Over the past decade results from a series of research studies have contributed to the development and evaluation of the Arthritis Self-Management Program (ASMP), a volunteer-led patient education program for persons with arthritis. To date, these studies have primarily focussed on program effectiveness, process, implementation, and dissemination. In these studies self-efficacy was identified as an important construct contributing to the program's effectiveness, however, the exact relationship between self-efficacy and health outcomes has not been determined. In this dissertation research I investigate the evidence of a causal relationship between self-efficacy and three program outcomes (a decrease in depression, less pain, and a higher self-rating of overall health status), and attempt to determine the nature of that relationship. The research methodology involved the use of structural equation modeling (SEM) with two longitudinal samples, one (n=122) of 1991 ASMP participants in British Columbia, the other (n=189) of 1992 ASMP participants in Ontario. In the analysis self-efficacy was paired separately with depression, pain and perceived health status. The results of the SEM failed to confirm a dominant causal relationship from self-efficacy to depression, or to pain. This may indicate that these variables have a reciprocal or "spiral" relationship or that both sets of variables may be caused by factors not considered in the analysis. The results of the SEM between self-efficacy and perceived health status did, however, show that higher self-rated health status leads to higher self-efficacy at a later time. The data did not show statistical significance for other causal patterns among these variables. The findings suggest that self-efficacy may play a moderator role in the complex relationship involving individuals with arthritis, their behaviors, and health outcomes. As well, the findings have implications for health promotion planning and research in that they reinforce the complex interplay of psychological and behavioral variables (probably influenced by social variables) in programs which attempt to give individuals greater control over their health. The efficacy and effectiveness of the ASMP has been established in previous studies. This study in no way calls these into question. It does, however, suggest that the mechanism by which these effective outcomes are achieved warrants further investigation. / Graduate and Postdoctoral Studies / Graduate

Submitted in partial fulfilment of the requirements for the degree of Master of Arts (Clinical Psychology) in the Department of Psychology University of Zululand 1992. / Single parenting is becoming much more common today for a variety of reasons. The single parent family is a result of divorce, desertion or separation, death or having a child illegitimately, Some women make this choice for palitico-feminist reasons, wanting parenthood but being unwilling to cohabit with a man. It may well reflect a deep seated need to prove her independence. The present study has been motivated by the fact that becoming a single parent is usually a traumatic process with much heated and confused emotion in relationships over and above the basic problem of just one adult figure having to cope with small children. The aim of the study was to elicit from a group of single mothers their needs, to prioritize these needs, then form an on-going self—help group programme. It was hypothesized that a self-help group programme for single mothers would improve parental attitudes, parenting skills and interpersonal functioning. Parental attitudes, parenting skills and interpersonal functioning were assessed over three assessment periods, i.e. pretest, post test and fallow up. The following psychological measures were used: Maternal chi1d—rearing attitude scale, Parenting skills qualitative and quantitative ratings and Carkhuff scales far levels of interpersonal functioning. The project consisted of meetings with the group of single mothers at weekly intervals over two months. The group meetings were videotaped for evaluation by independent judges, for levels of interpersonal functioning. A short written qualitative evaluation of the programme was required of the mothers. After the programme was instituted there was no significant change in parental attitudes and parenting skills* One can assume that this group of single mothers had an extensive knowledge of child-rearing practices and parenting skills. This might be so because the group was composed of educated and professiona1 mothers. At the same time one cannot cone 1ude that educated and professional mothers have good parental attitudes and parenting skills because there is no available literature or research findings to support that cone 1usion. Interpersonal functioning improved remarkedly in terms of empathy, respect, genuineness and se1f—disc1osure. The single mothers evaluated the programme as goad and helpful to their children. They all wished that the programme could continue. One of the limitations of the study was the fact that the sample was small. But the number met the requirements for a group. Another limitation was that the group only comprised of one category of single mothers, i.e. educated and professional mothers. Perhaps if the group has a mix of categories, i.e. lay mothers and teenage mothers, resu1ts yielded would show a significant change in child—rearing attitudes and parenting skills. Single motherhood is very stressful. Single mothers find it difficult to cope with the role strain, isolation and 1one1iness. Even though some single mothers might be financially adequate they still need emotional support. Interpersonal functioning is improved if people with a similar problem are put in a group. Members recognize that they are not alone in having an emotional problem. The simple sharing of experiences is an important human need.

