This study investigated temporal patterns of therapeutic alliance development across treatment and their relationship to outcome, and the relationship between client attachment styles and interpersonal problems and alliance strength and patterns across treatment. Sixty-six clients diagnosed with major depression participated in one of two 16-week treatment conditions: Process-experiential therapy and Cognitive-behavioural therapy. Results revealed two alliance “shape” patterns; Stable Linear and Steep Linear-Quadratic, as well as two alliance “shape and level” patterns; High Strength Linear-Quadratic and Low-to-Mid Strength Stable. Results indicated that the two alliance “shape” patterns did not differentially predict treatment outcome. With respect to “shape and level” patterns, results revealed that clients with a High Strength Linear-Quadratic alliance pattern had better treatment outcomes than clients with a Low-to-Mid Strength Stable alliance pattern. In terms of client attachment style, results indicated that clients with a Steep Linear-Quadratic “shape” pattern report more discomfort with closeness at pre-treatment. Further, clients with a High-Strength Linear-Quadratic “shape and level” pattern report more confidence and less need for approval at pre-treatment. With respect to client interpersonal problems, results revealed that clients with a Steep Linear- Quadratic “shape” pattern report being more cold and distant at pre-treatment and clients with a Low-Mid Strength Stable “shape and level” pattern report being more socially inhibited, less assertive, and more overly-accommodating at pre-treatment. Lastly, results revealed that specific client attachment characteristics and interpersonal problems differentially predict total average alliance strength as well as the average strength of the client and therapist bond across treatment.

This study investigated temporal patterns of therapeutic alliance development across treatment and their relationship to outcome, and the relationship between client attachment styles and interpersonal problems and alliance strength and patterns across treatment. Sixty-six clients diagnosed with major depression participated in one of two 16-week treatment conditions: Process-experiential therapy and Cognitive-behavioural therapy. Results revealed two alliance “shape” patterns; Stable Linear and Steep Linear-Quadratic, as well as two alliance “shape and level” patterns; High Strength Linear-Quadratic and Low-to-Mid Strength Stable. Results indicated that the two alliance “shape” patterns did not differentially predict treatment outcome. With respect to “shape and level” patterns, results revealed that clients with a High Strength Linear-Quadratic alliance pattern had better treatment outcomes than clients with a Low-to-Mid Strength Stable alliance pattern. In terms of client attachment style, results indicated that clients with a Steep Linear-Quadratic “shape” pattern report more discomfort with closeness at pre-treatment. Further, clients with a High-Strength Linear-Quadratic “shape and level” pattern report more confidence and less need for approval at pre-treatment. With respect to client interpersonal problems, results revealed that clients with a Steep Linear- Quadratic “shape” pattern report being more cold and distant at pre-treatment and clients with a Low-Mid Strength Stable “shape and level” pattern report being more socially inhibited, less assertive, and more overly-accommodating at pre-treatment. Lastly, results revealed that specific client attachment characteristics and interpersonal problems differentially predict total average alliance strength as well as the average strength of the client and therapist bond across treatment.

