Chronic pain is a one of the most common causes of disability and sick leave. Psychological factors play a central role in the experience of pain and are important in the management of pain. However, for many people with chronic pain CBT is not available. There is a need to develop alternative ways to deliver treatments that reach more individuals with chronic pain. Internet-based treatments have been shown to be effective for several disorders and recent research suggests that internet-based CBT for chronic pain can be effective. The present thesis included four randomized controlled studies with the aim of evaluating whether guided internet-based treatments based on CBT can help individuals with chronic pain regarding psychological variables. Study I investigated the effects of an internet-based CBT intervention with telephone support for chronic back pain. The study showed reductions in some variables assessed.      Study II investigated the effects of an internet-based CBT intervention for chronic back pain without telephone support and with a live structured interview before inclusion. It was found that the treatment can reduce some of the distress associated with chronic pain. Study III investigated the effects of a guided internet-delivered CBT as a secondary intervention. Participants were patients who had previously completed multidisciplinary treatment at a pain management unit. Results showed that the internet-based treatment can be a feasible option for persons with residual problems after completed pain rehabilitation. Effects remained at six-month follow-up.    Study IV focused on the effect of a guided internet-delivered acceptance and commitment therapy (ACT) for persons with chronic pain. Results suggest that an internet-delivered ACT treatment can help persons with chronic pain. Effects remained at six-month follow-up. In conclusion, guided internet-based CBT can decrease distress associated with chronic pain.

Hintergrund: In den letzten Jahren ist zunehmend deutlich geworden, dass Konsumenten von Ecstasy sich hinsichtlich Gebrauchsmuster und -kontext wie auch Spontanverlauf, Risiken und Konsequenzen von Konsumenten anderer legaler und illegaler Substanzen unterscheiden und möglicherweise eine recht eigenständige Gruppe darstellen. Diese eigenständige Gruppe wird im angelsächsischen Raum zum Teil auch als club drug user bezeichnet. Alarmierend waren die Vermutungen aus Voruntersuchungen, dass club drug-Konsumenten auch nach dem Konsum geringer Mengen von Ecstasy bemerkenswerte und möglicherweise überdauernde neurobiologische Veränderungen mit assoziierten kognitiven Beeinträchtigungen und Störungen aufzeigen. Dies stellt an sich eine mögliche Gefährdung der Konsumenten dar, zusätzlich wiederum können kognitive Veränderungen auch Einfluss nehmen auf den Verlauf des weiteren Suchtmittelkonsums und den Erfolg von Interventionen. Ziel: In der MAYA-Studie (Munich Assessment of Young Adults) werden an einer epidemiologischen Bevölkerungsstichprobe junger Erwachsener (Stichprobe A) sowie an einer klinischen Stichprobe von Ecstasy-Konsumenten (Stichprobe B) die Art und das Ausmaß kognitiver Störungen und Defizite in Abhängigkeit von Gebrauchsmustern und anderen Einflussfaktoren untersucht. Bei der Stichprobe A handelt es sich um ein Subsample der EDSPStudie. Zusätzlich zu den bereits erhobenen Charakterisierungen werden spezifische neurokognitive Maße (vor allem Aufmerksamkeit, Gedächtnis und exekutive Funktionen) und Fragebögen (Impulsivität, BDI, STAI etc.) erhoben. Die Probanden erhalten weiterhin ein Screening mit dem neu eingeführten Instrument WHO ASSIST (Alcohol, Smoking and Substance Involvement Screening Test). Wenn indiziert, wird eine Intervention im Sinne eines Motivational Enhancement durchgeführt. Initiale Auswirkungen werden in einem Telefoninterview sechs Wochen später überprüft. Ergebnisse: Die vorläufigen Ergebnisse beruhen auf einer Teilstichprobe. Insgesamt handelte es sich eher um Konsumenten mit geringgradigem bis moderaten Konsum. Dennoch ließen sich Unterschiede zwischen den Konsumentengruppen (Ecstasy, Cannabis, Alkohol) und den Nichtkonsumenten erkennen. Die Konsumenten von Ecstasy unterschieden sich am ausgeprägtesten von den Kontrollen. Die sich bisher abzeichnenden Unterschiede bei Aufmerksamkeit, Gedächtnis und exekutiven Funktionen scheinen bei der Gedächtnis- und Merkfähigkeit am ausgeprägtesten zu sein. Bei diesen vorläufigen Ergebnissen sind die Untersuchungsgruppen noch sehr heterogen und enthalten z.B. Probanden, die ihren Ecstasykonsum bereits wieder aufgegeben haben. / Introduction: In recent years it has become