The present study was designed to test the efficacy of a bibliotherapy-relapse prevention (BT-RP) program for panic attacks in which the active BT-RP condition was compared to a waiting-list control condition. Prior to the administration of the six-month BT-RP program, all participants completed an initial BT intervention (Febbraro, 1997) based on the book Coping with Panic (Clum, 1990). The BT-RP program was designed to: (a) review major components of the initial intervention; (b) increase practice of panic coping skills and therapeutic self-exposure; (c) enhance social support for panic recovery; (d) teach cognitive restructuring skills related to relapse prevention; (e) provide a protocol to follow in the event of a setback; and (f) reduce overall levels of stress. Brief monthly phone contacts were included in the BT-RP condition. Thirty-six participants, 17 in the BT-RP condition and 19 in the WL control condition, completed the study. A 2 (Treatment condition: BT-RP versus WL control) X 2 (Time: Pre-BT-RP assessment versus Post-BT-RP assessment) mixed-model research design was used to analyze the results. Results indicted significant reductions from pre- to post-treatment in the BT-RP condition for panic cognitions, anticipatory anxiety, agoraphobic avoidance, and depression, but not in the WL condition. When statistically controlling for initial levels of these variables via analyses of covariance (ANCOVAs), significant post-treatment differences in the expected direction emerged for these four dependent measure and for state anxiety. In addition, the BT-RP group reported significantly fewer panic attacks during the six-month course of the treatment trial than the WL control group on a measure of retrospective recall of full-blown panic attacks. There was also a statistically significant proportional between-group difference in terms of clinically significant improvement for full-blown panic attacks and agoraphobic avoidance in favor of the BT-RP group. However, no significant between-group differences emerged for the maintenance of initial treatment gains for panic frequency, panic symptoms, panic cognitions, anticipatory anxiety, or agoraphobic avoidance. Results of the present study are discussed in the framework of benefits of the present BT-RP program, limitations of the findings, recommendations for future research in this area, and implications for BT treatments in general. / Ph. D.

The purpose of this study was to examine whether a newly developed Internet-based, eight-week self-change program, Self-Help Intervention Program for the Consequences of Trauma (SHICT), was effective to treat trauma consequences. The SHICT consisted of education, anxiety management skills, cognitive restructuring, and exposure modules that included writing exposure and in vivo exposure. It also provided a mastery approach where individuals begin treatment with the least anxiety-provoking component (i.e., relaxation) and progress to the most fearful component (i.e., exposure). This approach was employed to ensure that trauma victims learn and become skilled users of anxiety-reducing coping techniques and decrease the likelihood of untoward responses to writing exposure. Thirty-three participants were randomly assigned to either a SHICT condition or a wait-list condition and 27 completed participation. Trauma-related symptoms, state anxiety, depression, coping skills, social support, and self-efficacy were assessed at pre and post-treatment. Results indicated that overall the SHICT group reduced symptoms and increased coping skills more significantly than the control group. Particularly, individuals in the SHICT group decreased intensity and frequency of avoidance behavior, frequency of intrusion, state anxiety, and depression more significantly than those in the control group. The SHICT group also increased general coping skills and coping self-efficacy more significantly than the control group. The SHICT produced medium to large effect sizes in many symptom and coping-related measures. The SHICT group demonstrated more clinically significant improvement than the control group in several symptom and coping-related measures. Increased coping self-efficacy and perceived social support levels and decreased wishful thinking coping were significantly correlated with symptom improvement. Both exposure and cognitive skills mastery levels were significantly correlated with decreased intensity and frequency of avoidance behavior. / Ph. D.

Treatment outcome studies investigating potential treatments for panic disorder invariably begin with a lengthy assessment designed to determine whether a potential subject meets criteria for the disorder. Through the process of assessment, subject are usually given some form of feedback about their condition, if only to tell them they meet criteria to enter the study. Assessment and feedback are thought to have therapeutic effects and empirical evidence is beginning to document this (Bien, Miller, & Tonigan, 1993; Finn & Tonsager, 1992). To date, there have been no studies that investigate the effects of assessment plus feedback or assessment alone on individuals with panic attacks. This study investigated whether assessment or assessment plus feedback produced any differential effects on panic attack sufferers. Seventy participants were randomly assigned to one of four groups: 1) assessment with mailed feedback (n=17); 2) assessment with face-to-face feedback (n=14); 3) assessment with no feedback (n=19); and 4) no assessment or feedback (n=20). Assessment consisted of completing a composite self-report instrument that asks about frequency of panic attacks and panic-related symptomatology. Feedback was standardized and computer generated but individualized based on scores on the assessment measure. All groups completed the outcome measures and between group differences were examined. No statistically significant differences were found between these four groups on any dependent measure. However, for a smaller subset of participants (N=35) who had at least one full panic attack at pre-assessment, a significant reduction in frequency of combined (full plus limited-symptom) panic attacks was seen pre to post, F(1,32)=7.47, p<.01, with a marginally significant two-way interaction of Time and Condition, F(2,32)=3.12, p<.06. Basically, both feedback groups showed a reduction in panic attacks while the assessment only condition remained the same. / Master of Science

