<p>The purpose of this thesis was to develop novel ways to study tinnitus, to investigate the course of tinnitus, and to study the effects of cognitive-behaviour therapy on tinnitus related distress. Data from 377 tinnitus patients were collected.</p><p>A group of 216 patients completed audiological measures and were assessed in a structured interview. The Klockhoff and Lindblom's grading system was used and its inter-rater reliability assessed in a subsample showing a high degree of correspondence. A discriminant analysis showed that a substantial proportion of patients could be correctly classified into grade II or III, by measures of pitch, minimal masking level of tinnitus, avoidance of situations because of tinnitus, and tolerance in relation to onset.</p><p>Using tests developed in cognitive psychology, it was found that tinnitus patients had impaired performance. There was no evidence for an attentional bias towards tinnitus related words using a computerized emotional Stroop task, but masking sounds of an "on-and-off" character were more disruptive than constant masking when patients performed the digit-symbol test. It is suggested that tinnitus distress may be increased by the 'changing-state' character of the tinnitus signal, or alternatively by intermittent masking sounds.</p><p>In a case-study a patient received an i.v. injection of lidocaine while Positron Emission Tomograpy was conducted. The brain activity associated with tinnitus included the left primary, secondary and integrative auditory brain areas, as well as right paralimbic areas related to negative feelings. The precuneus (Brodmann area 7) might be a brain area involved in the aversiveness associated with tinnitus.</p><p>Using a tinnitus questionnaire as the dependent measure it was found that tinnitus maskability at admission predicted distress at follow-up for an average of five years following admission. Some improvement in tinnitus occurred over time, but this was more evident in patients who had received a cognitive-behavioural treatment program.</p><p>The effect of an Internet based cognitive-behavioural self-help treatment program for tinnitus was investigated showing a high dropout rate, but with positive results in that the treated patients improved.</p>

The purpose of this thesis was to develop novel ways to study tinnitus, to investigate the course of tinnitus, and to study the effects of cognitive-behaviour therapy on tinnitus related distress. Data from 377 tinnitus patients were collected. A group of 216 patients completed audiological measures and were assessed in a structured interview. The Klockhoff and Lindblom's grading system was used and its inter-rater reliability assessed in a subsample showing a high degree of correspondence. A discriminant analysis showed that a substantial proportion of patients could be correctly classified into grade II or III, by measures of pitch, minimal masking level of tinnitus, avoidance of situations because of tinnitus, and tolerance in relation to onset. Using tests developed in cognitive psychology, it was found that tinnitus patients had impaired performance. There was no evidence for an attentional bias towards tinnitus related words using a computerized emotional Stroop task, but masking sounds of an "on-and-off" character were more disruptive than constant masking when patients performed the digit-symbol test. It is suggested that tinnitus distress may be increased by the 'changing-state' character of the tinnitus signal, or alternatively by intermittent masking sounds. In a case-study a patient received an i.v. injection of lidocaine while Positron Emission Tomograpy was conducted. The brain activity associated with tinnitus included the left primary, secondary and integrative auditory brain areas, as well as right paralimbic areas related to negative feelings. The precuneus (Brodmann area 7) might be a brain area involved in the aversiveness associated with tinnitus. Using a tinnitus questionnaire as the dependent measure it was found that tinnitus maskability at admission predicted distress at follow-up for an average of five years following admission. Some improvement in tinnitus occurred over time, but this was more evident in patients who had received a cognitive-behavioural treatment program. The effect of an Internet based cognitive-behavioural self-help treatment program for tinnitus was investigated showing a high dropout rate, but with positive results in that the treated patients improved.

