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Turkington, Douglas. "Cognitive-behavioural therapy (CBT) for schizophrenia." Thesis, University of Newcastle upon Tyne, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.271209.
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Brown, Shona Lynsey. "Cognitive behavioural therapy for non-cardiac chest pain." Thesis, University of Edinburgh, 2013. http://hdl.handle.net/1842/9722.
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Objectives: This thesis aims to explore evidence for the effectiveness of cognitive behavioural therapy (CBT) for non-cardiac chest pain (NCCP). Design: The systematic review aimed to evaluate evidence for CBT as an effective intervention for anxiety in the NCCP population. Study one describes the chest pain characteristics, illness beliefs and prevalence of anxiety in a NCCP sample in a cross-sectional design. Study two explores the acceptability and clinical effectiveness of a CBT-based self-help intervention for NCCP patients, using a between subjects, repeated measures design. Methods: A systematic review was completed via a comprehensive literature search for comparative studies examining CBT-based interventions for NCCP including a measure of anxiety. In the empirical study, participants completed measures of anxiety, illness beliefs and indices of chest pain (self-reported frequency, severity and impact on activities) at baseline. Comparisons between illness beliefs and anxiety were undertaken using descriptive statistics and Pearson correlations. Participants were randomised to receive a CBT-based self-help intervention booklet or treatment as usual, with questionnaires re-administered at three-month follow-up. ANOVAs were used to evaluate whether the intervention led to improvements in anxiety levels, or increased belief in participants’ personal control of symptoms. Results: Ten studies met inclusion criteria for the systematic review, with four studies showing evidence regarding the effectiveness of CBT for anxiety. Approximately two thirds of the thesis research sample reported on-going pain following clinic attendance, for the majority this was ‘very mild’ or ‘mild’ pain. Almost half (47%) reported experiencing clinically significant anxiety. Stress was the most common causal attribution advocated by the sample to explain their chest pain. Anxiety scores were significantly associated with psychological attribution scores, but not with personal control or illness coherence beliefs. In study two, 87 participants completed the study and ITT analyses were completed on 119. There were no significant differences between the groups in terms of reduced anxiety or self-reported belief in personal control of symptoms. The intervention booklet was evaluated largely positively by those who reported reading it. Conclusions: CBT-based self-help appears an acceptable intervention for those diagnosed with NCCP. Further research is needed to identify those who are most likely to benefit from such self-help intervention.
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Collins, Ronan. "'Client choice' : how some CBT therapists construct collaboration : implications for CBT and counselling psychology practice." Thesis, University of Roehampton, 2016. https://pure.roehampton.ac.uk/portal/en/studentthesis/client-choice-how-some-cbt-therapists-construct-collaboration--implications-for-cbt-and-counselling-psychology-practice(db45cd83-20bf-4c12-a917-256c04221ed1).html.
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Collaboration between therapist and client has been put forward as a core element of successful therapeutic encounters. There has been debate as to the nature of collaboration in cognitive behavioural therapy. In the UK this debate has intensified since the introduction of Increasing Access to Psychological Therapies (IAPT) in 2008 as CBT is the favoured therapeutic modality within IAPT. Collaboration in CBT has been conceptualised in dichotomous ways. From one perspective it is constructed in positivistic terms, in which the therapist implements manualised protocols with little consideration for the therapeutic relationship; from the other perspective collaboration is constructed in dialogic terms, in which therapist and client use CBT interventions to consider new meanings that the client deems to be relevant. The current study used a discourse analytic methodology to investigate how CBT therapists construct collaboration in their therapeutic practices. The aim was to explicate interpretive repertories that participants used in the construction of collaboration. Semi-structured interviews were used with 8 CBT therapists. Questions related to the arguments for and against the nature of collaboration in CBT. A client choice interpretive repertoire was used by all participants. It was constructed in various ways in line with either positivistic or dialogic perspectives or elements of both. Individual participants constructed client choice from both perspectives suggesting that the dichotomy in perspectives on collaboration in CBT may not be clear-cut. There is an implication for counselling psychology practitioners to reflect on their use of dichotomous perspectives to conceptualise their professional identities.
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Andersson, Peter. "Implementation of website for cognitive behavioural therapy using the development framework Symfony." Thesis, Linköping University, Department of Computer and Information Science, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-54722.
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This report follows the process of developing a website for cognitive behavioural therapy using the web development framework Symfony. The purpose was to find out if it is appropriate to use Symfony to ease development and maintenance of a website for therapy. For this to be true the framework had to be able to help create a website that was secure, user-friendly and easy to maintain.
The website was developed using several features of the framework including database abstraction, automatic code generation and URL-rewriting. A plugin was used to enhance the security by adding a complete solution for user authentication. The website was tested by using built-in test functionality of the framework that could run test on functions or emulating a browser visiting the website.
During the development the framework was tested and evaluated. The worst drawback turned out to be Symfonys steep learning curve, its security solution that only worked if the website was installed correctly and its slow loading time. Except those faults the framework performed well and was easy to use ones the initial learning time was over.
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Turner, Laura. "A systematic review of cognitive behavioural therapy (CBT) for the management and treatment of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) and Cognitive Behavioural Therapy (CBT) for CFS/ME : an interpretative phenomenological analysis." Thesis, University of Sheffield, 2014. http://etheses.whiterose.ac.uk/6931/.
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au, mwise@westnet com, and Michael Wise. "Mad Science: Discourses of Schizophrenia and Therapy for Hearing Voices." Murdoch University, 2004. http://wwwlib.murdoch.edu.au/adt/browse/view/adt-MU20041221.95451.
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People who are diagnosed with severe mental illness experience some of the most extreme and pervasive prejudice of all groups in Western society. How can this still be so? Although the term mental illness is typically reserved for the most serious of cases, psychiatrys medical model is expanding into increasingly everyday realms. Thus, in concert with efforts to reduce social stigma, mental illness is becoming normal. Nevertheless, abnormality is a requirement of biopsychiatry and its offshoots; professionals require some thing to remedy. How do clinical professionals manage these tensions? And what alternatives are there to the pathologizing of such phenomena?
Such concerns are considered in relation to my main thesis question: How do professionals represent schizophrenia and hearing voices in theoretical texts, and how is that played out in the minutiae of therapy practices? Drawing on discourse analysis and conversation analysis, I critique professional categorizations of what are typically known as schizophrenia, mental illness, patients, clients, and therapists. My case in point is the experience of hearing voices - pathologically known as auditory hallucinations. Delusional beliefs are also considered.
In Part 1, accounts of voices as supernatural or ordinary phenomena, or as a symptom of severe mental illness, are considered. Mainstream psychiatric and psychological texts are analyzed and critical alternatives are summarized.
In Part 2, a selection of studies of interactions involving severe mental illness are reviewed and ongoing analytic/methodological debates are discussed. A cognitivebehavioural therapy group for hearing distressing voices then provides data from clinical talk-in-interaction for analysis. I focus on negotiations of reality (the ordinary versus the psychiatric) and on what I take to be sanist prejudice-in-action.
Part 3 relates findings from Part 2 to the context and findings of Part 1. There is also discussion of the positive implications of a more social and dialogical approach to understanding and otherwise dealing with the phenomena in question; for voice hearers, schizophrenics, and society at large.
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Brewster, Kay. "Client experiences of cognitive behaviour therapy (CBT) : factors influencing engagement." Thesis, Lancaster University, 2015. http://eprints.lancs.ac.uk/75548/.
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This thesis constitutes a qualitative exploration of individuals’ experiences of cognitive behaviour therapy (CBT) in both physical and mental healthcare settings. The literature review comprises a meta-synthesis of nine papers exploring experiences of CBT, which resulted in the identification of six themes: shared experience allowing reconnection; CBT skills enabling changing relationship with illness; therapist factors central to engagement; therapy as challenging; the importance of being able to talk to someone outside of the family; and therapy as life-changing. The main implication of these findings is the need for greater consideration of the complex nature of social support in the context of chronic illness and the specific challenges and benefits of engagement in CBT in this population. The empirical paper provides a qualitative exploration of the experiences of adults who have dropped out of CBT in a community mental healthcare setting. Thematic analysis resulted in the identification of five themes: the role of therapist factors; limitations of the CBT model; CBT as pathologising; the socio-political context of CBT; and responsibility for engagement and change. This is the first qualitative exploration of CBT drop-out across diagnostic groups and, as such, this study contributes an important insight into the challenges associated with engagement in CBT and the influence of socio-political context. Finally, the strengths, limitations and challenges of the research process are discussed in the critical appraisal, with particular reference to the broader theme of occupying the position of both clinician and researcher.
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Giles, Clover. "A replicated, single case, feasibility study of group cognitive behavioural therapy+ for provoked vulvodynia." Thesis, Örebro universitet, Institutionen för juridik, psykologi och socialt arbete, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-73359.
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Rudge, Marion. "An Exploratory Analysis of Change During Group CBT for Social Phobia in Clinical Practice: A Treatment-Effectiveness Study." Thesis, University of Canterbury. Psychology, 2007. http://hdl.handle.net/10092/1417.
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The effectiveness of a Group CBT programme for Social Phobia was assessed using 18 participants recruited from a routine practice setting. Therapy was based on CBT techniques as practiced routinely by the clinical practice, and were not modified for the study by factors such as strict exclusion criteria and adherence to rigid manualised treatments. Pre- to post-treatment effect sizes compared favourably with those reported in a meta-analysis (Taylor, 1996). The findings provide support for the accessibility and effectiveness of group CBT techniques for Social Phobia in field settings. While some individuals within the sample experienced dramatic improvement, some remained severely impaired even at post-treatment. The results of Hierarchical Multiple Regressions indicated that lower levels of pre-treatment depression severity, higher levels of attendance, and greater homework compliance, were predictive of more improvement on some, but not all, measures of outcome. Implications for treatment are discussed.
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Avdagic, Elbina. "Enhancing Treatment Engagement, Adherence and Outcomes in Generalised Anxiety Disorder (GAD)." Thesis, Griffith University, 2014. http://hdl.handle.net/10072/367878.
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Generalised anxiety disorder (GAD) is a chronic condition affecting around 5% of the population over the lifetime (Kessler, Berglund, Demler, Jin, & Walters, 2005). It is characterised by pervasive and uncontrollable worry and is associated with high rates of comorbidity and significant psychosocial impairment (Roemer & Orsillo, 2007). Although cognitive-behavioural therapy (CBT) has been found to be an efficacious treatment for GAD, the percentage of individuals with GAD who do not engage and adhere to CBT treatment protocols, disengage from therapy prematurely or continue to experience significant residual symptoms after treatment is larger than for other anxiety disorders (Wittchen, 2002; Westra, Arkowitz, & Dozois, 2009). Thus, addressing factors related to motivating individuals with GAD to start therapy, adhere to treatment protocols and improve their treatment response is an important task for researchers (Hoyer & Gloster, 2009). The current research investigated three factors identified in the literature as having a significant impact on engagement in therapy, adherence and therapy response. These factors include illness representations, motivational style and acceptance strategies. The research comprised of a series of three studies that aimed to contribute to the research literature and provide further clarification regarding some limited or inconsistent findings identified in previous research in relation to treatment engagement and treatment response rates of individuals with GAD.Thesis (PhD Doctorate)
Doctor of Philosophy in Clinical Psychology (PhD ClinPsych)
School of Applied Psychology
Griffith Health
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Akhtar, Nazreen. "The experiences of cognitive behavioural therapists when delivering manualised therapy to Black and Minority Ethnic clients." Thesis, University of Wolverhampton, 2016. http://hdl.handle.net/2436/620346.
