Essential hypertension has a complex and multiple biological, psychological and social aetiology and remains one of the most serious physical disorders affecting the Black population of South Africa today. Pharmacological treatment has been the predominant approach to blood pressure reduction, but considering that the greater part of essential hypertension has its origin in biobehavioural and cognitive functioning a non-pharmacological treatment approach to essential hypertension is receiving extensive interest both in research and therapeutic practice. This study attempted to implement a specific cognitive-behavioural treatment "package' which was tailored to the emergent aetiology in an urban Xhosa woman suffering from Mild hypertension who was on antihypertensive medication and to evaluate the treatment using a single case-study methodology. A combination of relaxation training and cognitive-behavioural modification was provided over a fifteen week period and evaluated both quantitatively and qualitatively. It was found that a combination of over-weight, occupational stress and anger could have contributed and/or caused the patient's hypertension. The results also show a significant reduction in blood pressure during the treatment phase as well as a reduction in weight, experienced anxiety and angry emotion, and by the end of the study the patient's blood pressure had been reduced to normal levels. Finally the feasibility of using such a treatment approach is discussed in relation to the South African context and the case study method is evaluated as a research tool in light of the findings.

The purpose of the study was to explore the use of Creative Visualization in the context of Family Therapy for treatment of a family of a child with allergies. Based on a single-case research design, the study included pre- and posttest measures; baseline, continuous, and follow-up self-report of symptoms; plus examination of physician's clinical records to determine the efficacy of the intervention. A further purpose of the study was to explore the possible usefulness of a test being developed on the basis of the Psychosomatic Family Model, the Leuven Family Assessment, as an outcome measure. The subject family was an intact family with one adolescent daughter whose most important allergic symptom was poorly controlled asthma, at least partially due to noncompliance with medical advice. The measures included the Leuven Family Assessment, a measure based on the Psychosomatic Family Model, which has been developed for use with families of children with eating disorders; the Family Adaptability and Cohesion Scale (FACES III), a measure based on the Circumplex Family Model, which is a well-accepted measure of family functioning; symptom self-report; and consultation with the child's physician to report hospital admissions and emergency room visits. The baseline period was two weeks, the intervention consisted of two weeks of Relaxation Training and eight weekly meetings for combined Family Therapy and Creative Visualization, and the follow-up consisted of telephone contact with the symptomatic adolescent beginning fourteen weeks after the last family therapy session and continuing for eight weeks. Post-therapy results show a trend toward expected changes in family structure and functioning and marked improvement in the asthmatic symptoms of the adolescent. Creative Visualization is an intervention tool well worth further exploration in the context of family therapy; and the Leuven Family Assessment merits further investigation and development as an outcome measure. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

In the present study we used an empirical validation approach to determine psychosocial variables related to adaptive management of diabetes in two samples of diabetic children and their families. Children from the Kansas University Medical Center (n = 31) and children from the Virginia Diabetes Association (n = 25) provided results of the glycosylated hemoglobin test (a measure of diabetic control); completed self-report measures on variables of anxiety, coping, family adjustment, and health locus of control; and underwent structured interviewing. Parents completed parallel self-report measures, as well as an assessment of child behavior. In addition, a subsample of parent-child dyads participated in a role-play measure of family interactions around the child’s diabetes. All demographic variables and psychosocial measures were not Significantly different across the Kansas and Virginia samples. Children in optimal control of diabetes had more structured and organized family environments, more frequently believed that ''powerful others'' were responsible for their health, and showed lower levels of negative coping with family problems than children in nonoptimal diabetic control. Surprisingly, children in optimal diabetic control showed poorer knowledge of diabetes and its management than children in nonoptimal control. Psychological interventions to promote adaptive diabetic control should incorporate findings related to family environment, locus of control, and the child’s style of coping with family problems. / Ph. D.

