Prokrastinering innebär att individen trots medvetenhet om negativa konsekvenser skjuter upp en handling. Den bidrar till stress, färre hälsofrämjade beteenden och sämre prestation. Demografiska faktorer och pågående utbildning påverkar sannolikheten för prokrastinering. Relationen mellan stress och prokrastinering behöver utforskas, speciellt hur interventioner riktade mot stress påverkar fenomenet. En longitudinell interventionsstudie med upprepad mätning undersökte effekten av ett KBT-baserat stresshanteringsprogram (KBSP) på prokrastinering och interaktionseffekter med stress. Stickprovet togs ur populationen sjuksköterskestudenter vid ett högre lärosäte i en medelstor svensk stad. Interventionsgruppen var 28 deltagare, varav 3 män. De mättes två gånger med tio veckors intervall. Bortfallsgruppen (21 deltagare) uppföljdes. Kontrollgruppens 44 deltagare (varav 3 män) mättes en gång. Ingen signifikant skillnad fanns mellangruppernas prokrastinering före interventionen.Flera signifikanta resultat erhölls, följande avser interventionsgruppen. Ett beroende t-test visade på signifikant skillnad mellan prokrastinering före och efter interventionen. En stark positiv bivariat korrelation fanns mellan stress och prokrastinering vid T1. Prokrastinering predicerade stress vid T1 och T2. Resultatet indikerade att 26.1 % respektive 31.7 % av variansen i stress kunde förklaras utifrån prokrastinering. Resultatet talar för att prokrastinering kan förändras och att KBT-baserade metoder för stress skulle kunna ha komponenter som påverkar. Slutsatserna gäller främst studenter och begränsas av att de bygger på självskattningar. Vidare longitudinell forskning med fler mätmetoder behövs. / Procrastination isintentionally postponing an action, despite of the potentially negative consequences. It contributes to stress, fewer health promoting behaviors and poorer performance. Demographic factors and ongoing academic education affects the probability for procrastination. The relationship between stress and procrastination needs to be studied, especially how interventions aimed at stress affects the phenomenon. A longitudinal intervention study with repeated measurements investigated the effect of CBT-based stress management program (CBSM) on procrastination and interaction effects with stress. The sample was nursing students at a Swedish university. The intervention group was 28 participants including 3 men. They were measured twice with a ten week interval. A follow-up was conducted on the dropout (21 participants). The control group's 44 participants (including 3 men) were measured once. No significant difference was found between groups in procrastination before the intervention. Several significant results was obtained, the following refers to the intervention group. A dependent t-test showed significant difference between procrastination before and after the intervention. A strong positive bivariate correlation was found between stress and procrastination at T1. Procrastination predicted stress at T1 and T2. The results indicated that 26.1% and 31.7% of the variance in stress could be explained by procrastination. The results indicate that procrastination is susceptible to change and that CBT-based methods for stress management might have components that affects it. The conclusions apply mainly to students and is limited by self-assessments as reserch method. Further longitudinal research with more measurements are needed.

Schizophrenia is a complex and pervasive brain disorder that effects millions of people in the United States. There are three tiers of symptoms associated with the disorder, they include: positive symptoms, negative symptoms and thought disorders. The most common method of treatment for this disorder involves the use of antipsychotic medications, and while these medications have been shown to be effective in treating certain positive symptoms of the disorder, they have a tendency to be less effective in treating the negative cluster of symptoms and the thought disorders that can be highly debilitating for patients. The aim of this review was to determine the level of effectiveness of psychosocial treatments for the disorder, and in particular to look in to Cognitive- Behavioral Therapy (CBT) as an adjunctive method of treatment to be used in conjunction with medication. By performing searches using the PsycInfo, ERIC, EBSCO and Medline databases, the researcher was able to draw the conclusion that while there are some complications and areas of improvement in study construction, CBT can indeed be a helpful method of treatment for many patients. Importantly, CBT tends to be a very flexible treatment that can accommodate many different combinations of symptoms at varying levels or severity and stages of the illness. A discussion of a possible model of treatment that uses CBT was also undertaken to provide readers with a practical example of how this form of treatment can be used. / text

