People's inability to cope with the demands of modern life, has led to a significant increase in the incidence of anxiety being experienced by people from all walks of life. People are suffering from anxiety without knowing the root cause of it and it was found from the anxiety cases studied that its origin can in many cases be traced to the birth experience where specific negative suggestions were imprinted on the subconscious. In this study the influence of the birth experience as the underlying cause of anxiety and the effect of it on the formation of the self-concept and self-actualisation have been explored. The research shows that a subconscious origin exists in the development of anxiety. In the research for this study, Medical Hypnoanalysis, which is based on a process of diagnosis and therapy, was used as therapeutic method with several clients suffering from anxiety symptoms. In this research the perceptions formed in the subconscious during the birth experience were examined and related to the anxiety experienced during childhood and later life. The case studies, their diagnoses and the follow-up therapeutic sessions relating to the birth experience were investigated and discussed. Educational Psychologists show a specific interest in and a tendency to get involved with, or implement Medical Hypnoanalysis in therapy. It became obvious from this study that Medical Hypnoanalysis supplements the needs of the Educational Psychologist as a tool in therapy. In this study guide lines have been presented to the Educational Psychologist for the treatment of anxiety originating from the birth trauma by regressing the client back to this traumatic experience. Suggestions on how to conduct the birth regression sessions have also been presented and clarified. Through the case studies the identification and removal of the highly charged emotional and negative beliefs that were responsible for the anxiety symptom have been demonstrated. The case studies have furthermore demonstrated the successful utilisation of positive and healing suggestions to achieve the therapeutic goals. The results of this study show that Medical Hypnoanalysis can be used effectively in the treatment of the root causes of anxiety. / Psychology of Education / D. Ed. (Psychology of Education)

L’épidémie du VIH a bouleversé le rapport de la médecine à l’individu et inversement. D’une part, la forte stigmatisation associée à la contamination par le virus a rendu le vécu de la maladie plus complexe que pour toute autre pathologie. D’autre part, la chronicisation de l’infection impliquant une prise en charge complexe à base d’une multithérapie au long cours a contraint les soignants à s’interroger plus en profondeur sur la relation intime du patient à son traitement, et tout particulièrement sur l’observance thérapeutique. L’idée de ce travail de thèse est de poursuivre une argumentation en faveur d’une nouvelle approche moins paternaliste de l’observance aux antirétroviraux, incluant un partage des savoirs entre le médecin et le patient, et de l’appliquer à des populations de patients dont les comorbidités compliquent la prise en charge telles que la dépendance aux opiacés et l’infection par le virus de l’hépatite C. A travers une série d’articles, nous avons montré que la prise en compte de la perception du patient vis-à-vis des soins permettait de mieux comprendre la non-observance aux traitements. Chez les personnes traitées pour leur dépendance, la non-observance peut être définie comme l’injection du traitement de substitution ou la consommation d’opiacés illicites. La diminution ou l’arrêt de ces pratiques est un processus long, souvent ponctué de rechutes et elles peuvent être le reflet d’une prise en charge inadaptée. Les résultats de ce travail ont permis de mettre en évidence l’effet positif d’un accès à des soins adaptés, à travers une prise en charge de la pathologie mais aussi la réduction des risques liés à la non-observance. Il s’agit là de promouvoir une relation plus délibérative entre le médecin et le patient. / The epidemic of Human Immunodeficiency Virus (HIV) has profoundly changed the relationship between medicine and humans and vice versa. On the one hand, the intense stigmatization associated with HIV infection has made the disease more complex than for any other pathology. On the other hand, the chronicization of infection has forced care providers to investigate in greater detail the intimate relationship between patient and treatment, and more particularly, the therapeutic adherence. My research work aimed to investigate this latter argument in greater detail, favoring a less paternalistic approach toward therapeutic adherence in HIV-infected patients and applying this approach to multi-treated populations with comorbidities such as drug dependence and hepatitis C. Through several articles, we tried to put in evidence that a model of care that includes patient’s perception about care may lead to better understand non-adherence to treatment (ongoing drug use, drug injection or treatment diversion). In fact, injection cessation or reduction of opioid consumption in dependent individuals is a non-linear process which could take a long time, and which is often punctuated with relapse. Our findings showed the positive impact of access to adequate care to treat not only the disease but also the harm related to non adherence to treatment. The idea is to promote a more deliberative relationship between physician and patient, including a harm reduction approach.

