Treatments for depression are not overly effective. Thus, aptitude-by-treatment interactions (ATIs), or interactions between particular treatments and client characteristics may be key to increasing treatment outcomes. Aptitudes of particular interest are 1) emotional and 2) etiological factors. Emotional factors related to positivity (i.e., fear of happiness, fear of positive evaluation, anticipatory anhedonia) are of practical interest due to recent increases in positivity-based treatments and of theoretical interest due to reward devaluation theory, which states that depressed individuals may be motivated to be fearful/avoidant of positivity. Etiological beliefs regarding causes of depression (i.e., physical, childhood, characterological) are of interest due to budding literature boasting the treatment benefits of matching relevant treatments to etiological beliefs. In the current study, participants were provided with four depression treatment descriptions and were asked about the personal fit, preference, and effectiveness of these treatments as well as completed an online battery of questionnaires. Emotional hypotheses supported reward devaluation theory, as individuals who were highly fearful of happiness and positivity were less interested in treatments specifically targeting positivity than other treatments, differing from the overall group preferences. Some evidence from etiological hypotheses also supported use of these beliefs in treatment planning, as individuals with childhood etiological beliefs were more interested in pastocused treatments, as well as those with characterological beliefs (after accounting for other clinical variables). Thus, incorporating emotional and etiological factors into treatment planning may allow for an enhanced discussion of why treatments in direct contrast with clients’ etiological beliefs or preferences may be the treatments that they need the most.

All people experience pain and for some people, acute pain may over time develop into long-term disabling problems. Already at an early stage, it is possible to identify people at risk for long-term problems and psychologically oriented interventions have been shown to successfully prevent future disability. However, not all people are helped by treatment and there is room for improvement. Moreover, subgroups of people suffering from pain, with different profiles of psychological factors have been identified, indicating that people with pain problems differ. The first aim of this dissertation was to improve the understanding of how people differ. The second aim was to use these individual differences and to match people to psychological treatment based on their psychological profile. The third aim was to explore what happens during treatment that might be important for treatment outcome. The findings show that people who belonged to subgroups with elevated levels of psychological factors had less favorable outcomes over time, despite treatment, than people with no elevations. Moreover, people with elevations in several psychological factors had even less favorable outcomes. Psychological treatments aimed at preventing future disability performed well, but using profiles to match people to treatment did not improve outcomes further; people who were matched to a treatment and people who were unmatched had similar outcomes. However, the profiles used for matching were unstable over time and there is need to improve the identification of psychological variables used for treatment matching. Finally, a number of psychological factors were shown to be valuable targets for treatment; if the treatments successfully produced change in people’s thoughts and emotions related to pain the treatment outcomes were better. The findings were summarized in a flow chart showing the recommended clinical approach to people seekinghealth care for acute pain problems.

