This work looks at the 2009 Iranian show-trials through modern discourses of biopolitics, sovereignty, and history. I argue that, understood as a theatrical phenomenon, the show trials are situated within the Foucauldian mode of biopower. The latter entails a shift from a politics of death to the preservation of the bios. The show-trials also perform a particularly modern narrative of state sovereignty and teleological history. To consider them in this way requires a rethinking of Michel Foucault’s theory so as to include juridico-philosophical discourse within a biopolitical framework. I propose that, as a performative act, the confessions transform the very thing they are confessing. Through the work of Jean Baudrillard and Jacque Derrida, I argue that the confessions make possible a reconceptualization of the political space of sovereignty as simulacrum and that of the political time of history as hauntology. / Graduate

Unique characteristics of cluster randomized trials (CRTs) complicate the interpretation of standard research ethics guidelines. Variable interpretation by research ethics committees may further complicate review and conduct. An international web-based survey was administered to corresponding authors of 300 randomly sampled CRT publications. We investigated ethics review and consent practices, investigator experiences with ethics review, and the perceived need for CRT-specific ethics guidelines. The response rate was 64%. Ethics review and consent were under-reported in publications. Ethics approval was obtained in 91%, and consent from individual and cluster level participants in 79% and 82% of trials. Consent varied by level of experimental intervention, data collection, and cluster size. Respondents cited variability among ethics committees (46%), and negative impacts of ethics review on their studies (38%). The majority perceived a need for ethics guidelines (73%), and guidance for ethics committees (70%). CRT-specific ethics guidelines are required to ensure practices meet ethical standards.

The Resident-Medical Student Shadowing Program is a novel program in which first-year medical students shadowed a first-year resident during their clinical duties. It was developed to enhance the preparedness of medical students for clinical training. To examine the program’s effectiveness, a randomized control trial was conducted within a concurrent triangulation mixed methods study. Student participants were compared to controls using validated questionnaires. Participants’ experiences were further explored using semi-structured interviews. Results indicate that participation gave students an understanding of the clinical environment and their role within it, and taught them the skills and knowledge needed to perform that role. Students’ learning was enhanced by the relationship developed with their resident, facilitated by the residents’ approachability and relatability and their dedication to teaching. Residents, in turn, gained expertise in teaching and learned about professionalism. Suggestions for implementing this program in the future as well as future directions for research are discussed. / Measurement, Evaluation and Cognition

A prospective study was performed to evaluate a biological medication in the treatment of digital dermatitis (DD) in dairy cattle. The study was divided into four parts; i) on farm evaluation of DD and treatment effects and comparison between the biological ointment and OTC-spray, ii) statistical evaluation, iii) histological examination using FISH and iv) microbiological examination and culture if bacteria found in biopsies from infected skin.

Objectives. Ascertain if there has been a secular trend in 3-months prevalence of casually reported back pain. Evaluate if such back pain predicts concurrent health as well as future sick leave, disability pension, hospitalization and survival. Study differences in diagnostic assessment and labelling between physicians. Evaluate if a comprehensive manual therapy programme reduces sickness absence. Materials and methods. Combined population samples from 1973 to 2003 with a total of 12,891 observations with self-reported back pain and covariates. 7,074 of these individuals were followed for an average of 8.5 years and outcomes were self-reported health as well as official register data on sick leave, disability pension, hospitalisation and mortality. The Gotland Low Back Pain Study, a randomised controlled trial with participation of two general practitioners and two orthopaedic surgeons treating 160 patients with acute/subacute low back pain, with 10 weeks diagnostic evaluation and treatment and a two-year follow up. Results. Back pain prevalence increased 16% per ten years (OR 1.16, 95%CI 1.11-1.22). Back pain was negatively associated with self-rated health (p<0.0001), increased the risk of disability pension (p<0.002), and hospital admissions (p<0.0005), but not number of days in hospital, sick leave or mortality. General practitioners used terms from manual medicine and reported more pseudoradicular pain, while orthopaedic surgeons used non-specific pain labels, reported more true radicular pain and used more x-ray examinations. Among those on sick leave at baseline, manual therapy patients showed faster return to work (HR 1.62, 95%CI 1.006–2.60) and a lower point-prevalence of sick leave than reference patients at end of treatment period (ratio 0.35, 95% CI 0.13–0.97) but not after two years. Conclusions. There was a strong secular trend towards increase in self-reported back pain from 1973 to 2003. Such pain had a negative effect on some of the health outcomes and does not appear to be harmless. Physicians from different specialities labelled the condition differently. The manual therapy programme proved to be more effective than the established treatment regarding return to work.

