No description available.

This thesis focuses on the development of an operational and theoretically eclectic concept of psychological well-being. A comprehensive research strategy was employed to examine various personality factors thought to be components of psychological health (i.e., the basis of the proposed concept). The general approach involved four major phases: (1) the clustering of various variables and identification of underlying key factors purported to be related to psychological health based on the writer's clinical experience and review of the mental health literature, (2) the formulation of an ~ priori concept of psychological well-being based on the operational definition of those factors, (3) the construction of an inventory designed to examine the proposed concept, and (4) the interpretation of the results and their implications for the development of the overall concept based on the examination of the factorial structure, validity and reliability of the inventory. The"a posteriori concept" evolved out of this process. The results of the present study indicate that the most valid and reliable factorial components of psychological well-being are self regard,interpersonal relationship, independence, problem-solving, assertiveness,reality testing, stress tolerance, self-actualization and happiness; social responsibility and flexibility emerged as questionable components of the a posteriori concept. The inventory which was designed to study the concept was successful in significantly differentiating various levels of psychological health. This way of conceptualizing and assessing psychological well-being has potential applicability for mental health practitioners and researchers.

Thesis (M.P.H.M.)--Mahidol University, 1999.

The need to provide effective Cognitive Behavioural Therapy (CBT) treatments in routine clinical practice necessitates effective methods of CBT training, which are scalable and can be disseminated in populations without ready access to specialist trainers or large scale funding. This thesis seeks to add theoretical and empirical guidance to the development of evidence-based CBT training. The first chapter reviews the current literature on effective CBT training, and suggests theoretical and methodological guidance for future research on evidence-based training practices. Cohort studies (Chapters 2 – 4) examine data from former trainees for guidance on accurate CBT competence measurement and effective CBT training components. The fifth and sixth chapters report randomised-controlled trials examining the effects of internet-based training (IBT) on therapists’ competence and patient outcomes (Chapter 6). Findings from the literature review (Chapter 1) and Chapter 2 suggested the need for training effectiveness trials using treatment trial methodology, which includes ‘blind’ observer ratings of therapist behaviour as the measure of competence. Chapter 3 found that extensive training led to significant improvement in competence for trainees with a range of individual baseline characteristics. Since such extensive training is not accessible to the majority of practicing therapists, Chapter 4 examined which elements of extensive training were perceived by trainees as having the greatest positive effect on competence; thus providing empirical guidance in planning more scalable forms of training, such as IBT. Findings from the first four chapters provided guidance in planning the two randomised controlled trials outlined in Chapters 5 and 6, resulting in rigorous empirical data showing significant positive effects of IBT on therapists’ competence and on their patients’ clinical outcomes. Finally, the results of this thesis are related to the framework for developing evidence-based training, which was suggested in Chapter 1 and suggestions for future research are made.

Diss. (sammanfattning) Umeå : Umeå universitet, 2006. / Härtill 4 uppsatser.

No description available.

The aim of this thesis was to develop yoga as a complex intervention in health care for the improvement of health-related quality of life (HRQoL) in adult cancer. As the Indian tradition of practising yoga increases in popularity worldwide, populations in the West are beginning to see yoga as an opportunity to prevent and treat health conditions. The Medical Research Council’s framework has provided a methodology to address a paucity of coherent evidence for the myriad of unsupported health claims made by yoga enthusiasts. The thesis structure included a step-by-step approach to investigate biomedical theories of how yoga might work to improve health, to synthesise evidence of yoga interventions, to model their process and outcomes, and to test evaluation procedures in the context of a randomised controlled trial (RCT). The results of a bibliometric analysis indicated an overall increase in the publication rate of yoga research in health care, and in 2005 this research began to focus on cancer. A component analysis, semi-structured patient interviews (n=10) and oncologist surveys (n=29) were successively designed, implemented and analysed to advance a model of yoga intervention specific to adult cancer. The cumulative results were applied to design three yoga interventions randomly allocated to men and women receiving treatment for cancer (n=15). Outcomes of the feasibility study demonstrated that yoga intervention is appropriate for adult patients and can be administered safely in a clinical setting. In its conclusion, this thesis produces evidence-based support for the optimisation of yoga intervention in the context of a large-scale RCT for HRQoL in adult cancer, and it provides recommendations to improve research methodology and reporting of complex interventions in health care.

