Dissertations / Theses on the topic 'Mental Disorders. Acupuncture Therapy'

A qualitative, art-based research approach is used in this study to explore the relationship between trauma and eating disorders in art therapy treatment. The literature review illuminates the function, presentation, and treatment of eating disorders and trauma. Adolescent developmental challenges are discussed in relation to eating disorders, given that this is the period when the diagnosis manifests. The nominal research on the use of art therapy for underlying trauma with clients who are in treatment for eating disorders suggests the importance of considering the implications for the field of art therapy. Two-semi-structured, art-based interviews are the primary data gathering component in understanding the connection between eating disorders and trauma. An axial coding process is used to analyze the textual and visual data to reveal emergent themes. The results of the analysis process suggest that art, which bypasses verbal defenses, allows the client to access and externalize internal experiences such as trauma. The study also reveals the interconnected nature of eating disorders and trauma. The findings recommend future study of this relationship and the necessity of addressing significant traumatic experiences in addition to abuse and most importantly to acknowledge trauma as a primary focus of treatment.

Psychosis is suggested to be a leading cause of disability, not only as a direct result of the distressing experiences, but due to the social adversity, increased isolation and subsequent negative impact upon quality of life. While psychological therapies for psychosis show promise in assisting people in recovering from psychosis, relatively little is known about the processes involved, specifically the processes worked through to allow clients to understand and adopt strategic, therapeutic approaches to care. This study aimed to explore how people experiencing psychosis made use of understandings and strategies developed during the joint activity of therapy. Semi-structured interviews were conducted with 11 participants (six psychologist-client pairs) towards the end of, or recently after, finishing therapy for psychosis. Transcribed interviews were analysed using grounded theory. The model constructed presents multi-directional, dynamic interactions between three core categories; ‘Enabling Personal Empowerment’, ‘Navigating a Collaborative Journey’ and ‘Building Belief to generate Trust’. This study explored how processes are derived during therapy, both individually and collaboratively, to help clients better understand and implement the most beneficial strategies introduced through therapy. Through exploring these derived processes, a possible model for the conceptualisation of processes which occur during therapy for psychosis, grounded in client and psychologist accounts of therapy, was generated.

Theoretical assumptions and emerging research point to possible mechanisms of change in acceptance and commitment therapy (ACT) for psychosis. However, the specific processes by which change occurs remain unclear and under-researched. No current research has explored processes facilitating change in the group format of an ACT intervention for psychosis. Participant perspectives were sought to help elucidate potential mechanisms of change. Nine participants of ACT groups for people with psychosis were interviewed about their experiences of the intervention. Interviews were analysed using methods and techniques informed by grounded theory. A proposed model outlined key mechanisms of awareness, relating differently and reconnecting with life, which led to reductions in distress and behavioural change. Leaning on others highlighted the importance of the group context in supporting change processes. The processes identified, and the mechanisms through which these were achieved, as articulated by participants, were consistent with proposed change processes. Participants also offered additional insights based on experiential accounts. Contributions to theoretical understandings and clinical practice are discussed.

Difficulties with emotion regulation are a core feature of anxiety disorders (ADs) in children and adults. Interventions with a specific focus on emotion regulation are gaining empirical support. Yet, no studies to date have compared the relative efficacy of such interventions to existing evidence-based treatments. Such comparisons are necessary to determine whether emotion-focused treatments might be more effective for youth exhibiting broad emotion-regulation difficulties at pretreatment. This study examined an emotion-focused cognitive-behavioral therapy (ECBT) protocol in comparison to traditional cognitive-behavioral therapy (CBT) in a sample of children with a primary anxiety disorder diagnosis. Moderation analyses examined whether children with higher levels of emotion dysregulation at pretreatment would show greater levels of improvement in ECBT than CBT. Ninety-two youth ages 7 to 12 years (58% male) with a primary diagnosis of separation anxiety disorder, generalized anxiety disorder, or social phobia were included. Participants were randomly assigned to ECBT or CBT. Results showed that youth in both conditions demonstrated similar improvements in emotion regulation and that pretreatment levels of emotion dysregulation did not moderate treatment outcomes. Additional analyses showed that ECBT and CBT were similarly effective on diagnostic, severity, and improvement measures. Future work is needed to further explore the ways that emotion regulation is related to treatment outcome for anxious youth.

The purpose of this study is to determine if a new intervention using techniques from Acceptance and Commitment Therapy (ACT; Hayes et al., 1999) in combination with activities from The Body Project (Stice et al., 2009), will be able to reduce negative body image concerns and increase mindfulness skills in college females. Prior to receiving the intervention, participants completed a pre-test measuring their current body image concerns as well as mindfulness abilities. The intervention was administered in a large, group setting and took approximately 35 minutes to administer. After receiving the intervention, participants completed the same assessment measures as the pre-test, but in a post-test form. Results indicate that there was a significant difference in body image after participants received the intervention of ACT and The Body Project. There was not a significant difference for the mindfulness facets measured in the study. This research contributes to a growing area of eating disorder treatment using ACT, and can help provide evidence for the benefits of using specific ACT and The Body Project activities for treating and preventing negative body image.

