Thesis (Ph. D.)--University of California, San Diego, and San Diego State University, 2004. / Vita. Includes bibliographical references (leaves 122-130).

Thesis (Ph. D.)--Conservatory of Music and Dept. of Psychology. University of Missouri--Kansas City, 2006. / "A dissertation in music education and health psychology." Advisor: Robert Groene. Typescript. Vita. Title from "catalog record" of the print edition Description based on contents viewed Nov. 1, 2007 Includes bibliographical references (leaves 119-141). Online version of the print edition.

It was hypothesized that effect size in therapy outcome research would correlate positively with congruence effects. Congruence was defined as the degree to which what had been practiced in treatment was scored as improvement when outcome was measured. Additionally, it was hypothesized that correcting effect sizes for estimated nongeneralizable change attributable to congruence (i.e., representativeness reduction) would significantly reduce the average magnitude of effect.

Many scholars have noted the pervasiveness of individualism in American culture, particularly in the marriage culture. Unfortunately, assuming individualism in the marriage culture poses very specific threats to marriage as an institution. Some claim that these individualistic assumptions have also infiltrated the marital sciences, undermining the efforts of researchers who hope to defend marriage. This dissertation explores that claim by analyzing seven of the most popular marital outcome instruments used by marital researchers today for individualistic assumptions. Using a conceptual analysis called "contrasting relations," the meanings of both the content and the process of the instruments are laid out according to their underlying ontological assumptions. Two types of ontology guide the analysis: weak relationality, that from which individualism arises, and strong relationality. As the results demonstrate, the instruments are in fact almost entirely underlain with individualistic assumptions. It is argued that outcome instruments used by marital researchers can only measure individualistic relationships (weak relationality), and are incapable of measuring strong relationships, implying that marital researchers are ill-equipped to measure relationships. Implications and future directions are explored.

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Clients rarely present with prototypical presentations for which an “off the shelf” cognitive-behavioural therapy (CBT) approach can be used, and the most frequently cited rationale for case conceptualisation is matching clients’ unique presentations and therapy goals with available theory and research. In this, it is argued that case conceptualisation guides therapy by ensuring that individual cognitive and behavioural processes are targeted, thereby maximising therapy efficacy. Therefore, therapists who are competent in case conceptualisation should achieve better outcomes. However, little is known about the relationship between competency in case conceptualisation and general CBT competence, or how competency in case conceptualisation is linked to therapy outcome. Forty audiotapes selected from an ongoing study (CoBalT: Cognitive Behavioural Therapy as an adjunct to Pharmacotherapy for Treatment Resistant Depression in Primary Care: a randomised controlled trial) were rated for competency in case conceptualisation and competence in CBT using the Collaborative Case Conceptualisation – Rating Scale (CCC-RS) and Cognitive Therapy Scale – Revised (CTS-R) respectively. The assessment of competence was carried out by independent groups of researchers with expertise in these assessments, blind to treatment outcome. Therapy outcome was measured using The Beck Depression Inventory II (BDI-II). The results showed that 1) competence in case conceptualisation shared a strong and positive relationship with general CBT competence and, 2) that competence (in case conceptualisation and general CBT competence) was associated with better treatment outcome for depression. The results highlight competence in case conceptualisation as an important facet of therapist CBT competence, and indicate that investing in the training and selection of therapists competent in case conceptualisation as well as CBT competence has the potential to enhance treatment outcomes.

This study was designed to answer two research questions. First, factors associated with placement decisions to three treatment modalities in a university counseling center were examined; the skills training group for dialectical behavior therapy plus individual therapy (DBT), the interpersonal process group plus individual therapy (IP), and individual therapy only (IND). Individual therapy in all three conditions did not follow a specific theoretical orientation. Of 203 participants (55 males, 148 females), 83 were in DBT, 53 were in IP, and 67 were in IND. Client information included demographic variables (e.g., age, gender) and clinical variables (i.e., diagnosis, and scores from Global Assessment of Functioning, the Outcome Questionnaire-45; OQ-45, and the College Adjustment Scale; CAS). As predicted, the results indicated that clinical characteristics played a significant role in referral decision making, with clients in the DBT condition reporting higher clinical severity. Second, the effectiveness of the skills training group (DBT) was examined, testing the hypothesis that people in DBT start out with more clinical problems but make greater progress than those in IP and IND. Treatment outcome was measured by the OQ-45 and the CAS, each collected at multiple time points. Data from 101 people were available for the OQ-45, and 77 people for the CAS. The results did not provide support for the hypothesis. Although significant change was observed over the course of treatment, no clear patterns of superior outcomes for any of the three treatment conditions emerged.

