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Bipolar disorder (BPD) is associated with negative health outcomes and high relapse rates and group psychoeducation (PE) is recognised as an effective intervention when used in conjunction with pharmacological treatment. Unhealthy beliefs and attitudes have not been measured or related to outcomes in group PE and the mechanism for how PE exerts its effect are unidentified. Aims: (a). An adapted group psychoeducation intervention will change (improve) unhealthy personal beliefs about illness and attitudes towards medication when compared to a treatment as usual group. (b). Changes in unhealthy personal beliefs and attitudes will be maintained overtime (a 12 month follow up period). (c). People who subsequently relapse compared to those who do not relapse, will have less improvement in their unhealthy personal beliefs about illness and attitudes towards medication from PE. (d). An evaluation of the efficacy of psychoeducation in a systematic review for bipolar disorder in preventing relapse and other outcomes will identify factors that relate to clinical outcomes. Methods: A 10 session PE intervention was adapted and 38 participants with bipolar disorder I or II (using DSM-IV criteria) were recruited from a Specialist Affective Disorders Service. A waiting list assessment time was used as a parallel group control and a longitudinal study took place over a 12 month follow up period in all participants once they had received the intervention. A mirror image study reviewed case notes to identify relapse 12 month pre versus post intervention. Assessments measuring, beliefs and attitudes, mood symptoms and satisfaction where carried out, 8 weeks prior to intervention (waiting list), pre intervention, and 6 and 12 months post intervention. Results Summary: The waiting list control comparison showed significant improvement in attitudes measured by the Personal Beliefs about Illness Questionnaire (PBIQ) and Drug attitude Inventory (DAI) and symptoms and functioning. Beliefs on all domains of the PBIQ improved significantly (p<0.001) as did attitudes toward medication (p<0.001) there were also small but significant improvements in mood symptoms. In all participants (n=38) improvements were maintained over the 12 month follow up period. Nine people relapsed in the 12 months after the intervention compared with 22 before (p<0.002) and relapsers improved significantly less than non-relapsers following PE on the PBIQ (p=0.012) and the DAI (p=0.046). Conclusions: A group PE intervention reduced unhealthy personal beliefs and attitudes, both manic and depressive relapse and improved functioning. Improvements are maintained over time except adherence which remained unchanged. The amount of improvement in the PBIQ and DAI is related to relapse with non relapsers improving more than relapsers. The systematic review provides reasonable evidence that psychoeducation is at least modestly effective in preventing relapse in bipolar disorder, with the strongest evidence for reducing overall and manic relapse.

One of the great challenges for positive psychology is that academics, researchers and authors are yet to reach agreement on the terminology, constructs and methodology of the various positive psychological concepts and interventions. One such concept that has been ambiguously and often inconsistently conceptualised is happiness. Interventions that are structured around these conceptualisations have produced mixed results, which are attributable to various aspects such as the unidimensional conceptualisation of the concept, inconsistent measurement, psychometric measuring instruments that have not been validated for the population in question, and fragmented intervention methodologies. Research was, therefore, needed regarding happiness and the development of interventions aimed at increasing happiness. Therefore, this thesis aimed to investigate the concept, manifestation, measurement and development of happiness and positive psychological interventions (PPIs) within a tertiary educational environment. A mixed method research approach was followed to reach the research objectives. The first study aimed to examine the psychometric properties of positive psychological assessment measures, and to determine the relationship between flourishing and academic performance within a tertiary educational institution. A quantitative cross-sectional survey design was used to address this objective. The Mental Health Continuum Long Form, Positive and Negative Affect Scale and Satisfaction with Life Scale were administered and indicated acceptable levels of internal consistency. The MHC-LF would need to be adapted for future studies within the tertiary educational environment. No significant correlations could be established between academic performance and flourishing. However, cross-tabulation indicated some evidence of the impact that flourishing/languishing had on academic performance. Individuals with moderate levels of flourishing typically performed in the „above average‟ to „excelling academically‟ range. Languishing individuals performed at the lower levels of the academic performance spectrum. The results indicated that a large number of individuals within this tertiary educational environment were languishing. Flourishing students experienced higher levels of positive affect and satisfaction with life, as well as lower levels of negative affect than their languishing and moderately flourishing counterparts. The second study aimed to investigate the main streams of research on happiness, the approaches/models flowing from these philosophies and the methodology of happiness interventions. A quantitative meta-analysis of the literature was used to address the aforementioned research objective. Seeing that the literature presents with such incongruent findings regarding the effectiveness of PPIs, research was needed to establish how happiness