Background: Psychological research has consistently demonstrated the importance of cognitions in the form of thoughts and images on an individual’s wellbeing. Having pain-related verbal cognitions has been shown to lead to poorer outcomes for patients (McCracken & Turk, 2002). Research in other conditions has shown mental images have a more powerful impact on emotion than verbal cognitions (Holmes & Matthews, 2005). To date however, little work has explored the role of mental imagery in adjustment to chronic pain. Methods Fourteen semi-structured interviews were conducted with individuals with chronic pain. Interview transcripts were analysed according to grounded theory methods to construct a substantive theory of the impact spontaneously-invoked images of pain have on functioning. Results Eight participants reported pain-related imagery and three reported mental images associated with related symptoms. In line with previous findings (Gillanders et al., 2012; Gosden, 2008) the frequency and intensity of pain-related images influenced the degree of distress experienced. There was a distinction made between intrusive mental images and visual descriptions or metaphors of pain. The former being conceptualised as a visual cognition and playing a role in the aetiology and maintenance of distress in chronic pain and therefore an adverse impact on functioning. Conclusion Enhancing our understanding of pain related imagery and its impact on functioning could inform the design of interventions in clinical practice. Working systematically with patients’ idiosyncratic pain related images and the beliefs that are associated with them could be a helpful specific target for therapy.

There is agreement among researchers that phonological awareness deficits are one of the main causes of dyslexia. Some researchers support the view that phonological awareness can be improved by teaching reading through a topdown approach (whole word) or a bottom-up approach (grapheme-phoneme); others claim that the combination of these two complementary approaches is more successful. The goal of this research combined reading intervention programme was to enhance the six 'dyslexic students' phonological awareness and to improve their reading in English in the inclusive English as a foreign language classroom. The research studied the effects the reading intervention programme, which systematically combines the two complementary approaches for the same duration of time in each session, had on the six Israeli research 'dyslexic students'. The present study is an inductive action research applying a case study design using qualitative research tools. Data from in-depth pre- and post-intervention interviews is triangulated with the participants' diaries, the practitioner's journal and the documentation of the pre- and post-intervention participants' assessments. Thematic data analysis indicated an improvement in the participants' phonological awareness, reading in English and functioning in the inclusive EFL classroom as a result of the combined reading intervention programme. The contribution to knowledge points to the fact that while a four-month cognitive intervention programme with 'dyslexic students' in Israel, studying English as a foreign language may improve students' cognitive functioning in English, it is insufficient in enabling students to allay their fears regarding the expectations of Israeli society, and their ability to succeed in life. Propositions suggest conducting a further action research study which examines the implementation of an additional emotional intervention to the cognitive one. The development of the emotional intervention will enable evaluation of the effects of a combined programme on 'dyslexic students' in Israel.

Past research indicates a causal relationship between emotional writing and health benefits (Smyth, 1998). At present, little is known about the mechanisms underlying change or if the emotional writing paradigm may be applied to a clinical setting. This present study reviewed current models of trauma and hypothesised three mechanisms of change leading to future health benefits: exposure, devaluation, and benefit-finding. Instructions for the standard writing paradigm were manipulated to isolate and increase engagement with each of these processes. It was hypothesised that if any one of these processes were to underlie health benefits, participants assigned to that condition would obtain more benefit than standard writing participants. Individual differences were also hypothesised to interact with each process to amplify or detract from their influence in leading to future benefit. A total of 201 university students were recruited from Griffith University. Participants were assigned to one of five writing conditions: Control, Standard, Exposure, Devaluation, and Benefit-Finding. Sessions were conducted once a week for three weeks. Physiological and self-report measures were taken before, during and after writing sessions. Follow-up assessments of psychological and physical health were taken at 2 and 6-months post-writing. Essay content analysis suggested that participants wrote in the instructed manner. Participants assigned to each of the groups experienced expected amounts of distress and affect changes. Overall, results failed to replicate the beneficial health effects for the standard emotional writing paradigm. There were no significant physical or psychological benefits for the standard trauma-writing participants in comparison to control. However, a trend in the appropriate direction was noted for illness visits at 6-months. Furthermore, in support of Greenberg and Stone's (1992) findings, standard writing participants who disclosed more severe and personal experiences evidenced significant illness visit reductions in comparison to control. Comparisons between standard and experimental trauma writing groups failed to support hypotheses that any one mechanism was responsible for physical health benefits. Examination of psychological self-report measures indicated exposure participants experienced the greatest reduction on the Impact of Events Scale at two months. However, these participants experienced greater reduction of positive affect and growth for the experience. They also became more anxious, depressed, and stressed at six-months follow-up. Process variables were examined within the exposure condition to explain these findings. Habituation was found to be strongly associated with the alternate outcomes. Individual differences. Including alexithymia, absorption, and negative affect, were also related to outcome. Benefit-finding participants experienced the greatest increase on a measure of post-traumatic growth at two-months and positive affect for the experience, but the finding was significant only in comparison to exposure and devaluation groups. The results of this study failed to identify the process of change, but suggest specific areas for future research. The findings demonstrate the importance of comprehensive health research to avoid blanket statements that suggest a paradigm either does or does not lead to health benefits. The results also support the manipulation of the writing paradigm to examine the role of emotion processing in trauma and health research.

