This study investigated the experience of posttraumatic growth for breast cancer survivors who volunteered to complete a survey (N = 277). A number of participants also provided narrative responses containing their personal experiences of breast cancer (N = 100). Demographic characteristics, breast cancer variables, optimism, coping strategies, and participation in psychosocial interventions were examined in relation to posttraumatic growth as measured by the Posttraumatic Growth Inventory. Differences between those who participated in psychosocial interventions versus those who did not were examined. The relation of coping strategies utilized and optimism level to interventions accessed was also of interest. Predictors of posttraumatic growth were examined via generalized linear modeling. Finally, the narrative responses were investigated by means of content analysis. The results provided evidence that demographic characteristics (i.e., affiliation with religion and lower levels of education) and one breast cancer variable (i.e., increased number of years since diagnosis) were related to experiences of posttraumatic growth for breast cancer survivors. Use of active forms of coping, optimism level, and participation in recreational interventions were also related to posttraumatic growth. Those who participated in psychosocial interventions were more likely to be employed and have higher levels of education than those who did not access interventions. Use of several active coping strategies and one passive coping strategy increased the likelihood of accessing a number of different psychosocial interventions. Posttraumatic growth was predicated by affiliation with religion, lower levels of education, increased number of years since diagnosis, knowledge of breast cancer stage, higher levels of optimism, and use of one passive and two active coping strategies. Many of these findings support previous research, however some conflict with prior results. The narrative responses contained information regarding diagnosis and treatment, impact of breast cancer, coping with breast cancer, and support accessed. Although the negative impact of breast cancer was discussed in terms of short and long-term, positive long-term changes were also reported. A variety of coping strategies and supports were utilized by the participants as well.

Dementia means significant cognitive decline in language, memory and executive functions. Dementia is associated with progressive communication difficulties, which can result in reduced quality of life. To promote quality of life, the communicative environment, participation in group activities and cognitive stimulation have great significance. Cognitive stimulation can delay, slow or prevent symptoms of dementia. Furthermore, information and communication technology (ICT) has promising results in relation to dementia. However, research including psychosocial intervention are limited, which motivates present study. The present study is the first Swedish study which purpose was to promote social interaction for people with dementia through conversational sessions as a group activity when using the communication aid CIRCA (Computer Interactive Reminiscence and Communication Aid). Further purpose was to contribute to the understanding of high technological communication aids’ potential to facilitate and support communication for people with dementia. Five individuals with dementia were recruited from a residential care home. The study comprises a seven-session CIRCA-based group activity, and the material consist of seven hours and fifteen minutes recordings. The analysis included mapping of conversational topics where particularly interesting interactive phenomena were selected that were considered representative of the interaction. The results showed that the conversational sequences could relate to the content of CIRCA, the management of the tablet or were as a result of the content in CIRCA. Characteristic interactional phenomena were enjoyable group dynamics with laughter, humour, singing and social inclusion where participants contributed with information, personal experiences and asked each other questions. Furthermore, a symmetric interaction emerged between participants and between participants and the facilitator. The participants considered the group sessions in use of CIRCA to be enjoyable, amusing, informative and provided conversational topics and simplified the conversations in comparison to without communication aid. The results indicate that CIRCA has promising potential to be utilized as a group activity for people with dementia. CIRCA could be applicable in residential care homes where caregivers’ opportunities to socialize one-to-one is limited. Furthermore, the multimedia of CIRCA can offer a variation that may cater to several individuals interests. CIRCA could constitute a group intervention to promote activity, interaction and social relationships, that could improve the quality of life of people with dementia.

Due to its limiting effects on the independency of life, the Alzheimer's disease has a radical impact on a diseased person. Their dependency on others influences all their family members, though especially those ones, who are taking immediate part in the caregiving for their relatives. The new changes in the family caregivers' lifestyle have an extensive influence on their health and the care about the diseased itself. In this empirical study we intended to examine the presence and the intensity of a burden, an anxiety and a depression among the family caregivers, who are being provided with psychosocial and other professional help. It's a transverse survey among the 102 family caregivers caring for their relatives with diagnosed Alzheimer's disease or some other form of dementia. The caregivers were tested for the level of subjective burden by Zarit Burden Inventory (ZBI) and for the anxiety and the depression by Beck Depression Inventory (BDI II), Geriatric Depression Scale (GDS) and Beck Anxiety Inventory (BAI), the results were processed with the statistical analysis and Pearson correlation coefficient. In the study sample there were 83 % of women and 62 % of the caregivers were older than 50 years. According to our findings 86 % of people caring for less than 2 years and 89 % of people caring...