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Rationale: This study was conducted to help improve mental health care for Black and Minority Ethnic (BME) clients as previous research carried out in non-western countries has suggested that western-developed psychotherapies often need to be culturally adapted to become more effective in treating this client group. The aim of this study was to explore how CBT therapists deliver manualised CBT with BME clients and if they make any adaptations, how and to what extent are they implemented. Method: Interpretative Phenomenological Analysis (IPA) guided the conduct and analysis of one-to-one, semi-structured interviews with six CBT therapists working in an Improving Access to Psychological Therapies (IAPT) service. The inclusion criteria for participants was accreditation with the BABCP, completion of an IAPT programme CBT diploma and to be currently working in an IAPT service, at least two years experience as a CBT therapist and at least four cases of completed therapy with BME clients. Findings: Four master themes emerged (1) CBT is based on western principles, (2) The complex nature of CBT, (3) Changing practice of manualised CBT and (4) The influence of therapist factors. Conclusion: The participants experienced many issues in their practice of manualised CBT with BME clients which led them to make changes including adaptations to manualised CBT. They described their current practice as being integrative as they incorporated therapeutic approaches other than pure manualised CBT, making them more flexible and adaptable. The adaptations involved altering the cognitive and behavioural interventions to better suit the individual needs of the client. The adaptations took into account the client’s culture, religion, language, psychological mindedness, acculturation to their host country, education and age. The participants’ confidence in CBT and their self-identity as therapists also influenced their overall practice of therapy. Recommendations for practice are discussed in relation to therapeutic practice, training of therapists, supervision and policy makers.
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Reinhardt, Stefanie. "A grounded theory of the conceptualisation of the therapeutic relationship by practitioners of cognitive-behavioural therapy (CBT)." Thesis, University of East London, 2011. http://roar.uel.ac.uk/3552/.
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The concept of the therapeutic relationship has been emphasised by different therapeutic traditions. In Cognitive-Behavioural Therapy (CBT) the therapeutic relationship has received more attention in recent years after being considered less important than the application of cognitivebehavioural techniques to outcome. Qualitatively the therapeutic relationship in cognitive-behavioural therapy has generally been described as the working alliance. This study has sought to explore how practitioners of CBT conceptualise the therapeutic relationship in their work. Data were collected in the form of audio recorded semi-structured interviews with eight psychologists, some of whom were also CBT therapists. A constructivist version of grounded theory was chosen to analyse the data, which reflected epistemological and methodological considerations. The core dynamic suggests that the therapeutic relationship in CBT is an individual, ever-changing concept shaped by each therapist's training, experience, ongoing practice and reflection. The participants' practice of CBT was influenced by, and influential to the personal meaning they attributed to the therapeutic relationship. The therapists' prior training and experience provided the conceptual basis for the understanding of the therapeutic relationship. This conceptualisation was adapted to fit the participants' work contexts. A process of reflection enabled the clinicians to incorporate ideas they held about CBT and the therapeutic relationship into their work, and allowed for the continual adaptation and refinement of the concept of the therapeutic relationship. Suggestions for further research are made considering that practitioners of CBT come from diverse professional backgrounds and there are implications for the training and practice of this range of practitioners.
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Noble, Ariele M. "'You know, you've got to be kind of human' : how CBT therapists experience personal therapy in clinical practice." Thesis, University of Roehampton, 2017. https://pure.roehampton.ac.uk/portal/en/studentthesis/you-know-youve-got-to-be-kind-of-human(88a9e8c0-6645-4224-aeea-5d95bc045b06).html.
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This study explores the subjective experiences of CBT therapists who have undergone personal therapy and seeks to gain insight into the significance of personal therapy in CBT clinical practice. Seven CBT therapists who have undergone personal therapy were interviewed. Interpretative Phenomenological Analysis (IPA) was chosen to generate rich interview data. Participants were asked about their experience of personal therapy in clinical practice. Participants' narratives were analysed using IPA to identify common themes. The analysis resulted in twelve interrelated themes from which three master themes emerged. The first theme, 'Personal therapy creates conflict', explores a paradox that arises between personal therapy and CBT clinical practice; participants suggest that personal therapy equips them with therapeutic tools that paradoxically hinder their capacity to practice a standardised protocol-led CBT. The second master theme, 'Personal therapy ties me to humanity', suggests that the gap between personal therapy and CBT practice narrows by participants' 'use of self': calling upon their own vulnerabilities to forge fundamental connections with their clients based on the shared experience of being human. This study finds that all participants value 'being human' with their clients, however, struggle to find the space 'to just be' within an action-focused, goal-orientated CBT model. This is further explored in the final theme, 'Personal therapy: Being and doing'. Potential implications of the themes that emerged were considered. This study contributes to the literature on CBT and counselling psychology, and to the understanding of a divide in the psychotherapy profession between evidence-based priorities and expectations of reflective practice.
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Ince, Paul. "The implementation of NICE recommended cognitive behavioural therapy and family intervention for people with schizophrenia." Thesis, University of Manchester, 2014. https://www.research.manchester.ac.uk/portal/en/theses/the-implementation-of-nice-recommended-cognitive-behavioural-therapy-and-family-intervention-for-people-with-schizophrenia(6585af86-a742-4587-9c3e-8b3d37885560).html.
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This thesis has been prepared in the paper based format and includes a systematic review, a novel empirical piece of research and a critical reflection. The thesis focuses on the implementation of the National Institute for Health and Clinical Excellence’s (NICE) guidance recommendations for the psychological interventions for those people suffering from schizophrenia. Papers 1 and 2 have been prepared for submission in ‘Psychology and Psychotherapy: Theory, Research and Practice’ and the ‘Journal of Mental Health’ respectively. Paper 1 includes a systematic literature search and narrative synthesis exploring if the recommendations for psychological interventions for schizophrenia were being met. Rates of implementation for Cognitive Behavioural Therapy (CBT) and Family Intervention (FI) were compared. The barriers against implementation and the strategies aimed at improving implementation were reviewed. Rates of implementation varied from 4% to 100% for CBT and 0% to 53% for FI. Previously reported barriers to implementation were found, with organisational barriers being most common. Implementation strategies discovered included training packages for CBT and FI. Rates of implementation are below recommended levels suggesting inequalities in the provision of psychological interventions for schizophrenia are present. Strategies to improve implementation that are comprehensive and supported from all levels of the NHS are considered to be most effective. Paper 2 reports a quantitative piece of research exploring if behaviourally specific and plain English language guidance can improve healthcare professional intentions to perform actions in line with recommendations for schizophrenia. An independent measure, single blind, randomised controlled design was used to disseminate guidance in two formats; the ‘original’ and ‘alternative’. Self-report measures revealed no significant results when comparing the original guidance to the alternative for the cognitive determinants of behaviour, actual behaviour change, or comprehension and satisfaction with the guidance. Behaviourally specific and plain English language does not affect intentions or behaviour to implement recommended guidance for the provision of psychological interventions for schizophrenia. A more multi-factorial approach including organisational culture may be required. Paper 3 is a critical reflection of the submitted papers and research process as a whole. Strengths and limitations of the included studies, the findings in the context of wider research, implications for clinical practice and future research are discussed.
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Cheng, Theresa Sin Yee. "Exploring acquired brain injury (ABI) clients' experience of receiving cognitive behavioural therapy (CBT) delivered by trainees : a qualitative study." Thesis, London Metropolitan University, 2014. http://repository.londonmet.ac.uk/714/.
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A recent systematic review suggests the effectiveness of Cognitive Behavioural Therapy (CBT) with brain injury client groups has been inconclusive and limited (Cattelani, Zettin & Zoccolotti, 2010). Although CBT has beneficial results in many specific psychiatric disorders, the rates of positive outcomes for managing psychological difficulties in the acquired brain injury (ABI) client group are still not satisfactory. Mixed or negative results have been reported in the existing literature (Cattelani, Zettin & Zoccolotti, 2010). Indeed, recent literature has highlighted a need to further develop existing CBT approaches for clients with ABI (Wilson, 2011), to assist practitioners in overcoming potential challenges caused by the complexities faced in this field. This qualitative study explores ABI clients’ experiences of CBT to provide better understanding of what may produce a greater therapeutic alliance and positive outcome. Six participants with ABI were interviewed in a semi-structured format about their experiences of CBT. Interpretative Phenomenological Analysis (IPA) was employed to develop an in-depth and coherent understanding of participants’ experiences. Three super-ordinate themes were identified namely, ‘Professional relationship’; ‘Understanding my struggles’; and ‘Acceptance’. Each super-ordinate theme was associated with three sub-themes. Findings of the present study highlight the essential elements for the effectiveness of CBT. These elements are the quality of the therapeutic relationship, the client’s willingness and readiness to engage in therapy, the adaptations needed in therapy to address the client’s limitations, and the need for a balanced focus between the behavioural and cognitive components employed in therapy. Furthermore, findings imply that process-based adaption is as important as technique-based adaption when delivering CBT to ABI clients, suggesting that the quality of therapeutic relationship and the process issues are both relevant to the therapeutic outcome.
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Woodford, Joanne. "Development and feasibility randomised controlled trial of guided Cognitive Behavioural Therapy (CBT) self-help for informal carers of stroke survivors." Thesis, University of Exeter, 2014. http://hdl.handle.net/10871/17401.
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Background: One-in-three carers of stroke survivors experience depression with no psychological treatments tailored to meet their needs, such as barriers to attending traditional face-to-face psychological services. A cognitive behavioural therapy (CBT) self-help approach may represent an effective, acceptable solution. Methods: Informed by the MRC framework (2008) for complex interventions, six studies informed development, feasibility and piloting of a CBT self-help intervention for depressed carers of stroke survivors: Study One: Systematic review and meta-analysis of psychological interventions targeting depression and anxiety in carers of people with chronic health conditions; Study Two: Interviews to understand difficulties experienced by depressed and anxious carers; Study Three: Interviews to understand positive coping strategies used by non-depressed and non-anxious carers; Study Four: Drawing on results of Studies One to Three, iterative modelling to develop the CBT self-help intervention; Study Five: Feasibility randomised controlled trial to examine methodological and procedural uncertainties for a Phase III definitive trial; Study Six: Updated systematic review and meta-analysis. Results: Study One: 16 studies identified for inclusion yielding small and medium effect sizes for depression and anxiety respectively, with trends for individually delivered treatments over shorter session durations to be more effective for depression. Six additional studies were included in Study Six, replicating Study One results; Study Two: Depressed and anxious carers experience difficulties adapting to the caring role, managing uncertainty, lack of support and social isolation; Study Three: Non-depressed and non-anxious carers utilise problem-focused coping strategies to gain balance and adapt to caring role, use assertiveness, seek social support and positive reinterpretation; Study Four: Developed a theory-driven CBT self-help intervention; Study Five: Recruited 20 informal carers in 10-months, representing 0.08% of invited carers randomised with high attrition in the intervention arm. Lack of GP recognition, gatekeeping and barriers to accessing psychological support identified as reasons for poor recruitment. Conclusions: A greater appreciation is required concerning barriers experienced by informal carers of stroke survivors to accessing support for depression and type of acceptable psychological support.
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Varley, Melissa C. "Clinicians' views of computer-guided CBT in adult mental health and factors related to referrals." Thesis, University of Edinburgh, 2011. http://hdl.handle.net/1842/9783.