should be conceptualised, which moderating factors should be addressed in this conceptualisation, and what the content of PPIs should be. A qualitative meta-analysis of the literature indicated that happiness is approached from either a hedonic, eudaimonic or integrated approach. These philosophies gave birth to a stream of scientific literature regarding happiness and its various conceptualisations, namely (a) Subjective well-being; (b) Hedonic well-being; (c) Eudaimonic well-being; (d) Psychological well-being; (e) Flourishing, and (f) Authentic happiness. Furthermore, the results highlighted three causes for failing interventions: (a) unidimensional models/approaches towards happiness, (b) targeting the concept of happiness instead of the mediating factors; and (c) fragmented methodological interventions. The study suggested a multidimensional model for happiness and happiness interventions. Furthermore, the study proposed a multifaceted methodology for happiness interventions, comprising self-administered intentional activities, group-administered interventions and individual coaching. The third study aimed to evaluate a PPI aimed at increasing happiness of students in a tertiary educational institution. A longitudinal pre-experimental research design was used to address the aforementioned research objective. Qualitative data were used to explore the findings further. The results indicated that the overall happiness of a student may be increased through developing individuals on both an emotional and psychological level. The results showed some scientific merit to a multifaceted approach towards PPIs. The PPI affected all the aspects conceptualised in this study except for two components of authenticity, namely authentic behaviour and relational orientations. / PhD, Industrial Psychology, North-West University, Vaal Triangle Campus, 2012

As doenças cardiovasculares (DCVs) lideram o ranking de causas de mortes em países desenvolvidos, produzindo custos socioeconômicos elevados. Dentre os fatores de risco para as DCVs, a hipertensão arterial sistêmica (HAS) surge como uma das principais causas para seu desenvolvimento. Estima-se que, no Brasil, a prevalência da HAS em adultos ultrapasse os 30%, o que a torna um grave problema de saúde pública, sendo seu controle uma das áreas prioritárias de atendimento dos Serviços de Atenção Primária à Saúde. Pelo fato da HAS possuir evolução silenciosa e lenta, os pacientes muitas vezes negligenciam sua condição deixando de seguir o tratamento proposto. Além disso, fatores psicológicos como depressão, ansiedade e estresse podem interferir, tanto no surgimento da HAS como na adesão ao tratamento. A falta de adesão à terapêutica, seja ela medicamentosa ou não, torna-se um problema para os profissionais de saúde. Diversos estudos mostram a importância de intervenções psicológicas para a implantação de mudanças e manutenção de comportamentos que interferem no controle da HAS. O objetivo deste trabalho foi avaliar o efeito de uma intervenção cognitivo comportamental sobre a pressão arterial (PA), as variáveis psicológicas, o índice de massa corporal (IMC), o comportamento alimentar e a atividade física de hipertensos atendidos em Serviços de Atenção Primária da cidade de Ribeirão Preto/SP. Participaram deste estudo 84 pacientes que foram avaliados utilizando-se entrevista semi-estruturada, Inventário de Sintomas de Stress para Adultos de Lipp (ISSL), Inventário de Depressão de Beck (BDI) e Inventário de Ansiedade de Beck (BAI). Os pacientes foram submetidos a uma avaliação inicial e uma avaliação final, para que posteriormente os dados das duas avaliações pudessem ser comparados. Entre uma avaliação e outra os pacientes foram divididos em dois grupos: Grupo de Terapia Cognitivo Comportamental (GTCC) e Grupo de Orientação (GO). Vinte e dois pacientes frequentaram os grupos propostos, sendo 11 do GTCC e 11 do GO, enquanto 62 não participaram de quaisquer grupos. Os resultados mostraram que não houve diferença estatística significante entre o GTCC e o GO, o que pode estar relacionado ao baixo número de participantes. Quanto às características sócio demográficas (n=84) observou-se que a maioria era do sexo feminino (76,2%), com idade superior a 50 anos, com companheiro (60,7%), com nível de escolaridade até o ensino fundamental completo (53,6%), sem emprego ou aposentados (60,7%) e com renda familiar superior a três salários mínimos (62,0%). Observou-se ainda que a maioria apresentava IMC acima da taxa de normalidade (75,0%) e não praticava atividade física (64,3%). Tinham sua PA controlada 54,8% dos sujeitos e 94% faziam uso de medicação. Quanto aos fatores psicológicos, 53,6% apresentavam sintomas de estresse, 20,2% obtiveram pontuação do BDI que indicava sintomas de transtorno depressivo e 23,8% apresentavam sintomas ansiosos. Considerando-se a baixa frequência de participação nos grupos buscou-se também avaliar a não adesão ao tratamento proposto. Comparando-se os participantes que aderiram aos grupos (n=22) com aqueles que não aderiram (n=62) observou-se diferença estatística significante quanto ao sexo, estado civil, escolaridade, renda familiar, diabetes melittus, conhecimento da PA, conhecimento da PA tida como normal e presença de estresse. No Grupo Adesão houve predomínio de participantes do sexo feminino (95,5%), sendo que a maioria não possuía companheiro (59,1%), tinha nível de escolaridade elevado (72,7%) e possuía renda familiar superior a três salários mínimos (77,3%). No que se refere ao conhecimento e manejo da HAS, no Grupo Adesão, 100% dos participantes conheciam a sua PA após os encontros grupais. Quanto à presença de estresse, houve diminuição de 59,1% para 31,8% entre aqueles indivíduos que aderiram ao tratamento proposto. Os dados indicaram que as mulheres procuram mais os serviços de saúde e que o nível de escolaridade e a renda familiar elevados podem favorecer a adesão ao tratamento. A análise qualitativa dos motivos