Thesis (PhD (Social Work))—University of Stellenbosch, 2005. / It is generally accepted that the inability to consummate a marriage causes couples great distress, and can finally lead to divorce. Limited research has been done on the unconsummated marriage in South Africa. International studies have pointed out that the unconsummated marriage is a reality and a prevalent problem. While medical and therapeutic intervention is available, many people still suffer in silence and feel embarrassed about their condition. The purpose of this study was to gain a better understanding of the emotional and psycho-social experiences and perceptions of the couple in an unconsummated marriage. In order to achieve this goal, the objectives of the study were to explore the experiences of the couple in an unconsummated marriage in order to obtain the couple’s perception of their marriage; to present a literature overview on the subject of marriage within the context of the family life cycle; to describe the nature and causes of an unconsummated marriage; to critically describe approaches and models that may be used for the assessment of an unconsummated marriage; and to reflect on the implications of the emotional and psycho-social experiences and perceptions of the couple in an unconsummated marriage within a postmodern systemic framework. The purpose of the literature study was to provide a context for the research study. The researcher conducted an extensive literature review in order to establish and refine the research subject and to guide the empirical study. An exploratory study was executed and the purposive non-probability sampling method utilised. The sample for this study was obtained from Intercare Medical Centre, Johannesburg and The Square Medical Centre, Umhlanga between April 2004 and November 2004. Ten couples that have not consummated their marriage were included in the sample. An interview schedule with open-ended questions was used to conduct joint interviews with the couples. The empirical study enabled the researcher to draw certain conclusions. The main conclusion was that males and females in an unconsummated marriage experience and perceive control-related problems; negative feelings towards their own and their partner’s body; a fear of engaging in an intimate relationship and other phobias; a feeling of sin and moral dilemma; feelings of guilt and shame; the manifestation of depression and apathetic attitudes; personal distress and psychological problems; a feeling of serious regret and sadness; self-blame, self-destructive behaviour, mutilation and suicidal thoughts and episodes; and lastly, a lack of information on how to be sexually intimate with a partner. A number of recommendations flowed from the findings. The main recommendation was that healthcare professionals such as social workers should be better educated about the phenomenon of the unconsummated marriage in order to make a correct diagnosis and deliver high quality medical and therapeutic intervention.

published_or_final_version / abstract / Community Medicine / Doctoral / Doctor of Philosophy

Recent research suggests that psychological techniques may facilitate injured athletes' rehabilitation, yet little is known about the psychological techniques trainers currently employ and how they view these interventions. In this study, 206 athletic trainers assigned Likert scale ratings to 11 psychological techniques indicating how much they valued a specific technique, how skillfully they employed it, and how often they utilized it. Trainers also responded to an open ended question asking how they would deal with the psychological aspects of an injury described in a short scenario. Results revealed a tentative model for the way trainers view psychological techniques. Categories of techniques included techniques involving the modification of physical and psychological states (goal setting, pain management, relaxation, imagery, and breathing techniques), techniques involving verbal cognitive techniques (communicating openly, changing negative self talk, emotional counseling, and crisis counseling), and non-recommended techniques (encouraging heroism and screening negative information). The study explored trainers' perceptions of each of the 11 psychological techniques in depth and discussed these findings. The study found that although trainers highly value psychological interventions in their work with injured athletes, they assigned low ratings to the techniques they knew little about. However, as exposure to sport psychology information increased, ratings assigned to the techniques that modify physical and psychological states also increased. Similarly, the longer trainers had worked in their field, the more highly they valued the verbal cognitive interventions. In contrast, neither exposure to sport psychology information or athletic training experience proved predictive of ratings assigned to the non-recommended psychological techniques. These findings suggest the importance of introducing skills training for psychological techniques early in the athletic trainers' educational curriculum so that trainers can gain awareness of the efficacy of certain psychological techniques and skill at using these techniques. Moreover, trainers could benefit from course work explaining potential negative consequences of employing harmful or ineffectual psychological interventions.