A experiência com psicólogos no campo da Saúde mental, especificamente nos Centros de Atenção Psicossocial de Transtorno Mental, levou-nos a observar que estes parecem privilegiar os conflitos intrapsíquicos em detrimento aos aspectos sócio-históricos e familiares dos sujeitos que demandam por esse serviço. Esta observação nos impulsionou a questionar a ação do estudante de psicologia nos Centros de Atenção Psicossocial e a problematizar a sua formação acadêmica. Assim, algumas indagações levantadas constituíram-se como objetivo desta pesquisa: será que a experiência vivenciada por esses estudantes contempla as demandas que emergem nesses Centros, sejam elas de usuários ou da própria equipe? Até que ponto a formação deste futuro profissional, predominantemente voltada a uma ação clínica em consultório, o prepara para as emergências e urgências que surgem nesses Centros? Para a compreensão do campo a ser investigado realizou-se uma entrevista semidirigida com 7 (sete) estudantes, concluintes do curso de psicologia, oriundos de agências formadoras particulares e públicas, situadas na cidade do Recife. Através da elaboração de núcleos de sentido e levantamento de conteúdos temáticos, as narrativas obtidas permitiram-nos perceber que a ação do psicólogo clínico nestes Centros é caracterizada, principalmente, por um processo de construção permanente que dirige seus cuidados tanto ao usuário como a seus familiares, parceiros fundamentais para a (re )inserção do paciente no convívio social. As narrativas também nos revelaram que são muitos os desafios vividos pelos profissionais, considerando-se, principalmente, a estigmatização em tomo da doença mental e a necessidade da adoção de concepções e posturas que contemplem as dimensões psíquicas e histórico-sociais envolvidas no processo de adoecimento. Pretende-se que os resultados dessa pesquisa possam contribuir para a formação de uma postura crítica e reflexiva na ação profissional do psicólogo em Saúde mental, de forma a lhe oferecer subsídios para uma ação clínica voltada as reais necessidades da população que demanda pelos serviços dos Centros de Atenção Psicossocial de Transtorno Mental.

A questão que permeou este trabalho de tese consistiu em interrogar em que medida os grupos terapêuticos Projetos de Vida, oferecido às mulheres em sofrimento psíquico, dão suporte à sua (re) inserção social, sobretudo no que diz respeito à vida laborativa. Os referenciais teóricos adotados para a contextualização desta temática abrangeram as determinações do Ministério da Saúde quanto à perspectiva psicossocial dos atendimentos aos usuários dos CAPS e as elaborações teóricas de Hannah Arendt sobre ação humana no contexto da vida ativa. Este trabalho teve como objetivo compreender como as usuárias dos CAPS de transtorno mental de Recife-PE experienciam os grupos terapêuticos Projetos de Vida e de que modo tais experiências repercutem no seu viver cotidiano. Teve como objetivos específicos: descrever o trabalho realizado no grupo; contextualizar o ambiente sociofamiliar e laborativo vivenciado pelas usuárias participantes da pesquisa; descrever a experiência prática cotidiana das usuárias a partir das vivências nesse grupo e a repercussão no seu cotidiano. Trata-se de uma pesquisa qualitativa, cujas narrativas foram realizadas através de entrevista aberta, questionário sociodemográfico e consulta a documentos (prontuários e livro de registro de grupos). Para a compreensão das entrevistas, utilizou-se o Interpretativismo de Wilhelm Dilthey, buscando-se compreender os sentidos dados a estes grupos terapêuticos em suas vidas laborativas. No processo de desvelamento, os relatos obtidos abrangeram aspectos comportamentais e emocionais, com destaque a: melhor preparação e conscientização para a convivência sociofamiliar; melhorias no âmbito pessoal de bem-estar e sentimentos de acolhimento, valorização e oportunização de conforto e segurança emocional no convívio interpessoal. Houve, também, relatos de que as vivências contribuíram para o retorno à vida laborativa profissional e para o fornecimento do resgate da reabilitação e reinserção social. As narrativas indicam, ainda, que a maioria dos processos interventivos realizados nos referidos grupos é voltada para o estímulo e incentivo a outros aspectos da vida, que não o laborativo, com destaque para o enfrentamento ao estigma da doença mental e a autoconfiança para a reinserção social. Os relatos sobre as abordagens terapêuticas mencionam um razoável espectro de recursos técnicos para o alcance do que se propõe: discussões temáticas sobre saúde e doença mental; reflexões sobre comportamento; passeios terapêuticos e emprego de artes. Os desejos manifestos se voltam para pretensões de retomada de atividades e aquisição de novos projetos, o que reflete a mudança no papel social da mulher na contemporaneidade. Sobretudo, as narrativas apresentadas corroboram a importância do cuidado às pessoas em sofrimento psíquico, bem como reafirmam o pressuposto de Hannah Arendt sobre vida ativa, qual seja, a ação humana torna-se sem sentido se não for voltada para alguma forma de realização. / The question that pervaded this thesis was to examine to what extent the therapeutic groups Life Projects, offered to women in psychological distress, give support to their social (re) integration, particularly with regard to the working lives. The theoretical framework adopted to the contextualization of this thematic covered the determinations of the Ministry of Health regarding the psychosocial perspective of care to users of CAPS and the Hannah Arendt theoretical elaborations on human action in the context of active life. This study aimed to understand how users of mental disorder CAPS in Recife-PE experience the therapeutic groups Life Project and how such experiences impacting their daily lives. The project has as specific objectives: to describe the work realized in the group; contextualize the social-family and occupational environment experienced by the women participating users of research; describe the everyday practical experience of users from the experiences in this group and how it impacted on their daily lives. This is a qualitative research, whose narratives were made through open interview, sociodemographic questionnaire and consultation documents (records and group record book). For understanding the interviews, it was used the Wilhelm Dilthey interpretivism, seeking to understand the meanings given to these therapeutic groups in their occupational lives. In the process of unveiling, the obtained reports covered behavioral and emotional aspects, especially to: better preparation and awareness of the social-family conviviality; improvements in the personal level of welfare and feelings of acceptance, appreciation and facilitation of comfort and emotional security in interpersonal living. There were also reports that the experiences contributed to the return to professional working lives and for the supply of the rescue of rehabilitation and social reintegration. The narratives also show that most interventional procedures performed in these groups is aimed at stimulating and encouraging other aspects of life, excluding the working lives, especially to face the stigma of mental illness and the self-confidence for the social reintegration. The reports on the therapeutic approaches mention a reasonable range of technical resources for the achievement of what is proposed: thematic discussions on health and mental illness; reflections on behavior; therapeutic riding and arts application. The manifested desires turn to intending of the recovery of activities and acquisition of new projects, which reflects the change in women's social role in contemporary society. Above all, the narratives presented corroborate the importance of caring for people in psychological distress and reaffirm the Hannah Arendt assumption on active life, namely, human action becomes meaningless if it is not directed to any embodiment.