Fear of cancer recurrence (FCR) is defined as “fear, worry, or concern relating to the possibility that cancer will come back or progress (Lebel et al., 2016, p. 3266). FCR is the most frequently reported concern identified among cancer survivors (Baker, Denniston, Smith, & West, 2005; Lebel, Rosberger, Edgar, & Devins, 2007). Although approximately 50% of cancer survivors experience moderate-to-high levels of FCR (Simard et al., 2013), few psychosocial interventions exist that directly target this construct. The overarching study objectives were: (a) to adapt a manualized, 6-week, cognitive-existential group therapy intervention for FCR to an individual format; (b) to pilot-test the feasibility, acceptability, and satisfaction of this individual intervention on n=3 participants; and (c) to further pilot-test the efficacy of the individual intervention on n=25 participants, via a randomized controlled trial (RCT). In study 1, n=3 cancer survivors (1 male, 2 females) completed the one-on-one therapy intervention for the psychological treatment of FCR. Sessions were 60-90 minutes long, and included cognitive restructuring exercises, behavioural experiments, relaxation techniques, existential processing of the here-and-now, and finding meaning in life post-diagnosis. Participants completed questionnaire packages throughout the intervention and an exit interview to determine their overall feedback on the intervention. Quantitative analyses revealed downwards trends in fear of cancer recurrence and cancer-specific distress across participants. Qualitative analyses of the exit interviews revealed that all participants found the intervention useful, and that the sessions had favourable pacing and length. In study 2, the FCR intervention was further pilot-tested via an RCT. Twenty-five female cancer survivors were randomized to an experimental group or a wait-list control group. Sessions included cognitive restructuring techniques, behavioural experiments, confronting existential distress, and relaxation exercises. Nineteen women (n=9 intervention, n=10 control) completed the 6-week therapy intervention, and completed questionnaire packages at pre-, post- and 3-month follow-up. Between-within ANOVAs revealed significant interactions in the primary outcome measure of FCR, and secondary outcome measures of cancer-specific distress and uncertainty in illness for participants in the experimental group. Repeated measures ANOVAs revealed reductions in FCR, cancer-specific distress, uncertainty in illness, reassurance-seeking, cognitive avoidance, and intolerance of uncertainty, and revealed improvements in positive reinterpretation and growth, use of emotional support and mental health (improved quality of life) for participants in the experimental group, as compared to the wait-list control group. The variables that changed either maintained or improved at follow-up. Results from this study demonstrate promising results in addressing FCR in cancer survivors via a cognitive-existential intervention. Future research should continue investigating the specific therapeutic ingredients that are most effective for the psychological treatment of FCR.

The aim of this thesis is to present current trends in the treatment of schizophrenia and to mediate the experience of people with schizophrenia that are treated during hospitalization. The theoretical part consists of two chapters. The first chapter briefly characterizes schizophrenia and describes how the disease can affect the quality of life. The second chapter deals with the forms of treatment that are currently considered the most appropriate and presents how this group of patients perceives the treatment. The empirical part is based on a qualitative methodology. The study involved 9 people with the schizophrenic disease aged 19-43 years undergoing the stabilization phase of treatment during hospitalization. Data were obtained using semi-structured in-depth interviews and then analyzed by interpretive phenomenological analysis. Based on the analysis, two thematic domains were identified: the respondents' experience with treatment during hospitalization, and the respondents' experience with the interventions offered during hospitalization. The obtained results are described and also discussed with other researches dealing with similar topics. Keywords schizophrenia, treatment, perception of treatment, psychosocial intervention, quality of life

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Introduction: More than half a million Canadians are living with dementia and 260,000 of these individuals live at home. As dementia progresses, persons with dementia require more assistance from caregivers to meet their daily needs including stimulation and emotional support. However, caregivers receive little training in this role. Namaste Care is a program originally developed for use in long-term care homes promoting a structured routine, a slow pace of care, and multisensorial activities for persons with advanced dementia. The program has not yet been adapted or evaluated for use by caregivers of community-dwelling older adults with moderate to advanced dementia. The objective of this study is to explore the feasibility, acceptability and preliminary effectiveness of a version of Namaste Care adapted by caregivers. Methods: A multiphase mixed methods design was used. In the adaptation phase, six caregivers participated in workshop sessions to adapt Namaste Care for home use. In the evaluation phase, 12 caregivers received training to use the adapted program. Surveys were used to collect data on caregiver quality of life, perceptions of caregiving, self-efficacy, and burden at baseline and 3-month follow-up. Qualitative interviews at 3-month follow-up were also completed to assess the acceptability of the program and implementation facilitators and barriers. Findings: All caregivers used the program for a minimum of twice a week as planned and used a variety of program activities. The retention rate was 83%. Caregivers perceived that the program improved their relationships with persons with dementia. Implementation facilitators were receiving a Namaste Care Toolbox and written resources about Namaste Care. No statistically significant effects were found with regards to the outcome measures listed above. Conclusions: The adapted Namaste Care program was feasible and acceptable for use by caregivers. There is a need to conduct a larger trial to determine the extent of its effects. / Thesis / Doctor of Philosophy (PhD) / With the growing numbers of family and friend caregivers across Canada supporting people living with dementia at home, there is a need to better prepare caregivers for their role. The aim of this study is to adapt, implement and evaluate a sense-based, skill-building program called Namaste Care delivered by caregivers of older adults living with moderate to advanced dementia. First, workshops for caregivers were held to adapt the Namaste Care program for home use. Afterwards, 12 caregivers received training in using the adapted program and delivered the program for three months. Caregivers used the program at least twice a week as intended and delivered a variety of activities. The program improved relationships with persons with dementia. No significant changes for caregiver quality of life, positive beliefs of caregiving, burden, and confidence were found. Next steps are to further test the effects of the program in a larger trial.