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Objectives: Computer-guided CBT could help to increase much needed access to lowintensity psychological interventions. Evidence for effectiveness has led to the inclusion of certain packages in NICE guidelines but application in clinical settings is unclear. Low uptake and high dropout suggest problems with acceptability and barriers to uptake. Studies neglect to report on acceptability to clinicians despite indications that clinicianrelated variables and attitudes could influence their use of CCBT. This study investigates clinicians‟ views of CCBT and factors related to referring to it, following experience of low referrals to a CCBT pilot, with the aim of learning more about barriers to access and how this might be improved. Method: A mixed quantitative and qualitative design was used. An online survey was developed to gather views on CCBT, its implementation and demographic information. This was sent to a sample of clinicians in the clinical psychology department, mental health nurses and general practitioners, some of whom were involved in the CCBT pilot project and some not. Descriptive statistics, non-parametric correlations, chi-squared analyses and framework thematic analysis was carried out on 72 completed surveys. Results: Most clinicians identified both benefits and concerns of CCBT. Most approved of CCBT but likelihood to refer varied and many preferred to offer other interventions. Clinician-related variables associated with likelihood to refer were whether clinicians saw mild to moderate cases, approval of CCBT and perceived patient uptake. Views regarding the effectiveness of CCBT influenced choices to offer it, with negative beliefs about effectiveness including a perceived need for human contact. There was moderate interest in receiving CCBT training. Most thought it should be accessed widely, with some concern raised about access in public settings. Although GPs were not involved in the CCBT pilot, many expressed interest in receiving training and referring. Conclusions: Clinicians‟ views of CCBT are mixed and some believe it is ineffective and unacceptable to patients, which influences their decisions to offer it. This includes perceptions about key aspects of therapy, such as human contact. Therefore some clinicians need more convincing of the CCBT evidence-base before they are likely to refer to it. Nevertheless there is moderate interest in using CCBT and more so in those seeing mild to moderate cases. CCBT may have a position in stepped care services but views of referrers should be considered and training offered. More research is needed on implementing CCBT, barriers to access and its role alongside other interventions.
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Cutler, Christopher John. "Can the content of a client's construing of personality development be used to predict outcome in Cognitive Behavioural Therapy (CBT)?" Thesis, University of Leicester, 2009. http://hdl.handle.net/2381/7827.
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Background: A variety of factors impact on the outcome of therapy including the therapeutic relationship, the therapist, the family background and co-morbid problems of clients. The Personal Constructs of clients, particularly their concept of ideal self and presenting problem, have been found to affect outcome in therapy. However the impact of a client’s wider pattern of construing is an area that has been neglected. In particular, this study investigated whether clients’ constructs of factors influencing personality development were associated with outcome in cognitive behaviour therapy (CBT) groups. Method: Clients were recruited from CBT groups for a range of different clinical presentations. The study was in three stages. In stage one participant’s constructs around factors influencing personality development were found using dyadic elicitation. In stage two, a participant group categorised the constructs, and all participants then ranked the constructs using a modified resistance to change methodology. In the third stage, the ranking of constructs was compared between participants with good or poor therapeutic outcomes using a Mann-Whitney analysis. Results: A total of 26 participants were recruited, of whom 22 were involved in the comparison of good and poor outcome. Participants identified sixteen constructs of influences on personality development. A particularly sophisticated hierarchical model was developed spontaneously by participants, providing methodological validation. In comparing groups, it was found that constructs about education being ranked low were associated with poor outcome, and dropping out of therapy. Conclusions: CBT groups have many parallels to educational settings. Therefore it was hypothesised that if individuals ranked education constructs low they would find it more difficult to gain benefit from a CBT group. It was suggested that rather than assigning clients to treatment based on diagnosis, more attention should be given to what they construe as ‘helpful’.
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Anclair, Malin. "Fears, Stress and Burnout in Parents of Children with Chronic Conditions : Treatment with Cognitive Behavioural Therapy and Mindfulness." Doctoral thesis, Karlstads universitet, Institutionen för sociala och psykologiska studier, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-48462.
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The aim of the present research was threefold: to investigate the fears of parents of children with chronic conditions; to evaluate the effectiveness of their treatment with either mindfulness-based therapy or cognitive behavioural therapy (CBT); and to assess treatment outcome in terms of health-related quality of life (HRQoL). Long-term stress can lead to some form of chronic stress reaction. In study one, fears of future cancer recurrence and of late effects of treatment were most prominent among parents of CNS tumour patients. Study two investigated the effectiveness of two group-based interventions on stress and burnout among parents of children with chronic conditions. Parents were offered either a CBT or a mindfulness programme. Both interventions significantly decreased stress and burnout. Study three focused on the HRQoL and life satisfaction of the parents in study two. The results indicate improvements for participants in both treatment groups regarding certain areas of HRQoL and life satisfaction. To conclude, fears concerning future cancer recurrence and late effects of treatment are most prominent among parents of children with cancer. Another conclusion is that CBT and mindfulness decrease stress and burnout and may have a positive effect on areas of HRQoL and life satisfaction.The aim of the present research was threefold: to investigate the fears of parents of children with chronic conditions who suffer from fears, stress and burnout; to evaluate the effectiveness of their treatment with either mindfulness-based therapy or cognitive behavioural therapy (CBT); and to assess treatment outcome in terms of health-related quality of life (HRQoL). Research on parents of children with chronic conditions has shown that this parent group frequently suffers from psychological problems. Long-term stress can lead to some form of chronic stress reaction. In study one, parents of children with brain tumours were asked to rate the extent to which they experienced a set of specific fears related to their child’s brain tumour and its treatment. Fears of future cancer recurrence and of late effects of treatment were most prominent among parents of CNS tumour patients. Study two investigated the effectiveness of two group-based interventions on stress and burnout among parents of children with chronic conditions. After a waiting list control period, parents were offered either a CBT or a mindfulness programme. After eight group therapy sessions, both interventions significantly decreased stress and burnout. Study three focused on the HRQoL and life satisfaction of the parents in study two. The results indicate improvements for participants in both treatment groups regarding certain areas of HRQoL and life satisfaction. To conclude, many parents of children with chronic conditions suffer from stress-related mental illness and need targeted interventions for their own problems. The present research concludes that fears concerning future cancer recurrence and concerning late effects of treatment are most prominent among parents of children with cancer. Another conclusion is that CBT and mindfulness decrease stress and burnout and may have a positive effect on areas of HRQoL and life satisfaction in parents of children with chronic conditions.
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Tshabalala, Jan. "A model of cognitive behavioural therapy for HIV-positive women to assist them in dealing with stigma." Thesis, Pretoria : [S.n.], 2009. http://upetd.up.ac.za/thesis/available/etd-10172009-130134/.
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Filgate, Eleanor Megan. "Adherence to e-therapy for adults with eating disorders : a systematic review : a retrospective case series investigation of blended internet-based cognitive-behavioural therapy (ICBT) and face-to-face cognitive-behavioural therapy (CBT) in the treatment of adults with eating disorders." Thesis, University of Edinburgh, 2018. http://hdl.handle.net/1842/31506.
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Background: Eating disorder (ED) researchers continue to explore the effectiveness of e-therapy in improving symptoms and its treatment acceptability, however issues relating to poor uptake, adherence and dropout pose a challenge. Within this portfolio, the systematic review aimed to explore adherence to e-therapy for the treatment of ED, specifically exploring rates and predictors of uptake, completion, and dropout from randomised controlled trials (RCT) of ED e-therapy. The empirical project aimed to explore in-depth symptom change for ED cases engaged in blended internet-based cognitive behavioural therapy (ICBT) and face-to-face ED input. Acceptability of blended input was also explored. Methods: For the systematic review, literature searches were undertaken in March and September 2017 across EMBASE, PsycINFO, MEDLINE, Ovid and Cochrane Central Register of Controlled Trials (CENTRAL) and ProQuest databases. Key papers were assessed against five quality criteria (random assignment to groups, blinding to treatment allocation, quality of content, level of contact, sample size with sufficient power). Using a retrospective case series design, the empirical project explored changes over time of ED, anxiety, depression, quality of life (QoL), motivation for change, overall psychological functioning and clinician-rated/patient-rated improvement. Standardised health assessment measures captured symptoms over multiple time-points, and data was analysed using t-tests, multi-level modelling (MLM) and visual analysis. Acceptability of treatment was tentatively explored using an open feedback questionnaire. Results: Systematic review results identified intervention (content, acceptability, delivery method/location), participant (nature of symptoms, BMI, education, prior therapy, personality, views on e-therapy) and therapist-related factors (therapeutic support) were indicated in predicting uptake, completion and dropout across ED e-therapy. In the empirical project, study findings were inconclusive regarding symptom change attributable to blended input. Model fit improved when severity of ED symptoms predicted overall psychological functioning and patient-rated improvement over time, however findings were non-significant - potentially due to the study being underpowered. Conclusions: Promising evidence exists for ED e-therapy as an acceptable treatment option, however understanding which content nurtures engagement best is needed. Further research is needed into the factors predicting ED blended treatment outcome.
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Swartz, Damian. "Levels of physical activity in people living with chronic pain: Do they change after participating in a Chronic Pain Management Program?" Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/30994.
Full textAbstract:
Purpose: The purpose of this study was to determine whether levels of physical activity in people with chronic pain change after participating in a Chronic Pain Management Program (CPMP) at Groote Schuur Hospital (GSH). Methods: A pre-experimental pre-test, post-test study was conducted, consisting of 14 men and women suffering from chronic pain who were referred to a Chronic Pain Management Program (CPMP) from the Chronic Pain Management Clinic at GSH in Cape Town, South Africa. Subjective and objective measuring tools, including pedometry, were used to collect data and non-parametric analysis was conducted to analyse data. Results: 14 participants met the Inclusion criteria. Levels of physical activity changed markedly, but not significantly. Objectively-tested and self-reported physical activity levels changed significantly among participants who took part in a CPMP. Significant improvements in Pain Severity Scores and Pain Interference Scores occurred after the CPMP and there was convergent validity between self-reported and objectively-tested levels of physical activity in those suffering from chronic pain after the CPMP. Conclusion: The Chronic Pain Management Program at Groote Schuur Hospital in Cape Town has shown to improve function and physical activity of those patients living with chronic pain who take part in the CPMP, with function improving significantly, and physical activity nearly doubling in the group being tested who took part in the 5-week long program. The CPMP at GSH should be seen as the beginning of a greater movement towards increasing physical activity in the chronic pain sphere. Research in more public healthcare facilities is needed to increase knowledge around education, pacing and implementation strategies across South Africa.
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Gallen, Kirsty Louise. "The clinical effectiveness of CBT-based self-help for symptoms of fatigue in multiple sclerosis." Thesis, University of Edinburgh, 2015. http://hdl.handle.net/1842/21011.
Full textAbstract:
Purpose: The aim of the systematic review was to address whether psychological interventions were able to reduce fatigue severity or the impact of fatigue in individuals with Multiple Sclerosis. The empirical study aimed to evaluate the effectiveness of a CBT based self-help workbook at reducing perceived impact of fatigue in a clinical sample of MS patients. Methods: A systematic search of the literature was carried out between the years 1980 and February 2015 to review whether psychological interventions were effective for fatigue management in Multiple Sclerosis. A randomised controlled trial examined the effectiveness of a CBT-based self-help workbook for the reduction of fatigue impact in MS. Participants were randomly allocated to one of three groups treatment as usual (TAU), pure self-help (PSH) or guided self-help (GSH). Results: Eleven studies were included in the systematic review, which indicated that CBT based interventions aiming to reduce fatigue or depression were most effective at reducing the severity of fatigue. Impact of fatigue can be reduced through mindfulness, CBT, motivational interviewing and to a lesser extent acceptance and commitment therapy. The empirical study did not find any significant differences between groups, however satisfaction with the workbook was high. Conclusions: The review suggests that there is a clear role for psychological interventions in fatigue management in MS, although further robust research into different therapeutic modalities is needed. From the empirical study it appears that the low level CBT-based intervention for fatigue in MS was not effective at reducing the perceived impact of fatigue. This study reflects an inclusive, clinical sample, recruited from a specialist rehabilitation unit, with high levels of multidisciplinary input which may have diluted any potential effect of the workbook. Objectives: The aim of the systematic review was to address whether psychological interventions are able to reduce fatigue severity or the impact of fatigue in individuals with Multiple Sclerosis Data sources: A search was conducted of: Psychinfo, Medline, Embase, CINAHL between 1980 and February 2015. Review methods: All studies were evaluated against a set of quality criteria by author (KG) with a proportion of studies being independently reviewed by author (DP) to ensure reliability of ratings. Results: Eleven studies were included in the review. CBT based interventions with a focus on fatigue management and depression appear to significantly reduce fatigue severity with medium to large effect. Significant reductions in fatigue impact can be found from mindfulness groups, motivational interviewing and CBT. Effect sizes for CBT interventions ranged from negligible to medium. For the mindfulness and motivational interviewing interventions effect sizes were not able to be calculated. The acceptance and commitment therapy intervention did not find a significant reduction in fatigue but found a medium effect for the intervention. Conclusions: There is a clear role for psychological interventions in the reduction of fatigue management but more high quality research needs to be carried out.