This thesis is an ethnography of the phenomenon of self-help. It begins by noting a problematic at the centre of the topic: the term self-help connotes, on the one hand, an autonomous agent ("self'), and on the other, a reliance on other agents ("help"). More substantively, the term attaches itself to two opposing ideological positions, individualism and collectivism. This strange splitting of the term is reproduced in a contemporary context, where we see the genre of self-help books, which is built around the highly individualistic activity of reading as a quest for self-help, and self-help groups, which are built around the collective, co-presence of members as they mutually help one another. But the phenomenon is engaged by separate, non-overlapping literatures that treat self-help books as having a status independent of self-help groups; one attends to self-help books, but disregards self-help groups, while the other attends to self-help groups, but disregards self-help books. Thus self-help books and self-help groups get polarized. This effectively makes the original problematic around the term itself disappear, because it' simply ignores it. This research turns this character of self-help into a topic for study. It looks at what holds the term together, that is to say, self-help books and self-help groups, when they appear to be entirely independent phenomena, and yet still share the term self-help. It is interested in the significance of the term, why it gets invoked as a description of particular activities and what that entails as a practical matter. It wants to see how self-help is performed. It identifies a hybrid of self-help books and self-help groups - a self-help workshop. This third site of self-help brings individual readers of self-help books into a context of collective, social activity. It uses this as a strategy with which to examine the relationships between self-help books and self-help groups, self and help. It undertakes a detailed empirical analysis of a corpus of self-help books, a selfhelp workshop and a range of self-help groups, drawing on textual, discursive and ethnographic modes of inquiry. It then uses this empirical work to map self-help and engage it as a wider, cultural phenomenon in the modem period.

This study focused on how assistive technologies (ATs) affect the ability-disability construct of adult-onset locomotor disabled individuals in the South African city of Johannesburg. Its main aim was to understand the socialized use of assistive technologies in adult-onset locomotor disabilities and to unravel how the socialized use of assistive technologies affect the users’ interpretations of the ability-disability construct; through the perceptions of the participants within a developing world context. Relatively, there have been few ATs studies in South Africa and they have excluded the ‘voice ‘of the disabled people. Ten conveniently sampled adult-onset locomotor disabled individuals participated. An interpretive technique in the form of semi structured one hour interviews was used for data collection. The descriptors of events for the thematic analysis were the patterns or themes in which participants were constructing the narratives of their lives. These patterns were formulated using Braun and Clarke (2006) six stages of identifying, analysing and reporting patterns within the data. Transcribed texts from the ten semi-structured interviews were subjected to thematic analysis based on how the participants perceived their assistive technologies. Four central themes emerged which centred on how people perceived their ability-disability; the social acceptability of ATs, accessibility factors and new trends in assistive technologies. The research findings indicate that most adult onset disabled individuals in a South African context tended to embrace the promises of technology centred on positive attributes such as: improved communication with others, increased mobility, physical safety, personal autonomy, control over one's body and life, independence, competence, confidence, the ability to engage in the workforce and participation in the wider community. Although such positive attributes seemed to reinforce perceived ability as the boundary between disabled bodies, technology was blurred. However, this perceived ability was found to be rather misleading since it was premised in the same medical and social discourse that ‘disabled’ individuals. T he participants’ narratives were constantly constructing and reconstructing the way they perceived themselves as able or disabled. The studies therefore recommend that, disability narratives on the perception of ATs should be viewed as fluid, complex and multi-layered.

No description available.

Thesis (Ph. D.)--Carleton University, 2002. / Includes bibliographical references (p. 176-194). Also available in electronic format on the Internet.

Thesis (M. A.)--Trinity Evangelical Divinity School, 1996. / Abstract. Includes bibliographical references (leaves 200-229).