Under 1990-talet implementerades i Sverige en metod för behandling av aggressivitethos barn och unga, som kallas Aggression Replacement Training (ART). Metoden ärutvecklad i USA av Arnold P. Goldstein och hans kollegor. Metoden har sin teoretiskagrund inom den sociala inlärningsteorin och bygger till stor del på behandlingsprinciperinspirerade av kognitiv beteendeterapi. ART som behandlingsmetod för aggressiva barnoch unga har fått stor spridning i Sverige och en av de kommuner som erbjuder ARTsom öppenvårdsinsats inom socialtjänsten är Västerås. Denna uppsats utgår från ettuppdrag från familjebehandlingen i Västerås Stad, som önskar belysa vilka eventuellaupplevda effekter deras variant av ART har gett. Förutom detta syftar uppsatsen ocksåtill att teoretiskt beskriva ART med avseende på teoretiskt ursprung och praktiskttillämpning. Studien, som har en kvalitativ ansats, utgår från en specifikbehandlingsgrupp om fem barn, vars föräldrar har intervjuats om vilka eventuellaeffekter de upplever att behandlingen gett. Resultaten är inte helt entydiga, då vissaföräldrar väldigt tydligt upplevt stora förbättringar när det gäller ilska och aggressivitethos sitt barn, medan andra föräldrar inte tycker sig se några större förändringar.Genomgående är dock föräldrarna nöjda med metoden och dess genomförande somsådant, men efterfrågar t.ex. intensivare och mer långvariga insatser för att ökamöjligheten för deras barn att ta till sig behandlingen fullt ut. / During the 1990’s a method of treatment for aggression and anger problems in childrenand youth was introduced in Sweden, witch is called Aggression Replacement Training(ART). ART was first developed in the United States, by Arnold P. Goldstein andcolleagues. The method has its theoretical foundation in the social learning theory and isinspired by the treatment principles found in cognitive behavioural therapy. ART as atreatment method for aggressive children and youth has been widely spread in Swedenand one of the cities that offers ART within their social services are Västerås. This essayis a mission from the unit of family treatment in Västerås Stad, who has an interest inelucidate possible treatment outcomes from their work with ART. In addition to that, thepurpose of this essay is to describe the theoretical foundations and practical appliancesof ART. This study, which has a qualitative approach, emanate from a specific treatmentgroup of five children, whose parents has been interviewed about what, if any, outcomethey experience that the treatment has resulted in. The results are not really univocal.Some of the parents experience very significant improvements in their child’sexpression of anger and aggressiveness, whereas some other parents don’t experienceany improvement at all. Consistently though, all of the parents are very pleased with themethod itself and its implementation, but some of them ask for more intensive and farreachinginterventions, to increase the possibilities for their children to fully ingest thetreatment.Key

<p>The objectives of this study were to determine the effects of a back education programme on biomechanical knowledge, back beliefs, the occurrence of LBP, disability, and work loss among employees at an industrial setting in Cape Town, South Africa. Furthermore, the study sought to determine the perceptions of back education that are held by industrial<br /> employees.</p>