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Meaden, Ann. "The experience of rational emotive behaviour therapy." Thesis, University of Wolverhampton, 2010. http://hdl.handle.net/2436/113730.
Full textAbstract:
The literature review produced for this thesis systematically analysed qualitative studies of cognitive therapy using a methodology checklist and a meta-synthesis technique. Ten papers which used qualitative analysis to look at clients’ experiences of Cognitive Behavioural Therapy (CBT) met the selection criteria. Seven themes emerged. Three were linked to a therapeutic relationships theme; the trusted listener, power and authority and others like me. Four were linked to the impact of cognitive therapy theme; empowering information, analysing the problem, thinking differently and doing things differently. It was concluded that future research should focus on the components of cognitive therapy and that differences in technique between CBT and Rational Emotive Behaviour Therapy (REBT) should be explored via a qualitative study of clients’ experiences of REBT. A qualitative approach was taken to look at clients’ experiences of REBT. Seven participants were interviewed using a semi-structured interview guide and the resulting transcripts were analysed using interpretive phenomenological analysis. Three themes emerged: one which looked at what it was like to have mental health problems; a second, which looked at clients’ expectations and experiences of the more technical aspects of therapy, and a third which examined the therapeutic relationship. All of the participants appeared to value therapy. However, the extent to which they knew about and used the theory and philosophy of REBT varied greatly. These results suggest that further research needs to be carried out which looks at how people benefit from therapy as clients views may differ from those of therapists. A critical appraisal of the research process was written using the REBT model to reflect the experience of producing the thesis.
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Barban, Karen. "The Implementation of a Structured Format of Brief Cognitive Behaviour Therapy (CBT) Methods to Overcome the Barriers and Facilitate the Delivery of CBT by Primary Healthcare Providers for Patients with Depression: A Pilot Evaluation." Thesis, Laurentian University of Sudbury, 2013. https://zone.biblio.laurentian.ca/dspace/handle/10219/2059.
Full textAbstract:
Cognitive behaviour therapy is a well-documented first-line treatment for mild to
moderate depression. Primary healthcare providers have encountered several barriers
when trying to provide CBT in an office-based setting and as such, adoption of this
evidence-based treatment has been suboptimal. Primary healthcare nurse practitioners
(PHC NPs) have an in-depth knowledge of advanced nursing practice, and are
responsible for the assessment, diagnosis and management of patients with acute and
chronic conditions, such as depression. PHC NPs are also ideally situated in the health
care system to deliver CBT to their patients. The objectives of this project were to
develop a format for the delivery of brief CBT methods that was feasible in the PHC
setting, increase PHC providers’ confidence to implement CBT and ultimately increase
their adoption of CBT
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McMurchie, Will. "Beating the Blues : Computerised Cognitive Behaviour Therapy for the treatment of depression and anxiety with older people." Thesis, University of Edinburgh, 2011. http://hdl.handle.net/1842/9793.
Full textAbstract:
Introduction: With increasing longevity the population of the world is becoming older and there are growing numbers of people over the age of 65 years. This has implications for services providing psychological treatment to older people as there is likely to be an increasing demand for evidenced-based treatments such as Cognitive Behaviour Therapy (CBT) in the coming years. There are, however, relatively few clinical psychologists specialising in working with older people and therefore additional ways of dealing with the growing demands are essential. Computerised Cognitive Behaviour Therapy (CCBT) offers one potential option and NICE recommends Beating the Blues (BTB) as the most clinically and cost-effective package for treating depression. However, no study to date has explored the use of BTB with older people. Objective: The objective of the study was to address this gap in the literature and had the following aims: 1) to explore the uptake rate of BTB with older people; 2) to explore the characteristics of older people opting to receive BTB; 3) to explore the drop-out rate from BTB with older people; and 4) to determine if BTB was effective in reducing symptoms of depression and anxiety in older people experiencing these difficulties. The findings were compared to previous research on BTB with younger adults. Methodology: A between-groups, repeated measures design (with assessment time as the repeated measure) was used. Participants were given a free choice of receiving BTB plus treatment as usual (BTB+TAU) or treatment as usual alone (TAU). Treatment as usual was provided by clinicians from older people community mental health teams (e.g. psychiatric nurses) and the only constraint that was placed in this was that no face-to-face psychological therapy from an accredited therapist could be provided. The participants opting to receive BTB also completed eight sessions of BTB on a weekly basis. All participants completed a range of outcome measures prior to commencing treatment (pre), after eight weeks (post) and after a further 4 weeks (one month follow-up). Results & Discussion: The results indicated that 56.9 per cent of the participants opted to receive BTB and they reported having significantly more experience and confidence using a computer than those who declined BTB. It was also found that 72.7 per cent of older people completed all eight sessions of BTB (27.3 per cent discontinuation rate). This was comparable to what has been found in previous studies of BTB with younger adults. A two (treatment group) x three (time) repeated measures ANOVA revealed that, in comparison to the TAU group, the BTB+TAU group showed statistically significant greater improvements on measures of depression and anxiety by the end of treatment. This was maintained at one month follow-up. Furthermore, in comparison to the TAU group the BTB had a higher percentage of participants who met criteria for clinically significant improvement by the end of treatment and at one-month follow-up. The results suggest that BTB is an acceptable and effective treatment for older people experiencing depression and anxiety and the implications of these findings are discussed.
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Pateraki, Eleni. "Interaction between asthma and anxiety : a systematic review of cognitive-behavioural therapies and a qualitative exploration of young people's experiences." Thesis, University of Edinburgh, 2015. http://hdl.handle.net/1842/20958.
Full textAbstract:
Aims: There is a well-established link between asthma and anxiety, leading to exacerbations for both conditions. National guidelines and policy documents recommend the provision of psychological interventions for this comorbidity, although evidence for their effectiveness is inconclusive. This thesis had two objectives: a) to evaluate cognitive-behavioural therapy (CBT) interventions for reducing anxiety in adults and/or children with asthma, given that CBT has a stronger evidence base for relevant respiratory and mental health conditions, b) to explore the lived experience of the interplay between childhood asthma and anxiety directly from the affected population in order to identify specific thinking and behaviour patterns that may maintain this comorbidity. Method: The first journal article outlined a systematic review. Three major electronic databases and manual searches were used to find relevant published and unpublished research. Trials meeting inclusion criteria, primarily utilising validated anxiety measures and employing both cognitive and behavioural techniques, were evaluated using adapted quality criteria. The second empirical article implemented interpretative phenomenological analysis (IPA) to explore the mechanisms maintaining the interplay between asthma and anxiety as experienced by 11 young people (aged 11-15) living with the comorbidity. Results: Fourteen trials met the inclusion criteria for the systematic review. The reviewed trials showed reasonable preliminary support for the effectiveness of CBT for anxiety in individuals with asthma across the age range. The favourable results were largely maintained long-term. The empirical article revealed three super-ordinate themes: i) ‘the influence of asthma’ by inhibiting valued activities or developmental tasks, triggering catastrophic thinking and leading to a generalisation of asthma coping strategies to managing anxiety; ii) ‘the influence of anxiety’ by affecting appropriate medication use and triggering hyperventilation-induced asthma exacerbations; and iii) ‘the interaction between asthma and anxiety’ by forming an unhelpful positive feedback loop and triggering symptom confusion. Conclusions: The systematic review discussed the moderate overall study quality and called for more methodologically robust research, examining CBT models tailored to this population and utilising clinically representative samples. The empirical article pointed to possible maintaining mechanisms identified, which lend themselves to a cognitive-behavioural framework, potentially including mindfulness-based interventions, and may be used to tailor psychological treatments.
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Vernmark, Kristofer. "Therapeutic alliance and different treatment formats when delivering internet-based CBT for depression." Doctoral thesis, Linköpings universitet, Psykologi, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-142389.
Full textAbstract:
Depression är en funktionsnedsättande problematik som påverkar en stor del av den vuxna populationen varje år. Trots ett omfattande behov av hjälp så råder det brist på tillgång till effektiv behandling. Kognitiv Beteendeterapi (KBT) är en evidensbaserad metod som har stöd vid behandling av depression och förmedlad via internet skulle metoden kunna tillgängliggöras för fler. Dock är det i dagsläget oklart vilka format och vilket innehåll som kan användas när behandlingen förmedlas via internet, samt vilken betydelse den terapeutiska alliansen har för en behandling som till största del sker på distans. Syftet med denna avhandling var att undersöka effekterna för olika format av internetbehandling (epostterapi, guidad självhjälp och blended treatment) vid depression, samt alliansens roll i dessa format. Studiernas resultat visar på att epostterapi och internetförmedlade självhjälpsprogram med behandlarstöd var effektiva metoder för att behandla depression. Alliansskattningar var höga, vilket visar att en positiv terapeutisk allians kan uppnås i internetbehandling. Patientskattningar av allians kunde inte predicera utfallet i någon av behandlingarna, men behandlarskattad allians predicerade förbättring på depressionsskattningar i blended treatment. Den här avhandlingen innehåller den första randomiserade kontrollerade studien på KBT-baserad epostterapi vid depression, samt det första internet-förmedlade självhjälpsprogrammet baserat på beteendeaktivering och ACT.Depression is a debilitating disorder that affects a large part of the adult population every year. Yet there is still a lack of access to effective care for people in need. Cognitive Behaviour therapy (CBT) is an evidence-based method for treating depression that together with the increased availability of Internet services provides an opportunity to increase access to effective treatment. Internet-based interventions can be effective in the treatment of depression, but there is a lack of knowledge concerning which formats of delivery that can be used and if therapeutic alliance is of equal importance when providing treatment over the Internet. The overall aim of this thesis was to examine the effects of different treatment formats (email therapy, guided self-help, and blended treatment) in internet-based CBT for depression and to further examine the role of alliance in these treatment modalities. Findings from this thesis show that email therapy and internetbased treatment programs were effective methods for treating depression. Alliance ratings were high, showing that a positive therapeutic alliance can be achieved in internet-based treatments. Patient-rated alliance could not predict outcome in any of the different treatment formats. However, therapist-rated alliance predicted change in depression during blended treatment. This thesis includes the first randomized controlled study on CBTbased email therapy, and the first internet-based behavioral activation program with ACT-components, for adult depression.
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Edgington, Louise Jane. "The design and implementation of a new cognitive behavioural therapy (CBT) based intervention for the management of sensory experiences in adolescents with autism." Thesis, University College London (University of London), 2014. http://discovery.ucl.ac.uk/10021651/.
