Gestational diabetes mellitus impacts between 3-10% of pregnancies, and increases the risk of pregnancy complications and lifelong health effects for mother and child (Bellamy, Casas, Hingorani, & Williams, 2009; Ross, 2006; Ryser Rüetschi et al., 2016). About half of cases occur without an evident risk factor (American College of Obstetricians and Gynecologists (ACOG), 1994; Dode & Santos, 2009). The present study was designed to examine possible psychophysiological connections linking psychological stress and stress reactivity, the magnitude of an individual’s response to stress, to blood sugar metabolization during mid-pregnancy between 24-28 weeks gestation. Participants were recruited from Sanford Health in Fargo, where patients underwent routine Oral Glucose Tolerance Testing (OGTT) a diagnostic assessment in which higher results indicate less blood sugar metabolization. They also completed a Virtual Trier Social Stress Task while psychological and physiological markers of stress reactivity were assessed. Additionally, maternal stress and stress reactivity were assessed using psychosocial questionnaires. There was support for proposed psychophysiological connections, including models in which positive associations between OGTT and maternal stress and anxiety were moderated by psychological stress reactivity. Results suggest that both the presence of stress and a women’s responses to that stress are influential over blood glucose metabolization during pregnancy. Continuing research in this area may have implications for improving outcomes of women at higher risk of GDM and other adverse pregnancy and perinatal outcomes.

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Current clinical diagnostic procedures may lead to an V over-identification of hypertension. The lack of a comprehensive assessment may also lead to difficulty in timing cognitive-behavioral interventions to coincide with periods when blood pressure is most elevated. The goals of the current study were (a) to determine if a laboratory relaxation procedure would be capable of discriminating those individuals who generally have elevated blood pressure from those who react with increased blood pressure specifically to laboratory assessment, and (b) to identify "markers" of emotional states which would enable individuals to determine when their blood pressure was elevated. Fifty-one undergraduate students at Virginia Tech volunteered to participate in a two-hour laboratory session consisting of baseline blood pressure measurements, a relaxation procedure and a battery of psychological questionnaires assessing anger, anxiety and Type A. This was followed by a two-day self-monitoring period consisting of approximately twelve self-reports of mood state concurrent with blood pressure measured by a portable, semi-automatic monitor. Results suggested that blood pressure response to the laboratory relaxation procedure was associated with the difference between average ambulatory blood pressure and laboratory blood pressure for diastolic A blood pressure only. Anger arousal and anger expression were unrelated to either average ambulatory blood pressure or high versus low ambulatory blood pressure readings. Perceptions of the environment as hostile and demanding did discriminate between high versus low systolic blood pressure and diastolic blood pressure readings. A cluster of negative moods discriminated between high and low systolic blood pressure readings. A cluster of moods characteristic of the Type A behavior pattern also discriminated high versus low systolic blood pressure readings as well as high versus low heart rate readings. One of the clearest findings of the study was the relationship between the type of analysis used and the probability of finding an association between psychological variables and blood pressure. In general, across subject analysis yielded fewer significant relationships than analyses emphasizing within subject variation. Exploring this further, two case studies are presented which illustrate statistical procedures for analyzing the relationship between blood pressure and mood in single case designs. / Ph. D.

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There has been wide recognition for a number of years that psychological components played a part in the etiology and treatment of some cases of chronic urticaria. Divergent opinion has been expressed regarding the importance of these components and their specific indentification. Most contentions in this area are supported by meager experimental evidence and the formulations are too often based on the superficial observation of a large number of cases or on the intensive study of the individual case. The hypothesis of this research is that siqnificant psvchological components exist in patients with chronic urticaria and that these components are amenable to precise delineation. This study presents a combined statistical, psychometric and clinical approach to the field of psychosomatic disorders in general and to the problem of chronic urticaria particularly. Hypnotic and psychoanalytic procedures were utilized to supplement evidence procured by traditional objective instruments. The sample of twenty-two cases is large enouqh to minimize the criticism of the individual case.

