska tas på större allvar och för att de drabbade individerna ska få rätt sorts stöd är det av stor vikt att identifiera samt uppmärksamma halitosis eventuella effekter på livskvaliteten. Syftet: Syftet med studien var att identifiera och sammanställa kunskap kring halitosis eventuella effekter på upplevd livskvalitet med speciellt avseende på oralhälsorelaterad livskvalitet, social ångest och sociala relationer. Metod:Examensarbetet är en allmän litteraturstudie där systematiska och manuella sökningar användes för att finna artiklar. Resultat: Studiens resultat är baserat på 17 vetenskapliga originalartiklar. Gemensamt visar artiklarna en negativ korrelation mellan halitosis och oralhälsorelaterad livskvalitet, halitosis och social ångest eller halitosis och sociala relationer. Majoriteten av artiklarna visar att individer med halitosis anpassar sina sociala liv efter symptomet. Slutsats: Halitosis kan konstateras vara mer än bara dålig andedräkt. Genom att bland annat ha en negativ påverkan på en individs självförtroende kan halitosis leda till psykisk ohälsa i form av social ångest, försvårade sociala relationer och försämrad oral hälsorelaterad livskvalitet vilket kan påverka livskvaliteten. Det är därför av stor vikt att tandvårdspersonal beaktar den orala hälsan ur ett bredare perspektiv där halitosis kan uppmärksammas. / Background: In order for halitosis to be taken more seriously and for the affected individuals to receive the right kind of support, it is important to identify and pay attention to halitosis's possible effects on the quality of life. Aim:The aim of the study was to identify and compile knowledge about halitosis possible impact on perceived quality of life particulary regarding oral health related quality of life, social anxiety and social relationships. Method: The study was a general literature study where systematic and manual searches, in three different databases, were used to find articles. The selection of articles where made in three steps. Results: The study results is based on 17 scientific original articles. The articles mutually show a negative correlation between halitosis and oral health-related quality of life, halitosis and social anxiety or halitosis and social relationships. Conclusion:By affecting an individual's self- esteem, halitosis can lead to psychological distress in terms of social anxiety, impaired social relationships and impaired oral health related quality of life, which can affect the general quality of life. It is therefore at the utmost importance that dental professionals take oral health into account from a broader perspective where halitosis can be noted.

Parmi tous les problèmes de santé chronique, les troubles anxieux combinent une prévalenceélevée, une apparition précoce, une chronicité élevée et des conséquences sur lefonctionnement majeur. Or l’anxiété comme pathologie a été plutôt évaluée d’un point de vueclinique ; l’impact des sous types sur la qualité de vie et les coûts a été de façon généralemoins étudié, surtout sur l’impact à long terme, et les études présentent des variationsimportantes d’estimation des coûts.Il est intéressant d’évaluer ces sous types de trouble anxieux du point de vu de la qualité devie liée a la santé ainsi que les paramètres objectifs des consommations de soins et coûts ;l’étude des conséquences de la rechute est particulièrement importante. Nous avons mesuréles coûts associés à l’ensemble des sous types des troubles anxieux, en utilisant une extractiond’une base de données administrative américaine sur plusieurs centaines de milliers depatients, et ainsi permis d’avoir un estimé précis des coûts médicaux, de comparer les coûtsassociés aux différents diagnostics d’anxiété, de les comparer à ceux de l’épisode dépressif, etde l’influence de la relation dynamique entre les troubles anxieux et la dépression. Nousavons ensuite étudié l’évolution de l’impact sur la qualité de vie et le fonctionnement duTrouble Anxieux Généralisé et de la Phobie Sociale à travers deux essais cliniques et estimédans ces essais les utilités associées à des états de santé. Des efforts de recherche accrus sontnécessaires pour fournir des données prospectives sur l’aspect dynamique des TroublesAnxieux et de la dépression, et évaluer les coûts indirects également en pratique cliniquecourante. / Anxiety disorders are unique among all chronic conditions, both physical and mental, inhaving a combination of very high prevalence, early age at onset, high chronicity, andsubstantial role impairment. Anxiety disorder was mostly evaluated of a clinical standpoint;the impact of subtypes on the quality of life and costs were generally less studied, especiallyon long-term impact, and studies show large variations of cost estimates. It is interesting toevaluate these subtypes of anxiety disorder from the point of view of health related quality oflife and the objective parameters of health care consumption and costs. The consequences ofrelapse are of particular importance due to the chronicity of these disorders. We measured thecosts associated with all subtypes of anxiety disorders, using an extraction of a U.S.administrative database on hundreds of thousands of patients, and thus allowed to have anaccurate estimate of medical costs, compared the costs associated with different diagnoses ofanxiety, compared with those of the depressive episode, and studied the dynamic relationshipbetween anxiety disorders and depression. We then studied the evolution of the impact onquality of life and functioning of the Generalised Anxiety Disorder and Social Phobia throughtwo randomised clinical trials and found in these tests associated utilities to health states.Increased research efforts are needed to provide prospective data on the dynamic aspect ofAnxiety Disorders and Depression, and to also measure the indirect costs in clinical practice.