Submitted by Irene Nascimento (irene.kessia@ufpe.br) on 2017-04-27T18:34:36Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação para biblioteca.pdf: 2019803 bytes, checksum: 5b2c8e4210d0dd6f5c0f10165b0c455b (MD5) / Made available in DSpace on 2017-04-27T18:34:36Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação para biblioteca.pdf: 2019803 bytes, checksum: 5b2c8e4210d0dd6f5c0f10165b0c455b (MD5) Previous issue date: 2016-06-09 / A tuberculose (TB) é uma das doenças infecciosas mais antigas no mundo, e até os dias atuais ainda permanece sendo um sério problema para a saúde pública global. O Tratamento Diretamente Observado (TDO) caracteriza-se como elemento chave, no fortalecimento da adesão ao tratamento da TB e na prevenção do aparecimento de cepas resistentes aos medicamentos, uma vez que ainda existem taxas de cura inferiores a meta preconizada e um número ainda elevado de abandono do tratamento. Em Pernambuco a estratégia TDO foi implantada inicialmente pela capital Recife a partir de 2005-2007 e segundo dados, no ano de 2013 chegou a uma cobertura de 63,5% em todo o estado. Para o presente estudo foram utilizados dados secundários retirados do Sistema de Informação de Agravos e Notificações (SINAN) no período 2005 a 2014. Os resultados apontam que a maioria dos pacientes são adultos jovens do sexo masculino, não brancos, alfabetizados, moradores de zona urbana e entre as doenças e agravos o mais presente foi o alcoolismo. A taxa de incidência da TB apresentou uma média em torno de 48,6%. Os casos de óbitos, no estado, apresentou uma média de 4,3. A forma pulmonar predomina diante das demais, com uma média de mais de 4000 (85%) casos ao ano no Estado. A média de cura e abandono ficou em torno de 71,3% e 9,9% respectivamente. A realização do TDO só veio a surtir efeito no estado a partir de 2007 (53,86%) seguindo até o ano de 2014 com 60,37%.Foi observado que nos últimos 10 anos de estudo (2005-2014) a probabilidade de cura, a partir da diferença de médias entre os grupos, foi de 26% a mais para o grupo dos tratados (TDO) do que para o grupo controle (não TDO). Esses resultados são corroborados por três diferentes critérios de Matching (pareamento) via Propensity Score (escore de propensão): o vizinho mais próximo, indicando que os indivíduos submetidos ao TDO têm em média 23% de chances a mais de cura, com base nos Estratos, este percentual é de 21% e o Kernel, apresentou 23% a mais de chances de cura. / Tuberculosis (TB) is one of the oldest infectious diseases in the world, and to this day still remains a serious problem for global public health. The Directly Observed Treatment Short-Course (DOTS) is characterized as a key element in strengthening adherence to TB treatment and prevention of the emergence of resistant strains to drugs, since there are still healing rates below the recommended target and an even higher number abandonment of treatment. In Pernambuco the DOTS strategy was implemented initially by Recife capital from 2005-2007 and second data, in 2013 reached a 63.5% coverage throughout the state. For the present study were used secondary data taken from Diseases and Notifications Information System (SINAN) in the period 2005 to 2014. The results show that most patients are young, adult males, not white, literate, urban residents and among the diseases and disorders the most present was alcoholism. The TB incidence rate in PE averaged around 48.6%. The cases of deaths, in the state, showing that PE is an average of 4.3. The pulmonary form predominates on the others, with an average of more than 4000 (85%) cases per year in the state. The average healing and abandonment was around 71.3% and 9.9% respectively. The realization of the DOTS only came to take effect in the state from 2007 (53.86%) followed by the year 2014 with 60.37%. It was observed that in the last 10 years of study (2005-2014) the probability of cure from the mean of difference between the groups was 26% higher for the group of treated (DOTS) than for the control group ( not DOT). These results are supported by three different criteria Matching by Propensity Score: the nearest neighbor matching, indicating that individuals submitted to DOTS have averaged 23% chance more healing, based on Strata this percentage is 21% and Kernel, showed 23% more chances of cure

The current study takes an initial step toward deriving a method for empirically based, theory-driven treatment matching in a military population suffering from PTSD. Along with the more overt symptoms of PTSD (e.g., persistent hyperarousal), secondary cognitive symptoms have also been shown to be significantly associated with avoidance and intrusive symptoms, as well as contribute to functional impairment. Based on the factor analytic and treatment literature for PTSD, it appears that there are two central mechanisms associated with beneficial therapeutic change that underlies both CPT and PE treatments (i.e., habituation, changes in cognitions). Additionally, different traumatic events and peritraumatic responses may be associated with unique symptom profiles and may necessitate targeted treatment. The present study proposes a novel approach to treatment matching based on the factor structure of PTSD and underlying mechanisms of treatment response. More broadly, this paper provides evidence for a broader understanding of peritraumatic responses and the potential implications of these responses for symptom profiles and illness trajectories.

This study is an exploration, through ethnographic and auto-ethnographic inquiry, of the personal world, gambling experiences and underlying biopsychosocial vulnerabilities of three individual case studies - one male and two females - each representing a different sub-type of pathological gambler. It comprises the integration and implementation of a psycho-structural stage matching model to explore comorbidity and identify certain biopsychosocial manifestations in the respective stages of pathological gambling. Long term treatment strategies were identified and patient treatment matching was explored. Further, it comprises my personal relationship and therapeutic treatment of these sub-types of gamblers over a period of one year and longer. In this study it is hypothesized that formulating appropriate matching long term treatment strategies should be based on the stage of change, the phase in the psycho-structural model, as well as the gambler's underlying vulnerability. From this a comprehensive gambling disposition profile can be completed with proper intervention matching approaches. A number of other hypotheses emerged from this study that could provide valuable information and serve as a guideline to those working with pathological gamblers. / Psychology / D.Phil.

This study is an exploration, through ethnographic and auto-ethnographic inquiry, of the personal world, gambling experiences and underlying biopsychosocial vulnerabilities of three individual case studies - one male and two females - each representing a different sub-type of pathological gambler. It comprises the integration and implementation of a psycho-structural stage matching model to explore comorbidity and identify certain biopsychosocial manifestations in the respective stages of pathological gambling. Long term treatment strategies were identified and patient treatment matching was explored. Further, it comprises my personal relationship and therapeutic treatment of these sub-types of gamblers over a period of one year and longer. In this study it is hypothesized that formulating appropriate matching long term treatment strategies should be based on the stage of change, the phase in the psycho-structural model, as well as the gambler's underlying vulnerability. From this a comprehensive gambling disposition profile can be completed with proper intervention matching approaches. A number of other hypotheses emerged from this study that could provide valuable information and serve as a guideline to those working with pathological gamblers. / Psychology / D.Phil.