Analgesic products can produce serious side effects. Because potent analgesics are not under medical surveillance but are available to the public without a medical prescription, any attempt to influence consumer behaviour in relation to these products must be via interventions at pharmacist level. The Australian government is now pressuring the pharmacy profession to monitor effectively the use of such non-prescription medication. The aim of this study was to train community pharmacists on brief intervention strategies for use in a pharmacy setting in relation to combination analgesic products. Focus groups showed that participants had concerns about adopting confrontational counselling styles, as they feared this would antagonise consumers leading to loss of patronage without having an impact on consumer behaviour. This concern was later reinforced by consumer interviews, which showed that a significant proportion of respondents thought that the use of non-prescription analgesics was their responsibility. A protocol for the sales of analgesic products was designed with these issues in mind. The transtheoretical model of change (TTM) and motivational interviewing were selected as theoretical frameworks, as they take into account differences among consumers in motivation and in intention to change behaviour and are congruent with pharmacists' concerns. Consumer-centred intervention strategies were tailored to the individual consumer according to his/her readiness to change. This approach was borrowed from the area of smoking secession in which it has been related to positive clinical outcomes. The assumption was made that TTM-based intervention would also be effective in a pharmacy setting in relation to analgesic products. In the initial pilot study, community pharmacists who simply attended a workshop in the cognitive-behavioural intervention strategies failed to incorporate the newly acquired skills to their practice and consequently lost their proficiency. In the subsequent pilot study, when the workshop was followed by ongoing on-site training with immediate feedback and coaching through the use of pseudo-patron visits, the investigator was able to shape community pharmacists' practice behaviour in relation to the monitoring of pharmacist only analgesic products. The methodology was then refined and in the final study trained pharmacists were significantly more likely than control pharmacists and baseline to engage in a number of behaviours related to the study intervention. These included handling the sales of pharmacist only analgesics themselves, identifying inappropriate use, assessing readiness to change, and delivering an intervention according to the consumer's readiness to change. The results suggested that in pharmacy practice post qualifying therapeutic skill transfer is not achieved by workshop presentation alone. Modelling of the desired behaviour involving reinforcement and feedback is necessary.

The purpose of the current study was to develop a manualized treatment for fibromyalgia syndrome (FM) and to examine the efficacy of the treatment in a randomized controlled clinical trial. FM is a chronic musculoskeletal pain disorder characterized by tender points and generalized pain. Depression, chronic fatigue, and sleep disturbance are common. A biopsychosocial model served as a framework for understanding FM by integrating psychological, social, and physical factors. Cognitive-behavioural therapy (CBT), an empirically validated treatment for arthritis, has also been used with FM patients in an attempt to improve pain control, reduce disability, and increase self-efficacy. Overall, the attention/placebo controlled studies employing CBT as a treatment for FM show that it is not superior to a credible attention placebo. The current study attempted to combine the necessary components of CBT with interpersonal therapy to address relational patterns and personality characteristics that can affect ability to cope with chronic pain. One hundred and five women diagnosed with FM by a rheumatologist were randomly assigned to the CBT-interpersonal treatment condition or an attention-control condition. There were 8 treatment groups with a mean of 6-7 participants in each. The treatment consisted of weekly 2-hour sessions over 8 consecutive weeks. Outcome measures included: FM impact, pain, health care utilization, depression, coping, and self-efficacy. An intention-to-treat analysis was conducted. Results showed that the impact of FM symptoms was reduced following treatment compared to the control group and this was statistically and clinically significant, but was not maintained at 3-month follow-up. Significant improvements were also observed in coping strategies, some of which were maintained at follow-up. Importantly, self-efficacy improved significantly following treatment compared to the control group. Self-efficacy beliefs have been related to pain, coping efforts, disability, and psychological functioning. Directions for future research may include a focus on long-term maintenance of treatment gains that may be mediated by improvements in self-efficacy. There is strong evidence that changes in self-efficacy are enduring and affect changes in health behaviours and health status.