The aims of this thesis were to investigate the utility of in vitro drug sensitivity testing to optimize the use of cancer chemotherapy and to assess the properties of a new cancer drug in a phase I clinical trial. Tumour cells from patients were analysed with the short-term Fluorometric Microculture Cytotoxicity Assay (FMCA). In samples from a wide spectrum of tumour types, the effect of the drug combination FEC (5Fu-epirubicin-cyclophosphamide) was generally appropriately predicted from the effect of the best component drug. However, of samples intermediately sensitive to the best single drug, 45% converted to sensitive when testing the combination. Thus, combination testing may identify advantageous interactions and improve in vitro test performance. In tumour samples from peritoneal carcinomatosis, significant differences in drug sensitivity between diagnoses were observed, cross-resistance between most drugs was modest or absent, and the concentration-effect relationships for two drugs in individual samples varied considerably. Thus, for optimal selection of drugs for intraperitoneal chemotherapy, differences in drug sensitivity at the diagnosis and individual patient level should be considered. In samples from patients with ovarian carcinoma, drug sensitivity was related to tumour grade, histologic subtype and patient treatment status. In a homogeneous subset of patients, the FMCA predicted individual patient tumour response with high sensitivity and specificity. Thus, if carefully interpreted in the context of important clinical variables, in vitro testing could be of value for individualizing chemotherapy in ovarian cancer. Employing a once weekly dosing schedule in a phase I trial, the mechanistically new and preclinically promising NAD depleting drug CHS 828 produced dose limiting thrombocytopenia and gastrointestinal toxicity without clear evidence of anti-tumour efficacy. It is concluded that in vitro drug sensitivity testing could be a way to optimize the use of chemotherapy and that successful development of new cancer drugs needs improved strategies.

This thesis uses the International Classification of Functioning, Disability and Health (ICF) model (World Health Organisation, 2001) to explore the multidimensional presentation of strengths and problems in young people with cystic fibrosis (CF), firstly examining its theoretical “fit” to the health condition, and secondly using it to characterise the performance of those with CF. Few studies in the literature demonstrate such an holistic approach to the physiotherapy assessment and management of this population. It was expected that this description of performance would provide a framework for identifying key areas for physiotherapy exercise intervention. This then formed the basis for further studies to examine the effect of a targeted exercise program (compared to current exercise practice) on inpatient outcomes, as well as on outcomes of outpatient management. The position paper included provides theoretical support for the ICF model as an appropriate tool in the management of young people with CF. Building on this, Study 1 explored the practical utility of the ICF model for describing the presentation of young inpatients and outpatients with CF. Eighty-four participants with CF were recruited as a consecutive series who satisfied selection criteria to provide a cross-sectional view at younger (7-12 years, n=51) and older (13-17 years, n=33) ages. Musculoskeletal, respiratory and physiological measures represented the body structures and functions domain, the six-minute walk test and jump tests were included in the activities domain, and participation was described by the Cystic Fibrosis Questionnaire–Revised Version and Fels Physical Activity Questionnaire. Contextual factors were also considered (age, gender, inpatient/outpatient status). In this exploratory study, performance of this population was compared to normative data where available. Also, correlations between measures within and