This thesis focusses on the role of attentional bias for health-threat information in the production and maintenance of medically unexplained symptoms, somatoform disorders and high levels of physical symptom reporting. It is comprised of three separate papers. Paper 1 was prepared for Clinical Psychology Review as a systematic review of the evidence concerning attentional bias for health–threat information in populations presenting with somatoform/somatic symptom disorders and high levels of physical symptom reporting. From the 20 studies deemed relevant for review, it was concluded that - although limited - the evidence indicated that a relationship existed between attentional bias for health-threat information and levels of physical symptom reporting. No robust evidence was found to establish whether this relationship was a casual one. Paper 2 was prepared for Journal of Abnormal Psychology and investigated whether an exogenous cueing task could be used to reduce presumed attentional bias for health-threat information in a sample of high symptom reporting students. The results showed an unexpected attentional avoidance of health-threat information at baseline, which the study manipulation unintentionally exacerbated. No change in levels of physical symptom reporting was noted between groups (attributed to a methodological error) but a trend in relatively greater anxiety for those who received the manipulation was noted. It was concluded that avoidance may be a key factor in high symptom reporting and that this merited further research. Paper 3 provided a critical reflection of Papers 1 and 2, as well as the research process as a whole. Implications for theory and clinical practice as well as future research directions were discussed.

The thesis deals with attributional styles and their research in patients with psychosomatic disorder. The text is divided into a theoretical part and an empirical part. The term psychosomatic disorder is defined in the theoretical part. The essential links between psychosomatic disorder, stress and cognitive processes are mentioned. Selected attribution theory and the concepts of attributional styles, then make up the majority theory. In the empirical part, there are hypotheses defined using three psychodiagnostic methods tested on a set of people with psychosomatic disorder and compared with the healthy population. Key words: attribution attribution theory attributional style psychosomatic disorder/psychosomatic illness somatoform disorders

Bakgrund: Som vårdgivare möter vi ofta patienter med psykosomatiska symtom och sjukdomar, patienter med fysiska symtom som saknar tydlig organisk förklaring. Inom primärvården har cirka 30% av patienterna medicinskt oförklarliga symtom. Tidigare forskning har visat att vårdgivare känner sig osäkra och otillräckliga när de handlägger patienter med psykosomatiska symtom. Det tycks vara svårt att veta hur man ska bemöta denna patientgrupp och hjälpa dem att uppnå god hälsa. Syfte: Syftet med litteraturstudien var att beskriva hur vuxna patienter med psykosomatiska symtom upplevde mötet med och bemötandet av sin vårdgivare samt beskriva de inkluderade artiklarnas datainsamlingsmetod. Metod: En beskrivande litteraturstudie baserades på tio vetenskapliga artiklar. Artiklarna söktes fram i databaserna PubMed och Cinahl. Ansatsen på de inkluderade artiklarna var både kvalitativ och kvantitativ. Artiklarna har noggrant granskats i syfte att finna skillnader och likheter. Resultat: Patienter som fick känslomässigt stöd, förklaringar, togs på allvar och var delaktiga i beslut var de som kände mest välbefinnande och tillfredsställelse med vårdgivaren och det bemötande de fick. De patienter som möttes av oengagerade vårdgivare, blev ifrågasatta och upplevde ett motstånd, kände att de var en börda för sjukvården. De inkluderade artiklarnas datainsamlingsmetoder var intervjuer och enkäter. Slutsats: Resultatet visade att många patienter med psykosomatiska symtom sökte bekräftelse. Kommunikation var viktigt för att dessa patienter skulle känna trygghet och förtroende. Genom vidare forskning och viss förändring i omhändertagandet av dessa patienter, skulle sjuksköterskan kunna bidra med denna trygghet i större utsträckning. / Background: As healthcare providers we often meet patients with psychosomatic symptoms and diseases, patients with physical symptoms who lack clear organic explanation. In primary care, approximately 30% of patients have medically unexplained symptoms. Previous research has shown that healthcare providers feel insecure and insufficient when handling patients with psychosomatic symptoms. It seems difficult to know how to respond to this patient group and help them achieve good health. Aim: The aim of the literature study was to describe how adult patients with psychosomatic symptoms experienced the encounter with and the treatment of their healthcare providers, and to describe the data collection methods of the included articles. Method: A descriptive literature study based on ten scientific articles. The articles were searched in the PubMed and Cinahl databases. The included articles were designed both qualitative and quantitative. The articles have been carefully reviewed in order to find differences and similarities. Result: Patients who received emotional support, explanations, were taken seriously and participated in decisions were those who felt most well-being and satisfaction with the care and the response they received. Patients who were met by uncommitted healthcare providers, and were questioned and experienced a resistance from their providers, were those who felt that they were a burden on healthcare. Data collection methods in the included articles were interviews and questionnaires. Conclusion: The result showed that many patients with psychosomatic symptoms sought confirmation. Communication was important for these patients to feel safe and confident. Through further research and some change in the treatment of these patients, the nurse could contribute to this safety to a greater extent.

