Thesis (Ph. D.)--Victoria University of Technology, 2005. / Includes bibliographical references.

This research assessed the clinical utility of an augmented Short Form 36 (SF-36) instrument, namely, the Treatment Outcomes in Pain Survey (TOPS) in an Australian chronic pain population. A pretest-posttest quasi-experimental design was adopted. Intervention comprised patients attending the Comprehensive Outpatient Pain Education and Rehabilitation (COPER) program, which is an intensive, inter-disciplinary, three-week, cognitive behaviour therapy based outpatient chronic pain treatment. Statistical analysis comprised pre-treatment and post-treatment means and standard deviations, effect sizes, paired samples t-tests, and Cronbach's alpha. Australian norms for 86 (42 males and 44 females) patients were presented for initial values and treatment-related improvements. Internal consistency reliability coefficients (Cronbach's alpha) demonstrated that the TOPS was a reliable measure of group outcomes. Two dimensions, Life control and Total Pain Experience, were sensitive enough to follow individual patients. All SF-36 domains and ten of the fourteen TOPS domains improved significantly following treatment. Despite the limitations to this research, the results are consistent with previous findings (Fishbain, 2000; Morley, Eccleston, & Williams, 1999) that cognitive behavioural, multidisciplinary pain treatment is associated with improvement in a number of biopsychosocial aspects of chronic pain as measured by the TOPS. These include Pain Symptom, Lower Body Functional Limitations, Perceived Family/Social Disability, Objective Family/Social Disability, Total Pain Experience, Life Control, Solicitous Responses, Upper Body Functional Limitations, Fear Avoidance, Patient Satisfaction with Outcomes, as well as general health and wellbeing aspects measured by the SF-36 component of the TOPS. Limitations of the study and potential future research are discussed. / Thesis (MPsy(Clinical))--University of South Australia, 2005.

The aims of the present study were threefold: firstly, to further the understanding of the psychological response to heart disease; secondly, to consider the differences in the ways in which doctors and patients perceive heart disease; and thirdly, to consider how the doctor, patient, and condition interact within the illness process over a period of time. The nature of coronary heart disease (CHD) was considered, and the influence of psychological variables in CHD was discussed. Psychological factors in illness were examined, with particular emphasis on health beliefs, illness behaviour, compliance, and the doctor-patient relationship. Conclusions were drawn that to understand the illness process in heart disease, doctor, patient, and condition must be considered together, in an interactional framework. Two pilot studies were performed. The first study found that heart patients' health beliefs differed from a normal population. The second pilot study, with raised cholesterol patients, suggested the existence of five major components of the illness process: illness perception, illness effect, health orientation, doctor-patient relationship, and compliance. The main study considered groups of heart and cholesterol patients (experimental groups) and a group of general outpatients (control group), over a four-to-six month period. Patients were interviewed and given a questionnaire concerning their feelings regarding their condition. Doctors and judges also completed similar questionnaires. Results indicate that cholesterol patients rate superior coping to the other groups, and both experimental groups were higher than controls with regard to patient understanding, responsibility for health, and communication with doctor. Findings suggests alterations should be made in current conceptualization of illness behaviour. and that patient and doctor assessment of condition severity were found to be unrelated to illness behaviour. Doctor and patient perception of patient behaviour were found to be discrepant. Modifications in the treatment of heart and cholesterol patients are suggested.

This research began as an examination of the problem solving strategies of individuals who believe they can control reinforcements they recelve (internals) and those who believe that outside forces control reinforcements (externals) under different conditions of skill and chance. This developed into a study of the cognitive functioning of internals and externals in concept formation tasks. Internal and external persons were identified using the internal-external locus of control scale developed by J.B. Rotter and his colleagues. Three studies were conducted uSlng different tasks and groups of Subjects. The subjects of the first study were required to find a principle relating one of two response words to a list of five stimulus words. There were fifty trials using different sets of words. Three groups of subjects were used, each made up of internals and externals. The group under the skill condition was instructed that their performance depended primarily on their own skill; the group under the chance 1 condition (quasi chance) was instructed that their performance on the task would probably be no better than chance due to the extreme difficulty of the task; and the group under chance 2 (pure chance) were told that their performance on the task was totally controlled by chance as the arrangement of the words was purely arbitrary. It was expected that internals would perform better than externals under the skill condition while externals would perform better than internals under chance 2. Subjects' perception of, and reactions to, the task were measured by a post-task questionnaire. The results did not uphold the predictions. Externals, relative to internals, utilised, produced and changed significantly more solution hypotheses while working on the task. The two groups did not differ in the number of correct answers and both of them were unsuccessful in deciphering the principle. In terms of subjects' reactions to the task, it was found that the internals reacted differently to the skill and chance 2 conditions, while externals were stable across these conditions. Moreover, subjects construed the chance 1 condition as resembling a skill condition. The different ways ln which internals and externals handled their solution hypotheses was further investigated in the second study. Two groups, one of internals and one of externals, were asked to scan a list of characteristics describing an object, and then to scan another list containing objects, one of which was best described by the characteristics. The two lists were presented separately to the subjects in order to discover whether subjects needed to switchback between the two lists while attempting to identify the correct object. The subjects' reaction times in studying the characteristics (preparation time) and in naming the appropriate objects (solution time) were recorded. The subjects' perception of and reactions to the task were measured by a post-task questionnaire. The results strongly supported the predictions: the internals preparation and solution times were significantly faster than those of the externals who also used more switchbacks than internals. Moreover, both groups performed equally well on the task (in terms of naming the appropriate objects). Analysis of the subjects' perception of the task indicated that internals perceived the task to be more skill controlled than externals. The third study was conducted to clarify some methodological problems associated with the first study and to further investigate the problem solving behaviour of internals and externals. Subjects were presented with a series of sets one per trial for twenty four trials, each of which consisted of two letters and two numbers. Certain sets were constructed using a common principle and subjects were required to identify the principle. Subjects perception of, and reactions to the experiment were measured by a post task questionnaire. The results showed that more externals were successful at finding the principle than internals. Externals used less trials per solution hypothesis and guessed on more trials than internals. Both groups had similar numbers of correct answers. More internals than externals, however, employed complex solution hypotheses. It was also found that the internals confidence in finding the principle before commencing the task was higher than that of the externals. Taken in conjunction the three studies indicate that finding the solution per se to the tasks did not differentiate internals from externals as readily as their different approaches to the tasks. The internals were more cautious and systematic in handling their solution hypotheses and processed information more efficiently and thoroughly. The externals, on the other hand, adopted a "butterfly" approach to testing their solution hypotheses, readily switching between them and returning to previously rejected hypotheses. They were less able than internals to process simultaneously two aspects of the task. It was concluded that the different problem solving behaviours of internals and externals resemble distinctive cognitive styles. Whether these cognitive styles are effective in terms of identifying the solution to a problem seems to depend largely on three main factors: the skill element of the task, the type of task, and the level of task difficulty.