Full textAbstract:
Background. There is growing recognition of the impact of sensory difficulties in autism. However, traditional ‘sensory integration therapies’ lack empirical support and behaviour-based measures may misrepresent some sensory experiences in autism, meaning that sensory atypicalities are poorly understood and supported. There is therefore a need for a new self-regulatory approach to understanding and managing sensory experiences, which is consistent with theory, and draws upon self-reports of individuals with autism. Aims. 1) To expand the evidence base of self-reports of sensory experiences of adolescents with autism. 2) To evaluate the effectiveness of a new 8-week CBT-based group intervention for self-regulation of sensory experiences. Methods. Twelve adolescents aged 11 to 16 years with diagnoses of autism and IQs above 70, from one mainstream secondary school completed the study. A randomised controlled trial (RCT) design was used. To address Aim 1, self-reports were elicited pre-intervention, in a semi-structured interview and analysed thematically. To address Aim 2, quantitative measures of sensory behaviours, anxiety and repetitive behaviours were taken at baseline, post-intervention and follow-up, together with qualitative interview data from experimental groups and parents, post-intervention. Results. Aim 1) Thematic analysis revealed 5 main themes: ‘need for control’, ‘resonance with stimulus affects reactivity’, ‘self in-relation-to others’, ‘barriers to coping relate to consciousness’, and ‘features of adaptive coping strategies’. Aim 2) Quantitative analysis revealed no significant intervention effects, although qualitative reports indicated the intervention raised meta-conscious awareness of sensory experiences, expression and use of language, sense of self in-relation-to others, and adolescents’ use of new coping behaviours. Conclusion. Striking qualitative data suggest the intervention was effective in raising meta-conscious awareness and self-regulation. Results indicate the future need for larger sample sizes, and for the development of more sensitive and valid sensory measures. Implications for EPs include facilitating supportive group dynamics, and developing parent and staff understanding.
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Valencia, Hernández María Luisa. "Cognitive behavioural therapy intervention for children and adolescents with Autism Spectrum Disorders and anxiety : A systematic literature review from 2009 to 2019." Thesis, Högskolan för lärande och kommunikation, Högskolan i Jönköping, HLK, CHILD, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-44315.
Full textAbstract:
Young people with Autism Spectrum Disorders (ASD) are more prone to experience anxiety disorders at a greater level compared to their neurotypical developing counterparts, causing lifelong impairments in family, social, academic and adaptive functioning. Early interventions in childhood have been designed to minimize these stressful events and to optimize children’s developmental outcomes. Cognitive behavioural therapy (CBT) is considered a first-line intervention of anxiety. The review aimed to synthesize empirical literature on modified CBT interventions from 2009 until 2019 focusing on reducing anxiety in children and adolescents with ASD. A systematic review of the literature was conducted in five databases. As a result, 10 articles were included to review. Modifications found were: a) audiovisual support and written materials, b) parental partic-ipation, c) sessions length, d) language, e) sensory and motor accommodations, f) emphasis into the behav-ioural component, g) enhancement of individual’s attention and participation, h) facilitating materials to access the content of CBT, and i) participants’ specific interests and worries. The interventions showed significant reductions in youth anxiety levels. Future research should focus on addressing which specific modifications contribute to anxiety reduction since to date, there is no evidence comparing standard CBT to modified CBT interventions. Moreover, there is a lack of anxiety-assessment instruments specially designed for individuals with ASD. In addition, considering the longstanding prevalence of male autistic rates, ASD diagnostic instru-ments should be revised to reduce bias that can mislead to an inattentive ascertainment of females with ASD.
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Miller, Emma. "The development of cognitive behaviour therapy (CBT) for children and young people within an educational psychology service." Thesis, University of Newcastle Upon Tyne, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.512172.
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Huxtable, David. "Late-life depression : a systematic review of meta-analyses and a meta-analysis of the effect of cognitive behavioural therapy in older adults with co-morbid physical illness." Thesis, University of Edinburgh, 2013. http://hdl.handle.net/1842/7915.
Full textAbstract:
Aims: To examine the efficacy of CBT for late-life depression in older adults with co-morbid physical illness and to review what has been revealed by meta-analytic studies with regards moderators of treatment in psychological approaches for late-life depression. Method: Systematic literature search and meta-analysis of randomised controlled trials (RCT) evaluating CBT for depression in older adults with co-morbid physical illness and systematic review of meta-analyses examining psychological therapies for late-life depression. Results: Nine papers met inclusion criteria for meta-analysis. CBT was superior to waiting list and treatment as usual control conditions, showing a statistically significant pooled standardised mean difference (SMD) of 0.63 (95 per cent CI, 0.29 to 0.97, p = 0.0003). This was largely maintained at follow up (SMD 0.5, 95 per cent CI, 0.08 to 0.92). Sensitivity analysis showed individual CBT yielded a large, statistically significant summary effect size of 0.80 (95 per cent CI, 0.45 to 1.16), but that group CBT did not show statistical superiority over controls. Clinician-rated measures of depression yielded larger effect sizes, with a SMD of 1.57 (95 per cent CI, 0.56 to 2.59, p = 0.002) as compared with patientrated measures: 1.03 (95 per cent CI, 0.75 to 1.31, p = 0.0001). Fourteen meta-analyses met inclusion criteria for systematic review. More recent publication was significantly correlated with increased reporting quality and reduced analysis of moderating factors. Duration of treatment, treatment setting and gender of participants showed no moderating impact on outcome. Depression severity, participant age, treatment modality, and study quality showed no consistent relationship with outcomes. Active or placebo controls were associated with reduced effect sizes when compared with no treatment or waiting list controls. Patient-rated outcome measures were associated with reduced effect sizes as compared with clinician-rated measures. Conclusions: When compared with treatment as usual and waiting list controls Individual CBT is effective in reducing depressive symptoms for depressed older adults with an underlying physical illness. Meta-analytic studies of late-life depression show variable results regarding moderators of treatment efficacy. More high quality studies examining the effectiveness of psychological therapies are needed with clinically representative older populations, particularly, the older-old and those with co-morbid physical illnesses.
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Lock, Sally, and n/a. "A Developmental Approach to the Prevention of Anxiety Disorders During Childhood." Griffith University. School of Applied Psychology, 2004. http://www4.gu.edu.au:8080/adt-root/public/adt-QGU20040615.140812.
Full textAbstract:
The studies presented in this thesis sought to investigate a number of developmental factors that influence the efficacy of preventive intervention for child anxiety disorders. Preventive intervention has emerged as a vital step forward in clinical research following data indicating anxiety disorders are among the most common forms of psychopathology in youngsters (Kashani & Orvaschel, 1990; Mattison, 1992). Several risk and protective factors associated with childhood anxiety disorders have been identified, along with effective treatment protocols (Kendall, 1994; Howard & Kendall, 1996; Barrett, 1998, 1999; Silverman et al., 1999a, 1999b), as prerequisites to the development of preventive programs for child anxiety problems (Spence, 2001). The first objective of this research was to add to the literature on risk and protective factors by investigating the role of peer interaction in the development of child anxiety problems. Study one examined developmental differences in the influence of peer interaction on children's anxiety-related cognition and behaviour. One hundred and sixty two children enrolled in grade 6 (n = 96) aged between 9 and 10 years, and grade 9 (n = 66) aged between 14 and 16 years participated in the study. Participants were stratified into either an at risk group or to a healthy group, based on their anxiety scores on the Spence Child Anxiety Scale (SCAS; Spence, 1997), and further allocated to a peer group comprising of 3 'healthy' (non-anxious) and 3 'at risk' (high anxious) children. Prior to and following a peer discussion, participants completed a standardised self-report measure of threat interpretation and response plans to two ambiguous vignettes (Barrett, Rapee, Dadds, & Ryan, 1996; Dadds, Barrett, Rapee, & Ryan, 1996). Results showed all participants evidenced changes in threat interpretation and response plans following the discussion with peers (p < .001). Overall, findings highlight the potential importance of peer interaction in the development of anxiety-related cognition and behaviour. The findings of study one have important implications for the future development of school-based intervention programs; specifically those conducted in the classroom. Study two sought to advance the current research on preventive intervention for child anxiety by establishing the age at which youngsters benefit the most from the FRIENDS program as a classroom-based universal intervention. Study two presents the results of a longitudinal study evaluating the effects of a universal school-based intervention for child anxiety at two developmental stages. The study involved a cohort of 733 children enrolled in grade 6 (n = 336, 45.6%) aged between 9 and 10 years, and grade 9 (n = 401, 54.4%) aged between 14 and 16 years, Participants were allocated to either a school-based cognitive behavioural intervention or to a monitoring group. Participants completed standardised measures of anxiety, depression and coping style. Participants identified as 'at risk' of an anxiety disorder were assessed for a clinical diagnosis with a structured diagnostic interview. Results indicated the universal intervention effective in significantly reducing anxiety (p < .001), depression (p < .001) and behaviour avoidance in children at post- intervention and 12-month follow-up intervals. Grade 6 children reported significantly higher anxiety at pre-intervention and greater reductions in anxiety at post intervention compared with the grade 9 (p < .001), although both primary and secondary school participants showed equal reductions in anxiety at 12-month follow up. Overall, findings suggest universal intervention potentially successful in reducing symptoms of anxiety and increasing coping skills in children. Primary school children reported the greatest changes in anxiety symptoms, suggesting earlier preventive intervention potentially more advantageous than later intervention. Developmental differences in anxiety, depression and coping strategies are discussed in addition to the implications and limitations of this study and directions for future research.
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Lock, Sally. "A Developmental Approach to the Prevention of Anxiety Disorders During Childhood." Thesis, Griffith University, 2004. http://hdl.handle.net/10072/367924.
Full textAbstract:
The studies presented in this thesis sought to investigate a number of developmental factors that influence the efficacy of preventive intervention for child anxiety disorders. Preventive intervention has emerged as a vital step forward in clinical research following data indicating anxiety disorders are among the most common forms of psychopathology in youngsters (Kashani & Orvaschel, 1990; Mattison, 1992). Several risk and protective factors associated with childhood anxiety disorders have been identified, along with effective treatment protocols (Kendall, 1994; Howard & Kendall, 1996; Barrett, 1998, 1999; Silverman et al., 1999a, 1999b), as prerequisites to the development of preventive programs for child anxiety problems (Spence, 2001). The first objective of this research was to add to the literature on risk and protective factors by investigating the role of peer interaction in the development of child anxiety problems. Study one examined developmental differences in the influence of peer interaction on children's anxiety-related cognition and behaviour. One hundred and sixty two children enrolled in grade 6 (n = 96) aged between 9 and 10 years, and grade 9 (n = 66) aged between 14 and 16 years participated in the study. Participants were stratified into either an at risk group or to a healthy group, based on their anxiety scores on the Spence Child Anxiety Scale (SCAS; Spence, 1997), and further allocated to a peer group comprising of 3 'healthy' (non-anxious) and 3 'at risk' (high anxious) children. Prior to and following a peer discussion, participants completed a standardised self-report measure of threat interpretation and response plans to two ambiguous vignettes (Barrett, Rapee, Dadds, & Ryan, 1996; Dadds, Barrett, Rapee, & Ryan, 1996). Results showed all participants evidenced changes in threat interpretation and response plans following the discussion with peers (p < .001). Overall, findings highlight the potential importance of peer interaction in the development of anxiety-related cognition and behaviour. The findings of study one have important implications for the future development of school-based intervention programs; specifically those conducted in the classroom. Study two sought to advance the current research on preventive intervention for child anxiety by establishing the age at which youngsters benefit the most from the FRIENDS program as a classroom-based universal intervention. Study two presents the results of a longitudinal study evaluating the effects of a universal school-based intervention for child anxiety at two developmental stages. The study involved a cohort of 733 children enrolled in grade 6 (n = 336, 45.6%) aged between 9 and 10 years, and grade 9 (n = 401, 54.4%) aged between 14 and 16 years, Participants were allocated to either a school-based cognitive behavioural intervention or to a monitoring group. Participants completed standardised measures of anxiety, depression and coping style. Participants identified as 'at risk' of an anxiety disorder were assessed for a clinical diagnosis with a structured diagnostic interview. Results indicated the universal intervention effective in significantly reducing anxiety (p < .001), depression (p < .001) and behaviour avoidance in children at post- intervention and 12-month follow-up intervals. Grade 6 children reported significantly higher anxiety at pre-intervention and greater reductions in anxiety at post intervention compared with the grade 9 (p < .001), although both primary and secondary school participants showed equal reductions in anxiety at 12-month follow up. Overall, findings suggest universal intervention potentially successful in reducing symptoms of anxiety and increasing coping skills in children. Primary school children reported the greatest changes in anxiety symptoms, suggesting earlier preventive intervention potentially more advantageous than later intervention. Developmental differences in anxiety, depression and coping strategies are discussed in addition to the implications and limitations of this study and directions for future research.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Applied Psychology (Health)
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Marshall, Karen. "Newcastle Chronic Obstructive Pulmonary Disease (COPD) Cognitive Behavioural Therapy (CBT) care study : a randomised controlled trial (funded by the National Institute for Health Research)." Thesis, University of Newcastle upon Tyne, 2016. http://hdl.handle.net/10443/3197.
