No description available.

No description available.

No description available.

Insomnia disorder is a debilitating sleep disorder that impacts nearly 10% of Canadian adults. Cognitive Behavioural Therapy for insomnia (CBT-I) is a psychological treatment that targets cognitions and behaviours to improve sleep outcomes. CBT-I has been shown to be an effective treatment for insomnia symptoms; however, little is known about the cognitive and physiological underpinnings of the treatment response. This thesis examines correlates of cognitive, clinical, and biological markers of change across group CBT-I treatment. Specifically, we evaluated: (1) objective and subjective cognitive and psychosocial functioning, (2) discrepancies between objective and subjective measures of sleep, and (3) the relationship between a biological marker of stress and sleep parameters. The first study in this thesis investigated how objective and self-report measures of cognitive functioning, and psychosocial functioning changed across CBT-I. Findings illustrated that changes in self-report cognitive ability and psychosocial functioning were related to the improvements in insomnia symptom severity across treatment. The second study investigated the discrepancy between objectively measured sleep with actigraphy and self-reported sleep variables. Findings showed that the mismatch between objective and subjective sleep parameters decreased early on during the implementation of CBT-I. Additionally, improvement of clinical symptoms was related to a decrease in sleep discrepancies across treatment. In the third study, we examined if there was a relationship between a biological marker of oxidative stress across CBT-I. Results showed that following CBT-I, the biological marker was related to both objective sleep parameters and self-reported symptom improvement. Overall, this thesis demonstrates that in our well-characterized sample of adults with insomnia disorder, group CBT-I was associated with significant post-group changes in cognitive, clinical, and biological factors. This has important implications for the factors that may influence an individual’s treatment response to CBT-I, and thus lead to improvements in tailoring treatments to optimize outcomes for treatment of insomnia disorder. / Dissertation / Doctor of Philosophy (PhD) / Insomnia disorder is a sleep disorder that negatively affects day-to-day-functioning and is associated with poorer mental and health outcomes. Cognitive Behavioural Therapy for insomnia (CBT-I) is an established psychological treatment that focuses on changing sleep behaviours and thinking patterns for improving sleep. This thesis aimed to examine factors that may be related to how CBT-I works to improve sleep with both self-reported and objective measures. We investigated whether cognition (e.g., memory and attention), different measures of sleep, clinical symptoms, and biological factors associated with sleep changed across treatment with CBT-I. Results indicated that several self-reported measures of cognition and sleep improved across CBT-I. Our findings suggest that these variables were related to improvements in sleep following CBT-I. By understanding what factors may be contributing to sleep difficulties and change across CBT-I, we can improve treatment outcomes and better adapt treatment strategies to those struggling with insomnia disorder.

Optimistic explanatory style refers to the way in which individual’s routinely attribute cause to the events in their lives (Ambramson et al., 1978) and can be successfully enhanced through the use of cognitive behavioural therapy (CBT) group-based workshops (Buchanan et al., 1999; Seligman et al., 2007). It has been successfully measured via the self-report Attributional Style Questionnaire (ASQ: Peterson et al., 1982) and has been associated with better performance and lower levels of state anxiety following negative feedback (Martin-Krumm et al., 2003), a lower incidence of stress-related physical illness (Jackson et al., 2002; Buchanan et al., 1999), and lower levels of job-related emotional distress (Hershberger et al., 2000). In 2005, teaching was identified as the second most stressful job undertaken within the UK (Johnson et al., 2005) and two independent reviews of the teacher-stress literature both concluded that further research is required to develop effective stress-management interventions (Kyriacou, 2000; Jarvis, 2002). Furthermore, Jarvis (2002) specifically highlights CBT-based interventions as an avenue which requires research within the teacher-stress domain. In 2005, Bryant (unpublished MSc thesis) highlighted a link between optimistic explanatory style and lower levels of stress in student Physical Education (PE) teachers who were undergoing the practicum element of their one-year postgraduate diploma of education. The current thesis explored the effectiveness of a CBT-based optimism training programme in developing optimism and reducing stress in student and neophyte PE teachers. A longitudinal, repeated-measures, mixed methods design was employed in a naturalistic setting. Using a pre-test, intervention, post-test design, the effects of CBT-based training were shown to enhance optimism and positive affectivity, and reduce cognitive stress in student teachers during the practicum element of their professional training. To strengthen causal links, a dose-response design was used to provide enhanced training to a sub-group of student teachers. Although differences in optimism and perceived cognitive stress were present in the results, they were not significant. Finally, a qualitative interview based follow-up study identified that participants who had received the prolonged CBT-based optimism training exhibited higher levels of optimistic explanatory style, lower levels of stress and more dispositional optimism than participants who received either the initial or no optimism training. Theoretical and practical implications of the current findings and directions for future research are discussed.