Priestley's One-to-One CBT programme is intended to reduce criminal recidivism. Data were collected from 1484 programme rounds in Sweden. 776 of these cases contained the data necessary for this study and were used in the analyses. The data included pre- and postprogramme test scores on areas addressed in the programme. The purpose of this study was to examine whether the tests or background data of participants have predictive properties for dropout and recidivism and whether test scores differ between sub-groups. To do this, t-tests and logistic regression analyses were performed. There were significant improvements on all scores post-programme. Only age predicted completion, with older participants being more likely to complete the program. Several variables were found to have predictive properties for recidivism. The most potent predictor for nonrecidivism was programme completion. The study finds a relation between some of the tests measuring psychological change, and recidivism. This partly supports the theory behind the programme.

The aims of the present thesis were: * To investigate how women patients with borderline personality disorder (BPD) perceive their suffering, quality of life and encounter with psychiatric care (paper 11 and III). * To describe BPD patients' and psychiatric professionals' perceptions of receiving and giving dialectical behavioural therapy, DBT (paper I). * To investigate how starting treatment of BPD patients with DBT affected the psychiatric professionals' experience of occupational stress and professional burnout (paper IV) Due to the different types of research questions the thesis deal with, it uses a mix of qualitative and quantitative research methods. In two of the studies (11 and 111) the main methods were qualitative. Data from free format questionnaires, individual- as well as group interviews and biographical texts, were analysed with content analysis or a hermeneutic approach. In study Ill the methods were quantitative. A summated rating scale measuring healthrelated quality-of-life (HRQOL) was analysed with descriptive and inferential statistics. In study IV quantitative and qualitative methods were combined. Two burnout inventories were analysed with descriptive and inferential statistics, and data from free format questionnaires and group interviews were analysed with qualitative content analysis. The main findings were that BPD patients suffer to an extent that is often unendurable, leading to deliberate self-harm (DSH) and suicide attempts to relieve suffering or just try to get away from it all (paper 11). In study Ill the BPD patients showed significantly poorer quality-of-life (even physical) than normal population controls of comparable age. The suffering, suicide attempts, DSH and poor quality-of-life (paper 11 and 111) put the patients in a position of voluntarily or involuntarily getting involved with psychiatric care. Study II revealed a double role of the psychiatric care in relation to BPD patients. On one hand, psychiatric professionals can add to the suffering by not being understanding and being disrespectful, on the other hand they can be helpful and relieve suffering by being respectful, understanding and validating. There was a clear relationship between the patients' experience of validation and the experience of being helped. DBT seems (both from the patients' and psychiatric professionals' perspective) to be a treatment with a philosophy, content and structure being able to relieve BPD patients suffering and helping them to independence and a bearable life-situation (paper I). Study IV confirms previous findings that psychiatric professionals experience treatment of self-harming patients as profoundly stressful. DBT was seen as stressful in terms of learning demands, but decreased the experience of stress in the actual treatment of the patients due to its high degree of structure and specific techniques. The DBT team-work and supervision were felt to be supportive, as was one particular facet of DBT, namely mindfulness training which some professionals felt also improved their handling of other work stressors not related to DBT. This finding also corresponds to BPD patients' perceptions of the mindfulness component in DBT, which they reported as particularly helpful (paper 1). It should be noted that the patient samples in the thesis may be considered as a "worse off" subgroup among BPD patients, as they usually entered special treatment programs after a period of escalating symptoms, which standard psychiatric services had had difficulties handling. The rather small number of participants and the lack of equivalent andlor concurrent control groups in the quantitative studies limit the generalization of the results.