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

Background & objective Cognitive Behavioural Therapy (CBT) and Motivational Interviewing (MI) have been the treatment of choice for problem or pathological gambling in the field in Western countries, and their efficacy has been supported by a considerable empirical research. Alternative treatments are little known; and such treatments for minority ethnic populations have been scarce. This study adopted Kazdin‘s procedures for assessing the acceptability of treatments (Kazdin, 1980a, 1980b, 1981) to test alternative treatments of problem or pathological gambling as a part of the broadening of treatment choices. This thesis presented 2009 survey results from counselling service providers in New Zealand on the acceptability of alternative treatments to problem or pathological gambling. The thesis, therefore, reports the responses of counsellors to counselling vignette case examples, not the views of actual clients viewing counselling. Methods The survey pack was distributed to counselling service providers in New Zealand. The survey included descriptions of sixteen vignettes of case examples of counselling treatments. Categories of clients in the vignette case examples included two genders (male, female) and three ethnicities (Pakeha, Maori, and Asian). Four counselling treatment conditions were selected from Solution-Focused Brief Counselling (SFBC), SFBC+Multicultural Counselling (SFBC+MC), Cognitive-Behavioural Therapy (CBT), and Motivational Interviewing (MI). CBT and MI were only administered to Pakeha clients for the purpose of comparison of the alternatives. Two measurements were used. The first a modified Problem Gambling Treatment Evaluation Inventory (TEI) was used to measure the acceptability levels of the alternative treatments for problem or pathological gambling. The Cross-Cultural Counselling Inventory-Revised (CCCI-R) was used for measuring the perceived cross-cultural competency of counsellors depicted in the vignette case examples. Findings Counsellors‘ ratings of the vignette case examples revealed the following findings: Measurement 1: Problem Gambling Treatment Evaluation Inventory (TEI). Overall, 1) The survey results of TEI questionnaires showed significant main effects across the four treatment conditions and the three client ethnicities, and there was no difference according to client genders. 1.1) SFBC+MC and SFBC were slightly more acceptable than CBT, and much more acceptable than MI. 1.2) The TEI scores for Pakeha clients were much higher than for Maori clients, and the scores for the Asian clients were in between. 2) There was a significant interaction effect between the four treatments and the three client ethnicities. 2.1) For Maori clients: SFBC+MC was much more acceptable than SFBC; for Pakeha clients: SFBC+MC was the most acceptable, closely followed by SFBC, CBT, then MI; and for Asian clients: SFBC was more acceptable than SFBC+MC. 2.2) SFBC+MC was most acceptable to Maori clients across all treatments and ethnic groups. 2.3) The variation in acceptability ratings for SFBC was larger than for SFBC+MC in Maori and Asian clients, and less variable in Pakeha. 2.4) Maori clients had the largest mean variation between SFBC and SFBC+MC, and Pakeha clients had the smallest mean variation. Measurement 2: Cross-Cultural Counselling Inventory-Revised (CCCI-R). The survey results of the CCCI-R showed significant main effects across the four treatment conditions and the three ethnicities. 1) The counsellors depicted in the vignette case examples under the SFBC+MC treatment condition were rated with the highest mean competence score and least variability across all the treatments and the ethnicities, the MI treatment condition were rated with the lowest mean score, CBT and SFBC were in between. 2) The counsellors described in the vignette case examples were rated more culturally competent with Pakeha clients and Maori clients than with Asian clients in the vignette case examples, the rating levels for both Pakeha and Maori were similar. 3) The Maori client in the vignette case examples had the largest mean gap between SFBC and SFBC+MC, and Pakeha client in the vignette case examples had the smallest mean gap. Clinical implications The tests of the acceptability of alternative treatment for problem or pathological gambling could provide useful information about 1) whether the above alternatives would be recommended or selected by the counselling service providers in their clinical practice, 2) which treatment would be more/less preferred by which ethnic group, 3) whether it would work or be worth the efforts to introduce or promote the above alternatives to the counselling service providers, 4) what needs to be explored for increasing levels of the acceptability of alternative treatment to problem or pathological gambling, 5) adding training in the techniques to counsellors training programme and curricula. The limitation of this study was discussed and future research was suggested.

Erythrophobie wird als klinische Bezeichnung für die Angst zu erröten verwendet, wenn das Einzelsymptom Erröten im Vordergrund einer Angstproblematik steht. Die vorliegende Übersicht beruht auf einer umfangreichen Literaturrecherche und wird ergänzt durch eigene klinische Beobachtungen aus einer Pilotstudie zur kognitiv-behavioralen Gruppentherapie der Errötungsangst. Wir referieren den aktuellen Kenntnisstand zu Erythrophobie in Bezug auf die differentialdiagnostische Einordnung, auf ätiologische und pathogenetische Konzepte sowie auf die Verhaltenstherapie der Störung. Insgesamt zeigt die Übersicht, dass Erythrophobie am sinnvollsten als Subsyndrom der Sozialen Phobie beschrieben werden kann. Patienten mit Errötungsangst als Hauptbeschwerde unterscheiden sich jedoch von anderen Patienten mit Sozialer Phobie im Hinblick auf Behandlungsanliegen, Inanspruchnahmeverhalten, Behandlungserwartung und Therapieziele sowie durch spezifische aufrechterhaltende Mechanismen der Störung, insbesondere durch eine übertriebene und inflexible Aufmerksamkeitsfokussierung auf körperliche Symptome. Der Einsatz eines Aufmerksamkeitstrainings als spezifisches Behandlungsmodul bei Errötungsangst ist vielversprechend und sollte in bekannte Ansätze zur Therapie der Sozialen Phobie integriert werden. Abschließend werden Impulse für weiterführende Forschungsaktivitäten skizziert. / Erythrophobia is the pathological form of fear of blushing. This review is based upon an extensive literature research and supplemented by clinical observations from a pilot study of a cognitive-behavioural group therapy for fear of blushing. Current knowledge about fear of blushing is reported regarding diagnostic considerations, aetiologic and pathogenetic mechanisms, and cognitive-behavioural therapy. In conclusion, this review indicates that fear of blushing should be classified as a sub-syndrome of social phobia. Patients suffering from fear of blushing as predominant complaint differ from other patients with social phobia in health-care utilisation, treatment expectation and treatment goals. However, the most prominent difference lies in the exaggerated and inflexible self-focused attention these patients direct to their arousal and bodily symptoms. Therefore, attention training as a specific treatment unit is promising and should be integrated in standard treatment approaches for social phobia. Finally, options for further research are outlined. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