between ICF domains were examined as suggested by the model itself. Finally, effects of contextual factors on performance were investigated using univariate analysis of variance. This first study and the position paper support the ICF model as an effective tool for describing performance of young people with CF, and for investigating functional relationships within and between domains. Results showed significant differences in this population compared to normative data, and interrelationships were identified within and between ICF domains. Between inpatients and outpatients in the specified age groups, there was a statistically significant difference in means for a number of measures, whereby inpatients displayed consistently poorer mean scores than outpatients, with this effect significantly stronger in the older age group. The application of the ICF model was useful for highlighting areas to target in physiotherapy exercise intervention, and for substantiating selected measures to assess the program’s effectiveness across domains. Study 2 was a randomised controlled trial with blinded assessor, which investigated the effectiveness of a 10-14 day inpatient-based exercise program (the Cystic Fibrosis: Fitness Challenge) (CF:FC) tailored for young people with CF (7-17 years). The CF:FC program (n=15) included exercise strategies based on recommendations from previous work in the field, and from findings from Study 1. This program included a portable exercise package (FitKitTM) designed to be adaptable to limited space environments such as at the hospital bedside, important when inpatients with CF are isolated according to infection control procedures. Participants in the control program (n=16) received the current exercise practice provided for young people with CF at a tertiary hospital, which included mainly aerobic-type activities to affect airway clearance. Performance on study measures (scoped within the framework of the ICF model, presented in Study 1) were compared pre- and post-intervention (admission and completion of the inpatient exercise program) between the groups. This trial showed significant improvements for participants in both groups from admission to discharge for a range of measures, including respiratory function, muscle strength and quality of life measures. Participants in the intervention group showed significantly greater improvements for some measures, for example: ankle dorsiflexor strength, six-minute walk distance and perception of their respiratory status. The continuation of the intervention and control programs into the outpatient setting was the focus of Study 3. The FitKitTM was provided for the intervention group, incorporating strategies to enhance adherence including a physical activity log (PAL) and internet-based follow-up. The control home exercise program consisted of the current practice provided on discharge. Interestingly, the control group improved significantly in hip abductor strength and six-minute walk distance during the outpatient period, whereas the intervention group sustained the improvements gained in the inpatient period but generally showed no further significant improvement. When the change from inpatient admission to outpatient follow-up was considered, it was apparent that greater improvements during the inpatient period provided a ‘buffer’ to accommodate for possible deteriorations in function in the outpatient phase. Issues regarding adherence to exercise programs during the outpatient period are discussed. This thesis confirms the usefulness of the ICF model for describing young people with CF, guiding assessment and review processes to achieve comprehensive management, and strengthening the evidence-base for targeted physiotherapy exercise intervention. A novel, tailored exercise program is introduced which is effective during inpatient periods, and provides a maintenance effect during outpatient periods, but strategies to enhance adherence during outpatient periods require further investigation.

