Objectives: Computer-guided CBT could help to increase much needed access to lowintensity psychological interventions. Evidence for effectiveness has led to the inclusion of certain packages in NICE guidelines but application in clinical settings is unclear. Low uptake and high dropout suggest problems with acceptability and barriers to uptake. Studies neglect to report on acceptability to clinicians despite indications that clinicianrelated variables and attitudes could influence their use of CCBT. This study investigates clinicians‟ views of CCBT and factors related to referring to it, following experience of low referrals to a CCBT pilot, with the aim of learning more about barriers to access and how this might be improved. Method: A mixed quantitative and qualitative design was used. An online survey was developed to gather views on CCBT, its implementation and demographic information. This was sent to a sample of clinicians in the clinical psychology department, mental health nurses and general practitioners, some of whom were involved in the CCBT pilot project and some not. Descriptive statistics, non-parametric correlations, chi-squared analyses and framework thematic analysis was carried out on 72 completed surveys. Results: Most clinicians identified both benefits and concerns of CCBT. Most approved of CCBT but likelihood to refer varied and many preferred to offer other interventions. Clinician-related variables associated with likelihood to refer were whether clinicians saw mild to moderate cases, approval of CCBT and perceived patient uptake. Views regarding the effectiveness of CCBT influenced choices to offer it, with negative beliefs about effectiveness including a perceived need for human contact. There was moderate interest in receiving CCBT training. Most thought it should be accessed widely, with some concern raised about access in public settings. Although GPs were not involved in the CCBT pilot, many expressed interest in receiving training and referring. Conclusions: Clinicians‟ views of CCBT are mixed and some believe it is ineffective and unacceptable to patients, which influences their decisions to offer it. This includes perceptions about key aspects of therapy, such as human contact. Therefore some clinicians need more convincing of the CCBT evidence-base before they are likely to refer to it. Nevertheless there is moderate interest in using CCBT and more so in those seeing mild to moderate cases. CCBT may have a position in stepped care services but views of referrers should be considered and training offered. More research is needed on implementing CCBT, barriers to access and its role alongside other interventions.

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Social Work / Master / Master of Social Work

Background: The prevalence of mental disorder in children and young people in the UK is estimated at 10-20% (Meltzer et al. 2003). The World Health Organisation advocates urgent preventive measures to reduce the impact of a predicted steep rise in global rates of depression (World Health Organization 2008 ). The mental health of young people is therefore a public health issue, nationally and globally. The UK children's policy agenda proposes that promoting emotional wellbeing is a shared responsibility between children's agencies at the Tier 1 level of Child and Adolescent Mental Health Services (DCSF 2008), but further research is required to develop low intensity, evidence based interventions to promote emotional and mental health. Schools have a remit to address emotional problems in students and evidence exists to support school based interventions to promote emotional wellbeing. However young people encounter barriers to help-seeking in primary care, which need to be understood in order to deliver appropriate support. There is an emerging evidence base for using guided self-help (GSH) to deliver cognitive behaviour therapy-based interventions to adults in primary mental health care (Gellatly et al. 2007). It is not known whether using GSH in high schools to deliver emotional wellbeing interventions to young people would be feasible or acceptable. Aims: To develop an emotional wellbeing intervention for high schools using GSH, and evaluate it for feasibility and acceptability. Methods: The Medical Research Council (MRC) Framework for complex interventions (MRC 2000) provided the conceptual structure of the research. The methodological approach was also strongly influenced by standards for qualitative research proposed by Popay et al (1998), particularly the need to be responsive to the research context. There were three stages: Consultation, Development and Implementation. In the Consultation stage 54 young people aged 11-15 were consulted in 6 focus groups in 3 inner city high schools in the UK. The outcomes supported the development of a GSH intervention, named the 'Change Project', which was the focus of the Development Stage. Pastoral and Special Educational Needs staff in schools received brief training to deliver the intervention, followed by weekly supervision for the duration of the Project. In the Implementation Stage the Change Project was piloted in the same 3 high schools. The Project was evaluated for acceptability and feasibility using qualitative interview methods and a survey of students. Two instruments were incorporated: the PHQ-2 (Kroenke et al. 2003) was included to identify students who would benefit from a referral to the school nurse and the Rosenberg Self Esteem Scale (Rosenberg 1965) was used to explore its suitability as an outcome measure with the target population. Results: Eight Project workers delivered the Change Project. Twenty one students used it. They were aged 11-17 years and included male, female, white and non-white students. Self reported personal outcomes for students were generally positive. Nine sets of baseline and post-intervention RSES scores were collected. There was a general trend for improvement in scores. Presenting difficulties included potentially clinical disorders which were successfully addressed with support from school nurses. Interviews were conducted with 23 students, and 27 school staff and questionnaire data were collected from 140 students. Project worker reports of the Change Project's acceptability and feasibility were mixed, though also generally positive. The acceptability and feasibility of the RSES is discussed. The ethos of pastoral care, support of senior figures and other contextual factors affected implementation quality in each school. Help-seeking in the young people was driven by peer norms of hiding signs of vulnerability. Conclusions: The Change Project intervention was generally felt to be useful and relevant and overall it was welcomed by staff and students. The intervention has potential for further development. Its acceptability and feasibility were co-dependent and strongly influenced the implementation processes, indicating the value of investing time in understanding social and cultural factors in the research context. Understanding organisational and individual barriers and facilitators of help-seeking in young people may encourage use of emotional support in school.