A series of five individual studies explored: (1) Whether a treatment focus emphasizing active anger expression would alter the subject's awareness of and ability to express anger and (2) Whether such a treatment focus would alter the subject's experience of illness in the form of her report of pain and stiffness as "better", "the same", or "worse" than yesterday's experience. The treatment strategy utilized general Gestalt principles and was further focused on specific techniques of Anger Therapy as an agent of change. Evaluation of outcome in this time-lagged multiple baseline design viewed the overall process from the beginning of a baseline observation period through a maximum of one week following the conclusion of the last six weekly treatment sessions; daily measurement of the process of change during treatment; and clinical description of the subjects and of the treatment process itself. The overall process was formally assessed in pre and post treatment testing which included the Novaco Anger Inventory, Buss-Durkee Hostility Inventory, Marlowe-Crowne Social Desirability Scale, and FIRO-B. Daily telephone interview measured the frequency of anger awareness, anger expression; and ratings of anger intensity, overall daily mood, pain, and stiffness. Information from the treatment process was integrated with that obtained from other sources in discussing the outcome for each subject. It was concluded that intense anger expression appeared to effect temporary or transitory improvement in pain; that there was a relationship between each subject's perceived daily anger intensity and pain which appeared consistent for all subjects studied; and that issues of need for approval and control appeared related to anger awareness and expression as measured by the psychometrics utilized. These were recommended as potentially fruitful areas of future investigation. Background data revealed striking similarities in birth order and parenting practices which seemed worthy of further study as well.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2017-03-27T10:22:27Z No. of bitstreams: 1 Augusta Renata Almeida do Sacramento.pdf: 9888290 bytes, checksum: fadb890d0459ba8b85c16f2db87c194a (MD5) / Made available in DSpace on 2017-03-27T10:22:27Z (GMT). No. of bitstreams: 1 Augusta Renata Almeida do Sacramento.pdf: 9888290 bytes, checksum: fadb890d0459ba8b85c16f2db87c194a (MD5) Previous issue date: 2017-03-15 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The proposal of this thesis, based on psychosomatic theoretical literature, was to present the perception of women with vitiligo about a group psychological intervention on their coexistence with the disease. The participants were evaluated in two moments, with the use of the following instruments: semi-structured interview and group psychological intervention. The intervention was carried out in five encounters, with a sample of 12 women, of the State of Sergipe, divided into Group A (n=8) and B (n=4), aged between 20 and 72 years old, who live with the disease in the range of 5 to 58 years old. The intervention included the use of three resources: word, body, and art. The data were analyzed and grouped into five main themes: 1) perception of self; 2) perception of the disease; 3) perception of the relationship with the disease; 4) perception of friendly, lovely and family relations; 5) perception of group psychological clinical intervention. The overall results indicate, for all participants, different expressions of psychological suffering associated with the illness by vitiligo, pointing to a not recognized grieving process. Women complain that there is no social validation of clinical condition presented and, at the same time, it does not seem to allow the personal recognition of losses arising with the pathology. There was either the need for guidance to the family because one realizes that living with vitiligo has the potential to affect not only the people with the disease, but also their family members, in addition to the love and friendship relational contexts. We observed that the intervention allowed the participants to express the anguish and to recognize the limitations and defensive behaviors due to the illness, being perceived by them in a positive way, therefore, revealing itself as a useful resource in the care of patients with vitiligo, striving for the development of resiliency. Bring these issues to debate can contribute to the minimization of individual and collective effects, by the reduction of discrimination and stigmatization associated with the diagnosis, which can contribute to a more satisfying prognosis and improvements to the quality of life of the public / A proposta desta tese, sustentada no referencial teórico da psicossomática, foi apresentar a percepção de mulheres com vitiligo acerca de uma intervenção clínica psicológica grupal na sua convivência com a doença. As participantes foram avaliadas em dois momentos, com a utilização dos seguintes instrumentos: entrevista semiestruturada e intervenção clínica psicológica grupal. A intervenção foi realizada em cinco encontros, com uma amostra de 12 mulheres, do estado de Sergipe, divididas em grupo A (n=8) e B (n=4), com idades entre 20 e 72 anos, que convivem com a doença no intervalo de 5 a 58 anos. A intervenção contou com a utilização de três recursos: palavra, corpo e arte. Os dados foram analisados e agrupados em cinco eixos temáticos: 1) percepção de si; 2) percepção da doença; 3) percepção da relação com a doença; 4) percepção das relações de amizade, amorosas e familiares; 5) percepção da intervenção clínica psicológica grupal. Os resultados gerais indicam, para todas as participantes, diferentes expressões de sofrimento psicológico associadas ao adoecimento por vitiligo, que apontam para um processo de luto não reconhecido. As mulheres se queixam de que não há uma validação social da condição clínica apresentada e, ao mesmo tempo, isso parece não possibilitar o reconhecimento pessoal das perdas advindas com a patologia. Verificou-se, ainda, a necessidade de orientações à família, pois se percebe que a vivência com vitiligo tem o potencial de afetar não somente as pessoas com a doença, mas também seus familiares, além dos contextos relacionais amorosos e de amizade. Observamos, igualmente, que a intervenção permitiu às participantes a expressão de angústias e o reconhecimento de limitações e comportamentos defensivos devido à doença, sendo percebida por elas de forma positiva, revelando-se, portanto, como um útil recurso no cuidado a pacientes com vitiligo, com vistas ao desenvolvimento da resiliência. Trazer ao debate essas questões pode colaborar com a minimização de efeitos individuais e coletivos, pela redução da discriminação e estigmatização associadas ao diagnóstico, o que pode contribuir para um prognóstico mais satisfatório e melhorias para a qualidade de vida desse público