Section A explores the role of creative arts therapies (CATs) in assisting recovery from severe mental illness (SMI). It examines the congruence of CATs with recovery models, and critically reviews evidence for the effectiveness of art and drama therapy with adults with mental health problems. It then examines one form of CAT which combines art and drama therapy – therapeutic puppetry. Underlying theoretical models and the existing evidence base with adults with SMI are outlined and critiqued. The review concludes with a summary of proposed arguments and research recommendations. Section B reports on a pilot investigation of group therapeutic puppetry with people with SMI. Background: Therapeutic puppetry is the use of puppets to aid emotional healing. There is no published research investigating the effectiveness of therapeutic puppetry with people with SMI. Aims: A pilot investigation of group therapeutic puppetry with people with SMI tested the hypotheses that this intervention results in improvements in mental wellbeing, self-esteem, and body connection. It also investigated mechanisms of change, and service user acceptability and experience. Method: This mixed methodology study utilised five single AB design case studies with time series data analysed using simulation modelling analysis. Qualitative data was collected via participant observation and participant interviews and analysed using thematic analysis. Results: Three participants experienced statistically and clinically significant changes in either positive or negative directions during the intervention, with all participants describing therapeutic puppetry as powerful and beneficial. Conclusions: Therapeutic puppetry is a potentially powerful medium which could be utilised by various mental health professionals. Service users find therapeutic puppetry acceptable and beneficial despite it being an occasionally difficult and intense experience. Section C is a critical appraisal of the conducted research, examining lessons learnt, identified training needs, changes to clinical practice and future research directions.

In this paper I investigate the emotional benefits of textile crafts in general and embroidery in particular. How can embroidery be used to express love and care for others? Can embroidery be used as a therapeutic tool? Using my own embroidery project Flower heart as a starting point, my research goes into craft as a manifestation of love, from handmade gifts in the 18th century to contemporary art, and crafting as a therapeutic medium, from rehabilitation of soldiers after WW1, to a recent study on 92 Finnish craft makers. My material is based on research on (textile) craft, research on occupational therapy, interviews with contemporary embroidery artists Michelle Kingdom, Alexandra Drenth and Willemien de Villiers, as well as my own experiences with the project Flower heart. My conclusions are that there are many emotional benefits to textile crafts. Our crafts can comfort us from sorrow, help us deal with pain, both physical and mental, make us connect to one another, provide meaning to our lives, anchor us in the present and live on long after we are gone as a manifestation of our lives and our love.