Syftet med föreliggande studie var att vidareutveckla en behandlingsspecifik följsamhetsskala för paniksyndrom vid internetförmedlad kognitiv beteendeterapi (IKBT). Studiens frågeställningar var 1) uppnår skalan tillräcklig interbedömarreliabilitet, 2) finns det ett samband mellan skalan och det tidigare använda följsamhetsmåttet antalet genomförda moduler, och 3) finns det ett samband mellan skalan och behandlingsutfallet. Interbedömarreliabiliteten mellan två bedömare testades genom två omgångar samskattning. 80 deltagare som behandlades med IKBT för paniksyndrom vid enheten för internetpsykiatri i Stockholm skattades sedan enligt den behandlingsspecifika följsamhetsskalan. Även antalet moduler deltagarna genomförde registrerades. Resultaten visade att skalan sammantaget hade en god interbedömarreliabilitet. Vidare korrelerade följsamhetsskalan positivt med både antalet genomförda moduler och behandlingsutfallet. Slutsats: Skattningsskalan vidareutvecklad i föreliggande studie visade indikationer på att vara ett tillförlitligt och användbart instrument för att mäta följsamheten till IKBT vid paniksyndrom. / The purpose of this study was to further develop a treatment-specific rating scale for adherence to internet-based cognitive behavioural therapy (ICBT) for panic disorder. The research questions for this study were 1) does the rating scale show satisfying inter-rater reliability, 2) is there an association between the rating scale and the commonly used measurement of adherence, module completion, and 3) is there an association between the rating scale and treatment outcome. The inter-rater reliability between two raters was assessed twice. 80 participants treated with ICBT for panic disorder at Internetpsykiatrin (the unit for internet-based cognitive behavioural therapy in Stockholm) were then assessed using the treatment-specific rating scale for adherence. Module completion was also registered. Results show that the rating scale had an overall satisfying inter-rater reliability. Furthermore, the rating scale correlated positively with both module completion and treatment outcome. Conclusion: The rating scale further developed in the present study showed indications of being a reliable and useful instrument for measuring adherence to ICBT for panic disorder.

Purpose: The aim of the systematic review was to address whether psychological interventions were able to reduce fatigue severity or the impact of fatigue in individuals with Multiple Sclerosis. The empirical study aimed to evaluate the effectiveness of a CBT based self-help workbook at reducing perceived impact of fatigue in a clinical sample of MS patients. Methods: A systematic search of the literature was carried out between the years 1980 and February 2015 to review whether psychological interventions were effective for fatigue management in Multiple Sclerosis. A randomised controlled trial examined the effectiveness of a CBT-based self-help workbook for the reduction of fatigue impact in MS. Participants were randomly allocated to one of three groups treatment as usual (TAU), pure self-help (PSH) or guided self-help (GSH). Results: Eleven studies were included in the systematic review, which indicated that CBT based interventions aiming to reduce fatigue or depression were most effective at reducing the severity of fatigue. Impact of fatigue can be reduced through mindfulness, CBT, motivational interviewing and to a lesser extent acceptance and commitment therapy. The empirical study did not find any significant differences between groups, however satisfaction with the workbook was high. Conclusions: The review suggests that there is a clear role for psychological interventions in fatigue management in MS, although further robust research into different therapeutic modalities is needed. From the empirical study it appears that the low level CBT-based intervention for fatigue in MS was not effective at reducing the perceived impact of fatigue. This study reflects an inclusive, clinical sample, recruited from a specialist rehabilitation unit, with high levels of multidisciplinary input which may have diluted any potential effect of the workbook. Objectives: The aim of the systematic review was to address whether psychological interventions are able to reduce fatigue severity or the impact of fatigue in individuals with Multiple Sclerosis Data sources: A search was conducted of: Psychinfo, Medline, Embase, CINAHL between 1980 and February 2015. Review methods: All studies were evaluated against a set of quality criteria by author (KG) with a proportion of studies being independently reviewed by author (DP) to ensure reliability of ratings. Results: Eleven studies were included in the review. CBT based interventions with a focus on fatigue management and depression appear to significantly reduce fatigue severity with medium to large effect. Significant reductions in fatigue impact can be found from mindfulness groups, motivational interviewing and CBT. Effect sizes for CBT interventions ranged from negligible to medium. For the mindfulness and motivational interviewing interventions effect sizes were not able to be calculated. The acceptance and commitment therapy intervention did not find a significant reduction in fatigue but found a medium effect for the intervention. Conclusions: There is a clear role for psychological interventions in the reduction of fatigue management but more high quality research needs to be carried out.