para a não adesão mostrou que a \"falta de tempo\" foi o principal motivo que dificultou a presenças dos pacientes nos grupos. De maneira geral, os participantes do estudo acreditaram que o \"desinteresse com a própria saúde\" foi o principal fator que interferiu na adesão aos grupos. As principais sugestões dos pacientes para melhorar a adesão estão relacionadas a mudanças na estrutura dos grupos. Os dados deste estudo podem ter sido comprometidos pelo baixo número de participantes nos grupos; o GTCC não favoreceu mais mudanças comportamentais do que o GO, o que indica que uma intervenção tão elaborada pode não ter uma boa relação custo benefício. Variáveis que não foram controladas podem ter favorecido as mudanças observadas no GO. Como alternativa para aumentar a adesão aos grupos pode-se propor telefonemas semanais aos pacientes, folhetos informativos, atenção da equipe multidisciplinar, auxílio da instituição de saúde na divulgação dos encontros e mudança do nome do grupo. Contudo, para a adequação desta intervenção cognitivo comportamental, novos estudos precisam ser realizados com amostras compostas por um maior número de sujeitos. / Cardiovascular diseases (CVDs) lead the ranking of causes of death in developed countries, producing high socioeconomic costs. Among the risk factors for cardiovascular diseases, hypertension has emerged as a major reason for their development. It is estimated that in Brazil, the prevalence of hypertension in adults exceeds 30% which makes it a serious public health problem, being its control a priority area in Primary Health Care. Because hypertension has silent and slow evolution, patients often neglect their treatment. In addition, psychological factors like depression, anxiety and stress can interfere with the onset of hypertension and treatment adherence. The nonadherence to drug therapy or other kinds of therapies becomes a problem for health professionals. Several studies shown the importance of psychological interventions for the implementation of changes and maintenance of behaviors that interfere with control of hypertension. The objectives of this study were to evaluate the effect of a cognitive behavioral intervention on blood pressure (BP), psychological variables, body mass index, physical activity and feeding behavior of hypertensive patients in primary care services of the city Ribeirão Preto/SP. The study included 84 patients, which were assessed using a semi-structured interview, Lipp\'s Inventory of Stress Symptoms in Adults (ISSL), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). They were submitted to an initial assessment and a final evaluation so that data from the two moments could be compared. Between assessments the outpatients were divided into two groups: Cognitive Behavioral Therapy Group (CBTG) and Orientation Group (OG), 22 of them adhered to treatment, 11 of the CBTG and 11 of the OG, while 62 did not adhere. The results showed no statistically significant difference between the CBTG and OG which may be related to the low number of participants. With regard to sociodemographic data (n = 84) it was observed that the majority were female (76.2%), older than 50 years, with a partner (60.7%), with an elementary level of education (53.6%), unemployed or retired (60.7%) and family income above three minimum wages (62.0%). It was also observed that the majority had body mass index above the normal rate (75.0%) and physical inactivity (64.3%). They had their blood pressure controlled and 54.8% and 94.0% of the subjects were using medication. As for psychological factors, 53.6% had symptoms of stress, 20.2% had BDI scores indicating symptoms of depressive disorder and 23.8% had anxiety symptoms. Considering the low adherence in groups it was also assessed the nonadherence to the proposed treatment. Comparing the participants who joined the groups (n = 22) with those who did not adhere (n = 62) it were observed significant differences regarding sexgender, marital status, education, family income, diabetes mellitus, knowledge of blood pressure, knowledge of blood pressure regarded as normal and the presence of stress. In the group where adherence treatment was observed, it was verified a predominance of female participants (95.5%), and that most had no partner (59.1%), had higher education (72.7%) and had a family income above three minimum wages (77.3%). With regard to knowledge and management of hypertension in the group that adhered to treatment, 100% of the participants knew their blood pressure after the group meetings. Regarding the presence of stress, it decreased from 59.1% to 31.8% among those individuals who have joined the proposed treatment. The data indicated that more women seek health services and the education level and family income levels may promote adherence to treatment. Qualitative analysis of the reasons for nonadherence showed that \"lack of time\" was the main reason that hindered the participation of patients in groups. Overall, the study participants believed that the \"indifference regarding their own health\" was the main factor that interfered with adherence to the groups. The main suggestions to improve patients\' adherence are related to changes in the structure of the groups. Data from this study may have been compromised by the low number of participants in the groups. The CBTG did not favor more behavioral changes than the OG, which indicates that such elaborated intervention may not have a cost-effective relation. Variables that were not controlled may have favored the changes observed in OG. As an alternative to increasing adherence to groups it can be proposed weeklytelephone calls to patients, newsletters, multidisciplinary care team, assisting of the health institution in order to promote the meetings and group name change. However, for the adequacy of cognitive behavioral intervention, further studies are needed with samples composed of a greater number of subjects.