This thesis uses the International Classification of Functioning, Disability and Health (ICF) model (World Health Organisation, 2001) to explore the multidimensional presentation of strengths and problems in young people with cystic fibrosis (CF), firstly examining its theoretical “fit” to the health condition, and secondly using it to characterise the performance of those with CF. Few studies in the literature demonstrate such an holistic approach to the physiotherapy assessment and management of this population. It was expected that this description of performance would provide a framework for identifying key areas for physiotherapy exercise intervention. This then formed the basis for further studies to examine the effect of a targeted exercise program (compared to current exercise practice) on inpatient outcomes, as well as on outcomes of outpatient management. The position paper included provides theoretical support for the ICF model as an appropriate tool in the management of young people with CF. Building on this, Study 1 explored the practical utility of the ICF model for describing the presentation of young inpatients and outpatients with CF. Eighty-four participants with CF were recruited as a consecutive series who satisfied selection criteria to provide a cross-sectional view at younger (7-12 years, n=51) and older (13-17 years, n=33) ages. Musculoskeletal, respiratory and physiological measures represented the body structures and functions domain, the six-minute walk test and jump tests were included in the activities domain, and participation was described by the Cystic Fibrosis Questionnaire–Revised Version and Fels Physical Activity Questionnaire. Contextual factors were also considered (age, gender, inpatient/outpatient status). In this exploratory study, performance of this population was compared to normative data where available. Also, correlations between measures within and between ICF domains were examined as suggested by the model itself. Finally, effects of contextual factors on performance were investigated using univariate analysis of variance. This first study and the position paper support the ICF model as an effective tool for describing performance of young people with CF, and for investigating functional relationships within and between domains. Results showed significant differences in this population compared to normative data, and interrelationships were identified within and between ICF domains. Between inpatients and outpatients in the specified age groups, there was a statistically significant difference in means for a number of measures, whereby inpatients displayed consistently poorer mean scores than outpatients, with this effect significantly stronger in the older age group. The application of the ICF model was useful for highlighting areas to target in physiotherapy exercise intervention, and for substantiating selected measures to assess the program’s effectiveness across domains. Study 2 was a randomised controlled trial with blinded assessor, which investigated the effectiveness of a 10-14 day inpatient-based exercise program (the Cystic Fibrosis: Fitness Challenge) (CF:FC) tailored for young people with CF (7-17 years). The CF:FC program (n=15) included exercise strategies based on recommendations from previous work in the field, and from findings from Study 1. This program included a portable exercise package (FitKitTM) designed to be adaptable to limited space environments such as at the hospital bedside, important when inpatients with CF are isolated according to infection control procedures. Participants in the control program (n=16) received the current exercise practice provided for young people with CF at a tertiary hospital, which included mainly aerobic-type activities to affect airway clearance. Performance on study measures (scoped within the framework of the ICF model, presented in Study 1) were compared pre- and post-intervention (admission and completion of the inpatient exercise program) between the groups. This trial showed significant improvements for participants in both groups from admission to discharge for a range of measures, including respiratory function, muscle strength and quality of life measures. Participants in the intervention group showed significantly greater improvements for some measures, for example: ankle dorsiflexor strength, six-minute walk distance and perception of their respiratory status. The continuation of the intervention and control programs into the outpatient setting was the focus of Study 3. The FitKitTM was provided for the intervention group, incorporating strategies to enhance adherence including a physical activity log (PAL) and internet-based follow-up. The control home exercise program consisted of the current practice provided on discharge. Interestingly, the control group improved significantly in hip abductor strength and six-minute walk distance during the outpatient period, whereas the intervention group sustained the improvements gained in the inpatient period but generally showed no further significant improvement. When the change from inpatient admission to outpatient follow-up was considered, it was apparent that greater improvements during the inpatient period provided a ‘buffer’ to accommodate for possible deteriorations in function in the outpatient phase. Issues regarding adherence to exercise programs during the outpatient period are discussed. This thesis confirms the usefulness of the ICF model for describing young people with CF, guiding assessment and review processes to achieve comprehensive management, and strengthening the evidence-base for targeted physiotherapy exercise intervention. A novel, tailored exercise program is introduced which is effective during inpatient periods, and provides a maintenance effect during outpatient periods, but strategies to enhance adherence during outpatient periods require further investigation.