While the focus of rehabilitation following traumatic brain injury (TBI) is often on management of physical and cognitive impairments, emotional and behavioural changes in the person with the injury may represent major hurdles in adjustment following injury. Mood, anxiety and adjustment disorders are common following TBI. A manualised cognitive behavioural therapy (CBT) treatment programme was developed that incorporated provision of education on consequences of TBI, used cognitive and behavioural strategies to recognise and manage emotional reactions to injury, and promoted achievement of personal goals. Participants were nine people with TBI referred to Massey University Psychology Clinic Wellington, for psychotherapy to assist in managing symptoms of psychological distress or adjustment difficulties following injury. Measures used included the Hospital Anxiety and Depression Scale (HADS) to monitor progress in reduction of symptoms of Anxiety and Depression; the Patient Competency Rating Scale (PCRS) to assess competency across areas of day-to-day living; and the Homework Rating Scale Second Edition (HRS-II) to assess the value of homework assignments for participants. Results were presented graphically in group format and in the form of individual case studies outlining progress in achieving individual goals. There was considerable variation in the responses of participants to treatment. When anxiety and depression were secondary to other referral issues such as fatigue and pain that remained high over treatment sessions, there was limited movement on HADS Anxiety and Depression scores. The small number of participants impacted on the ability to detect differences between Patient and Informant ratings on the PCRS or to demonstrate increased levels of awareness over treatment sessions. Consistent completion of Homework assignments proved difficult for participants. Factors that impacted on achievement of personal goals included ongoing levels of fatigue and pain, levels of personal expectation, interpersonal and organisational skills, insight into emotional reactions, and good family and social support. There is a part for a CBT approach in adjusting to changes following TBI, particularly in assisting with reassessing expectations following injury.

Rationale: This study was conducted to help improve mental health care for Black and Minority Ethnic (BME) clients as previous research carried out in non-western countries has suggested that western-developed psychotherapies often need to be culturally adapted to become more effective in treating this client group. The aim of this study was to explore how CBT therapists deliver manualised CBT with BME clients and if they make any adaptations, how and to what extent are they implemented. Method: Interpretative Phenomenological Analysis (IPA) guided the conduct and analysis of one-to-one, semi-structured interviews with six CBT therapists working in an Improving Access to Psychological Therapies (IAPT) service. The inclusion criteria for participants was accreditation with the BABCP, completion of an IAPT programme CBT diploma and to be currently working in an IAPT service, at least two years experience as a CBT therapist and at least four cases of completed therapy with BME clients. Findings: Four master themes emerged (1) CBT is based on western principles, (2) The complex nature of CBT, (3) Changing practice of manualised CBT and (4) The influence of therapist factors. Conclusion: The participants experienced many issues in their practice of manualised CBT with BME clients which led them to make changes including adaptations to manualised CBT. They described their current practice as being integrative as they incorporated therapeutic approaches other than pure manualised CBT, making them more flexible and adaptable. The adaptations involved altering the cognitive and behavioural interventions to better suit the individual needs of the client. The adaptations took into account the client’s culture, religion, language, psychological mindedness, acculturation to their host country, education and age. The participants’ confidence in CBT and their self-identity as therapists also influenced their overall practice of therapy. Recommendations for practice are discussed in relation to therapeutic practice, training of therapists, supervision and policy makers.

Magister Scientiae (Physiotherapy) - MSc(Physio) / The objectives of this study were to determine the effects of a back education programme on biomechanical knowledge, back beliefs, the occurrence of LBP, disability, and work loss among employees at an industrial setting in Cape Town, South Africa. Furthermore, the study sought to determine the perceptions of back education that are held by industrial employees. / South Africa