Previous research indicates that cognitive-behavioral therapy (CBT) is helpful in reducing depression in youth. However, little research exists into what specific components within CBT treatment protocols are associated with decreases in depression. Furthermore, little is known about how components within CBT treatment protocols reduce depression. Cognitive theories suggest that interventions targeted at negative cognitions reduce depression. Research has provided initial support for this position, although these studies did not utilize clinically depressed youth. Research has also shown that the therapeutic ingredients of therapist relational behaviors and group cohesion are important general factors in treatment; however, research exploring these variables in youth depression is lacking. Cognitive theories of depression suggest depressogenic thinking mediates the relationship between interventions and depression. However, no research exists exploring depressogenic thinking as a mediator between specific components of CBT treatment protocols and youth depression. The purpose of the current study was to investigate the association between specific components of a CBT treatment protocol and depression. The current study also sought to investigate depressogenic thinking as a mediator between the components of interest and depression. Participants were 42 girls, aged 9 to 14, who completed a manualized CBT group treatment protocol for depression. Participants completed a diagnostic interview for depression and completed self-report measures of depressogenic thinking. Group therapy sessions were coded for cognitive interventions, therapist relational behaviors, and group cohesion. The results of the main hypotheses indicated no significant associations between cognitive interventions, therapist relational behaviors, group cohesion and depression. Furthermore, tests of depressogenic thinking as a mediator could not be conducted based on the aforementioned results. However, post-hoc power analysis revealed extremely low power for the analyses. To further investigate the data, an exploratory analysis was conducted, with steps taken to increase power. Results from the exploratory analysis indicated the therapist relational behaviors measure consisted of two factors, both of which were significantly associated with post-treatment depression. Furthermore, the exploratory analysis revealed a significant association between cognitive interventions and post-treatment depression. Finally, no significant association was found between group cohesion and post-treatment depression. Implications, limitations, and recommendations for further areas of research are presented. / text

Cognitive Behavioural Therapy (CBT) is an underutilized evidence-based treatment for Anxiety Disorders. Increasing effective knowledge translation and implementation of CBT has significant public health implications. This study sought to increase the use of CBT by providing a 20-week-group-supervision program to Northern Ontario. Therapist measures of CBT knowledge competence were collected pre and post training, and treatment outcome measures were obtained by child and parent report. Clients in Northern Ontario were older (M=11.6years, Toronto M=10.0 years), were more likely on medication, and more likely to have a comorbid diagnosis than clients from an existing data-set in Toronto, Ontario. The training program was successful in increasing CBT knowledge competence and decreasing client anxiety in both locations, with greater improvements in self-reported anxiety in the Northern Ontario group. Therapist CBT knowledge competence was predictive of client symptom change as reported by parent but not child. Two therapist variables were found to be moderators.

Cognitive Behavioural Therapy (CBT) is an underutilized evidence-based treatment for Anxiety Disorders. Increasing effective knowledge translation and implementation of CBT has significant public health implications. This study sought to increase the use of CBT by providing a 20-week-group-supervision program to Northern Ontario. Therapist measures of CBT knowledge competence were collected pre and post training, and treatment outcome measures were obtained by child and parent report. Clients in Northern Ontario were older (M=11.6years, Toronto M=10.0 years), were more likely on medication, and more likely to have a comorbid diagnosis than clients from an existing data-set in Toronto, Ontario. The training program was successful in increasing CBT knowledge competence and decreasing client anxiety in both locations, with greater improvements in self-reported anxiety in the Northern Ontario group. Therapist CBT knowledge competence was predictive of client symptom change as reported by parent but not child. Two therapist variables were found to be moderators.