Abstract Background Congenital hemiplegia is the most common form of cerebral palsy accounting for 1 in 1300 live births. Children usually present with greater upper limb than lower limb involvement. Impaired unimanual capacity of the involved upper limb and deficits in bimanual performance contribute to difficulties with day to day activities and participation in home, school and community life. Interventions to address these deficits in upper limb unimanual capacity and bimanual performance have recently shifted focus to address limitations in activity performance rather than underlying impairments. One intensive intervention approach is constraint induced movement therapy, which entails placing a constraint on the unimpaired upper limb to focus intense and repetitive training of the impaired upper limb. To date, it is unclear whether constraint induced movement therapy is superior to a more traditional bimanual therapy to improve activity performance and participation outcomes for children with congenital hemiplegia, as there has been no direct comparison of the two approaches. Aim The primary aim of this research was to determine whether constraint induced movement therapy was more effective than bimanual training to improve activity performance and participation for children with congenital hemiplegia. The specific aims were to: i) determine the efficacy of therapeutic upper limb interventions on activity and participation outcomes for children with congenital hemiplegia, ii) systematically review the clinimetric properties (psychometric properties and clinical utility) of participation assessment tools for children with congenital hemiplegia, iii) examine the relationship between impairments, unimanual capacity and bimanual performance in children with congenital hemiplegia and, iv) determine whether constraint induced movement therapy is more effective than bimanual training to improve activity and participation outcomes for children with congenital hemiplegia. Research Design A matched pairs randomised design was chosen with children matched for age, gender, side of hemiplegia and upper limb function. Children were randomised within pairs to receive either constraint induced movement therapy or bimanual training in equal dosages. Both interventions used a day camp model, with groups receiving the same dosage and content of intervention delivered in the same environment. A novel circus theme was used in the camps to enhance children’s engagement and motivation. Children in the constraint induced movement therapy group wore a tailor made glove on their unimpaired hand during the intervention camp. Outcomes were measured across all domains of the International Classification of Functioning, Disability and Health at baseline, 3 and 26 weeks post intervention. The primary outcome measure for unimanual capacity of the impaired upper limb was the Melbourne Assessment of Unilateral Upper Limb Function, and bimanual performance was the Assisting Hand Assessment. A secondary outcome measure for unimanual capacity was the Jebsen Taylor Test of Hand Function. The Canadian Occupational Performance Measure was used as the primary outcome for participation and three measures, the Assessment of Life Habits, Children’s Assessment of Participation and Enjoyment and the School Function Assessment were included to explore their research utility and responsiveness to change. Results Two systematic reviews were performed prior to the commencement of the randomised trial. The first systematic review and meta-analysis of all upper limb interventions for children with congenital hemiplegia identified four treatment approaches with varying evidence to support their efficacy. Interventions included the use of intramuscular Botulinum toxin A injections to the upper limb augmenting upper limb training, neurodevelopmental treatment, constraint induced movement therapy and hand arm intensive bimanual training. Data were pooled for upper limb, self care and individualised outcomes. Results indicated a small to medium treatment effect favouring all four interventions on upper limb outcomes. Large treatment effects favoured intramuscular Botulinum toxin A injections combined with upper limb training for individualised outcomes. Overall, the systematic review and meta-analysis found no upper limb training approach to be superior although Botulinum toxin A injections appeared to provide a consistent supplementary benefit to a variety of upper limb training approaches. However it was unclear which type of upper limb training was optimal. Findings suggested that the two intensive intervention approaches that are the focus of this randomised controlled trial, constraint induced movement therapy and bimanual intensive training, required further research to support their efficacy. The second systematic review was performed to inform choice of participation measures for the randomised comparison trial. The review identified five specific measures of participation suitable for school aged children with congenital hemiplegia (Assessment of Life Habits, Children’s Assessment of Participation and Enjoyment, School Function Assessment (participation domain), Children Helping Out: Responsibilities and Expectations, School Outcome Measure) and two measures of individualised outcomes that could include specific participation goals (Goal Attainment Scaling and Canadian Occupational Performance Measure). Results suggested that no one measure