Cognitive behaviour therapy is a well-documented first-line treatment for mild to moderate depression. Primary healthcare providers have encountered several barriers when trying to provide CBT in an office-based setting and as such, adoption of this evidence-based treatment has been suboptimal. Primary healthcare nurse practitioners (PHC NPs) have an in-depth knowledge of advanced nursing practice, and are responsible for the assessment, diagnosis and management of patients with acute and chronic conditions, such as depression. PHC NPs are also ideally situated in the health care system to deliver CBT to their patients. The objectives of this project were to develop a format for the delivery of brief CBT methods that was feasible in the PHC setting, increase PHC providers’ confidence to implement CBT and ultimately increase their adoption of CBT

Hyperacusis is a type of decreased sound tolerance where the individual has decreased loudness discomfort levels (LDL), normal hearing thresholds and is sensitive to ordinary environmental sounds. Persons with hyperacusis frequently seek help at audiological departments as they are often affected by other audiological problems. Regrettably, there is neither a consensus-based diagnostic procedure nor an evidence-based treatment for hyperacusis. The principal aim of this thesis was to gain knowledge about the clinical condition hyperacusis. The specific aim of Paper I was to compare hyperacusis measurement tools in order to determine the most valid measures for assessing hyperacusis. Items from a constructed clinical interview were compared with the LDL test, the Hyperacusis Questionnaire (HQ) and the Hospital Anxiety and Depression Scale (HADS). LDLs were significantly correlated with the anxiety subscale of the HADS. A third of the 62 investigated patients scored below the previously recommended cut-off for the HQ. The results suggest that HQ and HADS in combination with a clinical interview are useful as part of the assessment procedure in patients with hyperacusis. The aim of Paper II was to further investigate the patient group with respect to individual characteristics, psychiatric morbidity and personality traits. It was shown that anxiety disorders and anxiety-related personality traits were over-represented, which suggests common or cooperating mechanisms. Avoidance behaviour proved to be very common in the patient group, as was being unable to work due to hyperacusis. In Paper III it was investigated in a randomized controlled trial whether Cognitive Behaviour Therapy (CBT) could be helpful for patients with hyperacusis. The effect of CBT for hyperacusis was assessed with measures of LDLs, symptoms of hyperacusis and of anxiety and depression, fear of (re)injury due to exposure to sounds, and quality of life, compared to a waiting list control group. There were significant group effects for a majority of the measures with moderate and strong effect sizes within- and between groups. After assessment the waiting list group was also given CBT, and was then reassessed with similar effects. The results were maintained for 12 months, concluding CBT to be potentially helpful for these patients.

Background Different therapies have different theoretical backgrounds which makes their comparison difficult. Process research seeks to understand what the common mechanisms are at work which contribute to successful outcome. The current study sought to compare the content of two therapies (Cognitive Behaviour Therapy and Interpersonal Therapy) in the treatment of depression and measure any changes that participants reported. Method Taped therapy sessions of IPT and CBT were transcribed and a coding scheme measuring content of therapy was developed. Participants’ accounts of therapeutic change were recorded between the two models of therapy across three time periods using a mixed design. The times periods were divided into: beginning, middle and end of therapy. Quantitative content analysis was used to measure frequency of occurrence of categories in therapy. Qualitative Content Analysis was used to compliment quantitative findings and to compare participants' accounts of change between the beginning and end of therapy. Results The results indicated that differences in content reflected the theoretical background of both therapies. The categories: affect expression, task activation and review, behavioural change and cognitive change, solution generation, discussion of the model, homework and assumptions occurred significantly more in CBT compared to IPT. All other differences between the models were not significant. Differences in content of therapy occurred between the beginning, middle and end of therapy. There was a reduction in symptoms of depression for participants in both groups as measured by the BDI but this reduction was not significant. The discussion related the findings to the current literature and presented ideas for future research.

No description available.

School-aged children with Autism Spectrum Disorder (ASD) experience significant difficulty with peer interaction (Lord & Bishop, 2010), an important aspect of childhood. Unresolved social skills difficulties lead to continued dysfunction in relationships which influence long term success. Research into the most effective strategies has increased but several questions remain. One approach that appears to help school-aged children is Cognitive Behavior Therapy (CBT) which focuses on changing how a person thinks about specific social situations as well as how they behave. This study evaluated the efficacy of a 15-week CBT-based social skills group intervention for boys aged 10-12 years diagnosed with an Autism Spectrum Disorder. Boys with average or better receptive language skills and IQ attended weekly sessions focused on teaching self-monitoring skills, social perception and affective knowledge, conversation skills, taking another persons perspective, social problem-solving, and friendship management skills. Group size varied from four to six participants. The intervention was based on two intervention programs available in the literature and was manualized. Eight of the fifteen participants were waitlisted (Delayed Treatment group) while the remaining participants began 15 sessions of intervention immediately (Immediate Treatment group). A repeated measures ANOVA was used to compare the Delayed Treatment group to the Immediate Treatment group on pre and post measures of social perception, peer interaction, social knowledge, pragmatic language, social responsiveness and general socialization skills. Compared to the Delayed Treatment group, the Immediate Treatment group showed significant improvements after intervention in social perception, peer interaction, and social knowledge. The Delayed Treatment group was also examined on all measures at three time points: prior to the waitlist time, pre-intervention, and post-intervention. Significant improvements only after intervention were present for peer interaction, social knowledge, and a parent report measure of socialization. The implications of these findings are discussed in relation to a model of social information-processing, the executive functioning theory of autism, and how cognitive behaviour therapy techniques may contribute to social skills intervention for children with ASD. The intervention used in this study shows promise but replication with larger samples is needed. / Rehabilitation Science

Thesis (DClinPsychol)--Salomons Centre. BLDSC no. DXN049056.

