This report follows the process of developing a website for cognitive behavioural therapy using the web development framework Symfony. The purpose was to find out if it is appropriate to use Symfony to ease development and maintenance of a website for therapy. For this to be true the framework had to be able to help create a website that was secure, user-friendly and easy to maintain. The website was developed using several features of the framework including database abstraction, automatic code generation and URL-rewriting. A plugin was used to enhance the security by adding a complete solution for user authentication. The website was tested by using built-in test functionality of the framework that could run test on functions or emulating a browser visiting the website. During the development the framework was tested and evaluated. The worst drawback turned out to be Symfonys steep learning curve, its security solution that only worked if the website was installed correctly and its slow loading time. Except those faults the framework performed well and was easy to use ones the initial learning time was over.

This thesis aimed to explore service users’ priorities and preferences for treatment of psychosis-spectrum difficulties, and experiences of Cognitive Behavioural Therapy (CBT). A literature review (Chapter 1) summarised current understanding and treatment of psychosis. A narrative review of qualitative studies examined treatment priorities and preferences of people with experience of psychosis (Chapter 2), and found that common priorities and preferences included improving social and functional ability, reducing symptoms of psychosis, and individualised, collaborative approaches to care, including alternatives to routine psychiatric treatment. A Delphi study of priorities and preferences for treatment of psychosis was conducted (Chapter 3), and identified priorities that included improving difficult emotional and cognitive states, understanding, coping, and self-esteem, along with treatment preferences such as individualised, collaborative care, greater provision of information, and choice of treatment. Three qualitative studies were conducted. The first (Chapter 4) explored the subjective experiences of young people seen in an Early Detection (ED) for psychosis service. Findings indicated that reluctance to communicate mental health concerns delayed help-seeking for the majority of participants. Disclosure of such concerns to staff in the ED service was considered helpful, especially in the context of CBT. The second qualitative study (Chapter 5) explored subjective experiences of CBT for psychosis. CBT-specific processes were summarised as ‘structured learning’, and the most commonly perceived benefits included improved understanding of psychosis and self, and normalisation. The ‘hard work’ of CBT was also highlighted, especially the disclosure and discussion of difficult life experiences and psychological problems. The third qualitative study (Chapter 6) evaluated experiences of involvement in a randomised trial of CBT for young people at risk of developing psychosis. Having a ‘chance to talk’ about mental health concerns was consistently valued by participants in both the control and the treatment arm of the trial. Valued experiences of CBT included ‘rethinking things’, especially through psychological formulation and re-appraisal of distressing beliefs. Participants also described difficult aspects of CBT, such as personal disclosure, though these were often considered necessary for recovery. Across studies, the importance of individualised, collaborative treatment was highlighted consistently. It is also evident that along with reductions in distressing psychological problems, participants across studies also highly valued social and functional aspects of recovery. The methodological limitations and strengths of these studies, along with implications for clinical practice and future research, are discussed.

Approximately 3% of 15 to 49-year-olds in Rwanda live with HIV, many of whom are young adults. They face multiple stressors including stigma, anxiety, depression, trauma, orphanhood, and poverty. Little is known about the types of coping that facilitate resilience. Cognitive behavioral therapy (CBT) delivered by lay counselors can help decrease mental health symptoms in HIV+ youth, but there is little research on how administering CBT affects HIV+ lay counselors’ own coping and mental health. Participants included 69 Rwandans (ages 21-27, M=10 years of education, 38 female, 26 orphans), comprising four groups: (1) HIV+ lay counselors who administered CBT (Youth Leaders, YL) (n=17) (2) HIV+ peer-parents (PPs; facilitators of non-CBT support groups for HIV+ youth) (n=17); (3) HIV+ community members (HIV+C) (n=18); and (4) HIV- community members (HIV-C) (n=17). Groups were administered self-report measures translated into Kinyarwanda to compare use of (1) coping strategies, including mindfulness, critical consciousness (awareness of social inequities), self-blame, denial, behavioral disengagement, positive reframing, acceptance, active coping, and religious coping, and (2) mental health outcomes of anxiety/depression, self-esteem, and HIV-related stigma. Relations between coping and health outcomes across all groups were investigated. Principal components factor analysis of seven coping strategies revealed two factors: avoidant (self-blame, denial, behavioral disengagement) and approach (positive reframing, acceptance, active coping, religious coping). ANCOVAs, partial correlations, and multiple regressions indicated that YLs and HIV-Cs used significantly less avoidant coping than PPs. YLs reported less behavioral disengagement than PPs, and PPs reported more positive reframing than HIV-Cs. YLs and PPs reported higher self-esteem and less stigma than HIV-Cs. YLs demonstrated lower anxiety/depression than HIV+Cs. No other group differences were significant. Among the entire sample, approach coping and mindfulness related to higher self-esteem, whereas stigma and behavioral disengagement related to lower self-esteem. Stigma and denial related to higher anxiety/depression. Positive reframing and mindfulness related to higher self-esteem only for individuals with low critical consciousness. Results suggest that training lay counselors in CBT may reduce their own maladaptive coping and depression/anxiety. Further, facilitating critical consciousness or mindfulness/reframing and decreasing stigma may help increase self-esteem and reduce anxiety/depression in HIV+ Rwandan young adults.