A single case study using a narrative approach to therapy was undertaken to examine the process and outcomes of therapy with a case of a 12 year old boy who presented with what could be described as an "anxiety disorder". The results were contrasted with the possible process and outcomes should a cognitive-behavioural approach have been used. This aspect of the Study was necessarily a speculative endeavour. Specific behaviours of the client and significant others were measured pre, post and followup. Positive changes occurred in the following behaviours: absence from school, reports of victimization, positive and negative self statements and statements by significant others.

Bullying is a phenomenon that has serious psychological consequences for victims, including low psychological wellbeing, poor social adjustment, psychological distress, and physical illness. Bullying has become a topic of increasing public concern and the focus of considerable research in Australia over the last decade. Parallel to this rise in interest in bullying research is a rise in research into resilience. Research has indicated that children facing distress will show a range of responses; some will regress, while others tolerate and even thrive in the face of trauma; it is this second group that are described as resilient. It was therefore postulated in this thesis that individuals exposed to bullying may not all succumb to the typical negative effects of being a victim of school bullying. While previous studies have noted the difference in reactions to bullying, this is the first study to investigate whether resilient victims can be identified, and their key psychosocial characteristics profiled. Based on this notion, it was predicted that victims of bullying could be taught a set of skills and attitudes that would build their resilience to the expected effects of bullying. The present research consisted of two studies. Study 1 had two phases. The first phase of Study 1 identified 'resilient victims' of school bullying by assessing participants on their levels of victimisation and their levels of wellbeing using a battery of questionnaires. Participants were assigned to one of four groups: resilient victims, non-resilient victims, healthy non-victims, or poor-health non-victims. From the original sample of 867 students, 111 were categorised into one of the four groups, and completed a second questionnaire package. The second phase examined the relationships between these resilience groups and eight psychosocial correlates of general resilience: individual protective factors, optimism, coping, social support, social skills, self-esteem, self-concept, and emotional intelligence. The results showed that there were significant discriminators between resilient and non-resilient victims, particularly on factors such as optimism, productive coping, self-concept and self-esteem, and so cial variables. The aims of the second study were to 1) develop a cognitive-behavioural group intervention program to teach social skills, perceived social support, self-esteem, optimism, and effective coping skills, to adolescent victims of school bullying; and 2) to investigate the effectiveness of the intervention. Ten year 7 and 8 students who reported negative consequences to high levels of bullying participated in the intervention program. Results indicated that the program had positive effects on the skills and attitudes that the program targeted. The program also appeared to have positive effects on the participants' levels of victimisation and general wellbeing.