The purpose of the current study was to develop a manualized treatment for fibromyalgia syndrome (FM) and to examine the efficacy of the treatment in a randomized controlled clinical trial. FM is a chronic musculoskeletal pain disorder characterized by tender points and generalized pain. Depression, chronic fatigue, and sleep disturbance are common. A biopsychosocial model served as a framework for understanding FM by integrating psychological, social, and physical factors. Cognitive-behavioural therapy (CBT), an empirically validated treatment for arthritis, has also been used with FM patients in an attempt to improve pain control, reduce disability, and increase self-efficacy. Overall, the attention/placebo controlled studies employing CBT as a treatment for FM show that it is not superior to a credible attention placebo. The current study attempted to combine the necessary components of CBT with interpersonal therapy to address relational patterns and personality characteristics that can affect ability to cope with chronic pain. One hundred and five women diagnosed with FM by a rheumatologist were randomly assigned to the CBT-interpersonal treatment condition or an attention-control condition. There were 8 treatment groups with a mean of 6-7 participants in each. The treatment consisted of weekly 2-hour sessions over 8 consecutive weeks. Outcome measures included: FM impact, pain, health care utilization, depression, coping, and self-efficacy. An intention-to-treat analysis was conducted. Results showed that the impact of FM symptoms was reduced following treatment compared to the control group and this was statistically and clinically significant, but was not maintained at 3-month follow-up. Significant improvements were also observed in coping strategies, some of which were maintained at follow-up. Importantly, self-efficacy improved significantly following treatment compared to the control group. Self-efficacy beliefs have been related to pain, coping efforts, disability, and psychological functioning. Directions for future research may include a focus on long-term maintenance of treatment gains that may be mediated by improvements in self-efficacy. There is strong evidence that changes in self-efficacy are enduring and affect changes in health behaviours and health status.

Despite the existence of evidence-based interventions for anxiety disorders, many barriers impede access to effective treatment services (e.g., distance from services, comorbidity). This dissertation aimed to investigate ways to overcome some of these barriers by exploring (1) the efficacy of therapist-supported distance cognitive behavior therapy (CBT) for anxiety disorders in adults, (2) the suitability of anxiety sensitivity (AS; a fear of arousal-related physiological sensations) as a target for transdiagnostic treatment, and (3) the efficacy of a distance CBT intervention for reducing high AS and its associated mental health and substance use symptoms. In Study 1, a systematic review showed that therapist-supported distance CBT was more efficacious than a waiting list and as efficacious as face-to-face CBT in reducing anxiety symptoms, increasing the likelihood of diagnostic remission, and improving quality of life. In Study 2, AS was associated with panic, posttraumatic stress, social phobia, and depressive symptoms. Of its lower order subscales, physical concerns predicted unique variance in panic, cognitive concerns predicted unique variance in depressive symptoms, and social phobia was predicted by social concerns. Together, Studies 1 and 2 suggest that distance CBT for anxiety is efficacious and that AS may be a suitable target for transdiagnostic interventions. As such, Studies 3 and 4 report on a randomized controlled trial investigating the efficacy and transdiagnostic implications of a telephone-delivered CBT intervention for high AS. The treatment significantly reduced AS relative to a waiting list and led to significant reductions in panic, posttraumatic stress, and social phobia symptoms (though not generalized anxiety or depressive symptoms). Treatment-related reductions in AS mediated these anxiety symptom changes. Participants in the treatment, vs. control, group also showed a significantly greater reduction in number of mental health diagnoses and in functional disability. Treatment also significantly reduced coping-with-anxiety drinking motives and physical alcohol-related problems for the treatment but not waiting list group. Reductions in AS mediated changes in coping-with-anxiety motives, while coping-with-anxiety motives mediated changes in physical alcohol-related problems. Taken together, findings from this dissertation provide evidence that distance-based and transdiagnostic AS-focused interventions may be two important and efficacious ways to overcome several barriers to anxiety treatment.