published_or_final_version / abstract / toc / Social Work and Social Administration / Doctoral / Doctor of Philosophy

The World Health Organization (1969) has declared that heart disease is the largest plague that ever faced humanity. Myocardial Infarction (MD, in addition to causing more deaths than all other diseases of the heart combined, is responsible for changes, and in many cases deterioration, in the quality of life of survivors. Intervention programs tend to focus on preventing re-occurrence of MI. At the same time there is an urgent need for sophisticated rehabilitation programs that aim to improve quality of life after MI. It is speculated here that identification of the personality factors that relate to the different adjustment patterms of different subgroups of post-MI patients will assist in the design of an efficient rehabilitation program. Accordingly, the present study focuses on the inquiry of the psychological mechanisms that mediate between the Type A behavior pattern (TABP) and adjustment style. An integrated crisis and developmental theory based on psychoanalytical, attachment and social learning theories is proposed. The Thesis put forward is that TABP is not a homogeneous pattern and that interpersonal dependency is an underlying personality factor that subdivides Type A patients to subgroups with different developmental and adjustment patterns. It is claimed here that dependent Type A patients have a dependent-independent developmental psychodynamic conflict, and that for them, TABP is an adopted defense mechanism. They are expected to have more adjustment difficulties to the specific characteristics of the post-MI crisis than inde pendent Type A patients for whom TABP is a socially learned developmental process in an urban Western environment. Type B patients, who also lack the psychodynamic conflict, are expected to adjust as a group better than dependent Type A patients. Seventy-nine white urban South African males aged 30-60 years, after clinical MI, were tested. A combination of qualitative and quantitative methods of assessment was used in order to test the relationships between personality factors and adjustment, which was defined by multi-dimensional criteria (32 indices of adjustment) that related to various aspects of life in the post-MI period. The results confirmed the heterogeneity of TABP, dependent Type A patients adjusted less well than independent Type A patients to 16 out of 32 indices of adjustment. As expected for the same 16 indices, the behavior of Type B patients was better adjusted than dependent Type A patients. The outcomes of the adjustment of post-MI patients to all 32 indices is discussed. On the basis of the study's results and the crisis and developmental theory set out here, a differential rehabilitation program is proposed that relates to the different needs of the subgroups of post-MI patients. / Thesis (Ph.D.)-University of Natal, Durban, 1986.