adequately captured all aspects of participation as outlined in the International Classification of Functioning, Disability and Health, and a combination of assessments would be required to broadly assess children’s participation in home, school and community life. The Canadian Occupational Performance Measure was selected as the primary outcome measure in the randomised trial as it had strong evidence for validity and reliability, had been used in paediatric clinical trials and was responsive to change. Three measures of participation, the Assessment of Life Habits which was completed by the parent/caregiver, the Children’s Assessment of Participation and Enjoyment which was completed by the child, and the School Function Assessment, which was completed by the child’s teacher, were selected to explore the research utility of the measures and their responsiveness to change. Analysis of cross-sectional data collected during screening and baseline assessments for the randomised trial found a strong relationship between bimanual performance and unimanual capacity. Scores on the Melbourne Assessment of Unilateral Upper Limb Function and stereognosis accounted for a significant amount of variance in scores on the Assisting Hand Assessment. There were only moderate associations between impairments (eg. sensory deficits and reduced grip strength) and bimanual performance and unimanual capacity. Age, gender, grip strength and two-point discrimination did not significantly influence bimanual performance. Results of the randomised controlled trial found no differences between groups on any baseline measure. A significant difference between groups favouring the constraint induced movement therapy group was found at 26 weeks on the Melbourne Assessment of Unilateral Upper Limb Function. There were no differences between groups on any other measure at either immediately post intervention at 3 weeks or in the medium term at 26 weeks. The constraint induced movement therapy group made significant gains in unimanual capacity (Melbourne Assessment of Unilateral Upper Limb Function and Jebsen Taylor Test of Hand Function) from baseline to 3 and 26 weeks. The bimanual group demonstrated significant improvement in movement efficiency (Jebsen Taylor Test of Hand Function) by 26 weeks. Significant gains in bimanual performance (Assisting Hand Assessment) were evidenced for both groups from baseline to 3 weeks. These gains were maintained at 26 weeks by the bimanual group only. There were no differences between groups on any participation measures. Both constraint induced movement therapy and bimanual training groups made statistically and clinically significant changes in perceived performance and satisfaction of identified functional goals from baseline to 3 and 26 weeks. Significant gains were made by both groups in personal care on the Assessment of Life Habits from baseline to 26 weeks. There were no changes for either group on the School Function Assessment and Children’s Assessment of Participation and Enjoyment. Conclusions This study found minimal differences between the two training approaches. Outcomes achieved by children reflected the mode of upper limb training, that is, improved and sustained gains in unimanual capacity were achieved with a unimanual approach (constraint induced movement therapy), and significant change in bimanual performance was achieved following bimanual training. The constraint induced movement therapy group made initial improvements in bimanual performance that were not sustained at 26 weeks, suggesting that intensive unimanual training may need to be followed by bimanual training in order to retain effects. Both interventions resulted in significant improvements in the achievement of individualised outcomes. Small gains in participation appeared to correspond with specific goal areas identified by children and their caregivers and highlighted the importance of goal directed training and measuring individualised outcomes. Regardless of the type of approach, intervention needs to be goal-directed, focusing on areas of central importance for children and their families.

Stress management interventions (SMIs) are increasingly used by organisations across both private and public settings. Such interventions are employed with the expectation that they will be effective in reducing levels of stress in participants and in turn, will provide a return to the organisation by way of increased productivity through performance improvements of those employees whose stress has been reduced. Despite the increasing popularity of SMIs, there exists a lack of evidence on whether they have any effect on the performance of users, and on the relative effectiveness of the components that often make up SMIs. Although the literature addressing SMIs and their effects is increasing, relatively few studies directly compare different techniques, and even fewer employ randomised controlled designs or follow-up measures. The assumed relationship between the reduction of stress and improvement of managerial performance does not appear to have been tested with a randomised controlled trial. The term “stress” as used in this study specifically denotes the concept of “distress” as defined by Selye (1956; 1987). To support this use of the term, the evolution of current terminology in the field of occupational stress is briefly discussed with specific reference to the development and influence in the wider literature of the Yerkes