No description available.

Design-oriented research is an approach to HCI research that frames HCI as a design discipline. One approach to design research is that of critical making, which incorporates critical thinking and practical ‘making’ into the design process whereby ‘making’ is framed as another context of thinking. Cybertherapy is any computationally mediated psychotherapy intervention technique. Contextually, cybertherapy is situated within the field of Psychology and yet it is argued here the area is non-binary by nature and highly relevant to the field of HCI. This study demonstrates the validity of critical making as a design-oriented research approach to the field of cybertherapy design and beyond. Through the immersive demonstration of critical making for cybertherapy innovation design, the design research approach is evaluated and argued to be a beneficial stance towards such non-binary research and development.

Background: The present study was designed to examine prefrontal cortical processes in anxious children that mediate cognitive regulation in response to emotion-eliciting stimuli, and the changes that occur after anxious children participate in a cognitive behavioral therapy treatment program. Methods: Electroencephalographic activity was recorded from clinically anxious children and typically developing children at pre- and post-treatment sessions. Event-related potential components were recorded while children performed a go/no-go task using facial stimuli depicting angry, calm, and happy expressions. Results: At pre-treatment, anxious children had significantly greater posterior P1 and frontal N2 amplitudes than typically developing children, components associated with attention/arousal and cognitive control, respectively. For the anxious group only, there were no differences in neural activation between face (emotion) types or trial (Go vs. No-go) types. Anxious children who did not improve with treatment showed increased cortical activation within the time window of the P1 at pre-treatment relative to comparison and improver children. From pre- to post-treatment, only anxious children who improved with treatment showed increased cortical activation within the time window of the N2. Conclusions: At pre-treatment, anxious children appeared to show increased cortical activation regardless of the emotional content of the stimuli. Anxious children also showed greater medial-frontal activity regardless of task demands and response accuracy. These findings suggest indiscriminate cortical processes that may underlie the hypervigilant regulatory style seen in clinically anxious individuals. Neural activation patterns following treatment suggest that heightened perceptual vigilance, as represented by increased P1 amplitudes for non-improvers, may have prevented these anxious children from learning the treatment strategies, leading to poorer outcomes. Increased cognitive control, as represented by increased N2 amplitudes for improvers, may have enabled these anxious children to implement treatment strategies more effectively, leading to improved treatment outcomes. Hence, P1 activation may serve as a predictor of treatment outcome, while N2 activation may serve as an indicator of treatment-related outcome. These findings point to the cortical processes that maintain maladaptive functioning versus the cortical processes that underlie successful intervention in clinically anxious children.

Background: The present study was designed to examine prefrontal cortical processes in anxious children that mediate cognitive regulation in response to emotion-eliciting stimuli, and the changes that occur after anxious children participate in a cognitive behavioral therapy treatment program. Methods: Electroencephalographic activity was recorded from clinically anxious children and typically developing children at pre- and post-treatment sessions. Event-related potential components were recorded while children performed a go/no-go task using facial stimuli depicting angry, calm, and happy expressions. Results: At pre-treatment, anxious children had significantly greater posterior P1 and frontal N2 amplitudes than typically developing children, components associated with attention/arousal and cognitive control, respectively. For the anxious group only, there were no differences in neural activation between face (emotion) types or trial (Go vs. No-go) types. Anxious children who did not improve with treatment showed increased cortical activation within the time window of the P1 at pre-treatment relative to comparison and improver children. From pre- to post-treatment, only anxious children who improved with treatment showed increased cortical activation within the time window of the N2. Conclusions: At pre-treatment, anxious children appeared to show increased cortical activation regardless of the emotional content of the stimuli. Anxious children also showed greater medial-frontal activity regardless of task demands and response accuracy. These findings suggest indiscriminate cortical processes that may underlie the hypervigilant regulatory style seen in clinically anxious individuals. Neural activation patterns following treatment suggest that heightened perceptual vigilance, as represented by increased P1 amplitudes for non-improvers, may have prevented these anxious children from learning the treatment strategies, leading to poorer outcomes. Increased cognitive control, as represented by increased N2 amplitudes for improvers, may have enabled these anxious children to implement treatment strategies more effectively, leading to improved treatment outcomes. Hence, P1 activation may serve as a predictor of treatment outcome, while N2 activation may serve as an indicator of treatment-related outcome. These findings point to the cortical processes that maintain maladaptive functioning versus the cortical processes that underlie successful intervention in clinically anxious children.