Made available in DSpace on 2016-04-04T18:29:46Z (GMT). No. of bitstreams: 1 Katia Perez Ramos.pdf: 753647 bytes, checksum: 25ab7599315fa364dd0b189fee2b2a8a (MD5) Previous issue date: 2009-05-12 / Universidade Estadual Paulista J?lio de Mesquita Filho / The study analyzed the psychometric properties of the Scale of Assessment of Body Dymorphic Disorder - SA-BDD. Were estimated the content validity, construct validity, validity of criterion and internal consistency of the instrument. The sample was integrated by three groups: G1: 30 patients diagnosed with BDD (F = 70% and M = 30%), G2: 400 college students (F = 74.5% and M = 25.5%) and G3: 10 professionals of Psychology (N = 4), Psychiatry (N = 2), Dentistry (N = 2) and Plastic Surgery (N = 2) with clinical experience between 8 and 31 years. The SA-BDD is a 35- item instrument answered by a 4-point Likert scale ranging from 1 (fully disagree) to 4 (totally agree). Originally, items were developed to evaluate three dimensions, described in the literature as typical of the BDD: 1. Concern with a defect in appearance, 2. Suffering and loss of social and/or occupational functioning, and other, 3. Concern is not better explained by other disorders such as anorexia. Items of the first version of the scale were reformulated and divided into groups of items with 4 statements regarding each level of intensity. Five (5) more items of groups were also developed to increase the number of items for differential diagnosis (dimension 3). A theoretical analysis of the 40 groups of items, carried out by independent judges, gave measure of the content validity of the scale. Judges have not agreed on five items. The scale was then applied to G1 and G2. The factor analysis with Varimax rotation pointed to a one-dimension solution, consisting of 28 items, loading above 0.53, bringing together two of the theoretical dimensions: "Concern with a defect in appearance and suffering and loss of social and or occupational functioning, and others." The validity of criterion, carried out by the Mann- Whitney U test showed that 30 of the 35 items are sensitive to discriminate individuals diagnosed with BDD from individuals without this diagnosis. The scale showed an excellent internal consistency with Cronbach's alpha equal to 0.97. It was concluded that 28 items should be retained for a new version of the instrument (SA-BDD-28), which showed good content validity, construct validity, validity of criterion and reliability. Considerations regarding the one-dimensional solution and suggestions for further study are made. / O estudo analisou as propriedades psicom?tricas da Escala de Avalia??o do Transtorno Dism?rfico Corporal EA-TDC. Foram estimadas a validade de conte?do, validade de construto, a validade de crit?rio e a consist?ncia interna do instrumento. Contou-se com tr?s amostras de participantes: G1: 30 pacientes diagnosticados com TDC de ambos os sexos (F=70% e M=30%); G2: 400 estudantes universit?rios de ambos os sexos (F=74,5% e M=25,5%); e G3: 10 profissionais das ?reas de Psicologia (N=4), Psiquiatria (N=2), Odontologia (N=2) e Cirurgia Pl?stica (N=2), com experi?ncia cl?nica entre 8 e 31 anos. A EA-TDC ? um instrumento composto de 35 itens que devem ser respondidos por meio de uma escala Likert de 4 pontos, que variam entre 1 (discordo plenamente) e 4 (concordo plenamente). Originalmente, foram desenvolvidos itens para avaliar tr?s dimens?es, descritas na literatura como t?picas do TDC: 1. Preocupa??o com um defeito na apar?ncia; 2. Sofrimento e preju?zo no funcionamento social, ocupacional e outros; 3. Preocupa??o n?o ? melhor explicada por outros transtornos, como a anorexia. Os itens desta vers?o da Escala foram reformulados em itens com 4 alternativas de resposta cada referente ao grau de intensidade. Foram criados tamb?m mais 5 itens para ampliar o n?mero de itens referentes ao diagn?stico diferencial (dimens?o 3). Em rela??o ? validade de conte?do verificou-se a pertin?ncia dos 40 itens ao construto, por meio da an?lise te?rica de ju?zes. Cinco itens n?o obtiveram concord?ncia de no m?nimo 80% entre os ju?zes e foram eliminados. A escala foi ent?o aplicada no G1 e no G2. A an?lise fatorial com rota??o varimax apontou para uma solu??o unidimensional, composta de 28 itens com cargas superiores 0,53, que se agruparam em um ?nico fator (F1). Este reuniu duas das dimens?es te?ricas em uma ?nica: Preocupa??o com um defeito na apar?ncia e Sofrimento e preju?zo no funcionamento social, ocupacional e outros . A validade de crit?rio, por meio da prova U de Mann-Whitney, mostrou que 30 dos 35 itens da escala s?o sens?veis para discriminar os indiv?duos diagnosticados com TDC dos indiv?duos sem o diagn?stico do transtorno. Dentre eles encontravam-se os 28 j? apontados pela an?ise fatorial. Submetidos a an?lise de consist?ncia interna, os 28 itens resultaram em alpha de Cronbach igual a 0,97. Concluiu-se que estes 28 itens deveriam ser retidos para a constitui??o de uma nova vers?o do instrumento (EA-TDC- 28), por deterem validade de conte?do, validade de construto, validade de crit?rio e precis?o. Considera??es em rela??o ? unidimensionalidade e sugest?es de continua??o dos estudos referentes a EA-TDC-28 s?o realizadas.