increasingly evident that ecstasy users represent a group distinct from users of other drugs. This is based on consumption patterns, context of use, development of use patterns and other factors. This group of users might be considered "club drug users", given the overlap, similarity of use patterns and consumptions within the class of club drugs. In recent neurobiological research, alarming results have been reported, indicating that persistent neurotoxic effects with concomitant cognitive problems may be induced by ecstasy consumption. Methods: In the Munich Assessment of Young Adults Study (MAYA) two samples of ecstasy users are investigated. Sample A is a sample of users drawn from an ongoing epidemiological longitudinal study of young adults in Munich. Sample B is an additional clinical sample. Both samples are characterized extensively and are neuropsychologically tested for attention, memory and executive functioning. A screening for harmful use is conducted with the German version of the WHO ASSIST (Alcohol, Smoking and Substance Involvement Screening Test). A Motivational Enhancement Intervention is applied when harmful use is detected. With a telephone interview the intervention's initial effect is assessed. Results: Initial results are based on a small sample. Use within the tested population is low to moderate. Still significant differences in attention, memory, and executive functioning could be detected with the current testing. Ecstasy users almost consistently showed the lowest cognitive functioning. The one difference is that ecstasy users were significantly faster in finger tapping and reaction. Note that the results are preliminary. The sample is heterogeneous, including both current and former users. Firmer results will be reported with the full sample size, allowing to further elucidate subgroups and interactions.

xiii, 118 p. : ill. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number. / Bullying behaviors are a growing concern in U.S. schools, and are documented to have detrimental effects for victims, perpetrators, and bystanders. Most interventions focused on bully prevention either have limited empirical support, or focus primarily on the behavior of the bully. We present here an alternative approach to bully prevention based on the growing recognition that interventions should be function-based. Bully Prevention in Positive Behavior Support (BP-PBS) gives students the tools necessary to remove the social rewards maintaining bullying behavior through a strong link to school-wide positive behavior support, a discrimination between "being respectful" versus "not being respectful" in unstructured settings, and the explicit teaching of a simple, school-wide response to bullying effective for victims, bystanders, and perpetrators of bullying. This is coupled with an efficient strategy for school staff to use when dealing with reports of bullying including a sequence of questioning and practice. A single-subject, multiple-baseline design across six students and three elementary schools was implemented in an empirical evaluation of the effectiveness of BP-PBS. Results indicated that implementation of the program not only significantly decreased incidents of bullying behavior for all six students observed, but also increased the likelihood of appropriate victim responses and bystander responses, indicating a substantial decrease in the social rewards that served to maintain bullying behavior. In addition, through a pre-post survey, students also reported improved perceptions of the bullying and safety at their schools. Finally, school staff members were able to implement the program with a high degree of fidelity and regarded the program as effective and easy to implement. These findings have major implications for the design and support of effective social culture in schools. Limitations of the research and future efforts are suggested to encourage the field in a new direction with bully prevention efforts, away from overly complicated definitions and interventions, toward a school-wide approach including specific strategies and a reconceptualization of the bullying construct. / Committee in charge: Robert Horner, Co-Chairperson, Special Education and Clinical Sciences; Kenneth Merrell, Co-Chairperson, Special Education and Clinical Sciences; Jeffrey Sprague, Member, Special Education and Clinical Sciences; Bruce Stiller, Member, Not from U of 0; Lou Moses, Outside Member, Psychology