The purpose of this research was to explore HIV/AIDS stigma in the workplace, with a special focus on the stigmatised. The sample consisted of 10 HIV/AIDS positive employees. A qualitative interview schedule was designed. The interview guide was used to facilitate one-on-one interviews with each participant. An analysis of the data revealed that the majority of the participants were shunned by family, friends and partners. Others were too ashamed or afraid to reveal their positive status. The majority of the participants did not feel comfortable revealing their positive status to their line managers and to their co-workers. All participants felt that others viewed people living with HIV/AIDS as dirty and unclean and many had been exposed to stigmatising behaviours towards them due to their HIV/AIDS positive status. As a coping mechanism, most participants noted that they would walk away if stigmatised against. Recommendations were made to address HIV/AIDS stigma in the workplace. / Industrial and Organisational Psychology / M. A. (Industrial and Organisation Psychology)

Fobi utgör ett område som varit anmärkningsvärt frånvarande inom psykodynamisk forskning. Denna studie syftar till att skapa en fördjupad förståelse för uppkomst av och svårigheter kopplade till fobi, samt hur psykodynamisk behandling av fobi bedrivs. Semistrukturerade intervjuer genomfördes med tio terapeuter. Materialet analyserades utifrån grundad teori (GT). Resultatet visade att självhävdelse var en central aspekt för att förstå uppkomst och svårigheter samt behandling av patienter med fobi, då svårigheter att uttrycka ilska och att visa den egna personen utifrån autentiska känslor och behov var genomgående teman. Resultatet visade också på två typer av social fobi där rädslan bottnade i olika upplevelser vilka utgjorde grunden till respektive sociala fobi. Den första typen av social fobi verkade bottna i en överjagsproblematik bestående av ointegrerade representationer av själv och andra, och behandlades med tolkande interventioner. För den andra typen verkade upplevelser av trauma utgöra grunden för fobin, och behandlingen av denna grupp baserades på stödjande inslag.

Virtual Reality is a computational technique that allows user interactio n, immersion and navigation in virtual environments that simulates real life. Because of this reason, its use in several areas of the knowledge is very promising, especially in Psychology, in phobia treatment. For driving phobia treatment, these features can also bring benefits. There are several systems that use Virtual Reality for driving phobia treatment. In these systems, the patient covers virtual routes with elements that cause him this phobia. These systems, however, sin for not offering flexibility to the psychologist in the creation of routes, becoming the treatment limited to previously constructed routes, that nor always reveal adequate for the fears presented for the patients. This research shows the development of a route creation system to be used in driving phobia treatment, built to follow two basic principles: provide high flexibility to the psychologist, so he has freedom to create customized routes, according to each patient s profiles, and have a simple and intuitive interface, minimizing difficulties on the construction of these routes. Besides, this system maps a constructed 2D route to a virtual environment, automatically and transparent, excusing knowledge of computational techniques related to these operations. This interface makes possible to the psychologist choose amongst common objects, found on the traffic of cities, and locate them according to his necessities. Moreover, it allows that external conditions to the route to be configured, such as climatic and traffic conditions. The system was evaluated by a group of psychologists, whose majority did not have difficulties in using the system, and considered the process of construction of routes simple and intuitive. At the end, a series of future works is presented, that configures as functionalities to be added or modified on the system, conferring to it bigger efficiency in its function. / A Realidade Virtual é uma técnica computacional que permite ao usuário imersão, interação e navegação em ambientes virtuais que simulam situações da vida real. Por este motivo, sua utilização em diversas áreas do conhecimento é muito promissora, em especial na Psicologia, para o tratamento de fobias. Para o tratamento da fobia de direção, estas características podem também trazer benefícios. Existem diversos sistemas que utilizam a Realidade Virtual para o tratamento de fobias de direção. Nestes sistemas, o paciente percorre rotas em ambientes virtuais com elementos que lhe causam esta fobia. Estes sistemas, entretanto, pecam por não oferecerem flexibilidade ao psicólogo na criação das rotas, tornando o tratamento limitado a rotas previamente construídas, que nem sempre se mostram condizentes com os medos apresentados pelos pacientes. Esta pesquisa mostra o desenvolvimento de um sistema de criação de rotas virtuais a serem utilizadas no tratamento de fobia de direção, construído de modo a seguir dois princípios básicos: proporcionar alta flexibilidade ao psicólogo, para que ele tenha liberdade na criação de rotas de acordo com o perfil de cada paciente, e possuir uma interface simplificada e intuitiva, minimizando as dificuldades de construção destas rotas. Além disso, o sistema mapeia uma rota construída em 2D para um ambiente virtual, de forma automática e transparente, dispensando conhecimento prévio de técnicas computacionais relacionadas a estas operações. Esta interface possibilita ao psicólogo escolher dentre objetos comuns encontrados no trânsito das cidades, e posicioná-los segundo suas necessidades. Além disso, permite que sejam configuradas condições externas à rota, tais como condições climáticas e de tráfego. O sistema foi avaliado por um grupo de psicólogos, cuja maioria não teve dificuldades em utilizar o sistema, e considerou que o processo de construção de rotas simples e intuitivo. Ao final, é apresentada uma série de trabalhos futuros, relativos a funcionalidades a serem adicionadas ou modificadas no sistema, conferindo- lhe maior eficiência. / Mestre em Ciência da Computação