Abstract Atrial fibrillation (AF) is a common arrhythmia in the clinical setting with a population prevalence of 1–2%. AF significantly increases the risk of stroke and death, worsens coexistent heart diseases and may leave the patient with disabling symptoms. The treatment of AF consists of the control of the underlying conditions, prevention of complications and symptom relief by controlling heart rate (rate control) or by targeting normal rhythm (rhythm control), with the latter achieved either by antiarrhythmic drug (AAD) therapy or catheter ablation (CA). Ablation therapy has generally been applied and studied after failure of AAD therapy. The aim of this study was to evaluate the safety and efficacy of first-line CA in AF. The other objectives were to assess the safety of continuous warfarin therapy during CA and to identify prognostic markers for treatment outcome. A meta-analysis of all randomised studies and a secondary analysis of one randomised study comparing CA and AAD as first-line therapy were performed. In the first study, ablation therapy reduced AF recurrences more than AAD therapy (HR 0.63) when provided as first-line therapy; the rate of complications was similar with both therapies. Some of the complications of ablation therapy were more serious than those encountered with AADs. The second study revealed that the antiarrhythmic efficacy of ablation therapy was more durable. In the third study, the efficacies of continuous and interrupted warfarin therapy were compared in 228 procedures; both strategies were found to be equally safe during a three month follow-up. Furthermore, an analysis of 2317 AF episodes revealed a new electrocardiographic feature at AF initiation, which was associated with AF relapse after the initiation of therapy. Finally, a thorough echocardiographic examination was performed in 49 patients prior to ablation therapy. Mild diastolic dysfunction was associated with AF recurrence. In conclusion, CA was more effective as a first-line therapy than AADs but may cause more severe complications. Continuous warfarin therapy was found to be safe during CA. New electrocardiographic and echocardiographic markers for treatment outcome were recognised. / Tiivistelmä Eteisvärinä on yleinen rytmihäiriö, jonka esiintyvyys väestössä on 1–2 % luokkaa. Eteisvärinä lisää merkittävästi kuolleisuutta ja aivoinfarktiriskiä, vaikeuttaa muiden sydänsairauksien oireita ja saattaa aiheuttaa invalidisoivia oireita. Eteisvärinän hoito keskittyy liitännäissairauksien hoitoon ja komplikaatioiden estoon sekä oireiden lievitykseen joko syketaajuutta säätämällä (sykkeenhallinta) tai pyrkimällä normaaliin rytmiin (rytminhallinta). Rytminhallinnassa käytetään yleisesti joko rytmihäiriölääkkeitä tai katetriablaatiohoitoa. Eteisvärinän katetriablaatiota on useimmiten käytetty ja tutkittu tilanteessa, jossa rytmihäiriölääkitys on osoittautunut tehottomaksi. Tämän tutkimuksen tavoitteena oli arvioida eteisvärinän katetriablaatiohoidon tehoa ja turvallisuutta ensilinjan hoitona. Muina tavoitteina oli katetriablaation turvallisuuden arviointi jatkuvan varfariinihoidon aikana sekä löytää uusia katetriablaatiohoidon tehoa ennustavia tekijöitä. Teimme meta-analyysin kaikista randomisoiduista tutkimuksista ja sekundaarisen analyysin yhdestä randomisoidusta tutkimuksesta, jotka vertasivat rytmihäiriölääke- ja katetriablaatiohoitoa ensilinjan hoitona. Ensimmäisessä työssä ablaatiohoito esti eteisvärinän uusiutumista tehokkaammin (riskisuhde 0.63), eikä komplikaatioiden yleisyydessä ollut eroa hoitojen välillä. Jotkut ablaatiohoitoon liittyvät komplikaatiot olivat kuitenkin luonteeltaan vakavampia kuin lääkehoidossa. Ablaatiohoidon eteisvärinää estävä vaikutus todettiin pidempikestoiseksi toisessa työssämme. Kolmannessa työssä vertasimme jatkuvaa ja tauotettua varfariinihoitoa 228 ablaatiotoimenpiteen aikana. Molemmat lähestymistavat osoittautuivat yhtä turvallisiksi 3 kuukauden seuranta-aikana. Analysoimme edelleen 2317 eteisvärinäkohtausta ja löysimme osalla potilaista uuden eteisvärinäkohtauksen alkuun liittyvän ominaisuuden, joka oli yhteydessä rytminhallinnan tehottomuuteen. Lisäksi teimme 49 potilaalle laajan sydämen ultraäänitutkimuksen ennen katetriablaatiotoimenpidettä. Diastolisen dysfunktion havaittiin olevan yhteydessä eteisvärinän uusiutumiseen. Yhteenvetona totesimme että katetriablaatiohoito on rytmihäiriölääkehoitoa tehokkaampaa ensilinjan hoitona, mutta siihen mahdollisesti liittyvät komplikaatiot olivat luonteeltaan hankalampia. Jatkuva varfariinihoito todettiin turvalliseksi katetriablaation yhteydessä. Löysimme lisäksi sydänsähkökäyrästä ja sydämen ultraäänitutkimuksesta uusia hoidon tehoa ennustavia tekijöitä.

Religion is important to many Americans and the way they approach life, but psychologists are less likely than the general population to be religious. Because of this, it is important to not only know how religious commitment can influence clients' outcome and experience in psychotherapy, but also how the level of match between client and therapist religious commitment might impact those variables. The current study was undertaken in order to investigate how client religious commitment impacts distress at the beginning and end of treatment, how therapist religious commitment impacts the use of religious/spiritual interventions in therapy, and whether the level of match between client and therapist religious commitment predicts client perception of therapy and/or outcome. Seven hundred and thirty individual therapy clients at a university counseling center completed measures of religious commitment, symptom distress, and concerns about therapy throughout their course of treatment. Forty-four therapists also completed a measure of religious commitment in addition to session-by-session checklists detailing what types of interventions they used in each appointment with participating clients. Client religious commitment was found to significantly predict lower initial distress (B = -0.77, p < 0.001, R2 = 0.07, 95% CI [-0.97, -0.57]) and lower distress at the end of therapy(B = -0.32, p = 0.001, R2 = 0.34, 95% CI [-0.51, -0.14]), and fewer concerns about therapy predicted better outcomes (B = 2.04, p < 0.001, R2 = 0.38, 95% CI [1.52, 2.52]). Contrary to the findings of previous research, therapist religious commitment did not predict use of religious/spiritual interventions in therapy (B = 0.05, p = 0.062, R2 = 0.09, 95% CI [-0.002, 0.11]). Finally, level of match between client and therapist religious commitment was not related to client concerns about therapy (B = -0.002, p = 0.161, 95% CI [-2.40, 9.57]) or client outcomes B = -0.014, p = 0.120, 95% CI [-0.03, 0.004]). Possible explanations and influencing factors are put forth and the findings are discussed in the context of a highly religious population.