Tinnitus is the experience of sounds in the ears without any external auditory source and is a common, debilitating, chronic symptom for which we have yet to develop sufficiently efficacious interventions. Cognitive behavioral therapy (CBT) has evolved over the last 20 years to become the most empirically supported treatment for treating the adverse effects of tinnitus. Nevertheless, a significant proportion of individuals do not benefit from CBT-based treatments. In addition, the theoretical underpinnings of the CBT-model are poorly developed, the relative efficacy of isolated procedures has not yet been demonstrated, and the mechanisms of therapeutic change are largely unknown. These significant limitations preclude scientific progression and, as a consequence, leave many individuals with tinnitus suffering. To address some of these issues, a contextual multi-method, principle-focused inductive scientific strategy, based on pragmatic philosophy, was employed in the present thesis project. The overarching aim of the thesis was to explore the utility of a functional dimensional process in tinnitus: Experiential avoidance—experiential openness/acceptance (EA). EA is defined as the inclination to avoid or alter the frequency, duration, or intensity of unwanted internal sensations, including thoughts, feelings or physical sensations. The thesis is based on experimental work (Study II, VI), process and mediation studies (Study I, III, V), and on randomized controlled trials (Study III, IV). Three main sets of findings supported the utility of EA in tinnitus. First, an acceptance-based treatment (i.e.,Acceptance and Commitment Therapy, ACT) was found to be effective in controlled trials. Study III demonstrated that face-to-face ACT was more effective than a wait-list control and a habituation-based sound therapy. Study IV showed that internet-delivered ACT was more effective than an active control condition (internet-discussion forum) and equally effective as an established internet-delivered CBT treatment. Second, processes research (Study I, III, V) showed that key postulated processes of change were linked to the specific technology of ACT and that these changes in processes were associated with therapeutic outcomes. Specifically, Study V found evidence to that decreases in suppression of thoughts and feelings over the course of treatment were uniquely associated with therapeutic gains in ACT as compared with CBT. Third, experimental manipulations of experiential avoidance and acceptance processes provided support to the underlying dimension (Study II, VI). That is, Study II, employing an experimental manipulation, found that controlling background sounds were associated with reduced cognitive efficiency and increased tinnitus interference over repeated experimental trials. In addition, in normal hearing participants, experimentally induced mindfulness counteracted reduced persistence in a mentally challenging task in the presence of a tinnitus-like sound stemming from initial effortful suppression of the same sound (Study VI). It is concluded that a principle-, contextual-focused approach to treatment development may represent an efficient strategy for scientific progression in the field of psychological treatments of tinnitus severity. / Tinnitus är upplevelsen av ljud i frånvaro av en extern ljudkälla och är ett vanligt, långvarigt och svårbehandlat hälsotillstånd. Kognitiv beteendeterapi (KBT) har det starkaste forskningsstödet för att behandla de negativa konsekvenserna av tinnitus. Detta till trots svarar inte en stor andel på KBT-baserade behandlingar för tinnitus. Behandlingsutvecklingen av KBT försvåras som konsekvens av att teorier som behandlingen vilar på är dåligt utvecklade, effekten av isolerade tekniker har inte bevisats, och att förändringsmekanismer är till största del okända. Föreliggande avhandling avsåg att adressera några av ovanstående problem genom att tillämpa en induktiv, flermetod, principstyrd vetenskaplig strategi baserad på pragmatisk kontextuell filosofi. Det övergripande syftet med avhandlingen var att undersöka användbarheten i en funktionell processdimension vid tinnitus: upplevelsemässigt undvikande—upplevelsemässig acceptans (EA). EA definieras som benägenheten att undvika eller förändra frekvensen, durationen eller intensiteten av icke-önskade inre sensationer som tankar, känslor och fysiologiska sensationer. Avhandlingen är baserad på experimentella studier (Studie II, VI), process och mediationsstudier (Studie I, III, V) och randomiserade kontrollerade studier (Studie III, IV). Tre övergripande fynd bekräftade användbarheten av EA vid tinnitus. För det första kunde det påvisas i randomiserade, kontrollerade studier att en acceptans-baserad behandling (Acceptance and Commitment Therapy, ACT) hade effekt på tinnitusbesvär. Studie III fann stöd för att ACT var mer effektiv än en väntelistekontroll och en habitueringsfokuserad ljudterapi. Studie IV fann stöd för att internet-förmedlad ACT var mer effektiv än en aktiv kontrollbetingelse (internet-diskussionsforum) och lika effektiv som en etablerad internet-förmedlad KBT-behandling. För det andra kunde processforskning (Studie I, III, V) påvisa att teoretiskt viktiga processer var relaterade till specifika tekniker i ACT och att dessa processer var i sin tur associerade med behandlingsutfall. Exempelvis kunde Studie V styrka att minskning i individers benägenhet att tränga undan tankar och känslor i relation till tinnitus var unikt associerat med behandlingsutfall i ACT i jämfört med KBT. För det tredje påvisade experimentella manipulationer av acceptans- och undvikande-processer användbarheten av EA (Studie II, VI). Studie II fann stöd för att kontroll över maskeringsljud var associerad med minskad kognitiv prestationsförmåga och ökade besvära av tinnitus över upprepade experimentella manipulationer i jämfört med att inte ha kontroll över maskeringsljudet. Slutligen visade Studie VI att bland normalhörande kunde experimentellt inducerad mindfulness motverka minskad förmåga att hålla ut i en mentalt krävande uppgift i närvaro av ett tinnitusliknande ljud till följd av initial suppression av samma ljud. Den övergripande konklusionen av vetenskapliga arbeten som sammanfattas i avhandlingen var att en principstyrd och kontextuell vetenskaplig strategi kan vara en framkomlig väg för att utveckla psykologiska behandlingar för tinnitusbesvär.