Diferentes ensaios clínicos randomizados demonstram que a Terapia Cognitivo-Comportamental (TCC) é muito efetiva no tratamento do Transtorno de Ansiedade Social (TAS). Entretanto, uma quantidade significativa de pacientes não apresentam melhora após a finalização da intervenção com TCC. Tal dado indica a necessidade de desenvolver novas estratégias de tratamento para o TAS. A Terapia Cognitiva Processual (TCP) é uma nova abordagem dentro do campo da TCC que tem como principal objetivo auxiliar os pacientes a identificar e modificar suas crenças centrais disfuncionais, sendo o Processo uma das principais técnicas utilizadas. Algumas pesquisas têm demonstrado a efetividade do Processo no tratamento do TAS e de outros transtornos psiquiátricos. Entretanto, novas pesquisas são necessárias para avaliação não somente de tal técnica, mas de todo o protocolo de intervenção da TCP. Esta pesquisa objetivou avaliar se participantes que receberam uma intervenção individual em TCP apresentam diferenças em relação a sintomas de ansiedade social, medo da avaliação negativa, esquiva e desconforto social, ansiedade, depressão, sofrimento psíquico, distorções cognitivas e viés atencional. Este é um ensaio clínico randomizado que comparou um grupo que recebeu intervenção em TCP e um grupo lista de espera no tratamento do TAS. O estudo apresenta três grupos de pesquisa: o TCP (n =18), o lista de espera (n =21) e o saudável (n =19). Um pesquisador independente ao estudo realizou a distribuição aleatória dos participantes com TAS entre os grupos TCP e lista de espera. Foram realizadas avaliações no pré e pós-teste através de diferentes escalas de auto-relato e do teste de Stroop emocional. Adicionalmente, o grupo TCP respondeu tais escalas a cada quatro sessões. O tratamento foi realizado em 16 sessões com duração de 1h30min cada utilizando a TCP no formato individual. Houve uma redução significativa nos sintomas de ansiedade social, ansiedade, depressão, esquiva e desconforto social, e sofrimento psíquico no grupo TCP ao longo do tratamento (p < 0,05). Tais reduções foram associadas a tamanhos de efeito grandes. Não foram observadas mudanças em nenhum dos instrumentos utilizados no grupo lista de espera (p > 0,05). Houve ainda uma significativa redução no medo da avaliação negativa após a utilização do Processo no grupo tratado, além de uma redução em distorções cognitivas (p < 0,05). Não foram observadas diferenças no pré e pós-teste em relação ao viés atencional nos três grupos da pesquisa (p > 0,05). Este estudo sugere que a TCP pode ser uma nova abordagem clínica efetiva no tratamento do TAS associado à diferentes comorbidades, haja vista que houve uma redução em sintomas de ansiedade social e sintomas comórbidos / Different randomized clinical trials show that Cognitive Behavioral Therapy (CBT) is highly effective in the treatment of Social Anxiety Disorder (SAD). However, a large number of patients do not show improvement after receiving CBT. This indicates that it is important to develop new treatments for SAD. Trial-Based Cognitive Therapy (TBCT) is a new approach within the field of CBT area. It aims to help patients to identify and to modify their dysfunctional core beliefs. One of the main TBCT techniques proposed by TBCT is the Trial. Some research studies have demonstrated the effectiveness of Trial in the treatment of SAD, and other disorders. However, further investigation is needed to firmly establish the efficacy not just for the Trial technique, but also the TBCT approach as a treatment for SAD and other disorders. This research aims to evaluate wheter SAD participants receiving TBCT individual-sessions differ from a SAD waiting list group condition regarding symptoms of social anxiety, fear of negative evaluation, social avoidance and distress, anxiety, depression, mental suffering, and attentional bias. This is a randomized clinical trial comparing TBCT and a Waitlist control condition for the treatment of SAD. The study has three groups: TBCT (n =18), Wailist (n =21), and healthy group (n =19). An independent researcher to study distributed randomly the participants with SAD between TBCT or Waitlist condition. Assessments were made at pre and post-test using several self-report scales, and the emotional Stroop test in the three groups. Additionaly, the TBCT group answered these scales each four sessions. The treatment was delivered in sixteen 1.5 hour sessions using the individual TBCT format. There were reductions in social anxiety, anxiety, depression, social avoidance and distress, and mental suffering symptoms at TBCT group (p < 0.05), but not in the Waitlist group (p > 0.05). Those reductions were associated with a large effect size. There was a significant reduction at fear of negative evaluation after Trial use, and reductions at cognitive distortions throughout the treatment as well (p < 0.05). There were no differences among the three groups regarding attentional bias at pre-test nor at post-test (p > 0.05). This study suggests that TBCT may be a new effective clinical approach to treat SAD associated with high rates of comorbidity, as there were significant reductions in the comorbid symptoms