People's inability to cope with the demands of modern life, has led to a significant increase in the incidence of anxiety being experienced by people from all walks of life. People are suffering from anxiety without knowing the root cause of it and it was found from the anxiety cases studied that its origin can in many cases be traced to the birth experience where specific negative suggestions were imprinted on the subconscious. In this study the influence of the birth experience as the underlying cause of anxiety and the effect of it on the formation of the self-concept and self-actualisation have been explored. The research shows that a subconscious origin exists in the development of anxiety. In the research for this study, Medical Hypnoanalysis, which is based on a process of diagnosis and therapy, was used as therapeutic method with several clients suffering from anxiety symptoms. In this research the perceptions formed in the subconscious during the birth experience were examined and related to the anxiety experienced during childhood and later life. The case studies, their diagnoses and the follow-up therapeutic sessions relating to the birth experience were investigated and discussed. Educational Psychologists show a specific interest in and a tendency to get involved with, or implement Medical Hypnoanalysis in therapy. It became obvious from this study that Medical Hypnoanalysis supplements the needs of the Educational Psychologist as a tool in therapy. In this study guide lines have been presented to the Educational Psychologist for the treatment of anxiety originating from the birth trauma by regressing the client back to this traumatic experience. Suggestions on how to conduct the birth regression sessions have also been presented and clarified. Through the case studies the identification and removal of the highly charged emotional and negative beliefs that were responsible for the anxiety symptom have been demonstrated. The case studies have furthermore demonstrated the successful utilisation of positive and healing suggestions to achieve the therapeutic goals. The results of this study show that Medical Hypnoanalysis can be used effectively in the treatment of the root causes of anxiety. / Psychology of Education / D. Ed. (Psychology of Education)

Bakgrund: Teknologi och behandlingsmöjligheter inom intensivvården är under ständig utveckling. Den växande möjligheten till livsuppehållande behandling är inte alltid gynnsam för alla patienter. Det är en utmaning att identifiera tidpunkten då behandlingen blivit medicinsk meningslös och därmed ska avslutas. Beslutsfattandet försvåras eftersom patienterna ofta inte kan tala för sig själva. Processen att komma fram till ett beslut kräver ett samarbete mellan läkare och sjuksköterskor för att tillgodose patientens bästa och anhörigas behov. Att ge alla inblandade en röst har visat sig vara en utmaning och kan leda till konflikt. Syfte: Att belysa intensivvårdssjuksköterskans upplevelse av samarbetet med läkare inför beslutsfattande kring avslutande av livsuppehållande behandling. Metod: En systematisk litteraturöversikt med kvalitativ ansats och induktivt förhållningssätt. Resultat: Sjuksköterskor upplever att deras involverade i beslutsfattandet är viktigt och åtar sig ett antal handlingar för att bidra till samarbetet, samtidigt som de känner sig exkluderade och att deras arbete är undervärderat. Beslutsfattandet upplevs komplext där tid, anhöriga och olika professionella perspektiv påverkar samarbetet. Hur samarbetet är utformad och vilka beslut som tas i enskilda situationer upplevs variera relaterat till hur den individuella beslutsfattaren är som människa och vilka erfarenheter de involverade har. Slutsats: Samarbetet mellan sjuksköterska och läkare vid beslutsfattande om avslut av livsuppehållande behandling är viktigt för att utforma vården efter den individuella patienten. Beslutsfattandet är komplicerat, där etiska och moraliska principer behöver tillgodoses. Genom att få bättre förståelse och reflektera över den professionella rollen kan samarbetet underlättas. Att ta beslut om människors livsöden förblir tungt, men rätt förutsättningar gynnar såväl yrkesprofessionella som patienter.