xiii, 99 p. : ill. (some col.) / Check-in-check-out (CICO) has been demonstrated to produce decreases in problematic behaviors and increases in academic engagement when used as a secondary intervention within a school-wide positive behavior support (SWPBS) framework. In general, research has suggested that CICO is most effective for children whose problem behaviors are sensitive to adult attention without modifications. However, research is lacking on secondary interventions intended for students whose problem behaviors are hypothesized to be maintained by escape or avoidance of academic tasks. Drawing from research on the utility of function-based interventions and the teaching of functional replacement behaviors to decrease problem behaviors and increase appropriate skills, a secondary intervention, Breaks are Better (BrB), was designed that builds off core features of CICO but also includes function-based components for addressing problem behavior maintained by task avoidance. Modifications included 1) defining specific expectations that were incompatible with problematic behavior during academic routines and 2) providing students with functional replacement behaviors that allowed them to recruit both brief breaks and help. Effectiveness of BrB was examined using an ABAB design across three participants whose off-task behaviors were hypothesized to be maintained, in part, by task avoidance or escape. The current study examined the following primary research questions: 1) is there a functional relation between the implementation of BrB and reduced rates of off-task behavior, and 2) is there a functional relation between the implementation of BrB and increases in the use of alternative replacement behaviors (help and break)? A functional relation was documented between the implementation of the BrB intervention and reductions in off-task behavior for two out of three participants (Gregg and Alex). However, for Diego, off-task behavior was somewhat variable during the final intervention phase. Results from the collection of contextual fit and social validity data indicated that students, teachers, and parents viewed BrB as effective, worth the required effort, and contextually appropriate for use in this school. / Committee in charge: Cynthia M. Anderson, Chairperson; Rick Albin, Member; Laura Lee McIntyre, Member; Jennifer Pfeifer, Outside Member

Hintergrund: In den letzten Jahren ist zunehmend deutlich geworden, dass Konsumenten von Ecstasy sich hinsichtlich Gebrauchsmuster und -kontext wie auch Spontanverlauf, Risiken und Konsequenzen von Konsumenten anderer legaler und illegaler Substanzen unterscheiden und möglicherweise eine recht eigenständige Gruppe darstellen. Diese eigenständige Gruppe wird im angelsächsischen Raum zum Teil auch als club drug user bezeichnet. Alarmierend waren die Vermutungen aus Voruntersuchungen, dass club drug-Konsumenten auch nach dem Konsum geringer Mengen von Ecstasy bemerkenswerte und möglicherweise überdauernde neurobiologische Veränderungen mit assoziierten kognitiven Beeinträchtigungen und Störungen aufzeigen. Dies stellt an sich eine mögliche Gefährdung der Konsumenten dar, zusätzlich wiederum können kognitive Veränderungen auch Einfluss nehmen auf den Verlauf des weiteren Suchtmittelkonsums und den Erfolg von Interventionen. Ziel: In der MAYA-Studie (Munich Assessment of Young Adults) werden an einer epidemiologischen Bevölkerungsstichprobe junger Erwachsener (Stichprobe A) sowie an einer klinischen Stichprobe von Ecstasy-Konsumenten (Stichprobe B) die Art und das Ausmaß kognitiver Störungen und Defizite in Abhängigkeit von Gebrauchsmustern und anderen Einflussfaktoren untersucht. Bei der Stichprobe A handelt es sich um ein Subsample der EDSPStudie. Zusätzlich zu den bereits erhobenen Charakterisierungen werden spezifische neurokognitive Maße (vor allem Aufmerksamkeit, Gedächtnis und exekutive Funktionen) und Fragebögen (Impulsivität, BDI, STAI etc.) erhoben. Die Probanden erhalten weiterhin ein Screening mit dem neu eingeführten Instrument WHO ASSIST (Alcohol, Smoking and Substance Involvement Screening Test). Wenn indiziert, wird eine Intervention im Sinne eines Motivational Enhancement durchgeführt. Initiale Auswirkungen werden in einem Telefoninterview sechs Wochen später überprüft. Ergebnisse: Die vorläufigen Ergebnisse beruhen auf einer Teilstichprobe. Insgesamt handelte es sich eher um Konsumenten mit geringgradigem bis moderaten Konsum. Dennoch ließen sich Unterschiede zwischen den Konsumentengruppen (Ecstasy, Cannabis, Alkohol) und den Nichtkonsumenten erkennen. Die Konsumenten von Ecstasy unterschieden sich am ausgeprägtesten von den Kontrollen. Die sich bisher abzeichnenden Unterschiede bei Aufmerksamkeit, Gedächtnis und exekutiven Funktionen scheinen bei