Purpose: The purpose of this study was to determine whether levels of physical activity in people with chronic pain change after participating in a Chronic Pain Management Program (CPMP) at Groote Schuur Hospital (GSH). Methods: A pre-experimental pre-test, post-test study was conducted, consisting of 14 men and women suffering from chronic pain who were referred to a Chronic Pain Management Program (CPMP) from the Chronic Pain Management Clinic at GSH in Cape Town, South Africa. Subjective and objective measuring tools, including pedometry, were used to collect data and non-parametric analysis was conducted to analyse data. Results: 14 participants met the Inclusion criteria. Levels of physical activity changed markedly, but not significantly. Objectively-tested and self-reported physical activity levels changed significantly among participants who took part in a CPMP. Significant improvements in Pain Severity Scores and Pain Interference Scores occurred after the CPMP and there was convergent validity between self-reported and objectively-tested levels of physical activity in those suffering from chronic pain after the CPMP. Conclusion: The Chronic Pain Management Program at Groote Schuur Hospital in Cape Town has shown to improve function and physical activity of those patients living with chronic pain who take part in the CPMP, with function improving significantly, and physical activity nearly doubling in the group being tested who took part in the 5-week long program. The CPMP at GSH should be seen as the beginning of a greater movement towards increasing physical activity in the chronic pain sphere. Research in more public healthcare facilities is needed to increase knowledge around education, pacing and implementation strategies across South Africa.

Comment les thérapies cognitives et comportementales, techniques issues du laboratoire, provenant d’Afrique du Sud et des États-Unis, ont-elle été importées en France comme assemblage thérapeutique ? À partir d’une enquête ethnographique, cette recherche retrace la trajectoire des thérapies cognitives et comportementales et la façon dont celles-ci se sont progressivement diffusées dans le champ de santé mentale, pour s’inscrire dans le paysage contemporain de l’intervention psychothérapeutique. Elle éclaire les conditions historiques et sociales dans lesquelles les thérapies cognitives et comportementales ont progressivement émergé comme outil thérapeutique pour les patients, les acteurs de la santé publique, les importateurs historiques, les médecins et les psychologues. Alliant observations (de consultations individuelles et de thérapies de groupes), entretiens ethnographiques (auprès d’importateurs « pionniers », de patients, de psychiatres, de psychologues, d’acteurs de la santé publique et d’acteurs associatifs), et collecte d’archives (scientifiques, institutionnelles, historiques), la démarche combinatoire de cette enquête a permis de recueillir le point de vue d’acteurs variés et d’éclairer les tensions qui surgissent entre des mondes de soin hétérogènes, aux conceptions de la pratique et de l’humain parfois antagonistes.À cette entreprise de diffusion, menée par des professionnels et des intermédiaires culturels, ont répondu bientôt des patients, entrepreneurs de leur trouble. À la rencontre des mouvements d’émancipation de ces patients et de leurs revendications en matière d’autonomie, qui associent de nouvelles compétences à la figure émergente du patient, les TCC proposent un modèle aisé à prendre en main et libre d’usage : il semble offrir de multiples prises pour l’action à destination de patients désireux d’outils pratiques rapides à utiliser, whatever works. / How did cognitive and behavioral therapy, coming from both South Africa and United States, have traveled to France as a therapeutic assemblage? Based on a field study, this research aims to trace the trajectory of cognitive and behavioral therapy and the way they progressively broadcast through the mental health field to be part of the contemporary mental health scene.My inquiry sheds light on the historical and social conditions in which CBT emerged as a therapeutic tool for patients, public health policy actors, historical importers, doctors and psychologists. Dealing with ethnographic observations (individual consultations and groups), interviews (with historical pioneers, both psychiatrists and psychologists from hospital and private practice, patients, public health policy and community-based organizations workers) collecting historical, scientific, institutional archives, the plural approach of the inquiry aims to gather various actors stakeholder’s perspectives in order to enlight tensions brought in heterogeneous worlds of care, where several conceptions of practice, human being’s antagonist ontologies cohabitate. Researchers, experimenters, translators, doctors, psychologists, public health policy professionals all contributed to translate and make cognitive and behavioral therapy intelligible in France. They came to participate, in some various ways, to promote them in the field of French psychotherapy.To this broadcasting collective enterprise, leaded by professionals and culture-brokers, patients soon responded, also becoming the stakeholders who contributed to mediate CBT. Crossing values such as self- reliance movements associated with new emerging patient-driven figure, CBT seems to offer a comfortable grip, easy to handle and to fit-in as a tool for everyday life. CBT stakeholders, driven by a pragmatist impetus in their collective enterprise, seem to be unified by the willing to find ways – whatever works – which can be used as resources for action, paying attention to singularity of objects in action to help patients .