This systematic review aimed to compare acceptance and commitment therapy (ACT) andcognitive behavioral therapy (CBT) as a treatment for anxiety disorders by means of asystematic review of the existing literature. Studies were identified by searching thedatabases of PsycINFO and PubMed. RCT studies comparing CBT and ACT as treatmentsfor anxiety disorders were included in the study. Seven studies met the inclusions criteria. Allseven studies showed that both CBT and ACT significantly improved psychological health.No statistically significant differences between the two treatment modalities was evident. Theresults suggest that ACT can be used as a viable treatment for individuals suffering fromanxiety disorder. / Denna systematiska litteraturstudie ämnar jämföra Acceptance and commitment therapy (ACT) och Kognitiv beteendeterapi (KBT) för behandling av ångestsyndrom. RCT studier med avsikt att jämföra KBT och ACT som behandlingsintervention identifierades genomsökningar på databaserna PsycINFO och PubMed samt inkluderades i uppsatsen. Artikelsökningen resulterade i 7 studier som matchade inklusionskriterierna. Samtliga studier påvisade att KBT och ACT signifikant förbättrade deltagarnas psykiska hälsa. Dock så återfanns ingen signifikant skillnad i en gruppjämförelse mellan behandlingsinterventionerna. Resultatet från denna systematiska litteraturstudie visar på att det finns en medelhög till högvetenskaplig evidens som pekar på små till inga skillnader mellan ACT och KBT på ångestsyndrom. ACT kan potentiellt användas som en likvärdig alternativ till guldstandarden KBT för behandling av ångestrelaterad problematik.

Cognitive behavioral therapy (CBT) has been shown to be an efficacious treatment for youth anxiety, but we do not have a satisfactory understanding of how CBT achieves its beneficial effects. The present study used a dynamical systems framework to model ecological momentary assessment (EMA) data collected via a cellular telephone and to examine patterns of affective variability over time and across CBT and client-centered therapy (CCT) treatments. Dynamical systems are systems that change over time in response to input from the environment and from itself at an earlier time. Associations between pretreatment variables and patterns of affect at pretreatment and over the course of the treatments were also examined. Results revealed significant decreases in affective variability over the course of treatment for participants in the CBT condition, but not for those in the CCT condition. Several variables (i.e., emotion regulation coping related to anger, depressive symptoms, and affiliative temperament) predicted initial affective variability ratings and changes in affective variability over time. Findings provide initial support for the dynamical systems approach to examining changes that occur during treatment. Implications for the examination of mechanisms of change are discussed. / Psychology

Objective: Test changes in (a) perceived coping efficacy, (b) negative self-statements, and (c) interpretive biases to threat as potential mediators of the relationship between treatment condition and long-term follow-up (average of 6.5 years after intervention). Test moderating effect of age at time of randomization on mediational effect for the 3 putative mediators. Method: Participants included 301 youth who had participated in the Child/Adolescent Multimodal Study (CAMS) and agreed to participate in a naturalistic follow-up study beginning an average of 6.5 years after the end of the acute treatment phase. In the intervention phase, participants (ages 7 to 17) were randomized to cognitive behavioral therapy (CBT), pharmacotherapy (sertraline), combined CBT and sertraline, or pill placebo. Putative mediators were measured at 4 time-points over the course of the intervention phase. The follow-up study consisted of five annual assessment visits that included ratings of current anxiety based on an interview by an independent evaluator who was blind to the randomization of participants. Results: Reductions on a measure of interpretive biases to threat over the course of the combined intervention condition mediated anxiety outcomes at the first follow-up visit. No other significant mediated effects were found for any of the putative mediators. Age did not significantly moderate any mediated effects. Conclusions: The findings suggest that interpretive biases to threat, an often elevated characteristic of anxious youth, may be important to address as part of the treatment of anxiety in order to maintain reductions in anxiety in the years following treatment. The specificity of this finding to the combined CBT and sertraline condition offers support for the synergistic effect of CBT and sertraline when implemented in tandem to reduce anxiety-related cognitive factors with long-term implications. / Psychology