<p>Tinnitus is common, and some individuals with tinnitus display high levels of distress. Cognitive behavioural therapy (CBT) is effective in reducing tinnitus distress, but is rarely available. CBT-based self-help, with or without guidance, has yielded positive results in other problem areas, and one initial randomized controlled trial (RCT) has shown promising results for tinnitus.</p><p>This thesis is based on four studies;</p><p>Study I showed that Internet-based self-help treatment with e-mail guidance alleviated tinnitus distress among consecutive patients and was rated as credible as traditional treatments. Active participation in treatment predicted outcome.</p><p>Study II, an RCT, showed that an extended and more interactive version of the Internet-based self-help treatment with e-mail therapist support appeared to be equally effective as a group treatment. In study III, another RCT, a self-help book with weekly telephone support was superior to a wait-list control group. No strong evidence for the importance of telephone contact on outcome was found. In both study II and III, the positive outcome remained after one year and self-help approaches appeared more therapist time-effective compared to group treatment. Also, the received treatment-dose for patients in guided self-help was not lower than in the group treatment.</p><p>Study IV found that the ‘Stages of Change’, from the transtheoretical model, are probably not the right theoretical framework to use with tinnitus patients. Predictors of outcome were found, but they were not in line with the theory behind the Stages of Change. The predictors were better understood when conceptualized as coping, showing that helplessness and less coping before treatment correlated with better outcome.</p><p>In sum, guided cognitive behavioural self-help can decrease tinnitus distress. It appears to be therapist time-effective and shows effects comparable to or slightly below traditional CBT for tinnitus. Effects remain one year after treatment and generalize to a routine clinical setting.</p>

Disproportionately high numbers of Black people use mental health services and experience involuntary treatment in the UK. There is no simple explanation, but research and policy suggest that groups run by and for Black people with mental health problems provide valued support. This study asks how community development (CD) practice can help these groups to develop and thrive. The research adopted an action research framework to develop four cycles of research, each informing the next, within a social constructivist paradigm. Methods were mainly qualitative: interviews, group discussions and observation, with a questionnaire survey in cycle one. This asked CD practitioners about their activities and helped to identify two groups for case studies in cycles two and three. During the case studies, groups received development support on their chosen topic while participating in qualitative research; activities were clearly demarcated. Reflective field notes added to the data. In the fourth cycle reflective conversations with eminent ‘critical friends’ refined and affirmed the learning. Thematic analysis was continuous and progressive. Findings suggest that CD practitioners can inspire and help Black people with mental health problems to come together in member-led, mutually supportive groups, justifying Black-only membership. Effective practitioners, especially Black role models, helped groups to generate self-belief and self-efficacy through collective action, enabling members to change their status, services and community. Those practitioners who demonstrated critical humility, commitment and competence broke the pattern of racial and psychiatric dominance. Others inadvertently reinforced societal oppression. A new concept is introduced to encapsulate the learning: the ‘liberation approach’ to CD which synthesises four perspectives: radical CD, mental health recovery, Black self-help and liberation theories. This approach helps groups to challenge oppressive processes, breaking the mould in which they feel constrained. The study contributes new theory, evidence and research methodology about CD and self-organising groups within this context.