Full textAbstract:
Title - Randomised controlled trial (RCT) to identify if cognitive behavioural therapy (CBT) with respiratory nurses reduces anxiety in patients with chronic obstructive pulmonary disease (COPD). (Trial Registration - ISCRCTN55206395). Introduction: Anxiety and depression are common comorbidities in COPD. The aim of this research is to identify if CBT delivered by respiratory nurses reduces anxiety in a large COPD population. Methods: Study Design – Prospective RCT. Sample Size - 112 for each arm were required. Approach – 1,518 patients were approached: 279 were recruited. Randomisation –Electronic randomisation was used. Intervention – CBT with a respiratory nurse plus self-help leaflets. Comparison – Self- help leaflets. Main Outcomes -Primary outcome was symptoms of anxiety. Secondary outcomes were depression and quality of life. Data collection – was undertaken by nurses blinded to treatment allocation. Results The groups were well matched at baseline. The CBT intervention achieved clinical and statistically significant change for all outcomes: HADS-Anxiety group mean change of 3.4 (SD 4.20) p=<0.001 CI 2.62- 4.17; HADS-Depression 2.20 (SD 3.62) p=<001, CI 1.53 – 2.87; CAT 2.7 (SD 6.36) p=< 0.001, CI 1.49 – 3.88 and EQ-5D utility group mean change of 0.08 (SD 0.31) p=0.007, CI - 0.14 - -0.02 at 3 months. The leaflet group achieved a clinical and significant reduction in group mean change of 1.9 (SD 3.80) p= <0.001, CI 1.19 - 2.55 in HADS-Anxiety and CAT 2.06 (SD 5.34) p=<0.001, CI 1.09 – 3.04. The HADS-Depression group mean change was only statistically significant 1.07 (SD 3.55) p=0.001, CI 0.44 – 1.71. The EQ-5D utility scores group mean change of - 0.003 (SD 0.31) p= 0.09 CI -0.06 – 0.05 which did not reach statistical or clinical significance. Conclusion Overall the CBT intervention was superior to the leaflet intervention.
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Mathers, William Eathorne. "The use of cognitive behavioural therapy (CBT) based on psychosocial skills by nurses in acute mental health inpatient settings : an evaluation of nurses' training." Thesis, University College London (University of London), 2010. http://discovery.ucl.ac.uk/10020602/.
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This thesis evaluates two short teaching modules which are managed by the author. The modules are convened for qualified mental health nurses who are working in acute adult inpatient wards in several London mental hospitals. The main purpose of the modules is to teach trainees psychosocial interventions (PSI) based on Cognitive Behavioural Therapy (CBT) to equip them to care for patients with severe mental illness. PSI has been found to be helpful for patients with psychotic symptoms in community contexts. In this study, the implementation of PSI in acute inpatient mental health settings is explored. In order to evaluate the effectiveness of the modules, a questionnaire was administered to each trainee (experimental group) before and after the modules to elicit their opinion of their ability in caring for patients with these psychotic symptoms. Their responses 'pre module' were then compared to their responses 'post module'. The same questionnaire was also given to colleagues matched for length of service and experience who had not undertaken the modules (reference group).The effectiveness of the modules was further evaluated by comparing the experimental group's post module responses to the responses of the reference group. The thesis also examines the aids and barriers to implementing the skills which trainees learned on the modules in their clinical practice. To achieve this, a focus group and semi- structured audio taped interviews were carried out with the experimental group. For the same purpose, a questionnaire was administered to the patients for whom they acted as 'primary nurse' throughout their stay on the ward. Their responses were compared to patients for whom the reference group acted as 'primary nurse'. The conclusion from the study was that the modules were effective in teaching trainees these skills, but that they found it difficult to implement them in practice.
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Du, Eliane. "Factors that impact on the usability of computerised cognitive behavioural therapy (CCBT) : mixed methods studies." Thesis, University of Edinburgh, 2017. http://hdl.handle.net/1842/22999.
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Computerised Cognitive Behavioural Therapy (CCBT) has been recommended for patients in the National Health Service (NHS) Primary Care across the United Kingdom for management of mild to moderate anxiety and depression. This approach also promises financial savings, and may fill the gap between demand and supply of face-to-face therapy. Studies have shown that CCBT is feasible and effective. However, dropout rates can be as high as 86%, but the reasons remain unclear and the information available is limited. This thesis explores factors that may impact on the usability and user experience of this computer-mediated therapy. Espousing the “real world” research philosophy and widely used methods in the Human-Computer Interaction (HCI) field for usability evaluations, four studies using a mixed-methods design were conducted. Study I was an online usability survey, which investigated if usability evaluations had been conducted for CCBT applications. Two versions of questionnaires were sent to four CCBT software developers and ten authors of randomised controlled trials. The categories and responses of the questionnaires gathered from five respondents were reviewed and summarised. The findings suggested that usability evaluations for CCBT were still in their infancy when compared to other healthcare interventions to which HCI approaches have been widely applied. Study II was a usability Heuristic Evaluation (HE) conducted with four expert evaluators to assess two different CCBT applications’ interfaces (MoodGYM and Living Life to the Full) against the self-designed usability heuristics for their compliance. The findings revealed numerous usability issues. Major problems related to navigation and inconsistency of the interfaces were identified. These could be rectified to enhance the user experience. Study III focused on other factors besides usability that might have an influence on the effective use of CCBT. Perceptions of service providers who were involved in both decision-making about CCBT availability and supporting its use were gathered. Nine service providers at different NHS organisations were interviewed. The interviews were analysed using techniques from Grounded Theory (GT). The findings suggested that the practitioners’ attitudes towards CCBT might have affected its service delivery. Four categories from the data analysis were identified: (1) shaping behaviour, (2) implementing and delivering, (3) making an appropriate referral, and (4) technology/CCBT packages - advancing with time. A conceptual model was also generated, “building support around CCBT”: a road-map that could address some of these issues. Study IV examined patients’ perceptions and acceptance of a CCBT application (Beating the Blues), its usability and the user experience, and also whether the user characteristics (e.g. computer experience (CE) and computer self-efficacy (CSE)) had any influence on patients’ use of this technology. A mixed-methods approach was utilised with a sample of 33 participants. Face-to-face and email interviews were conducted. Feedback was also gathered from a usability questionnaire and think-aloud protocol with seven participants selected from the sample. The data were analysed using Thematic and Saliency Analysis to uncover themes. Descriptive statistics were used to describe data from questionnaires. Two overarching themes from the interviews were identified: (1) access to CCBT services, and (2) perceptions and attitudes towards CCBT. Both themes revealed issues which might have significantly impacted on patients’ engagement with CCBT. Numerous flaws were also discovered in the application’s design and functionality (e.g. navigation, aesthetics, relevance of content, and inflexibility). However, the results from CE and CSE questionnaires suggested that participants were confident in using this technology. The four studies provided an in-depth understanding of factors that affect the usability and user experience of CCBT and possible reasons for the high attrition rates. The implications of this research point to the need for health policymakers to focus on the current implementation issues and on how best to deploy this treatment therapy to patients. Further development of CCBT is pivotal to its success, in particular, expanding contexts of use and increasing usability evaluations. Keeping users interested and engaged will improve treatment efficiency, completion rates and will achieve better clinical outcomes.
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Gutierrez-Ros, Maria Jose. "A single case experimental design to evaluate Sorensen's therapy for instability in Mood (STIM) in individuals with bipolar disorder delivered by staff with limited training in Cognitive Behavioural Therapy (CBT)." Thesis, University of Essex, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.517325.
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Dunne, Nivek. "Evaluation of psychology clinicians' attitudes towards computerised cognitive behaviour therapy, for use in their future clinical practice, with regard to treating those suffering from anxiety and depression." Antioch University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1503328670275243.
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Englund, Ida. "“Recruitment of research participants into randomized controlled trials of internet-based cognitive behavioural therapy (iCBT) for depression: a systematic review and meta-analysis”." Thesis, Uppsala universitet, Internationell mödra- och barnhälsovård (IMCH), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-415871.
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Introduction Research about health has become a very important part of the world today. Theres a constant need for new treatment methods and evidence. Recruitment is one of the most challenging parts of conducting a trial, especially in trials regarding mental health. The result of this is often a waste of money and resources in research. Method This study is a systematic review and meta-analysis investigating the recruitment in randomized controlled trials on internet-based CBT interventions for depression. Results The recruitment rates were calculated as number of participants screened divided by number of participants randomized into the trial. The overall recruitment rates of all the trials was 54.3%. The analysis of the recruitment moderators shown that a clinical recruitment setting together with referral as recruitment personnel.
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Persson, Joanne K. "Clinician attitudes towards, and patient well-being outcomes from, computerised Cognitive Behavioural Therapy : a research portfolio." Thesis, University of Edinburgh, 2018. http://hdl.handle.net/1842/33093.
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This thesis follows the research portfolio format and is carried out in part fulfilment of the academic component of the Doctorate in Clinical Psychology at the University of Edinburgh. An abstract provides an overview of the entire portfolio thesis. Chapter One contains a systematic review of published research exploring staff attitudes towards computerized cognitive behavior therapy (cCBT). Chapter Two is an empirical study examining a range of potential predictor variables on well-being outcomes from cCBT. Chapter one is prepared for Behavioural and Cognitive Psychotherapy, whereas chapter two is prepared for submission to the journal, Behaviour Research and Therapy. Both chapters follow the relevant author guidelines. Background: Evidence suggests that computerised cognitive behavioural therapy (cCBT) is both effective and efficacious in treating depression and anxiety. Numerous barriers to its implementation and uptake have been identified, however, including attitudinal variables and high patient attrition rates. Research examining predictors of response from cCBT have tended to adopt the pathological model of distress, focussing on symptom reduction rather than the promotion of well-being. Furthermore, exploration of possible predictors has tended to focus on a narrow range of factors (e.g. age, gender), neglecting key psychosocial variables (e.g. social identification, baseline distress) that could be exerting an effect. Aims: A systematic review examined staff attitudes towards cCBT for depression, anxiety, and comorbid depression and anxiety, focussing on three attitudinal domains: Perceived acceptability of cCBT; staff's self-reported intention to use cCBT in the future, and perceived advantages and disadvantages of cCBT for depression and/or anxiety. An experimental study was subsequently conducted, examining a range of potential predictors on well-being outcomes from a cCBT intervention utilising Beating the Blues. Method: A systematic search across five databases was conducted, followed by manual searches. Strict search criteria were applied, resulting in the identification of 15 studies. These were subjected to quality assessment, data extraction and synthesis. For the empirical study, data from 1354 participants was collected, with subgroup-analyses conducted on those completing measures of life and mental health satisfaction, functioning and well-being. Key potential predictors of interest were level of group identification, baseline distress, and socioeconomic deprivation. Results: Findings from the systematic review indicated that staff held relatively positive attitudes towards cCBT, with some ambivalence emerging in relation to perceived advantages and disadvantages of the intervention. The empirical study obtained significant effects of group identification on life and mental health satisfaction. A mediating impact of group identity on baseline distress emerged, whereas a moderating effect of baseline distress on deprivation was obtained for the functioning model. Discussion: The current findings demonstrated both positive and negative aspects of staff attitudes towards cCBT for depression and/or anxiety, whereas the empirical project established a clear link between social identification, baseline distress, and well-being. Results from both studies are discussed in terms of clinical implications relating to the uptake of cCBT.