RESUMO: De acordo com o estado da arte, existem intervenções psicofarmacológicas, psicológicas e psicossocias, com evidência científica dos seus resultados, no tratamento de pessoas com esquizofrenia e perturbação esquizoafectiva. No entanto, muitos destes doentes, não procuram ajuda dos serviços de saúde mental, não recebem os referidos cuidados ou não são detectados nem seguidos por estes. Esta realidade levou ao desenvolvimento de programas integrados, intervenções e estudos mais específicos, nomeadamente para tentar ultrapassar os obstáculos na acessibilidade aos cuidados de saúde e na continuidade de seguimento destes doentes. No conjunto das dificuldades apuradas, as questões da exequibilidade (feasibility) e da implementação, têm tido particular relevo na literatura científica recente, bem como a melhor forma de vencer as respectivas barreiras e adaptar essas intervenções às varias realidades, culturas e recursos. Objectivos: Objectivos gerais:1) Avaliar a exequibilidade e a implementação inicial de um programa de cuidados integrados, para pessoas com esquizofrenia ou perturbação esquizoafectiva, no contexto clínico das equipas de saúde mental comunitárias de um departamento de psiquiatria do Serviço Nacional de Saúde, em Portugal, com os recursos materiais e humanos existentes; 2) Avaliar o impacto deste programa, nestes doentes e na respectiva prestação de cuidados de saúde mental. Metodologia. Elaborámos um programa de cuidados integrados (Programa Integrar) com base no modelo clínico de case management, com seguimento mantido e integrado. Cada doente passou a ter um terapeuta de referência, um plano individual de cuidados e manteve o seguimento com o seu psiquiatra assistente. Foram seleccionadas intervenções, nomeadamente, psicoeducativas, familiares, estratégias para lidar com os sintomas e a doença, prevenção de recaídas e intervenções para melhorar o funcionamento social e ocupacional. A estas intervenções foi sempre associado o tratamento psicofarmacológico. O estudo delineado incluiu dois componentes: avaliação da exequibilidade e implementação inicial do programa de cuidados integrados (componente A) e avaliação do impacto deste programa (componente B), através de um estudo de intervenção, prospectivo, naturalista, não aleatorizado e não ontrolado. A amostra do estudo resultou das sucessivas referenciações, para o Programa Integrar, de pessoas com os diagnósticos de esquizofrenia ou perturbação esquizoafectiva, seguidas nas cinco equipas de saúde mental comunitárias do Departamento de Psiquiatria do Centro Hospitalar de Lisboa Ocidental, com uma área assistencial correspondente a uma população de, aproximadamente, 400 000 pessoas. Definimos etapas, estratégias, parâmetros e indicadores para o estudo da exequibilidade do programa. Efectuámos a monitorização e a avaliação de tarefas, procedimentos e intervenções recomendadas aos terapeutas de referência. Realizámos duas avaliações, uma no início do programa e outra após um ano de intervenção. Foram avaliadas as seguintes dimensões (com indicação do acrónimo do instrumento de avaliação utilizado entre parêntesis): psicopatologia (BPRS), depressão (MADRS), necessidades (CAN), incapacidade (DAS), actividade social e ocupacional (SOFAS), atitude em relação à medicação (DAI), insight (SAI), qualidade de vida (WHOQOL-S) e satisfação (POCS). Resultados: Dos 146 doentes que foram incluídos no estudo, 97 (66%) eram do sexo masculino e 49 (34%) do sexo feminino, com uma idade média de 36 anos. Destes oentes,116 (79,4%)tinham o diagnóstico (ICD10) de esquizofrenia e 30 (20,6%) de perturbação esquizoafectiva. Os restantes dados sociodemográficos eram típicos de populações afins em serviços de saúde mental nacionais. Do total de doentes (146) que iniciaram o estudo, 26 (18%) abandonaram o seguimento neste programa. Para o componente A da investigação (estudo de exequibilidade) salientamos: exerceram funções a totalidade (15) dos terapeutas de referência que receberam formação, 76 % efectuaram o número mínimo recomendado de sessões / ano por doente (≥18), 44,9 fizeram o número mínimo de sessões familiares pretendido (≥ 3). Nas intervenções mais específicas foram atingidos os objectivos em mais de 75% dos doentes, à excepção das intervenções domiciliárias (19,4%), prevenção do abuso de substâncias (45,4%) e do risco de suicídio (34,3%). O plano individual de cuidados foi realizado em 98 % dos doentes e em 38,9 % dos casos ocorreu a participação da família. Neste plano, a média de objectivos definidos foi de 5 e a média de objectivos atingidos correspondeu a 3 (p= 0,001). Na primeira avaliação, estavam a frequentar estruturas de reabilitação psicossocial 42 doentes (28,8%) e,12 meses após, esse número passou para 80 (74,1%).Também aumentou o número de doentes com actividade profissional a tempo completo, de 8 (7,4%) para 18 (16,7%). No componente B do estudo (avaliação do impacto do programa), em termos de psicopatologia, e para as pontuações médias globais do BPRS, ocorreu uma diminuição entre a primeira e a segunda avaliação (p=0,001), tal como nas subescalas: sintomas positivos (p=0,003), sintomas negativos (p=0,002), sintomas de mania (p=0,002) e sintomas de depressão/ansiedade (p=0,001). Na avaliação da depressão (p= 0,001) e da incapacidade (p=0,003), as diferenças foram significativas e favoráveis. O mesmo não sucedeu na atitude em relação à medicação (p=0,690) nem na escala de avaliação do insight (p=0,079). Em relação ao funcionamento social e ocupacional, qualidade de vida e satisfação dos doentes, ocorreu uma melhoria significativa da primeira para a segunda avaliação As necessidades sem resposta mais frequentes, na primeira avaliação, corresponderam aos itens: actividades diárias, contactos sociais, relações íntimas, relacionamento sexual, benefícios sociais, sintomas psicóticos, sofrimento psicológico, informação sobre a doença / tratamento e gestão/problemas de dinheiro. Para todos estes últimos nove itens, verificou-se uma diferença estatisticamente significativa, entre a primeira e a segunda avaliação, com diminuição destas necessidades, excepto nas relações íntimas, relacionamento sexual e nos problemas de dinheiro. Na distribuição