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This thesis is focused on the organization of interdisciplinary teamwork in the field of psychosomatic medicine at specialized clinics in Bavaria. The main objective is to describe the system of organization and management of local teams and principles that constitute the teamwork in the psychosomatic field. The paper consists of two parts, theoretical and empirical. The theoretical part deals with team and teamwork defintion, as well as its characteristics in health care and in multidisciplinary (interdisciplinary) teams with regard to the specifics of their management. Multidisciplinary teams and interprofessional cooperation is discussed in relation to the field of psychosomatic medicine. A summary of the current basis of psychosomatic medicine in the context of medical education, legislation and the health care system in the Federal Republic of Germany and the Czech Republic follows. The system of the field of psychosomatic medicine in Germany is one of the main reasons why the empirical part is focused on the German environment of psychosomatic practice. The results of this thesis bring a model of the teamwork at psychosomatic clinics in Bavaria, which the Czech environment can be inspired by in its concept and can build on the major discovered principles of teamwork. These are common visions...

The Self-Regulation Model (Leventhal, Nerenz & Steele, 1984) highlights the roles of patients' illness representations, coping, emotional reactions and appraisal of coping in the progression of chronic disease. This thesis incorporates previous literature on adherence, panic-fear and selfmanagement interventions into the model in order to (a) investigate coping with asthma and (b) develop an intervention aimed at improving asthmatic control. New measures of asthmatic control and illness representations of the consequences of having asthma were developed in order to operationalise the model. A cross-sectional study investigated factors influencing asthmatic control in a sample of 35 adult asthma sufferers recruited through a single general practice. Coping was poor, adherence being low and less than 50% of participants reporting current Peak Flow monitoring or medical contact during the previous 12 months. Good coping appeared to be a response to poor asthmatic control, rather than prophylactic. Good asthmatic control was associated with low perceived consequences, recent medical contact, moderate panic-fear and low general avoidance coping. These results imply that asthmatic control may be improved by encouraging sufferers to maintain regular contact with outpatient services and to implement prophylactic coping. Since epidemiological and clinical evidence suggested asthmatic control to be poor in young adults, an intervention was developed to improve asthmatic control in this group by modifying illness representations, coping and panic-fear. The intervention was evaluated in a randomised controlled study of 50 student asthma sufferers identified initially through an epidemiological screening of 2,979 students. It led to increased Preventer medication use and Peak Flow monitoring and decreased distress over the condition. However, the coping process changed and asthmatic control improved even in the control group, perhaps because self-monitoring of asthmatic control for the study constituted a change in coping. This unanticipated result was entirely compatible with the Self-Regulation Model. The thesis dearly demonstrates value of the Self-Regulation Model in understanding asthma self-management and developing clinical interventions.

The purpose of this study was to investigate the effects of spouse participation in treatment on symptomatology in individuals suffering from fibrositis, a form of soft tissue rheumatism which has no identifiable, organic etiology and which represents a chronic, intractable pain disorder. While spouse participation has been widely advocated in the treatment of fibrositis and other chronic pain disorders, its effects as a unitary variable had not yet been objectively measured. In the present study, spouse participation consisted of a six-week, seven session group therapy program. Educational materials, counseling, and mutual support were utilized. Patients themselves were not directly exposed to treatment. Five patient-spouse diads were randomly assigned to each of the two treatment groups. Coincidental attrition resulted in the loss of one diad from each group. A time-series design was used in which treatment and nontreatment intervals were alternated for the two treatment groups. Six dependent measures were administered to the patients at pretest, posttest, and follow-up. The measures assessed were: pain intensity, functional activity, psychological adjustment, emotional dependency, and awareness of disability. The last two measures were also administered at pretest, posttest, and follow-up to the spouses. Significant results beyond the .05 level of confidence were yielded on psychological adjustment and awareness of disability for the patients. Analysis of individual subscales revealed that a significant reduction had occurred on the following scales: somatization, depression, obsessive-compulsiveness, psychoticism, and emotional reliance on others. Improvement did not reach a statistically significant level on pain intensity, functional activity, or overall dependency. Significant results were achieved only on the variable of awareness of disability for the spouses. The findings indicate that spouse participation in treatment had measurable, beneficial effects on symptomatology for the patients in this study, and support the application of similar interventions with other fibrositis and/or chronic pain patients.