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Penman, Jean. "Engaging with persistent medically unexplained physical symptoms in healthcare : a realist psychosexual service evaluation." Thesis, University of Bedfordshire, 2015. http://hdl.handle.net/10547/622044.
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In this study the phenomenon of persistent physical symptoms (PPS) has been examined by realist evaluation of research and practice. Nimnuan et al., (2001) have shown that up to 35% of patients in primary care and 66% in specialist out-patient clinics have presented with such ‘medically unexplained’ symptoms. The cost in medical investigation to reach diagnosis for PPS is an estimated 10% of the annual UK National Health Service budget (Bermingham et al., 2010) but poor patient outcomes prevail (Dwamena et al., 2009). Currently, PPS is linked to high comorbidity with anxiety and depression (DH 2011b) and Cognitive Behavioural Therapy (CBT) is advised as the evidence based treatment for PPS (IAPT, 2014). However, a shortfall in clinical skills to address PPS is also demonstrated and engagement could be improved (De Lusignan et al., 2014). Moreover, the pragmatic study of alternative therapy modalities and processes for PPS is recommended (Leichsenring, 2005). To obtain a broader knowledge of process for patients with or without co-morbidity, practice based experience suggests that one such alternative is a brief psychodynamic intervention (STPP) for PPS. A Realist Literature Synthesis (Wong et al. 2013) highlights effective psychotherapeutic STPP interventions in real world circumstances in 5 comparison with CBT interventions for heterogenous PPS. STPP for PPS is found at least as effective as CBT, with improved engagement rates. Additionally, common factors were discovered between ‘third generation’ STPP and CBT for effective PPS interventions and these were developed into a preliminary cross-modality theoretical analytical framework. In the realist contextual evaluation (Pawson and Tilley, 1997) of a psychosexual service delivery, the majority of PPS sufferers were found only moderately co-morbid with anxiety and depression. For complete investigative study, clinical tools are developed providing integrative CBT/STPP principles for engagement with PPS for teaching, training and practice. In conclusion, the findings suggest that the reflexive insider position of the realist Therapist-Evaluator facilitates systematically derived Practice-Based Evidence of PPS process, meeting recommendations of Deary et al., (2007) to explore and define process and outcomes with PPS. The findings contribute to development of a conceptual platform to support health professionals in overcoming physical/mental health barriers to addressing PPS and wider patient access to effective care (NHSE, 2014, 2015).
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Norell-Clarke, Annika. "Cogito, ergo insomnis : I think, therefore I am sleepless." Doctoral thesis, Örebro universitet, Institutionen för juridik, psykologi och socialt arbete, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-35794.
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Insomnia is a common health complaint that often becomes a persistent problem. The theoretical frameworks for understanding and treating insomnia have mostly been behavioural, yet the importance of cognitive processes has received greater attention over the years. The overall aim of this dissertation was to expand the knowledge on the processes from the Cognitive Model of Insomnia by investigating them in novel contexts. Study I examined the outcomes from cognitive therapy for insomnia on adolescents. Study II explored the relationship between cognitive processes and the association with remission and persistence of insomnia in the general population. Lastly, Study III investigated if cognitive processes mediated between cognitive behavioural therapy for insomnia (CBT-I) and outcomes of insomnia and depressive severity in a sample of people with insomnia comorbid with depressive problems. The findings show that cognitive therapy for insomnia affected sleep for adolescents, thus this is a promising treatment option for this age group. Further, it was found that cognitive processes distinguished between adults with normal sleep and persistent insomnia. For people with insomnia, elevated sleep-related worry at baseline increased the risk of reporting persistent insomnia later on, whereas a lowering of selective attention and monitoring, and safety behaviours over time increased the likelihood of remission from insomnia. This has clinical implications for insomnia assessment and treatment, as well as theoretical implications, and warrants further research. CBT-I was associated with greater reductions in dysfunctional beliefs and sleep-related safety behaviours compared to control treatment. Dysfunctional beliefs mediated between CBT-I and insomnia severity and depressive severity respectively. This supports the importance of negative thought content in both insomnia and depression.
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Mantica, Valentina. "The impact of the experience of working with CBT on counselling psychologists' professional identity." Thesis, University of Roehampton, 2012. https://pure.roehampton.ac.uk/portal/en/studentthesis/the-impact-of-the-experience-of-working-with-cbt-on-counselling-psychologists’-professional-identity(a1d88072-5759-40e1-855b-10770bdd1c28).html.
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Cognitive behaviour therapy (CBT) is a therapeutic modality which is commonly argued to be oriented to a medical model, and so to diverge significantly in theory and practice from the traditional relational and humanistic roots of counselling psychology. A large body of literature and research exists which examines counselling psychologists’ professional identity in medical settings, but there appears to be a significant gap in the extant literature relating to how counselling psychologists experience professional identity specifically in the practice of CBT, a therapeutic modality which presently provides a considerable amount of employment for counselling psychologists. To address this gap, the present study sought to explore qualitatively whether counselling psychologists’ experience of their professional identity is affected by the inclusion of CBT in their practice. A sample of eight counselling psychologists who worked with CBT and had been qualified for at least five years were interviewed. Data gathered from the semistructured interviews were transcribed and analysed using interpretative phenomenological analysis (IPA), a method selected because it is concerned with the detailed examination of personal lived experience and the meaning of experience to participants. The methodology was approached within the contextual constructionist epistemological framework. Three superordinate themes, each containing four subordinate themes, emerged from participants’ accounts: (i) components of professional identity; (ii) the contribution of CBT to the professional self; and (iii) how CBT compromises the professional self. The findings are discussed in relation to the relevant literature, and lines of enquiry that have emerged have been located in current postmodern literature, arguments and debates. One main conclusion of the present study is that feeling comfortable with CBT can CBT, Counselling Psychology and Professional Identity 3 depend upon practitioners’ initial training, personal experience, cultural background, personal characteristics and personal beliefs – that is, the professional self as emerging from the personal self. Clinical implications, methodological limitations, directions for future research and reflections upon the researcher’s reflexivity are presented.
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Xanidis, Nikos. "Exploring the implementation of Cognitive Behavioural Therapy for psychosis (CBTp) using the Normalisation Process Theory (NPT) framework." Thesis, University of Glasgow, 2018. http://theses.gla.ac.uk/30812/.
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Objective: Evidence suggests that only a minority of service users experiencing psychosis have access to Cognitive Behavioural Therapy for psychosis (CBTp). Normalisation Process Theory (NPT) is a theoretical framework which focuses on processes by which interventions are implemented and normalised in clinical practice. This study explored the views and experiences of mental health professionals regarding the implementation of CBTp. Barriers and facilitators to implementation were explored using the NPT framework. Design: A qualitative methodology was adopted involving semi-structured focus groups and individual interviews. Methods: A total of 14 members of staff working in the community and crisis mental health teams were recruited. Thematic analysis was used to generate initial themes. The Framework approach was utilised to map initial themes to the NPT framework. Results: Inductive coding generated five overarching themes consisting of 15 individual subthemes which captured the perceived barriers to engagement; contextual barriers to implementation; optimisation of implementation; positive attitudes towards implementation; and expectations of implementing CBTp. All but two subthemes mapped on to the NPT framework. The deductive analysis suggested that difficulties in making sense of CBTp among professionals were reflected as service level barriers which impeded wider implementation. Conclusion: The results of this study suggested a mixture of barriers and facilitators to CBTp implementation. Interpreting our findings within an NPT framework indicates the importance of strong clinical leadership to address difficulties in sense-making and service investment in CBTp.
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Haarhoff, Beverly Ann. ""The map, the navigator, and the explorer": evaluating the content and quality of CBT case conceptualization and the role of self-practice/self-reflection as a training intervention : a thesis presented in partial fulfillment of the requirements of the Doctor of Philosophy in Psychology at Massey University, Albany, New Zealand." Massey University, 2008. http://hdl.handle.net/10179/1077.
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Cognitive Behaviour Therapy (CBT) leads the way as an evidenced based psychotherapy, and the evaluation of CBT training programs is increasingly seen as important if this position is to be maintained. In this dissertation, CBT case conceptualization, as a core psychotherapeutic competency, acquired in training, is evaluated. Case conceptualization, integrates precipitating, predisposing, maintaining, and protective factors, functioning as an explanatory and prescriptive roadmap for therapy. Gaining self-knowledge through exposure to some form of personal therapy is cited as important in gaining psychotherapeutic competency. Self-practice/ self-reflection, show promise as a form of personal therapy compatible with the principles of CBT. This study evaluates the content and quality of CBT case conceptualizations produced by a sample of 26 participants who have completed the Massey University Post Graduate Diploma, using three case conceptualization rating scales. In addition, the impact of a self-practice/self-reflection manualised training intervention designed to improve the quality of case conceptualization in trainee cognitive behaviour therapists, is explored using thematic analysis. The evaluation of the CBT conceptualizations showed predisposing factors and psychological mechanisms as receiving the most attention from participants. However, the majority of participants failed to pay attention to socio-cultural, biological, protective factors and factors pertaining to the therapeutic relationship. The majority of the participants were able to produce a 'good enough' CBT case conceptualization, however the ‘problem list’ was not well developed, and the conceptually relevant aspects of the therapeutic relationship and protective factors were given less attention. The effect of a self-practice/self-reflection training intervention on the quality of CBT case conceptualizations produced by the intervention group (n = 16) drawn from the main participant sample, was qualitatively evaluated using thematic analysis. Theoretical understanding of the model, self awareness, empathy, conceptualization of the therapeutic relationship, adaptation of clinical interventions, and clinical practice were all subjectively perceived by participants to have increased as a result of the intervention. An inferential analysis compared the performance of the intervention group (n=16) that of a comparison group (n=10), made up of the remainder of the larger sample described in the context of the first question. The comparison group had not been exposed to the manualised intervention. The comparison was both within, and between the two groups. The quality of the intervention group showed an improvement on one of the rating scales, indicating a possible link between the training intervention and case conceptualization competency, however, the improvement was not replicated by the other two rating scales. The findings are discussed in the context of improving CBT training with regard to case conceptualization.
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Barakat, Sarah. "Evaluation of an Online CBT Program for Bulimia Nervosa: A Randomised Controlled Trial of Pure vs. Clinician-Supported Self-Help." Thesis, The University of Sydney, 2022. https://hdl.handle.net/2123/29968.
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Cognitive behaviour therapy (CBT) is the treatment with the strongest evidence base for bulimia
nervosa (BN); however, the reality remains that majority of individuals with the illness do not seek or
access treatment. Innovative, low-resource delivery methods are needed to disseminate evidencebased treatments and overcome barriers to care. Online interventions offer promise as a costefficient and scalable alternative to therapist-led treatments, yet suboptimal rates of retention and adherence threaten their real-world applicability. The overarching aim of the present thesis was to evaluate a newly developed, online self- help treatment for BN, titled Binge Eating eTherapy (BEeT).
A secondary aim was to investigate the aspects related the design and delivery of the digital
intervention which are responsible for maximising treatment adherence and outcome. The findings
are discussed in terms of the capacity for clinically meaningful change to be achieved in both
clinician-supported and self-guided settings, the implications this may hold for future implementation of online interventions within the healthcare system, and the meaningful contribution this thesis provides to theoretical and empirical frameworks of digital intervention delivery.