Introduction: Resilience is an important trait and mechanism for older adults facing adversity in their later life. Physical activity has been established as an important determinant of mental health among older adults, in which relationship of resilience may play a mediating role. In order to examine the relationships among resilience, physical activity, and mental health in older adults, the current project is designed to conduct three studies. Study-1 aims to use qualitative method to identify the characteristics that contribute to resilience in a group of community-dwelling older adults in Hong Kong. Study-2 aims to develop and validate an age-specific resilience scale, named as "Resilience Scale for Chinese Older Adults (RSCOA)". Study-3 aims to test a model in which physical activity is hypothesized to influence mental health in path mediated by resilience. Methods: Twenty-five Chinese older adults (2 males, 23 females) aged 69 to 100 years (M=80.00, SD=39.08) were included in Study-1. Interviews were conducted to collect information about the adverse events in their lives, as well as their attitudes towards adversity and the beliefs underlying their approaches to overcoming adversity. The transcripts were analysed using qualitative content analysis. In Study-2, a sequential approach was used to develop the RSCOA in three stages. In stage 1, scale candidate items were generated and initial content validity of the RSCOA were explored. In stage 2, the factorial structure of the RSCOA was extracted using exploratory factor analysis. In stage 3, exploratory structural equation modeling was conducted to test the structure. The reliability and validity of the RSCOA were also examined. In Study-3, cross-sectional data was collected from a sample of 293 Chinese older adults [60 males, 233 females; age from 65 to 95 years old (M=76.58, SD=7.02)] from eight community senior centres located in three districts in Hong Kong. Correlation analyses were performed and path analysis was employed to assess the associations among physical activity, resilience and mental health variables. Results: In Study-1, 7 themes were emerged from the interviews: 1). Equanimity- the realisation that life has both joys and sorrows. 2). Positive attitudes towards life. 3). Meaningfulness- the realisation that life has a purpose and is full of hope. 4). Self-reliance- a belief in one's capabilities and the realisation that each person's life path is unique. 5). Social support- which comes from family and friends, health care professionals, staff in the senior centres and others' appraisal. 6). Environmental support- which includes the support from neighbours, community senior centres and government. 7). Spirituality and faith- which can take the form of a belief in destiny, gratitude or religious faith. For the scale development and validation, a pool of 70 candidate items for RSCOA was established with good content validity in stage 1. In stage 2, seven factors, namely perseverance, self-reliance, spirituality, social support, living in the moment, environmental support, and meaningfulness, reflecting internal, external and existential dimensions, were identified and reflected in 27 items in the construct of resilience. In stage 3, the 27-item RSCOA was further examined, by which 3 items were deleted to achieve acceptable internal consistency (α= 0.87) and good concurrent as well as construct validities, and finally a 24-item RSCOA was confirmed. The measurement model displayed satisfactory model fit and proven invariant across gender. Building on the three path models, it was found that significant mediation effects of resilience on the relations from physical activity to depression (β =-.54, p=.002), from physical activity to loneliness (β=-.25, p=.005), as well as from physical activity to psychological well-being (β=.37, p=.008). In sum, the results confirmed that resilience mediates relationship from physical activity to mental health among the older adults. Conclusion: The qualitative analysis found that resilience of the Hong Kong older adults is characterised by internal, external and existential factors. A reliable and valid age-specific instrument for measurement of resilience in Chinese older people was developed. Older adults who are more physically active reported greater psychological well-being and less mental health problems, and the effects were mediated by resilience. The results may be useful for developing interventions that aim at assisting older adults to enhance the positive experiences and mental health in their lives.