Bakgrund: Som vårdgivare möter vi ofta patienter med psykosomatiska symtom och sjukdomar, patienter med fysiska symtom som saknar tydlig organisk förklaring. Inom primärvården har cirka 30% av patienterna medicinskt oförklarliga symtom. Tidigare forskning har visat att vårdgivare känner sig osäkra och otillräckliga när de handlägger patienter med psykosomatiska symtom. Det tycks vara svårt att veta hur man ska bemöta denna patientgrupp och hjälpa dem att uppnå god hälsa. Syfte: Syftet med litteraturstudien var att beskriva hur vuxna patienter med psykosomatiska symtom upplevde mötet med och bemötandet av sin vårdgivare samt beskriva de inkluderade artiklarnas datainsamlingsmetod. Metod: En beskrivande litteraturstudie baserades på tio vetenskapliga artiklar. Artiklarna söktes fram i databaserna PubMed och Cinahl. Ansatsen på de inkluderade artiklarna var både kvalitativ och kvantitativ. Artiklarna har noggrant granskats i syfte att finna skillnader och likheter. Resultat: Patienter som fick känslomässigt stöd, förklaringar, togs på allvar och var delaktiga i beslut var de som kände mest välbefinnande och tillfredsställelse med vårdgivaren och det bemötande de fick. De patienter som möttes av oengagerade vårdgivare, blev ifrågasatta och upplevde ett motstånd, kände att de var en börda för sjukvården. De inkluderade artiklarnas datainsamlingsmetoder var intervjuer och enkäter. Slutsats: Resultatet visade att många patienter med psykosomatiska symtom sökte bekräftelse. Kommunikation var viktigt för att dessa patienter skulle känna trygghet och förtroende. Genom vidare forskning och viss förändring i omhändertagandet av dessa patienter, skulle sjuksköterskan kunna bidra med denna trygghet i större utsträckning. / Background: As healthcare providers we often meet patients with psychosomatic symptoms and diseases, patients with physical symptoms who lack clear organic explanation. In primary care, approximately 30% of patients have medically unexplained symptoms. Previous research has shown that healthcare providers feel insecure and insufficient when handling patients with psychosomatic symptoms. It seems difficult to know how to respond to this patient group and help them achieve good health. Aim: The aim of the literature study was to describe how adult patients with psychosomatic symptoms experienced the encounter with and the treatment of their healthcare providers, and to describe the data collection methods of the included articles. Method: A descriptive literature study based on ten scientific articles. The articles were searched in the PubMed and Cinahl databases. The included articles were designed both qualitative and quantitative. The articles have been carefully reviewed in order to find differences and similarities. Result: Patients who received emotional support, explanations, were taken seriously and participated in decisions were those who felt most well-being and satisfaction with the care and the response they received. Patients who were met by uncommitted healthcare providers, and were questioned and experienced a resistance from their providers, were those who felt that they were a burden on healthcare. Data collection methods in the included articles were interviews and questionnaires. Conclusion: The result showed that many patients with psychosomatic symptoms sought confirmation. Communication was important for these patients to feel safe and confident. Through further research and some change in the treatment of these patients, the nurse could contribute to this safety to a greater extent.

No description available.