Since research on forgiveness has flourished over the past three decades, multiple interventions have been developed to aid individuals in this arduous process. Two interventions in particular have been most-widely studied with diverse groups: Enright’s process model (Enright & Fitzgibbons, 2000) and Worthington’s REACH Forgiveness model (2006). Thus far, these forgiveness interventions have been led by trained professionals in an in-person group. In-person interventions pose issues of cost and attendance. In the current study, I adapted Worthington’s Christian-adapted REACH Forgiveness intervention into a self-directed workbook for Christians who have experienced an offense within a religious community. Participants (N = 52) voluntarily completed the workbook for partial course credit, taking an average of 6.66 hours of time, and assessments at three time points. I found a significant treatment condition x time interaction, Wilks’ ë = .31, F(6,31) = 11.57, p < .001, partial ç² = .69, which indicates that the effect of time depended upon the treatment condition to which participants were assigned. In addition, the current study produced a larger effect size comparable to benchmarks of previous in-person REACH Forgiveness interventions (d = 1.63), and fell within the upper limit of the standard of change. The current findings encourage further analysis of this self-directed intervention which is cost-effective, easily disseminated, and found effective in this initial study.

The aim of this diploma thesis is to depict the uniqueness of a person suffering from alcoholism, including a self-reflection of his own life before joining the AA group and after. Moreover, the thesis focuses on the perception of a person's addiction and especially his search for sobriety. The next objective is the identification of specific kinds and sources of social support for each individual in the context of AA group. The theoretical part concerns the concept of social support, the topic of self-help and self-helping groups, focusing on a self-help AA group. This part of the thesis also includes the characteristics of addictive behavior with the specifications of alcohol addiction. A qualitative research and a method of semi-structured interview have been chosen for the purposes of the empirical study. The analysis and interpretation of the data was inspired by the principles of the grounded theory. This empirical study is based on primary research areas: a description of active alcoholic's life perception, a strategy of the struggle with addiction, a way to abstinence through the self-help groups of AA and a reflection of the alcoholics' lives in sobriety.

Master of Science / Department of Architecture / David R. Seamon / Kamaiya is a system of Nepalese agriculture bonded labor. In typical wage labor, one can enter or withdraw from the labor market as an independent agent; in the case of bonded labor, however, a worker cannot control his or her labor power. The Kamaiyas were liberated by the Nepalese government in 2000, and promised land to build houses. Without enough money for construction, however, many of these “ex-Kamaiyas,” as they are now called, are without housing or live in sub-standard units. This thesis examines the housing possibilities for the ex-Kamaiyas and aims at creating basic guidelines for planning and designing low-cost, self-help housing. The thesis is an attempt to design affordable and environmentally responsive housing that draws on Nepalese vernacular traditions but incorporates some modern materials and construction methods. The research and designs are based on interviews with ex-Kamaiyas living in the Nepalese villages of Tesanpur, Janatanagar, and Bhuri Gaun. The thesis serves as a guide for non-profit organizations working to provide housing for the ex-Kamaiyas and consists of guidelines, termed “design patterns,” for laying out ex-Kamaiya neighborhoods and for designing and constructing individual houses. The thesis also provides step-by-step construction guidelines for building the houses. The thesis’s last chapter evaluates the proposed housing system and identifies strengths and weaknesses.