Psychological distress is common during pregnancy. The objective of this thesis was to evaluate the effectiveness of antenatal cognitive behavioural based treatments in reducing psychological distress in pregnant women. A systematic review was undertaken of randomised controlled studies utilizing antenatal cognitive behavioural based treatment in reducing anxiety and stress compared to treatment as usual. Eleven papers were identified through a systematic search of databases using predefined criteria comparing intervention groups to treatment as usual in pregnant women with anxiety or stress. The systematic review revealed preliminary evidence for the effectiveness of cognitive behavioural based treatment with several studies noting changes over time in anxiety and stress; however, only a few studies reported intervention effects when compared to control. While the systematic review results suggest that a small number of cognitive behavioural based interventions may be effective in reducing anxiety and stress during pregnancy compared to treatment as usual, confidence in these findings is limited due to methodological limitations such as lack of follow-up, high attrition rates and difficulties with generalisability. The evidence base is currently insufficient and further research which utilises a robust methodology is needed before any reliable conclusions can be drawn. An empirical study was conducted to examine the effectiveness of a brief, single-session stress reduction programme introducing cognitive behavioural techniques aimed at reducing general anxiety, other pregnancy related distress and improving general well-being and pregnancy outcomes. Twenty-nine participants with clinically significant levels of anxiety were recruited to the empirical study from the local maternity hospital. Participants completed measures of general anxiety, pregnancy related anxiety, general well-being and childbirth experience. The control was derived from a historical dataset where 37 participants were matched for baseline anxiety levels. The empirical study demonstrated significant reductions in general anxiety; however, similar findings were also observed in the control group. Significant reductions were observed with pregnancy related anxiety and women also reported their childbirth experience similarly regardless of delivery type. Although our findings were not significant when compared to control, our recruitment design resulted in good return rates following birth. Further studies using sophisticated study design with use of robust control group are required.

Cognitive models of Social anxiety disorder (SAD) routinely discuss the cognitive biases (e.g., attentional, interpretation, memory) that contribute to thinking about oneself negatively before, during, and after social or performance situations. However, these models do not mention other impacts of negative self-evaluations - including negative evaluations of others - even though cognitive case formulations often include beliefs about oneself, others, the future, and the world. Importantly, CBT for SAD does not always lead to optimal subclinical symptoms at the end of treatment; suggesting that our most evidence-based treatments require modifications. Few studies have experimentally examined the presence of negative evaluations of others within social anxiety, which has led to inconsistent understanding about whether people with social anxiety demonstrate negative evaluations of others. These conflicting findings are even more complicated by no study examining if the negative self-evaluations that are commonly reported by people with SAD cause negative other-evaluations, and vice-versa. I outline two studies in this dissertation where I aimed to understand the relationship (or lack thereof) between negative self-evaluations and negative other-evaluations and its cognitive, behavioural, and emotional consequences. In Study 1, I randomly assigned an unselected sample (N = 152) to provide no-, medium-, or high-evaluations of a videotaped anxious person. Participants also took part in a 10- minute conversation task with a confederate posing as another participant. I measured social anxiety symptoms, state anxiety and electrodermal activity across four-time points, and several measures related to self- and other-evaluations. Overall, my manipulation was effective as participants responded to the subsequent other-evaluations in the way I anticipated. Despite this, I found no differences between conditions on most of my primary self-evaluation outcomes. However, I observed that participants in the high-evaluation condition demonstrated poorer memory recall. In Study 2, I randomly assigned an unselected sample (N = 169) to receive positive, ambiguous, or negative false-feedback following a conversation task with a confederate. My manipulation was effective, and again, I found no differences between conditions on my primary other-evaluation outcomes. Participants in the negative-feedback condition reported greater state anger following the negative evaluation for the remainder of the study, compared to participants in the other conditions. Ultimately, evaluations of others were less problematic than I initially expected. Because I did observe cognitive and emotional consequences of this self-other process, these findings could have important implications for further refinement of SAD models and treatments using Cognitive Behavioural Therapy.

The effectiveness of a Group CBT programme for Social Phobia was assessed using 18 participants recruited from a routine practice setting. Therapy was based on CBT techniques as practiced routinely by the clinical practice, and were not modified for the study by factors such as strict exclusion criteria and adherence to rigid manualised treatments. Pre- to post-treatment effect sizes compared favourably with those reported in a meta-analysis (Taylor, 1996). The findings provide support for the accessibility and effectiveness of group CBT techniques for Social Phobia in field settings. While some individuals within the sample experienced dramatic improvement, some remained severely impaired even at post-treatment. The results of Hierarchical Multiple Regressions indicated that lower levels of pre-treatment depression severity, higher levels of attendance, and greater homework compliance, were predictive of more improvement on some, but not all, measures of outcome. Implications for treatment are discussed.