der Gedächtnis- und Merkfähigkeit am ausgeprägtesten zu sein. Bei diesen vorläufigen Ergebnissen sind die Untersuchungsgruppen noch sehr heterogen und enthalten z.B. Probanden, die ihren Ecstasykonsum bereits wieder aufgegeben haben. / Introduction: In recent years it has become increasingly evident that ecstasy users represent a group distinct from users of other drugs. This is based on consumption patterns, context of use, development of use patterns and other factors. This group of users might be considered "club drug users", given the overlap, similarity of use patterns and consumptions within the class of club drugs. In recent neurobiological research, alarming results have been reported, indicating that persistent neurotoxic effects with concomitant cognitive problems may be induced by ecstasy consumption. Methods: In the Munich Assessment of Young Adults Study (MAYA) two samples of ecstasy users are investigated. Sample A is a sample of users drawn from an ongoing epidemiological longitudinal study of young adults in Munich. Sample B is an additional clinical sample. Both samples are characterized extensively and are neuropsychologically tested for attention, memory and executive functioning. A screening for harmful use is conducted with the German version of the WHO ASSIST (Alcohol, Smoking and Substance Involvement Screening Test). A Motivational Enhancement Intervention is applied when harmful use is detected. With a telephone interview the intervention's initial effect is assessed. Results: Initial results are based on a small sample. Use within the tested population is low to moderate. Still significant differences in attention, memory, and executive functioning could be detected with the current testing. Ecstasy users almost consistently showed the lowest cognitive functioning. The one difference is that ecstasy users were significantly faster in finger tapping and reaction. Note that the results are preliminary. The sample is heterogeneous, including both current and former users. Firmer results will be reported with the full sample size, allowing to further elucidate subgroups and interactions.

A multi-tiered system of supports offers a comprehensive model for the prevention of academic and behavior problems in schools. To date, research has emphasized the impact of universal and intensive interventions. However, the need for research on secondary or targeted group interventions (Tier 2) for those students who do not respond to the universal level of support is growing. This study evaluated CICO, a Tier 2 intervention, in improving student behavior when it is used with three elementary students from a high-need population and in conjunction with student accountability tracking, designed to promote parental involvement. Functional assessments indicated that all three students had attention-maintained problem behavior during instruction sessions. The study employed a concurrent multiple baseline design across students to assess the effects of CICO and CICO with accountability tracking on academic engagement and problem behavior. Results indicated that the team members were able to implement CICO with fidelity and their implementation of the intervention was effective in increasing academic engagement and reducing problem behavior. The CICO with accountability tracking implementation with one student contributed to further improvement of his target behaviors. These effects were shown to be maintained moderately well for two students who underwent fading. Results are discussed in terms of the study limitations and implications for practice and future research.

An educational framework known as School Wide Positive Behavior Support being implemented in school systems across the country provides the schools with three tiers of support to address both academic and behavior challenges. The purpose of this study was to evaluate the use of peer tutors when applied to a Tier 2 intervention known as Check-In Check-Out (CICO). Peer tutors performed the morning check-in with the tutees by setting the expectations for the day and giving the tutees their Daily Progress Report (DPR) form. Throughout the day, the tutees took the DPR form to each class where they received a score from the teacher. At the end of the class period, the peer tutors provided the tutees with feedback on the scores received on the DPR form. Once the school day finished, the peer tutees checked-out with the tutors and received a reward if they met their percentage goal. The results of this study showed that CICO implemented by peers improved classroom behavior for all three participants.