One of the great challenges for positive psychology is that academics, researchers and authors are yet to reach agreement on the terminology, constructs and methodology of the various positive psychological concepts and interventions. One such concept that has been ambiguously and often inconsistently conceptualised is happiness. Interventions that are structured around these conceptualisations have produced mixed results, which are attributable to various aspects such as the unidimensional conceptualisation of the concept, inconsistent measurement, psychometric measuring instruments that have not been validated for the population in question, and fragmented intervention methodologies. Research was, therefore, needed regarding happiness and the development of interventions aimed at increasing happiness. Therefore, this thesis aimed to investigate the concept, manifestation, measurement and development of happiness and positive psychological interventions (PPIs) within a tertiary educational environment. A mixed method research approach was followed to reach the research objectives. The first study aimed to examine the psychometric properties of positive psychological assessment measures, and to determine the relationship between flourishing and academic performance within a tertiary educational institution. A quantitative cross-sectional survey design was used to address this objective. The Mental Health Continuum Long Form, Positive and Negative Affect Scale and Satisfaction with Life Scale were administered and indicated acceptable levels of internal consistency. The MHC-LF would need to be adapted for future studies within the tertiary educational environment. No significant correlations could be established between academic performance and flourishing. However, cross-tabulation indicated some evidence of the impact that flourishing/languishing had on academic performance. Individuals with moderate levels of flourishing typically performed in the „above average‟ to „excelling academically‟ range. Languishing individuals performed at the lower levels of the academic performance spectrum. The results indicated that a large number of individuals within this tertiary educational environment were languishing. Flourishing students experienced higher levels of positive affect and satisfaction with life, as well as lower levels of negative affect than their languishing and moderately flourishing counterparts. The second study aimed to investigate the main streams of research on happiness, the approaches/models flowing from these philosophies and the methodology of happiness interventions. A quantitative meta-analysis of the literature was used to address the aforementioned research objective. Seeing that the literature presents with such incongruent findings regarding the effectiveness of PPIs, research was needed to establish how happiness should be conceptualised, which moderating factors should be addressed in this conceptualisation, and what the content of PPIs should be. A qualitative meta-analysis of the literature indicated that happiness is approached from either a hedonic, eudaimonic or integrated approach. These philosophies gave birth to a stream of scientific literature regarding happiness and its various conceptualisations, namely (a) Subjective well-being; (b) Hedonic well-being; (c) Eudaimonic well-being; (d) Psychological well-being; (e) Flourishing, and (f) Authentic happiness. Furthermore, the results highlighted three causes for failing interventions: (a) unidimensional models/approaches towards happiness, (b) targeting the concept of happiness instead of the mediating factors; and (c) fragmented methodological interventions. The study suggested a multidimensional model for happiness and happiness interventions. Furthermore, the study proposed a multifaceted methodology for happiness interventions, comprising self-administered intentional activities, group-administered interventions and individual coaching. The third study aimed to evaluate a PPI aimed at increasing happiness of students in a tertiary educational institution. A longitudinal pre-experimental research design was used to address the aforementioned research objective. Qualitative data were used to explore the findings further. The results indicated that the overall happiness of a student may be increased through developing individuals on both an emotional and psychological level. The results showed some scientific merit to a multifaceted approach towards PPIs. The PPI affected all the aspects conceptualised in this study except for two components of authenticity, namely authentic behaviour and relational orientations. / PhD, Industrial Psychology, North-West University, Vaal Triangle Campus, 2012