This thesis analyses the benefits of applying game elements to a Virtual Reality application for overcoming phobias, with a special focus on acrophobia, i.e. the fear of heights. Two different prototypes using the Oculus Rift head-mounted display were developed with a gradually exposure to heights. Both prototypes shared the same acrophobic scenario, but one included extra features from games such as engagement, motivation or goals. Twenty-four participants, divided into two groups of twelve, with moderate aversion to heights tested the prototypes. The participants’ heart rate and the time that they looked down from high altitudes were also measured and evaluated. The study showed slightly higher results regarding motivation for the prototype which included the additional game elements. Future studies should include a different head-mounted display, which would allow a longer time of play without motion sickness, and the participation of people diagnosed with acrophobia.

Meta-cognitive models have been utilized to explore the relations between worry and generalized anxiety disorder, as well as, the associations between rumination and depression. However, relatively few studies have focused on the role of meta-cognitive variables and social phobia symptoms. It is possible that individuals with social phobia follow a pattern of thinking similar to that of those who experience depressive rumination and worry. Specifically, it may be that individuals with social phobia hold positive beliefs about their highly negative prolonged post-event evaluations of social interactions. The primary goal of this study was the development and assessment of the Positive Beliefs about Post-Event Processing Questionnaire (PB-PEPQ). Further, it was predicted that post-event processing would mediate the relationship between positive beliefs about post-event processing and social phobia symptoms. The findings from this study suggested that the PB-PEPQ is a valid and reliable construct. Additionally, the findings provide initial evidence for a cognitive model in which individuals who tend to hold positive beliefs about post-event processing, tend to engage in post-event processing which may increase social phobia symptoms.

