xvi, 90 p. : ill. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number. / Empirical support for the efficacy of CBT in treating depression suggests that the majority of clients will respond to this intervention. However, the more nuanced, and clinically relevant, question of "Which clients will respond to CBT for depression?" has been difficult to answer. Research efforts have focused on two different approaches to this question. One approach focuses on trajectories of symptom change within the first weeks of treatment to identify clients who are most likely to achieve response. A second approach looks to pretreatment client variables such as hopelessness and dysfunctional attitudes to identify clients who are more likely to respond. The current study is the first to simultaneously compare these two approaches to the prediction of treatment outcome. The sample consists of 222 clients (65.32% female, 92.79% Caucasian), ages 18 through 64 (M =27.85, SD = 11.28), receiving treatment for mood and anxiety disorders (59% met criteria for comorhid disorders) in a CBT oriented psychology training clinic. Results suggest that the rate of change in depressive symptoms over the first five treatment sessions significantly and consistently predicted outcome over and above the majority of pretreatment variables, except for precontemplation stages of change scores and initial severity of depression and anxiety symptoms. Similarly, rate of change in anxiety symptoms significantly predicted outcome on two of the three measures over and above the majority of pretreatment variables, except for hopelessness and initial severity of anxiety symptoms. Post hoc analyses revealed different predictors of outcome when trajectories of change and pretreatment variables were examined separately. Both rates of change and a number of pretreatment variables predicted outcome. Finally, pretreatment predictors of rate of early symptom change such as a contemplative orientation to change and therapist experience, were identified which may suggest that therapists should target these factors to potentially maximize rapid early symptom change, and in turn outcome. The findings are discussed in terms of their implications regarding methodological approaches to treatment outcome research and treatment planning for adults with comorbidities. / Committee in charge: Anne Simons, Chairperson, Psychology; Philip Fisher, Member, Psychology; Hyoun Kim, Member, Not from U of O; Jane Mendle, Member, Psychology; Jeff Todahl, Outside Member, Counseling; Psychology and Human Services

Forskning tyder på att 200 000 personer i Sverige drabbas av en ätstörning någon gång under livet. Studiens syfte var att utforska behandlingen mot ätstörningar och de erfarenheter som patienter och deras anhöriga upplevt genom bemötande och delaktighet i vården och den inverkan de fått på deras tillfrisknad. Semistrukturerade intervjuer genomfördes med fem tidigare ätstörningspatienter och två anhöriga. Data analyserades med hjälp av tematisk analys. Av resultatet framkom ett övergripande tema: Se hela mig - kropp och själ hör ihop samt sex underteman: styrande stereotypa föreställningar, den stereotypa bildens följder, tillit och misstro, kompetens påverkan relationella band, medbestämmande och samverkan, maktobalans. Deltagarna saknade behandling för de tankar och känslor som upprätthåller ätstörningen. Auktoritära tillvägagångsätt främjade inte arbetsallians eller delaktighet. Deltagarna upplevde att utebliven psykologisk behandling orsakat att de fortsatt levt med negativa tankar och beteenden som mer eller mindre vidmakthållit ätstörda beteenden. Utifrån deltagarnas önskemål och beskrivningar av brister förefaller det behövas kompetenshöjande insatser kring bemötande i behandlingen av ätstörningar.

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Purpose: Cancers of the sinonasal tract are rare, comprise a diverse group of histologies and are known for their poor prognostic outcomes. The primary aim of this study was to evaluate the 2- and 5-year overall survival (OS) rates in patients treated with radical and palliative intent for sinonasal squamous cell carcinoma (SNSCC). Methods: A retrospective review of medical records of all patients presenting to Cape Town's Groote Schuur Hospital between January 2003 and December 2013 was carried out. All patients with histologically proven squamous cell carcinoma (SCC) of the maxillary sinus and nasoethmoidal complex who underwent treatment at Groote Schuur Hospital and/or iThemba LABS (Laboratory for Accelerator Based Sciences) were included. Fifty-five patients with cancers of the sinonasal tract were identified from the electronic patient system; 23 were excluded either because of different histologies, lack of histology or having initiated treatment outside of Groote Schuur Hospital. The medical records of 32 patients were utilised for final analysis. 2- and 5-year OS was calculated using Kaplan-Meier analysis. Results: The majority (75%) of patients had an ECOG performance status of 1 with facial asymmetry secondary to tumour mass or swelling being the most common presenting symptom (present in 68,75% of cases). 62,50% of cases originated within the maxillary antrum and 56,25% of cases were classified as keratinizing SCC. Twenty-six (81,25%) patients presented with stage IV disease; nodal disease was seen in 13 (40,63%) patients and distant metastasis in 4 (12,50%) patients. Most patients underwent palliative intent treatment with only 11 (34,38%) having radical treatment. The cumulative 2- and 5-year OS from the date of treatment initiation was 26% and 19% respectively. Median OS for the entire cohort was 7,7 months and was statistically significant between intent groups at 5,19 months (95% CI:3.43– 6.95) for palliative compared to 35,45 months (95% CI: 0.00–138.52) for radical patients (c2 = 7.80, p = 0.005). Conclusion: Despite a decline in incidence of disease over the last 30 years and the improved diagnostic and therapeutic modalities available today, the prognosis and survival outcomes for SNSCC remains poor.