Dodson Law (Yerkes, 1909). The aims of this thesis were to (1) compare the relative effectiveness of two component techniques often used in SMIs (somatic and cognitive techniques) in the reduction of stress, and (2) to examine the effect of the use of these techniques on the performance of managers in their workplace. Study One was a randomised controlled trial assessing the effect of the use of somatic and cognitive stress management interventions on stress and performance in managers. Participants were 112 corporate managers who were randomly assigned to one of two intervention groups (somatic or cognitive technique training) or to a wait list control group. The intervention groups were trained in their respective techniques over a 4 week period in brief (20-30 minute) face-to-face workshop sessions. Participants were provided with recordings of the techniques to assist practice between training sessions. At baseline, stress was assessed using the Occupational Stress Inventory – Revised Edition (OSI-R, Osipow, 1998), and managerial performance was assessed with the Personal Qualities Competency from the Inventory of Management Competencies (IMC, Saville Holdsworth Ltd., 1993). In the case of the IMC, self, colleague, and subordinate assessments were used. On completion of the 4 week intervention, the OSI-R was readministered, and then at week 12 and week 24, follow-up assessments of stress and managerial performance took place. At the week 12 follow-up, MANOVA for the OSI-R showed no significant difference between the somatic and cognitive interventions in their effect on stress, although both interventions did reduce stress relative to the wait list control group, as measured by the OSI-R. A significant intervention effect was also shown (ηp2 = 0.089, p = 0.002) for the combined intervention groups (cognitive and somatic). MANOVA for the Personal Qualities Competency showed a significant intervention effect for the self (ηp2 = 0.077, p = 0.008) and colleague (ηp2 = 0.064, p = 0.013) assessments, and a no significant effect (ηp2 = 0.032, p = 0.063) for the subordinate assessment at the week 12 follow-up point. Unfortunately, withdrawal and attrition reduced the sample size below that required for analysis at the week 24 follow-up point. Study Two was designed as a follow-up qualitative study that aimed to gather information on participants’ perceptions of the effects of the interventions on their stress and performance, and of their reasons for completion or no completion of the SMI. In this study, 14 participants from Study One took part in semi-structured interviews after the final follow-up assessment (week 24) for that study. The interviews were structured to elicit responses concerning participants’ perceptions of the demands of their workplace and their stress, their experience of using the stress management techniques (including perceived benefits or behavioural changes from that use), their reasons for completion or no completion of the intervention, and their own definitions of stress. Several important findings emerged from this study. First, participants described their workplace as characterised by high pressure and demand with rapid change and a perceived lack of personal control. Second, participants who continued to use the techniques they had learned after the formal intervention was completed did so because they perceived personal benefits in terms of their ability to relax and in terms of their perceptions of workload and demand. For those who did not complete the intervention, the predominant reasons reported for no completion were workplace task demands, lack of top management commitment to an intervention of this nature, and lack of personal gain once the techniques had been learned. In relation to defining stress, participants did not have agreement, but rather reported definitions reflecting a multifaceted complex amalgam of physiological, psychological, and emotional aspects. Research such as this is important in terms of its contribution to the general field of occupational stress and its alleviation. It addresses a long-standing need to assess the relative effectiveness of some of the subcomponents commonly employed as part of more complex multifaceted approaches to SMIs, and the effect of the techniques on both stress and performance. This thesis makes several contributions to existing knowledge. First, this thesis clarifies the origin of the Yerkes Dodson Law and its relevance to current stress management thinking. In management texts distress has come to be regarded as too much stress or pressure. This is coupled with the idea that some stress has a positive impact on performance due to an earlier and erroneous interpretation of the Yerkes Dodson Law. Second, Study One provides evidence of the relative effectiveness of two different SMI components in the reduction of individuals’ occupational stress, as well as evidence for the effectiveness of individual focussed SMIs in the reduction of stress in corporate managers. Third, Study One provides evidence for a positive effect on managers’ performance consequent to their use of stress management techniques. This thesis also sheds light on managers’ definitions of stress, and their reasons for completion or no completion of SMIs. In summary, individual focussed (or secondary) SMIs have the potential to reduce stress and to improve performance in corporate managers as perceived by both the individual and others in the workplace.