Objectives. To examine the clinical effectiveness of guided self-help (GSH) for anxiety and depression in routine clinical practice, and the role of self-efficacy, therapeutic alliance and socio-economic status in influencing that effectiveness. Design. A within-subjects repeated measures design in which participants served as their own controls by completing questionnaires across a control period prior to GSH intervention, then again at post-intervention and 3- and 6-month follow-up. Methods. GSH participants completed outcome measures for mental health (HADS) and work/social functioning (WSAS). Factors explored by regression as possible predictors of effectiveness were self-efficacy, therapeutic alliance and socioeconomic status. Results. Sixty people completed GSH, with analyses indicating effectiveness of GSH in significantly improving mental health and social functioning at post-treatment and 3-month follow-up, but not at 6-month follow-up. Effectiveness was also indicated under intent-to-treat conditions (n = 97) with medium effect sizes (≈ 0.6) for each outcome measure at post-treatment. Improvement in mental health was predicted by lower self-efficacy and greater therapeutic alliance. Completers of the intervention had significantly higher socio-economic status than non-completers. Conclusions. The current study has suggested effectiveness of GSH in routine clinical practice across different primary care services at post-treatment, but with less evidence of this at follow-up. Effectiveness has been highlighted to be influenced by self-efficacy and therapeutic alliance, suggesting the importance of considering non-specific factors when patients access GSH in primary care. This study underlines the need for further research exploring longer-term clinical effectiveness and examining for whom GSH works in order to constructively inform future evidence-based practice.

published_or_final_version / Gerontology / Master / Master of Social Sciences

Stress and depression are popular and powerful terms within the mental health field. Although the relation between the two terms has been discussed and investigated in lay and scientific discourse, less is known about how this relation is constructed online. Individuals wanting to learn more about these topics are increasingly turning online using a search engine as an initial quick method of obtaining mental health information. The present research examines the stress and depression discourse found on self-help websites using a social constructionist epistemological framework and the methodological approach of discourse analysis. In the first manuscript, I specifically examined how stress was constructed in the causal ontology of depression in six different websites. The analysis demonstrated that many possible relations between the two terms were included. This finding suggests that, in the online context, ensuring that website users find themselves represented in the text is of maximal importance. In the second manuscript, I examined how the stress and depression terms themselves were constructed. This analysis suggests that the stress discourse often borrowed from depression discourse, constructing the two terms in similar ways. This parallel construction involved defining both terms as mental illnesses, with corresponding symptoms and clinical presentations that required treatment. The degree of overlap between the two terms suggests that engaging the website user was more important than the specific label used to label the distress in the online context. I examine the contrast between the general, fluid, and elastic constructions of the mental health terms found online with the ever-evolving need for increased precision and demarcation of mental health conditions within the fields of psychiatry and psychology.

The purpose of the current study was to combine the factors previously determined to be related to African American help seeking into a single path model and, using structural equation modeling (SEM), determine the relative influence of each factor in the attitudes toward seeking mental health services (see Figure 2.2) among a community sample of African American adults from several metropolitan areas in the US. As such, SEM was utilized to compare the relative fit of two opposing models within this sample, one where a path from economic barriers to help-seeking attitudes was estimated freely and one where that path was constrained. Many have argued that for African Americans, economic constraints are barriers to seeking help. While existing literature fails to consistently support this contention, the current study does suggest that social status does carry significant weight in predicting attitudes toward seeking mental health services. Acculturation was not as strong of a predictor. Limitations , including the use of an abbreviated help-seeking scale, were discussed. In addition, implications for African Americans seeking services were also discussed.

The purpose of this study was to determine the extent to which women seeking services of a shelter for battered women in the Southwestern United States were similar to the existing picture of battered women. Supplemental questions were asked concerning the effects of substance abuse, marital status, and child abuse. Information was gathered from records of a sample of 100 women who sought shelter between September 1984 and August 1987. Results were compared with previous studies by Gayford (1975), Giles-Sims (1983), and Walker. Results suggested women in this study were similar to battered women who had been studied previously. No significant relationship was found between the use of drugs and/or alcohol and the type of abuse a woman experienced, between marital status and employment status, nor between the occurrence of child abuse and a woman's willingness to involve the police. Implications and recommendations for future research were presented.

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Objectives. To see whether a cognitive behavioural guided self-help approach can reduce mental health symptoms, which patients might benefit most, and whether such a treatment increases self-efficacy and internal locus of control. Design. Repeated measures and correlational designs were used. Methods. 173 patients were recruited at a cognitive behavioural guided self-help clinic in Edinburgh, of which 97 completed the three-session intervention. Verbal IQ was estimated with the National Adult Reading Test (NART). Measures of emotional symptoms, self-efficacy and locus of control were taken before and after treatment, with follow-up at one month and six months. Results. Patients completing the intervention made favourable gains, which were maintained at six months. Self-efficacy and locus of control measures were not robustly correlated with mental health improvement, but did show pre- to posttreatment changes in themselves. Conclusions. Guided self-help appears to be a useful treatment option for those with depression, anxiety and stress. The implications of the findings, the strengths and limitations of the study, and areas for future research are discussed.

No description available.

Volunteer tourism is a popular way for young Westerners to discover the world and at the same take on the role as an international aid worker. For a short time they get an opportunity to improve the life conditions of people in development countries and get to know a new culture. The discourse of “making a difference” is dominating the marketing and promotion of the volunteer trips, yet little research is to be found about what the volunteers contribute with and what “help”, provided by them consist of. The main purpose of this study was to explore eventual post-colonial legacies or structures in the practice of volunteer tourism by exploring how help, in the actual context is described and defined by the volunteer tourists themselves. The thesis is based on a field study, conducted during two months in Rio de Janeiro, Brazil. Data was collected through 14 semi-structured interviews with volunteer tourists and observations at the volunteer sites. The data was further analysed by using terms and perspectives from post-colonial theory. The analysis show that the help from the volunteer tourists principally were supposed to compensate for deficiencies in the host community and that it was directed towards individual advancement for the kids that the volunteers encountered in the projects. Tendencies that the help-actions sometimes were based on assumptions, rather than facts about the conditions in the host community were also identified. Furthermore that the actions taken on by the volunteers sometimes implied simplified notions on ways to achieve development.