A positive psychosocial intervention comprised of high autonomy support, task-involvement, and caring was implemented in physical activity classes to examine its effects on college women’s basic psychological needs (i.e. autonomy, competence, relatedness), exercise regulations (i.e. external, introjected, identified, integrated, intrinsic) and social physique anxiety (SPA). We hypothesized that at the end of the semester, participants in the intervention group (N = 73) would report greater need satisfaction, more self-determined regulations and less SPA than participants in the non-intervention group (N = 60). At T1 and T2, both the intervention and non-intervention participants reported “agreeing” with experiencing an autonomy supportive, task-involving, and caring environment. Furthermore, both groups at T1 and T2 reported moderate SPA. No significant group differences were found at T1. At T2, significant group differences were observed in the intervention and non-intervention groups’ report of external regulation and intrinsic regulation. The results suggests that group exercise instructors are capable of creating a positive psychosocial environment to enhance students’ intrinsic motivation.

Este estudo se pretende reflexão crítica a partir da apresentação das experiências de uma Enfermeira de CAPS. Trata-se de Narrativa baseada na historiobiografia com descrição detalhada do processo de implantação, organização e cenários da experiência do cotidiano do trabalho em serviço de saúde mental e da rede de atenção a saúde. Parte de reflexão crítica sobre as principais políticas de saúde mental cotejada com experiências da autora em trechos de diário de bordo e também das experiências em outros CAPS da cidade descritas por outros autores. Destacam-se a complexidade do trabalho em CAPS e do ato de estabelecer rede. Sublinham-se os desafios para as políticas públicas e políticas territoriais colocando como questão aos trabalhadores, cidadãos e governos a problematização e valorização das experiências do cotidiano como meio de compreensão das demandas e organização dos serviços para oferta de cuidados em saúde de modo articulado e resolutivo, bem como o sofrimento destes trabalhadores e a dificuldade de manterem-se produzindo sentido e prazer nesse modo de estar no mundo. . / This study intends to reflect critically from the presentation of the experiences of a CAPS Nurse. It is a Narrative based on historiobiography with a detailed description of the process of implantation, organization and scenarios of the daily experience of work in mental health service and the health care network. Part of critical reflection on the main mental health policies compared with the experiences of the author in excerpts from the logbook and from the experiences in other CAPS around the city described by other authors. The complexity of the work in CAPS and the act of establishing a network are highlighted. It highlights the challenges for public policies and territorial policies, placing as a matter of question to workers, citizens and governments the problematization and valuation of everyday experiences as a means of understanding the demands and organization of services to offer health care in an articulated and resolutive manner as well as the suffering of the workers and the difficulty of keeping producing meaning and pleasure in this way of being in the world..

Aims and Methods The overall aim was to evaluate methods of screening and assessment of distress, anxiety, and depression in cancer patients. Further, to evaluate effects of a psychosocial intervention and to explore changes of distress, anxiety, depression, and HRQoL during six months. Study I included 495 consecutive patients screened with the Hospital Anxiety and Depression Scale (HADS) at their first visit to an Oncology Department. Half of the patients with >7 on any of HADS subscales received standard care (SCG), and half received a psychosocial intervention (IG). To compare HADS with a thorough clinical assessment (CA), Study II included 171 identified patients representing both sexes, <65/≥65 years, and curative/palliative treatment intention. Results Screening with HADS identified anxiety or/and depression symptoms in 36% of the 495 patients. Thirty-six (43%) of 84 IG patients attended CA, resulting in support for 20 (24%) of them. There were no differences between SC and IG during follow-up, anxiety and depression decreased and HRQoL increased, although anxiety was still present and HRQoL impaired at six months. The Distress Thermometer (DT) ≥4 (sensitivity 87%, specificity 73%) is valid for screening of distress; its ability to measure changes over time is comparable to HADS. Of 319 patients screened with <8 on both HADS subscales, 196 (80%) were stable non-cases with HRQoL comparable to that of the general population and 49 (20%) patients were unstable non-cases, with deteriorated anxiety, depression, and HRQoL. >4 on HADS subscales may be useful for early detection of unstable non-cases. In Study II, HADS identified 49 (34%) and the CA 71 (49%) patients as having distress, anxiety or depression. CA identified more men and more young patients with distress than HADS did. Conclusion Screening and assessment identifies patients with persistent symptoms and increases access to CA and support. The DT may be used routinely in oncology care. When HADS is used, healthcare professionals should be aware of psychosocial problems perceived by patients but not covered by HADS. Most patients identified with distress seem to have resources to manage problems without needing additional support. Patients screened as non-cases indicate no need for re-assessment.