As doenças cardiovasculares (DCVs) lideram o ranking de causas de mortes em países desenvolvidos, produzindo custos socioeconômicos elevados. Dentre os fatores de risco para as DCVs, a hipertensão arterial sistêmica (HAS) surge como uma das principais causas para seu desenvolvimento. Estima-se que, no Brasil, a prevalência da HAS em adultos ultrapasse os 30%, o que a torna um grave problema de saúde pública, sendo seu controle uma das áreas prioritárias de atendimento dos Serviços de Atenção Primária à Saúde. Pelo fato da HAS possuir evolução silenciosa e lenta, os pacientes muitas vezes negligenciam sua condição deixando de seguir o tratamento proposto. Além disso, fatores psicológicos como depressão, ansiedade e estresse podem interferir, tanto no surgimento da HAS como na adesão ao tratamento. A falta de adesão à terapêutica, seja ela medicamentosa ou não, torna-se um problema para os profissionais de saúde. Diversos estudos mostram a importância de intervenções psicológicas para a implantação de mudanças e manutenção de comportamentos que interferem no controle da HAS. O objetivo deste trabalho foi avaliar o efeito de uma intervenção cognitivo comportamental sobre a pressão arterial (PA), as variáveis psicológicas, o índice de massa corporal (IMC), o comportamento alimentar e a atividade física de hipertensos atendidos em Serviços de Atenção Primária da cidade de Ribeirão Preto/SP. Participaram deste estudo 84 pacientes que foram avaliados utilizando-se entrevista semi-estruturada, Inventário de Sintomas de Stress para Adultos de Lipp (ISSL), Inventário de Depressão de Beck (BDI) e Inventário de Ansiedade de Beck (BAI). Os pacientes foram submetidos a uma avaliação inicial e uma avaliação final, para que posteriormente os dados das duas avaliações pudessem ser comparados. Entre uma avaliação e outra os pacientes foram divididos em dois grupos: Grupo de Terapia Cognitivo Comportamental (GTCC) e Grupo de Orientação (GO). Vinte e dois pacientes frequentaram os grupos propostos, sendo 11 do GTCC e 11 do GO, enquanto 62 não participaram de quaisquer grupos. Os resultados mostraram que não houve diferença estatística significante entre o GTCC e o GO, o que pode estar relacionado ao baixo número de participantes. Quanto às características sócio demográficas (n=84) observou-se que a maioria era do sexo feminino (76,2%), com idade superior a 50 anos, com companheiro (60,7%), com nível de escolaridade até o ensino fundamental completo (53,6%), sem emprego ou aposentados (60,7%) e com renda familiar superior a três salários mínimos (62,0%). Observou-se ainda que a maioria apresentava IMC acima da taxa de normalidade (75,0%) e não praticava atividade física (64,3%). Tinham sua PA controlada 54,8% dos sujeitos e 94% faziam uso de medicação. Quanto aos fatores psicológicos, 53,6% apresentavam sintomas de estresse, 20,2% obtiveram pontuação do BDI que indicava sintomas de transtorno depressivo e 23,8% apresentavam sintomas ansiosos. Considerando-se a baixa frequência de participação nos grupos buscou-se também avaliar a não adesão ao tratamento proposto. Comparando-se os participantes que aderiram aos grupos (n=22) com aqueles que não aderiram (n=62) observou-se diferença estatística significante quanto ao sexo, estado civil, escolaridade, renda familiar, diabetes melittus, conhecimento da PA, conhecimento da PA tida como normal e presença de estresse. No Grupo Adesão houve predomínio de participantes do sexo feminino (95,5%), sendo que a maioria não possuía companheiro (59,1%), tinha nível de escolaridade elevado (72,7%) e possuía renda familiar superior a três salários mínimos (77,3%). No que se refere ao conhecimento e manejo da HAS, no Grupo Adesão, 100% dos participantes conheciam a sua PA após os encontros grupais. Quanto à presença de estresse, houve diminuição de 59,1% para 31,8% entre aqueles indivíduos que aderiram ao tratamento proposto. Os dados indicaram que as mulheres procuram mais os serviços de saúde e que o nível de escolaridade e a renda familiar elevados podem favorecer a adesão ao tratamento. A análise qualitativa dos motivos para a não adesão mostrou que a \"falta de tempo\" foi o principal motivo que dificultou a presenças dos pacientes nos grupos. De maneira geral, os participantes do estudo acreditaram que o \"desinteresse com a própria saúde\" foi o principal fator que interferiu na adesão aos grupos. As principais sugestões dos pacientes para melhorar a adesão estão relacionadas a mudanças na estrutura dos grupos. Os dados deste estudo podem ter sido comprometidos pelo baixo número de participantes nos grupos; o GTCC não favoreceu mais mudanças comportamentais do que o GO, o que indica que uma intervenção tão elaborada pode não ter uma boa relação custo benefício. Variáveis que não foram controladas podem ter favorecido as mudanças observadas no GO. Como alternativa para aumentar a adesão aos grupos pode-se propor telefonemas semanais aos pacientes, folhetos informativos, atenção da equipe multidisciplinar, auxílio da instituição de saúde na divulgação dos encontros e mudança do nome do grupo. Contudo, para a adequação desta