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.

Analgesic products can produce serious side effects. Because potent analgesics are not under medical surveillance but are available to the public without a medical prescription, any attempt to influence consumer behaviour in relation to these products must be via interventions at pharmacist level. The Australian government is now pressuring the pharmacy profession to monitor effectively the use of such non-prescription medication. The aim of this study was to train community pharmacists on brief intervention strategies for use in a pharmacy setting in relation to combination analgesic products. Focus groups showed that participants had concerns about adopting confrontational counselling styles, as they feared this would antagonise consumers leading to loss of patronage without having an impact on consumer behaviour. This concern was later reinforced by consumer interviews, which showed that a significant proportion of respondents thought that the use of non-prescription analgesics was their responsibility. A protocol for the sales of analgesic products was designed with these issues in mind. The transtheoretical model of change (TTM) and motivational interviewing were selected as theoretical frameworks, as they take into account differences among consumers in motivation and in intention to change behaviour and are congruent with pharmacists' concerns. Consumer-centred intervention strategies were tailored to the individual consumer according to his/her readiness to change. This approach was borrowed from the area of smoking secession in which it has been related to positive clinical outcomes. The assumption was made that TTM-based intervention would also be effective in a pharmacy setting in relation to analgesic products. In the initial pilot study, community pharmacists who simply attended a workshop in the cognitive-behavioural intervention strategies failed to incorporate the newly acquired skills to their practice and consequently lost their proficiency. In the subsequent pilot study, when the workshop was followed by ongoing on-site training with immediate feedback and coaching through the use of pseudo-patron visits, the investigator was able to shape community pharmacists' practice behaviour in relation to the monitoring of pharmacist only analgesic products. The methodology was then refined and in the final study trained pharmacists were significantly more likely than control pharmacists and baseline to engage in a number of behaviours related to the study intervention. These included handling the sales of pharmacist only analgesics themselves, identifying inappropriate use, assessing readiness to change, and delivering an intervention according to the consumer's readiness to change. The results suggested that in pharmacy practice post qualifying therapeutic skill transfer is not achieved by workshop presentation alone. Modelling of the desired behaviour involving reinforcement and feedback is necessary.

People who are diagnosed with ‘severe mental illness’ experience some of the most extreme and pervasive prejudice of all groups in Western society. How can this still be so? Although the term ‘mental illness’ is typically reserved for the most ‘serious’ of ‘cases’, psychiatry’s medical model is expanding into increasingly everyday realms. Thus, in concert with efforts to reduce social stigma, ‘mental illness’ is becoming ‘normal’. Nevertheless, ‘abnormality’ is a requirement of biopsychiatry and its offshoots; professionals require some ‘thing’ to remedy. How do ‘clinical’ professionals manage these tensions? And what alternatives are there to the pathologizing of such phenomena? Such concerns are considered in relation to my main thesis question: How do professionals represent ‘schizophrenia’ and hearing voices in theoretical texts, and how is that played out in the minutiae of therapy practices? Drawing on discourse analysis and conversation analysis, I critique professional categorizations of what are typically known as ‘schizophrenia’, ‘mental illness’, ‘patients’, ‘clients’, and ‘therapists’. My case in point is the experience of hearing voices - pathologically known as ‘auditory hallucinations’. ‘Delusional’ beliefs are also considered. In Part 1, accounts of voices as supernatural or ordinary phenomena, or as a ‘symptom’ of ‘severe mental illness’, are considered. Mainstream psychiatric and psychological texts are analyzed and critical alternatives are summarized. In Part 2, a selection of studies of interactions involving ‘severe mental illness’ are reviewed and ongoing analytic/methodological debates are discussed. A cognitivebehavioural therapy group for hearing distressing voices then provides data from ‘clinical’ talk-in-interaction for analysis. I focus on negotiations of ‘reality’ (the ordinary versus the psychiatric) and on what I take to be sanist prejudice-in-action. Part 3 relates findings from Part 2 to the context and findings of Part 1. There is also discussion of the positive implications of a more social and dialogical approach to understanding and otherwise dealing with the phenomena in question; for voice hearers, ‘schizophrenics’, and society at large.