xvi, 90 p. : ill. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number. / Empirical support for the efficacy of CBT in treating depression suggests that the majority of clients will respond to this intervention. However, the more nuanced, and clinically relevant, question of "Which clients will respond to CBT for depression?" has been difficult to answer. Research efforts have focused on two different approaches to this question. One approach focuses on trajectories of symptom change within the first weeks of treatment to identify clients who are most likely to achieve response. A second approach looks to pretreatment client variables such as hopelessness and dysfunctional attitudes to identify clients who are more likely to respond. The current study is the first to simultaneously compare these two approaches to the prediction of treatment outcome. The sample consists of 222 clients (65.32% female, 92.79% Caucasian), ages 18 through 64 (M =27.85, SD = 11.28), receiving treatment for mood and anxiety disorders (59% met criteria for comorhid disorders) in a CBT oriented psychology training clinic. Results suggest that the rate of change in depressive symptoms over the first five treatment sessions significantly and consistently predicted outcome over and above the majority of pretreatment variables, except for precontemplation stages of change scores and initial severity of depression and anxiety symptoms. Similarly, rate of change in anxiety symptoms significantly predicted outcome on two of the three measures over and above the majority of pretreatment variables, except for hopelessness and initial severity of anxiety symptoms. Post hoc analyses revealed different predictors of outcome when trajectories of change and pretreatment variables were examined separately. Both rates of change and a number of pretreatment variables predicted outcome. Finally, pretreatment predictors of rate of early symptom change such as a contemplative orientation to change and therapist experience, were identified which may suggest that therapists should target these factors to potentially maximize rapid early symptom change, and in turn outcome. The findings are discussed in terms of their implications regarding methodological approaches to treatment outcome research and treatment planning for adults with comorbidities. / Committee in charge: Anne Simons, Chairperson, Psychology; Philip Fisher, Member, Psychology; Hyoun Kim, Member, Not from U of O; Jane Mendle, Member, Psychology; Jeff Todahl, Outside Member, Counseling; Psychology and Human Services