intervenção cognitivo comportamental, novos estudos precisam ser realizados com amostras compostas por um maior número de sujeitos. / Cardiovascular diseases (CVDs) lead the ranking of causes of death in developed countries, producing high socioeconomic costs. Among the risk factors for cardiovascular diseases, hypertension has emerged as a major reason for their development. It is estimated that in Brazil, the prevalence of hypertension in adults exceeds 30% which makes it a serious public health problem, being its control a priority area in Primary Health Care. Because hypertension has silent and slow evolution, patients often neglect their treatment. In addition, psychological factors like depression, anxiety and stress can interfere with the onset of hypertension and treatment adherence. The nonadherence to drug therapy or other kinds of therapies becomes a problem for health professionals. Several studies shown the importance of psychological interventions for the implementation of changes and maintenance of behaviors that interfere with control of hypertension. The objectives of this study were to evaluate the effect of a cognitive behavioral intervention on blood pressure (BP), psychological variables, body mass index, physical activity and feeding behavior of hypertensive patients in primary care services of the city Ribeirão Preto/SP. The study included 84 patients, which were assessed using a semi-structured interview, Lipp\'s Inventory of Stress Symptoms in Adults (ISSL), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). They were submitted to an initial assessment and a final evaluation so that data from the two moments could be compared. Between assessments the outpatients were divided into two groups: Cognitive Behavioral Therapy Group (CBTG) and Orientation Group (OG), 22 of them adhered to treatment, 11 of the CBTG and 11 of the OG, while 62 did not adhere. The results showed no statistically significant difference between the CBTG and OG which may be related to the low number of participants. With regard to sociodemographic data (n = 84) it was observed that the majority were female (76.2%), older than 50 years, with a partner (60.7%), with an elementary level of education (53.6%), unemployed or retired (60.7%) and family income above three minimum wages (62.0%). It was also observed that the majority had body mass index above the normal rate (75.0%) and physical inactivity (64.3%). They had their blood pressure controlled and 54.8% and 94.0% of the subjects were using medication. As for psychological factors, 53.6% had symptoms of stress, 20.2% had BDI scores indicating symptoms of depressive disorder and 23.8% had anxiety symptoms. Considering the low adherence in groups it was also assessed the nonadherence to the proposed treatment. Comparing the participants who joined the groups (n = 22) with those who did not adhere (n = 62) it were observed significant differences regarding sexgender, marital status, education, family income, diabetes mellitus, knowledge of blood pressure, knowledge of blood pressure regarded as normal and the presence of stress. In the group where adherence treatment was observed, it was verified a predominance of female participants (95.5%), and that most had no partner (59.1%), had higher education (72.7%) and had a family income above three minimum wages (77.3%). With regard to knowledge and management of hypertension in the group that adhered to treatment, 100% of the participants knew their blood pressure after the group meetings. Regarding the presence of stress, it decreased from 59.1% to 31.8% among those individuals who have joined the proposed treatment. The data indicated that more women seek health services and the education level and family income levels may promote adherence to treatment. Qualitative analysis of the reasons for nonadherence showed that \"lack of time\" was the main reason that hindered the participation of patients in groups. Overall, the study participants believed that the \"indifference regarding their own health\" was the main factor that interfered with adherence to the groups. The main suggestions to improve patients\' adherence are related to changes in the structure of the groups. Data from this study may have been compromised by the low number of participants in the groups. The CBTG did not favor more behavioral changes than the OG, which indicates that such elaborated intervention may not have a cost-effective relation. Variables that were not controlled may have favored the changes observed in OG. As an alternative to increasing adherence to groups it can be proposed weeklytelephone calls to patients, newsletters, multidisciplinary care team, assisting of the health institution in order to promote the meetings and group name change. However, for the adequacy of cognitive behavioral intervention, further studies are needed with samples composed of a greater number of subjects.