Ce travail décrit les trajectoires des adolescents qui sont amenés à être suivis en psychiatrie parce qu'ils refusent d'aller à l'école en France. Il se propose ainsi d’employer une démarche sociologique de théorie ancrée (Grounded Theory) afin de répondre à une question de santé publique. En 1991, on estimait que les enfants et adolescents refusant d'aller à l'école représentaient 5% des consultations de pédopsychiatrie en France. Depuis 25 ans, il demeure pourtant difficile de quantifier ce phénomène et son évolution, notamment parce que le refus scolaire ne correspond à aucune catégorie de maladie mentale. L'enjeu sociétal et économique est toutefois considérable. Les associations de parents alertent sur le coût élevé de la déscolarisation, la 'phobie scolaire' rencontre un écho médiatique constant, et les jeunes qui achèvent leurs études sans obtenir de diplôme ont un taux de chômage supérieur à la moyenne pour leur tranche d'âge. De plus, une littérature psychiatrique internationale considérable sur le refus scolaire s’adosse à de nombreuses institutions de soin dédiées à la rescolarisation (consultations et hôpitaux de jours) et de manifestations professionnelles à ce sujet. Dans un contexte de contraintes budgétaires du sanitaire et de crise du système éducatif français, la gestion par le champ médical du refus scolaire pose question. Premièrement, une analyse socio-historique de la littérature médicale internationale entre 1941 et 2018 décrit comment le problème du « refus scolaire » s’est développé dans le discours scientifique selon les deux courants distincts de la phobie scolaire (school phobia) et du refus scolaire (school refusal) ; et tend actuellement à s’élargir vers une problématisation médicale de toute absence scolaire. La deuxième et la troisième partie de ce travail explorent les processus décisionnels qui sous-tendent la médicalisation du refus scolaire à l’échelle individuelle. En effet, le diagnostic psychiatrique intervient relativement tard, à l’issue d’une carrière débutée au sein de l’institution scolaire et de la famille. Comment un jeune en vient-il à être désigné par la catégorie de 'phobie scolaire'? Cette approche interactionniste se fonde sur plus de 100 entretiens réalisés auprès de familles et de professionnels de l’école et analyse le travail produit par le jeune et par les acteurs qui l’entourent. On décrit comment les professionnels de l’école repèrent et qualifient ses difficultés de fonctionnement scolaire. Quatre styles de gestion du problème émergent au sein de l’école, selon le degré d’extériorisation du problème hors du champ scolaire, l’usage des pratiques de care et les modes relationnels avec les autres acteurs. Une analyse dite des « carrières » retrace la trajectoire d’adolescents déscolarisés, de l'école à l'hôpital, en partant du récit des jeunes et de leurs parents. Si les enquêtés présentent le refus scolaire comme une prise de décision brutale, celle-ci vient interrompre un processus de longue durée notamment caractérisé par un épuisement lié au travail de représentation de soi en société. Après la décision de refus scolaire, sont analysés le récit de la transformation de soi, le remaniement des relations aux autres (parents, camarades, enseignants, soignants), la déconstruction et la construction de certaines modalités de socialisation. / School refusal is an increasingly common motive for consultation in child psychiatry. According to the psychiatrists, situations leading to school refusal are extremely diverse, from anxiety feelings in the classroom to truancy, and may lead children to miss school occasionally or to give up their studies. This sociological study, uses the grounded theory to describe the career of teenagers who receive psychiatric care in France because they refuse to go to school. More than 100 in-depth interviews with teenagers, parents and school professionals allow to describe their careers from the school to the psychiatric care. First, we provide a socio-history of the medicalization of school absenteeism through the construction of medical categories (school phobia, school refusal, school attendance problems), based on a review of the international psychiatric literature from 1941 to 2018. Second, teachers discourse on school refusal, their daily management of student who refuse school and their involvement in the medicalization of the absenteeism of some pupils is analyzed. Four styles of management are described among school professionals. Third, the narratives of teenagers and of their parents are analyzed. If school refusal appears as an immediate shift, it answers to a process of long duration. For some students, struggling to attend school from day to day required a consuming work: the presentation of self in public places and emotional work towards peers. After refusing school, students ‘illness’ narratives describe their career in deconstructing and reconstructing their socialization and self.

We examined parental psychopathology and family environment in subthreshold and DSM-IV threshold conditions of social anxiety disorder (SAD) in a representative cohort sample of 1,395 adolescents. Offspring and parental psychopathology was assessed using the DIAX/ M-CIDI; recalled parental rearing and family functioning via questionnaire. Diagnostic interviews in parents were supplemented by family history reports from offspring. The cumulative lifetime incidence was 23.07% for symptomatic SAD, and 18.38 and 7.41% for subthreshold and threshold SAD, respectively. The specific parent-tooffspring association for SAD occurred for threshold SAD only. For subthreshold and threshold SAD similar associations were found with other parental anxiety disorders, depression and substance use disorders. Parental rearing behaviour, but not family functioning, was associated with offspring threshold SAD, and although less strong and less consistent, also with subthreshold SAD. Results suggest a continued graded relationship between familial risk factors and offspring SAD. Parental psychopathology and negative parental styles may be used defining high-risk groups to assign individuals with already subthreshold conditions of SAD to early intervention programs.