We assessed the relationship between several therapist variables and treatment outcome by examining the predictive power of therapist training/demographic characteristics, therapist competence and treatment integrity, and therapist style, to child outcome in a sample of 279 youth who participated in the Child and Adolescent Anxiety Multimodal Study (CAMS). All youth participated in 14 sessions of CBT (randomly assigned either with medication or without) delivered by trained therapists. Youth across both treatment conditions experienced significant treatment gains with youth in the CBT+MED and CBT only conditions showing greater gains than those in the placebo group. Therapist (a) prior clinical experience and (b) prior anxiety-specific clinical experience were significant predictors of treatment outcome across both parent- and diagnostician- rated measures. Higher levels of prior clinical experience predicted better outcome; higher levels of anxiety-specific experience were less favorable. Therapist treatment integrity, competence, and a collaborative style were also predictive of outcome. Therapists who were more collaborative and empathic, followed the treatment manual, and implemented it in a developmentally appropriate way, had youth with better treatment outcomes. Clinical implications and recommendations for future research are discussed. / Psychology

Functional connectivity measures have become one of the most common biomarkers when correlating brain activity to task and resting states post treatment. Mindfulness based stress reduction (MBSR) and cognitive behavioral therapy (CBT) are two well established forms of therapies treating clinical populations worldwide today. Although there are several studies that have investigated the neural correlations of these therapy forms individually, no systematic review has compared them side by side, to identify potential similarities and differences in functional connectivity. This systematic review attempts to shed light on how functional connectivity is altered during resting state after completed treatment, by reviewing a total of 4 CBT and 4 MBSR studies containing 337 participants. The results point to possible differences in resting state functional connectivity (rsFC) concerning the insula and similarities involving the cingulate cortex and other parts of the DMN. The insula has been suggested to be involved in the creation of motivation and the integration of bodily sensations and feelings. Furthermore, emotional reactions to personally valued behaviors and the retrieving of episodic memories is associated with the function of the cingulate cortex. These changes in rsFC might relate to the theoretical underpinnings of CBT and MBSR. However, more compelling research needs to be conducted before drawing conclusions on how these therapeutic approaches can alter rsFC and improve psychological health among individuals suffering from clinical conditions.

No description available.

Cette thèse a pour but de reconstituer le climat des 100 000 dernières années en Europe de l’ouest. L’étude du climat du passé permet de mieux comprendre la variabilité naturelle du climat sur laquelle se surimpose aujourd’hui le réchauffement climatique d’origine anthropique. Ce sont des molécules fossiles bactériennes dont la structure varie en fonction des conditions environnementales qui ont permis dans cette étude de reconstituer le paléoclimat à partir des sédiments du lac St Front dans le Massif Central. Les indices dérivés de ces molécules révèlent la variabilité climatique à long terme mais également les évènements rapides de changement climatique ainsi qu’une forte action anthropique en surimposition des changements climatiques régionaux sur les 5000 dernières années. Ce travail montre l’importance de la compréhension de l’outil utilisé et du fonctionnement du système naturel dans lequel il est étudié, préalables indispensables à l’obtention d’une séquence climatique crédible / This thesis aims to reconstruct the climate of the last 100,000 years in western Europe. The study of past climate allows to better understand the natural variability of climate on which human-induced global warming is superimposed today. Bacterial fossil molecules whose structure varies according to the environmental conditions were used in this study to reconstruct the paleoclimate from the sediments of lake St Front in the Massif Central. The indices derived from these molecules reveal the long-term climatic variability but also the rapid events of climate change as well as a strong anthropogenic action in superimposition of the regional climatic changes over the last 5000 years. This work shows the importance of understanding the tool used and the functioning of the natural system in which it is studied, essential prerequisites for obtaining a credible climate reconstruction