Children with Social Anxiety Disorder (SAD) characterized by persistent shyness and anxiety in social or performance situation, exhibit social skills deficits. These deficits include difficulty initiating conversations, maintaining eye contact, and taking turns when speaking, which in turn leads to impairments in their daily interactions and development of peer relationships (Greco, 2005; Miers, 2010). Although there are many subjective assessments for treatment outcomes for children with SAD, in order to become more thorough and effective when assessing treatment outcomes, more objective measures of actual behaviors are needed. This study uses digital vocal analysis to examine vocal parameters associated with anxiety such as pitch and volume in children with SAD pre and post treatment. Measuring vocal parameters during role-play behavioral assessment tasks allowed us to examine whether the software was capable of detecting differences in vocal characteristics that are consistent with the clinical presentation of the disorder. Children with SAD showed differences in vocal characteristics pre to post treatment, in regards to pitch, pitch variability, volume, and volume variability. There were significant changes in volume pre to post treatment, however the changes in pitch, pitch variability, and volume variability were not significant. These results suggest that post SET-C treatment, certain vocal characteristics, (one of the social skills deficits exhibited by children with SAD) improved. Implications of the findings are discussed.

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Dementia is a chronic disorder that affects approximately 40 million individuals throughout the globe. This study provides a preliminary description of psychotherapeutic treatment for the management of dementia. This study compares treatment outcomes by both modality (individual, family, and mixed) and provider type. Results found that therapy is a low-cost treatment, however, it is not being often used for people with dementia, or their family members. Participants (n=327) include individuals with ages ranging from 46-95(M=70.52, SD=12.16). Females made up 57.5% (n=188), while males made up 42.5% (n=139) of the sample. Descriptive statistics found that the number of sessions ranged from 1-62 (M=3.17, SD=5.24). The average cost of care for one episode of care was $155.21(SD=276.16), and estimated cost-effectiveness was 207.31 (490.84). There were significant differences found when comparing modality type, with mixed therapy being significantly different than both family and individual therapy across all treatment outcomes. The only significant difference in groups of provider types was in the number of sessions in an episode of care. Findings suggest that although talk therapy treatment has been shown to be cost-effective treatment, it is not used often in treatment.

The objective of the current research was to test the initial feasibility and potential efficacy of a group-based Acceptance and Commitment Therapy (ACT) intervention for partner aggression, compared to a support and discussion control group, in a clinical sample of adults. Specifically, the study was intended to provide preliminary evidence of the impact of an ACT group on psychological and physical aggression, and to examine the processes responsible for any treatment effects. One hundred and one participants (mean age = 31; 68% female) were randomly assigned to receive ACT or the support and discussion control group. Both interventions consisted of 12 weekly 2-hour sessions and participants were assessed with self-report measures at pre-treatment, twice during treatment, at post-treatment, and at 3- and 6-month follow-up. Results of growth curve modeling analyses demonstrated that participants in the ACT group had significantly greater decreases in psychological and physical aggression at post-treatment and follow-up, and also showed improvements in depressive symptoms, interpersonal problems, and social functioning. Finally, the effect of the ACT group on psychological and physical aggression was mediated by experiential avoidance, suggesting that the intervention had its effects, at least in part, through increasing emotional acceptance. These results demonstrate that an ACT approach to aggression may be a viable alternative to traditional treatments.