Because extreme weather events are relatively common in the Southeastern U.S., and the current treatments for phobias can be time-consuming and costly, it is important to find an effective early intervention program for those individuals who are at risk of developing severe weather phobia (SWP). Participants (N = 12) were randomly assigned to the experimental or modified control condition. Participants from both conditions participated in the therapist-aided self-help early intervention program. However, the modified control condition completed posttest measures approximately 3 weeks after baseline, before beginning the intervention. The intervention was most effective at reducing subjective fear and avoidance behavior related to severe weather events. Additionally, participants’ subjective views of their fears were no longer categorized as excessive, or unreasonable, nor did they avoid or endure severe weather with intense anxiety or distress after the three-week early intervention.

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Background: Digital mental health interventions (DMHI) hold promise for addressing mental health needs on a large scale. Among these interventions, Internet-based Cognitive Behavioral Therapy (iCBT) has proven effective in tackling various mental health issues. However, the effectiveness of these interventions is hindered by a lack of sustained user engagement. A lack of knowledge on what specific iCBT content is the most engaging and the absence of a standardized approach to measure engagement hampers progress in this area. Aim: To conduct an evaluation of engagement based on usage data to learn which and what kind of iCBT content from a self-tailored blended iCBT application is the most engaging in order to inform strategies and enhance efforts to improve the overall effectiveness of the intervention. Methods: An observational, quantitative study of real-world usage data was conducted to evaluate engagement levels across various iCBT modules available in the app. Four engagement metrics were obtained from the users´ usage data: Adherence Rate, Rate of Max. Progress, Return Rate, and Average Time Spent to create rank and compare engagement levels across the iCBT modules. Results: The results included data from the 1st of January to the 30th of April of 2023 for 138 iCBT modules. The mean engagement score for all iCBT modules was 56.41±9.85, with a median of 57.30 and a range of 67.97. The most engaging iCBT modules were “Thought traps and questioning thoughts” (81.4), “A model for social anxiety” (80.5), and “Safety Behaviors” (78.1). The most engaging iCBT module classifications were “Social phobia” (92.10), “Depressive disorder” (80.70), and “Post-traumatic stress disorder” (80.40). Conclusions: Based on real-world usage data of patients, it was possible to determine the extent to which users engaged with different iCBT modules comprehensively. The findings shed light on the strengths and weaknesses of the iCBT modules regarding engagement levels. The quantitative evaluation of “in the wild” patient usage data proved useful for assessing engagement levels of specific content within the app.

I Egen Hög Person är ett möte mellan illustration och ångesthantering; hur man på ett säkert sätt kan närma sig sina känslor medan man samtidigt håller en välbehövlig distans. Arbetet är resultatet av en idé som vuxit fram ur tanken att inte låta våra känslor begränsas till den mentala tillvaron; i det här examensar-betet får de ta plats i den fysiska världen. Frågeställningarna “Hur kan jag med hjälp av grafisk design skapa ett visuellt och taktilt verktyg för ångesthantering riktat mot vuxna?” och “Hur kan jag med hjälp av illustration humanisera och förkroppsli-ga känslorna som kommer med ångest?” undersöker hur man kan möjliggöra ett mer förstående och hälsosamt förhållande till sig själv och det man känner. För vad är det som händer när vi helt plötsligt sätter ett ansikte på vår ångest? Genom enkäter, workshops, bildanalys, mindmaps, moodboards, skisser och designsprint utforskas ångest och hur den bäst kan förmedlas visuellt. / I Egen Hög Person is a combination of illustration and anxiety management; how to safely approach your emotions while simultaneously maintaining a much-needed distance. It’s the result of an idea that came out of the thought of   not letting our emotions be limited to the mental state; in this thesis, they take a step out into the physical world. The questions “How can I use graphic design to create a visual and tactile tool for anxiety management aimed at adults?” and “With the help of illustration, how can I humanize and embody the emotions that come with anxiety?” explores how one can enable a more understanding and healthy rela-tionship to oneself and what one feels. Because what is it really that happens when we suddenly put a face to our anxiety? Through surveys, workshops, image analysis, mind maps, mood boards, sketches and design sprints, the subject of anxiety is explored, and how it is best conveyed visually.

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