Depression is a common psychopathology that causes affective, behavioral, and cognitive dysfunction and is present across cultural identities. To reduce the dysfunction and treat the symptoms that arise from depression, researchers have created positive psychological interventions (PPIs), which are empirically supported interventions that cause a positive change by targeting a positive variable. In the current study, I created a new PPI, the Best-Self PPI, that draws from elements of optimism, coherence, and character strengths PPIs. Specifically, I hypothesized that the Best-Self PPI would work by positively biasing self-referential processing, which may predict depression and psychological well-being. Participants (n = 133) were undergraduates between the ages of 18 and 32 (M = 19.97, SD = 1.66). Participants were primarily female (n = 85; 63.91%) and White (n = 87; 65.41%) and completed either the Best-Self PPI or wrote about a childhood memory (T1, +0 Days), completed the Self-Referential Encoding Task (T2 +1 Day), and then completed a set of outcome measures (T3, +8 Days). Although the intervention appeared to have no effect on depression, well-being, or affect compared to the control group, I found that: 1) self-referential processing bias partially mediates the relationship between self-critical rumination and depression, 2) self-referential processing bias and state self-esteem fully explain the relationship between self-critical rumination and depression, and 3) self-esteem fully explains the relationship between self-critical rumination and psychological well-being. The results provide new empirical evidence for why some interventions may reduce depression and promote psychological well-being through changes in self-evaluations. I encourage researchers to use the evidence in the current study that modifying self-referential processing and state self-esteem may affect depression and psychological well-being to improve existing interventions and create new interventions to promote psychological well-being above and beyond the elimination of suffering.

The number of women diagnosed as infertile continues to grow every year. The psychological impact of the infertility experience has been said to create distress equivalent to that associated with life-threatening illnesses and has been linked with posttraumatic stress disorder (PTSD). Using shattered assumption and stress-buffering theory, this quantitative causal comparative study explored the potential functional relationship between infertility and PTSD. The majority of the (all-female) participants were 24- to 34-year-old college graduates. A 2 X 3 factorial between-subjects ANOVA examined and compared the cause and effect of the independent variables, fertility treatment and psychological intervention, on the dependent variable, PTSD. A multiple linear regression was conducted to understand PTSD symptomology scores. The results revealed that the type of infertility treatment does not impact PTSD symptomatology in medically diagnosed women. However, the main effect of psychological treatment was significant, as was infertility treatment by psychological treatment interaction. Additionally, the impact of fertility problems on the participant's physical health was the highest ranking predictor, which suggests that stress levels in women receiving infertility treatment are equivalent to those in women with cancer, AIDS, and heart disease, as suggested by other researchers. This study has implications for positive social change, in that it may promote better understanding of the psychological impact of infertility and decreased PTSD symptomatology for medically diagnosed infertile women. It opens the door for future research about the effectiveness of psychological intervention, and provides awareness of possible PTSD susceptibility.

Purpose: The aim of the systematic review was to address whether psychological interventions were able to reduce fatigue severity or the impact of fatigue in individuals with Multiple Sclerosis. The empirical study aimed to evaluate the effectiveness of a CBT based self-help workbook at reducing perceived impact of fatigue in a clinical sample of MS patients. Methods: A systematic search of the literature was carried out between the years 1980 and February 2015 to review whether psychological interventions were effective for fatigue management in Multiple Sclerosis. A randomised controlled trial examined the effectiveness of a CBT-based self-help workbook for the reduction of fatigue impact in MS. Participants were randomly allocated to one of three groups treatment as usual (TAU), pure self-help (PSH) or guided self-help (GSH). Results: Eleven studies were included in the systematic review, which indicated that CBT based interventions aiming to reduce fatigue or depression were most effective at reducing the severity of fatigue. Impact of fatigue can be reduced through mindfulness, CBT, motivational interviewing and to a lesser extent acceptance and commitment therapy. The empirical study did not find any significant differences between groups, however satisfaction with the workbook was high. Conclusions: The review suggests that there is a clear role for psychological interventions in fatigue management in MS, although further robust research into different therapeutic modalities is needed. From the empirical study it appears that the low level CBT-based intervention for fatigue in MS was not effective at reducing the perceived impact of fatigue. This study reflects an inclusive, clinical sample, recruited from a specialist rehabilitation unit, with high levels of multidisciplinary input which may have diluted any potential effect of the workbook. Objectives: The aim of the systematic review was to address whether psychological interventions are able to reduce fatigue severity or the impact of fatigue in individuals with Multiple Sclerosis Data sources: A search was conducted of: Psychinfo, Medline, Embase, CINAHL between 1980 and February 2015. Review methods: All studies were evaluated against a set of quality criteria by author (KG) with a proportion of studies being independently reviewed by author (DP) to ensure reliability of ratings. Results: Eleven studies were included in the review. CBT based interventions with a focus on fatigue management and depression appear to significantly reduce fatigue severity with medium to large effect. Significant reductions in fatigue impact can be found from mindfulness groups, motivational interviewing and CBT. Effect sizes for CBT interventions ranged from negligible to medium. For the mindfulness and motivational interviewing interventions effect sizes were not able to be calculated. The acceptance and commitment therapy intervention did not find a significant reduction in fatigue but found a medium effect for the intervention. Conclusions: There is a clear role for psychological interventions in the reduction of fatigue management but more high quality research needs to be carried out.