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Woliter, Dean. "A realistic evaluation of a Cognitive Behaviour Therapy (CBT) intervention to support an adolescent diagnosed with Asperger syndrome in a mainstream secondary school." Thesis, University of Birmingham, 2014. http://etheses.bham.ac.uk//id/eprint/4747/.
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The use of Cognitive Behaviour Therapy (CBT) as a means to support adolescents diagnosed with Asperger syndrome is gaining interest and has recently been applied in a school setting (Grieg and Mackay, 2005; Sofronoff et al., 2005). The present study explores the use of CBT to support a pupil diagnosed with Asperger syndrome delivered by an educational psychologist in the pupil’s school setting. This application of CBT employed a ‘formulation’ approach in which a programme was written and then adapted in situ to meet the pupil’s needs. The CBT programme consisted of 7 weekly sessions of CBT lasting approximately 40 minutes each of the sessions were delivered in school in the morning prior to the start of lessons. The findings of the present study were analysed using a novel application of Realistic Evaluation methodology (RE) of a CBT intervention in addition to the pre and post CBT measures RE as a methodology seeks to consider the context of an intervention and its potential to triggering mechanisms that could facilitate or limit the progress of introduced intervention. The present study is an exploratory case study, employing a single case design within a realist evaluation framework, to describe the role of the context as a mediating or limiting factor on a CBT intervention. A year 8 pupil with a diagnosis of Asperger syndrome, referred to as B, attended a mainstream secondary school in the West Midlands. It was observed that there were changes for B in terms of his reported social communication and in his cognition. The exploration of the CBT intervention by RE analysis suggested that specific mechanisms were triggered in school and contributed to the observed outcomes. Conclusions are discussed in terms of the usefulness of this methodological approach but also for wider EP practice.
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Månsson, Kristoffer N. T. "Restructuring the socially anxious brain : Using magnetic resonance imaging to advance our understanding of effective cognitive behaviour therapy for social anxiety disorder." Doctoral thesis, Linköpings universitet, Psykologi, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-132637.
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Social anxiety disorder (SAD) is a common psychiatric disorder associated with considerable suffering. Cognitive behaviour therapy (CBT) has been shown to be effective but a significant proportion does not respond or relapses, stressing the need of augmenting treatment. Using neuroimaging could elucidate the psychological and neurobiological interaction and may help to improve current therapeutics. To address this issue, functional and structural magnetic resonance imaging (MRI) were repeatedly conducted on individuals with SAD randomised to receive CBT or an active control condition. MRI was performed pre-, and post-treatment, as well as at one-year follow-up. Matched healthy controls were also scanned to be able to evaluate disorder-specific neural responsivity and structural morphology. This thesis aimed at answering three major questions. I) Does the brain’s fear circuitry (e.g., the amygdala) change, with regard to neural response and structural morphology, immediately after CBT? II) Are the immediate changes in the brain still present at long-term follow-up? III) Can neural responsivity in the fear circuitry predict long-term treatment outcome at the level of the individual? Thus, different analytic methods were performed. Firstly, multimodal neuroimaging addressed questions on concomitant changes in neural response and grey matter volume. Secondly, two different experimental functional MRI tasks captured both neural response to emotional faces and self-referential criticism. Thirdly, support vector machine learning (SVM) was used to evaluate neural predictors at the level of the individual. Amygdala responsivity to self-referential criticism was found to be elevated in individuals with SAD, as compared to matched healthy controls, and the neural response was attenuated after effective CBT. In individuals with SAD, amygdala grey matter volume was positively correlated with symptoms of anticipatory speech anxiety, and CBT-induced symptom reduction was associated with decreased grey matter volume of the amygdala. Also, CBT-induced reduction of amygdala grey matter volume was evident both at short- and long-term follow-up. In contrast, the amygdala neural response was weakened immediately after treatment, but not at one-year follow-up. In extension to treatment effects on the brain, pre-treatment connectivity between the amygdala and the dorsal anterior cingulate cortex (dACC) was stronger in long-term CBT non-responders, as compared to long-term CBT responders. Importantly, by use of an SVM algorithm, pre-treatment neural response to self-referential criticism in the dACC accurately predicted (>90%) the clinical response to CBT. In conclusion, modifying the amygdala is a likely mechanism of action in CBT, underlying the anxiolytic effects of this treatment, and the brain’s neural activity during self-referential criticism may be an accurate and clinically relevant predictor of the long-term response to CBT. Along these lines, neuroimaging is a vital tool in clinical psychiatry that could potentially improve clinical decision-making based on an individual’s neural characteristics.Social ångest är en av de vanligaste psykiska sjukdomarna. Mer än en miljon svenskar bedöms lida av detta. Social ångest leder ofta till svåra konsekvenser för den som drabbas, men även ökade kostnader för samhället har noterats, t ex i form av ökad sjukfrånvaro. Även om många som drabbas inte söker hjälp så finns effektiva behandlingar för social ångest, både farmakologiska och psykologiska behandlingar rekommenderas av Socialstyrelsen. Kognitiv beteendeterapi (KBT) är en evidensbaserad och rekommenderad psykologisk behandling för social ångest. Trots att nuvarande interventioner är effektiva så är det fortfarande en andel individer som inte blir förbättrade. Det finns en stor andel studier som visar att individer med social ångest, i jämförelse med friska individer, karakteriseras av överdriven aktivitet i ett nätverk som har till uppgift att tolka och reagera på hotfull information. Denna aktivitet är lokaliserad i rädslonätverket där området amygdala spelar en central roll. Det finns ett behov att utveckla nuvarande behandlingar och denna avhandling syftar till att öka vår förståelse för en neurobiologisk verkningsmekanism bakom KBT för social ångest. I detta forskningsprojekt har magnetresonanstomografi (MRT) använts för att undersöka personer som lider av social ångest. Upprepade mätningar har genomförts, innan, efter, och vid uppföljning ett år efter ångestlindrande behandling. Utöver detta har individer som inte lider av social ångest undersökts för att förstå hur patienter skiljer sig från friska personer, men också för att undersöka om behandlingen normaliserar patientens hjärna. Under tiden som deltagarna undersöktes med MRT genomfördes två experiment för att ta reda på hur hjärnan reagerar på affektiv information. Deltagarna tittade på bilder med ansikten som uttrycker emotioner, t ex arga och rädda ansiktsuttryck, samt information som innehöll kritiska kommentarer riktade till personen själv eller någon annan, t ex ”ingen tycker om dig” eller ”hon är inkompetent”. Strukturella bilder på deltagarnas hjärnor har också samlats in vid varje mättillfälle. Utöver detta fick alla deltagare instruktioner om att de efter MRT skulle hålla en muntlig presentation inför en publik. Denna uppgift är oftast den värsta tänkbara för individer med social ångest, och syftet med uppgiften var att relatera hjärnans struktur och aktivitet till hur mycket ångest som individerna upplevde inför denna situation. I arbetet med denna avhandling har tre frågor ställts. a) Uppstår strukturella och funktionella förändringar i rädslonätverket direkt efter avslutad KBT (Studie I och II)? b) Är de tidiga förändringarna efter behandlingen även kvarstående ett år senare (Studie III)? c) Kan hjärnans reaktioner i rädslonätverket förutspå vilka individer som kommer att bli förbättrade av en ångestlindrande psykologisk behandling på lång sikt? Resultat från studierna i denna avhandling sammanfattas nedan: Reaktioner till självriktad kritik i amygdala är överdrivna hos individer med social ångest, i jämförelse med friska individer Reaktioner i amygdala minskar efter att individerna blivit behandlade med KBT och minskningarna korrelerar till minskade symptom av social ångest Den strukturella volymen av amygdala korrelerar positivt med hur mycket ångest individerna upplever inför en muntlig presentation, och minskningen av dessa symptom korrelerar även med hur mycket volymen av amygdala minskar efter KBT Minskningen av amygdalavolym och den samtidigt minskade reaktiviteten i amygdala till självriktad kritik är korrelerade. Medieringsanalyser antyder att det är den minskade volymen som driver förhållandet mellan minskad reaktivitet och minskad ångest inför att hålla en muntlig presentation Den strukturella minskningen av amygdala ses både direkt efter behandlingens avslut, men även vid uppföljning ett år senare. Hjärnans reaktivitet till självriktad kritik i amygdala minskar direkt efter behandling, men är inte kvarstående vid uppföljning ett år senare Kopplingen mellan hjärnans reaktivitet till självriktad kritik i amygdala och dorsala främre cingulum var starkare hos de som inte blev förbättrade (jämfört med de som blev bättre) av en ångestlindrande behandling på lång sikt Med hjälp av en stödvektormaskin (en. support vector machine learning) och ett mönster av hjärnaktivitet i dorsala främre cingulum innan behandling påbörjades, predicerades (med 92% träffsäkerhet) vilka individer som ett år senare var fortsatt förbättrade av en effektiv psykologisk behandling Utifrån dessa observationer är slutsatserna att strukturell och funktionell påverkan på amygdala är en möjlig neurobiologisk mekanism för minskad social ångest efter KBT, samt att reaktivitet i främre cingulum kan ge kliniskt relevant data om vem som kommer att bli förbättrad av en psykologisk behandling. Denna information kan potentiellt vara viktig i framtidens psykiatri för att utveckla existerande behandlingar, men även för att stödja klinikers beslutsfattande huruvida en viss individ bör erbjudas en specifik behandling eller ej.
Illustration on the cover by Jan Lööf. Cover image printed with permission from Jan Lööf and Bonnier Carlsen Förlag. The cover was art directed by Staffan Lager.
The thesis is reprinted and the previous ISBN was 9789176856888.
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Russell, Christopher. "A randomised controlled study of the relative efficacy and mechanisms of action of cognitive-behavioural coping skills training CBST) and acceptance and commitment therapy (ACT) for smoking abstinence." Thesis, University of Strathclyde, 2013. http://oleg.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=18816.
Full textAbstract:
Cognitive-behavioural Coping Skills Training (CBST) and Acceptance and Commitment Therapy (ACT) both conceptualise smoking relapse as prototypically motivated by a desire to avoid negative affect and associated cognitions and environments. However, they specify contrasting techniques for increasing smokers' abilities to forgo the powerful negative reinforcement of affect reduction that is available through smoking. Whereas CBST focuses on developing smokers' skills for avoiding and coping with negative affect, ACT aims to reduce smokers' avoidance of cues to negative affect instead foster' their willingness to fully experience these cues. A separate line of research suggests that individual differences in smokers' tendencies to suffer paradoxical effects of experiential avoidance may be an important determinant of CBST's therapeutic impact. This study compared the efficacy of group CBST (n = 37) and ACT (n = 42) for long-term smoking abstinence in motivated-to-quit, nicotine-depende nt smokers, and examined mediation of abstinence outcomes by each models' putative mechanisms of action. Moderation of abstinence outcomes by participants' paradoxical behaviour tendencies, as measured on four computer tasks prior to random assignment to CBST or ACT, was also examined. Efficacy analyses showed that CBST and ACT produced high and statistically equivalent rates of past 30-day abstinence at three month follow-up (37% vs. 52%). However at six month follow-up, ACT participants were 3.47 times more likely to report no smoking in the past 30 days, when controlling for other possible explanatory variables (15% vs. 39%). In support of the ACT model, 30-day abstinence outcomes following ACT were mediated by reductions in avoidance of internal smoking cues. In contrast, CBST outcomes were neither mediated by increased use of coping strategies, nor moderated by paradoxical behaviour tendencies. Overall, results suggest that rationalising and training acceptance-based respoonding to smoking cues may provide efficient alternative to traditional cognitive-behavioural interventions in the treatment of nicotine dependence.