The current study examined whether variables that have been found to influence treatment outcome serve as mediators of a child and adolescent cognitive behavioral treatment (CBT) anxiety program at multiple time points throughout the intervention. The study also examined mediating variables measured at multiple time points during treatment to determine the time lags necessary for changes in the mediator variable to translate into changes on treatment gains. Participants were 168 youth (ages 6 to 16 years; 54% males) and their mothers who presented to the Child Anxiety and Phobia Program (CAPP) at Florida International University (FIU). Overall, results indicate that the mediators at multiple time points influenced youth anxiety in a fluctuating manner, such that a decrease in skills at one given session caused changes in youth anxiety at a later session. This dynamic between the mediator and outcome may be reflective of the process of therapeutic change and suggests that skills gained from session to session took time to exert their effect on youth anxiety. The methodology employed helps to elucidate how variables mediate treatment outcome in youth anxiety disorders.

The present study examined whether or not the temporal pattern of symptom change defined as sudden gains is applicable to and has significant ramifications for understanding recovery from eating disorders. Sudden gains were defined as stable and clinically significant changes that take place between two sessions of treatment. Data for the current study were drawn from an efficacy study of CBT for eating disorders which included session-by-session measures of eating disorder symptomatology. Predictors of sudden gains were measured by an observer coded scale that included ratings of therapist use interventions, client change in behaviors and beliefs, client engagement, and homework completion. Three research questions were addressed: First, is the phenomenon of sudden gains present in CBT for eating disorders? Second, do sudden gains in CBT for eating disorders follow the three-stage model proposed for sudden gain recovery in other disorders (i.e., cognitive changes during critical sessions => sudden gains => upward spiral that includes further cognitive changes and greater long-term symptom improvement (Tang & DeRubeis, 1999b)? Third, what are the predictors of sudden gains in CBT for eating disorders that distinguish the critical session that takes place right before the sudden gain? Findings suggest that many eating disordered clients (62%) experienced at least one sudden gain during the course of CBT treatment. Three distinct types of sudden gains were identified: total symptom sudden gains, eating-related sudden gains, and body-related sudden gains. The average magnitude of these sudden gains was large representing on average 35% of total symptom improvement. Clients who experienced total symptom and body-related sudden gains demonstrated fewer eating disordered symptoms than the other clients at posttreatment. During the session preceding the sudden gain, therapists had increased levels of cognitive interventions and empathy, and clients experienced more cognitive changes and increased motivation.

Obsessive-compulsive disorder (OCD) is associated with substantial impairment across a number of life domains. Recently increased interest has been focused on the bi-directional relationship between OCD and family processes, particularly a subset of family reactions to OCD symptoms that are termed "accommodation." Accommodation consists of any changes in family members' behavior aimed at preventing or reducing the patient's rituals or their distress related to OCD symptoms. For example, family members may provide patients with supplies they need to ritualize (e.g., extra soap), or may engage in rituals themselves (e.g., excessive washing). Previous research has indicated high levels of accommodation are associated with more severe OCD symptoms and functional impairment on the part of patients, and may interfere with the first line psychosocial treatment for OCD, a form of cognitive behavior therapy (CBT) consisting of exposure (to cues provoking obsessions) and ritual prevention (ERP). Thus, the aims of this research project were to develop and test a brief intervention focused on reducing accommodation in the family members of adult OCD patients with the aim of facilitating the implementation of ERP. Eighteen patient and family member dyads participated in the study. All patients received a course of standard individual ERP for OCD. Family members were randomized to either the intervention group or a control group that did not receive any intervention. The goals of the two-session intervention were to identify current accommodation behaviors and provide alternative ways of responding to OCD symptoms. Patients and family members were assessed at baseline and regularly throughout the 25-week study. Results revealed that the intervention successfully reduced accommodation with a large effect size. Patients whose family members received the intervention showed greater levels of symptom reduction than patients whose family members had not. Hierarchical regression analyses revealed that change in family accommodation from baseline accounted for a significant amount of variance in later OCD symptoms. These results suggest that this intervention successfully enhanced the outcomes of standard CBT including ERP for adults with OCD. The findings support further exploration of this intervention in larger samples and in other diagnostic groups where accommodation is likely to occur.