Andningsbesvär är en av de vanligaste sökorsakerna på Sveriges akutmottagningar. Det är ett komplext tillstånd som består i både fysiska och psykiska faktorer och kräver såväl farmakologisk som icke-farmakologisk vård. Okunskap inom den icke-farmakologiska vården leder till utebliven behandling, förlängt patientlidande och stor risk för vårdskador. Syftet med detta arbete var att belysa akutsjuksköterskans interventioner för att underlätta och förbättra tillståndet för patienter med andningsbesvär inom akutsjukvård. Studiedesignen som tillämpats var en litteraturöversikt med systematisk metod. Vetenskapliga artiklar som behandlat icke-farmakologisk behandlingsstrategi av all form av andningsbesvär som presentationssymtom eller huvudsymtom inom akutsjukvård har inkluderats. Totalt 15 vetenskapliga artiklar uppfyllde kriterierna för studien och genomgick kvalitetsgranskning samt integrerad analys. Resultaten visade att interventionerna kan delas in i fysiska (aktiv motståndsträning, bukläge och kontrollerad andning), såväl som psykologiska (trygg närvaro, kommunikation och utbildning samt vårdrelation). Motståndsträning kan göras med såväl sammandragna läppar som med apparat med god effekt. Bukläge visade sig effektivt på vakna patienter med omfattande andningsbesvär och syrgasbehov. Riktad och strukturerad kommunikation och patientutbildning ledde inte bara till signifikant förbättrade symtom utan även till att patienterna tolererade interventionerna bättre. Även en god vårdrelation med sjuksköterskan visade på lättare acceptans till givna behandlingar. Den slutsats som drogs var att akutsjuksköterskan har en stor roll i att förbättra tillståndet för patienter med andningsbesvär. Akutsjuksköterska kan ge lättillgängliga, men värdefulla ickefarmakologiska insatser för både de fysiska och psykologiska aspekterna av andningsbesvären. De kan även bidra med kunskap och utbildning för patienterna som resulterar i minskad ångest, förbättrad livskvalitet och minskade sjukhusbesök. De undersökta interventionerna kan troligen med fördel implementeras inom sluten- såväl som öppenvård för att förbättra tillståndet hos patienter med andningsbesvär. / Breathlessness is one of the most frequent causes of visit in Swedish emergency departments. It is a complex condition consisting of both physical and psychological factors, requiring both pharmacological and non-pharmacological treatment approaches. Inexperience in nonpharmacological treatment causes missed treatment, prolonged patient suffering and increased risk of care related injuries. The aim of this study was to illustrate the interventions of the emergency care nurse in facilitating and improving the condition for patients with breathlessness in emergency healthcare. The study design applied was a literature review with a systematic method. Scientific articles covering non-pharmacological treatment approaches of any breathlessness as presenting or main symptom within emergency healthcare was included. 15 articles in total met the criteria for the study and underwent a quality control and integrated analysis. The results indicated that the interventions could be divided into physical (active resistance training, prone position and controlled breathing techniques) and psychological (assuring presence, communication and education and care relationship). Resistance training can be achieved either through pursed lips or specific devices with good results. Prone position proved effective in patients with severe breathlessness requiring oxygen therapy. Aimed and structured communication and patient education did not only result in improved symptoms but enabled the patients to better endure the interventions. A good care relationship too facilitated better acceptance to given treatment. The conclusion drawn was that the emergency care nurse played an immense role in improving the condition of patients presenting with breathlessness. The emergency care nurse could provide easily available, although valuable non-pharmacological contributions to both the physical and psychological aspects of breathlessness. Furthermore, they could contribute with knowledge and education for the patients resulting in relieved anxiety, improved quality of life and reduced hospital visits. The analyzed interventions could presumably be successfully implemented within both inpatient and outpatient care improving conditions for patients suffering from breathlessness.