Thesis (MPsy(Clinical))--University of South Australia, 2001.

Thesis (Ph. D.)--University of Missouri-Columbia, 2002. / Typescript. Vita. Includes bibliographical references (leaves 108-115). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 2002. / Typescript. Vita. Includes bibliographical references (leaves 108-115). Also available on the Internet.

Thesis (Ph.D.)--Memorial University of Newfoundland, 2000. / Bibliography: leaves 257-295.

Aim: This study aims to provide a qualitative understanding of the health-seeking behaviour of adult in-patients with multidrug-resistant tuberculosis in a public health sector setting. Methodology: A qualitative methodological approach was used in this study since it allows for an in-depth investigation and understanding of the health-seeking behaviour of MDR-TB patients. The study is seated in the arena of ethnographic inquiry, since ethnography investigates human behaviour as it is understood and experienced within a particular subtext and given reality, as it is created by the people of concern. In this regard, ethnography deals with developing an understanding of shared systems of meaning in societies that share similar social and cultural characteristics and can be applied to the study of any isolated group who have something in common. A total of four (4) 90-minute focus groups discussions were conducted with adult MDR-TB in-patients, comprising two male and two female groups. The data transcripts were analysed thematically in order to identify commonalties and variances among the responses of participants. Comparative analyses were made across the variable gender. Findings: The findings are discussed within the context of relevant empirical literature and theory, including the Health Belief Model, Health Locus of Control Theory and the Theory of Reasoned Action. These findings were constructed temporally in terms of pre-admission, admission and post-admission behaviour. What has emerged in this study is that health-seeking behaviours that are traditionally defined as "poor patient adherence" and " treatment delay" are mediated by a number of variables operating in both institutional and community contexts. At a community level, large-scale community ignorance and lack of knowledge of MDR-TB, social stigma, conflation of TB and MDR-TB and the lack of recognition of symptoms coalesce to produce poor treatment adherence and treatment delays. This situation is exacerbated by cultural practices that result in patients using dual healing systems and multiple remedies. The net result for TB sufferers is the advent of MDR-TB. At an institutional level a hierarchical biomedical bureaucracy conspires to produce a hostile, disempowering and inhumane experience for MDR-TB in-patients, which further compromises adherence behaviour and positive health actions. Recommendations: Within the context of a number of systemic recommendations, a range of practical patient-centered and staff centered interventions are suggested, followed by recommendations for future research and an appraisal of the limitations of this study. / Thesis (M.A.)-University of Durban-Westville, 2000.

In the health psychology literature there has been a proliferation of research linking forms of self-attention to psychological distress, especially to depression. The broad conclusion that self-attention is harmful, however, challenges the central premise of self-regulation theory - a theory detailing the role of self-attention as the engine of an adaptive regulating system that enables people to achieve their goals. In an attempt to reconcile these perspectives, I conducted two studies to distinguish the forms and states of self-attention that serve an adaptive self-regulation function from those that create a vulnerability to depression. Both studies included a pretest and a daily diary component. Participants were pretested on trait self-attention, trait negative affectivity (Study 1), depression (Study 2), and a goal inventory. Study 2 included a follow-up session where participants again completed the depression inventory. For the diary component, participants described and rated the most negative event they experienced during the rating period (twice daily for 2 weeks in Study 1; once daily for 4 weeks in Study 2). Diary self-report measures of self-attention included: level of rumination (Study 1), initial self-analysis (Study 2), and multi-day-protracted attention (Study 2). After the diaries were completed, participants' event descriptions were coded for goal-relevance and level of self-focused attention (SFA). Consistent with self-regulation theory, participants' goal-related events elicited stronger self-attentional responses (higher levels of SFA, rumination, initial self-analysis, and protracted attention) than did their goal-unrelated events. These within-person effects were not moderated by the pretest measures, nor did they predict levels of emotional distress. Thus, in daily life it appears to be typical and not harmful for people to respond to goal-setbacks by engaging in elevated levels of introspection, self-analysis, and even negative, symptom-focused rumination. With respect to individual differences, people higher in pretest rumination and in chronic daily rumination, initial self-analysis and protracted attention experienced higher levels of emotional distress. Chronic daily levels of initial self-analysis and rumination predicted emotional distress after controlling for pretest levels of distress. Thus, self-attention appears to create a vulnerability to depression only when people have chronic difficulty containing initial levels of self-analysis and rumination in response to negative events.