As the literature on work–family conflict grows and absenteeism increasingly comes into the spotlight, one cannot help but ask the question: “What is an acceptable absenteeism rate and how can an organisation control and manage absenteeism?” With current absenteeism rates as high as 12% and with an estimated R12 million lost per annum because of absenteeism, the idea of an on-site employer-sponsored childcare facility seems viable. The purpose of this study is to examine the relationship between absenteeism and on-site employer- sponsored childcare. The following dimensions of absenteeism will be examined over a period of a year: absence frequency, absence intensity, attitudinal absence and medical absence. The results of two companies, one with a facility and one without, will then be compared in order to establish the relationship between absenteeism and an on-site facility. To date, evidence remains mixed and the ongoing challenge of establishing real return on equity remains a major barrier to the support of on-site employer-sponsored childcare. / Industrial and Organisational Psychology / M. A. (Industrial and Organisational Psychology)

Background: Group CBT approaches have been shown to be equally as effective as individual CBT for reducing depressive symptoms and preventing relapse; however, the predictors of response are poorly understood. The primary objective of the studies presented in this thesis was to further examine the formal and process factors within group CBT for depression that contribute to various treatment outcomes. The first study investigated the relationship between group CBT for depression and changes in interpersonal distress, as well as the process mechanisms that might influence this relationship. The second study assessed whether formal feedback provided to therapists and clients derived from the Outcome Questionnaire (OQ-45), a robust measure of client functioning, would enhance group processes and treatment outcomes. Method: Study 1: Secondary data from clients having received individual CBT for depression at a community-based mental health training centre constituted one condition (18 clients). Data for the group condition (12 clients) were collected from clients attending group CBT for depression at a tertiary care facility. Relationship distress, as measured by the OQ-45 relationship distress subscale score, was assessed at intake and termination. Group participants also completed process measures at the start and end of treatment. In study 2, participants were recruited from a tertiary care facility to participate in a CBT group for depression. Participation involved completing brief questionnaires assessing psychological and process variables before and after treatment, as well as the OQ-45 at every session. Three groups (21 clients) received standard CBT and two groups (12 clients) received enhanced CBT, which included feedback about their progress from the OQ-45. Results: Results of study 1 suggest that clients who participated in group CBT experienced a significantly greater reduction in relationship distress across time than clients who participated in individual CBT. Results also indicate that therapeutic alliance, and not group cohesion, mediates the relationship between pretreatment relationship distress on posttreatment relationship distress in group CBT. Results of study 2 indicate that participants in the enhanced condition experienced greater improvements in quality of life, dysfunctional beliefs, and therapeutic bond at termination, relative to participants in the standard condition. Trends also suggest a greater reduction in depressive symptoms. Conclusions: Group CBT for depression may be more effective than the individual modality for reducing interpersonal distress. Furthermore, therapeutic alliance plays a significant role in improving interpersonal distress within a structured group CBT protocol. Feedback from the OQ-45 may help improve client outcomes and enhance therapeutic bonding with facilitators in group CBT for depression.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

I chose the theme of obsessive-compulsive disorder as a topic of my thesis. The main reason was that it is a disorder I have worked as a therapist in individual or group therapy frequently. Also I have participated in several studies as evaluator in Psychiatric Centre, and I collected data from dozens of patients. In the first part the thesis deals with the symptoms, clinical picture, prevalence, aetiology and treatment of OCD. Thesis is focuses on behavioural and cognitive models of the disorder in detail, because the treatment used in the present group of patients was CBT. Various models of cognitive behavioural therapy I discuss in more detail, because they allow different views of what happens to the patient and how to change it. The practical part has two parts. The first deals with the effectiveness of group cognitive behavioral approach for OCD patients, who use antidepressants but were resistant to previous treatment and were attended a daycare center at the Prague Psychiatric Center. The second part of the thesis deals with finding a predictor of successful cognitive behavioral therapy in these patients. The aim was to determine whether certain demographic or clinical factors that we evaluated before treatment may predict success outcome. The result is the finding that severity of the...