dos três estados de necessidades, para todos os itens, diminuíram as necessidades sem resposta e as necessidades com resposta parcial e aumentaram as situações em que deixaram de se verificar necessidades relevantes. Dos resultados obtidos para outros indicadores clínicos e de utilização dos cuidados, será importante referir que na comparação do ano anterior com o ano em que decorreu o programa, o número de doentes da amostra internados diminuiu 64,1%, bem como a média do número de internamentos (p=0,001). Em relação à duração dos internamentos, no ano anterior ao programa, os 39 doentes internados, tiveram um total de dias de internamento de 1522, sendo que, no ano do programa, para os 14 doentes internados, o total foi de 523 dias. Em termos absolutos, ocorreu uma redução de 999 dias (menos 65,6% dias). Também se verificou uma diminuição de 45,6 % de recaídas (p=0,001).Discussão e conclusões A exequibilidade do programa de cuidados integrados permitiu a aplicação do modelo clínico de case management, com seguimento mantido e integrado, através do qual cada doente passou a ter um terapeuta de referência assim como, em 98% casos, um plano individual de cuidados. As famílias continuaram a ser o principal suporte para os doentes, mas surgiram dificuldades quando se pretendeu uma participação mais activa destas no tratamento.A diminuição do número e da duração dos internamentos constituíram importantes resultados com implicações não só em termos clínicos mas também económicos. Os valores obtidos, para as diferentes variáveis, também sugerem o impacto favorável do Programa Integrar a nível da psicopatologia, das necessidades, da incapacidade, do funcionamento social e ocupacional, da qualidade de vida e da satisfação dos doentes. O mesmo não sucedeu para o insight e para a mudança de atitudes dos doentes em relação à medicação, resultados que devem ser igualmente considerados em futuros reajustamentos deste programa ou no desenvolvimento de novos programas. Como principais conclusões podemos referir que: 1) Foi possível a exequibilidade de um programa de cuidados integrados inovador e a implementação inicial desse programa, para doentes com esquizofrenia ou perturbação esquizoafectiva, com os recursos humanos e materiais existentes, no contexto clínico das equipas de saúde mental comunitárias, de um departamento de psiquiatria e saúde mental, em Portugal; 2) Na avaliação do impacto do programa, os resultados obtidos indiciam potencialidades de aplicação, deste programa de cuidados integrados, com vista à melhoria clínica e psicossocial destes doentes. Devem ser realizados estudos de replicação, ou complementares à presente investigação, no entanto, os dados obtidos são encorajadores para o desenvolvimento de programas similares, a nível nacional e internacional, que possam beneficiar um grupo mais alargado de doentes.------------ABSTRACT: Although there are psychological and psychosocial interventions well supported by scientific evidence, which show benefit when combined with psychopharmacological treatments, we know that a significant number of people with schizophrenia or schizoaffective disorders, do not seek help from mental health services, do not receive the care mentioned and are not detected or followed-up by them. This reality led to the development of integrated programs, interventions and more specific studies, to try to overcome the obstacles in the accessibility to the health services and on the follow-up of these patients. Amongst the barriers identified, feasibility and implementation of those programs have been of special relevance in recent scientific literature, as well as the best way to overcome such difficulties and adapt the interventions to the various realities, cultures and resources. Objectives: General objectives were defined: 1) Assessment of the feasibility and initial implementation of an integrated care program, for people with schizophrenia or schizoaffective disorder, in the clinical setting of community mental health teams, in a psychiatric department from the national health service in Portugal; 2) Impact evaluation of the integrated care program, for these patients and their mental health care delivery. Methods: We drew up an integrated care program (Program Integrar) based on the clinical case management model, with continuous and integrated follow-up. Each patient got one case manager, an individual care plan and kept the same psychiatrist. Were selected the appropriated interventions, namely: psycho-educative, family-based interventions, strategies for dealing with the symptoms and the disorder, relapse prevention and interventions to improve social and occupational functioning. These interventions were always associated with psychopharmacological treatment. The investigation was outline with two parts: assessment of the feasibility and initial implementation of the Program Integrar (part A of the study) and impact evaluation of the program (part B of the study). We designed a naturalistic, prospective, intervention study, non-randomized and without control group. Our chosen sample was made with successive referrals of patients with the diagnosis of schizophrenia or schizoaffective disorder, followedup in one of the five community mental health teams of the Psychiatric Department of Centro Hospitalar Lisboa Ocidental, with a catchment area for a population of about 400 000 people. Different stages, strategies, criteria and indicators for studying the feasibility of the program and its implementation were set and the tasks, procedures and recommended interventions of the case managers were monitored and evaluated. We did two assessments with an interval of one year and we evaluated the following dimensions (the acronym of the assessment instrument used in brackets): psychopathology (BPRS), depression (MADRS), needs (CAN), disability (DAS), social and occupational functioning (SOFAS), attitude toward medication (DAI), insight (SAI), quality of life (WHOQOL-S) and satisfaction (POCS). Results: Of the 146 patients who started the study, 97 (66%) were male and 49 (34%) females with a mean age of 36 years. Of these, 116 (79,4%) were diagnosed (ICD10) with schizophrenia and 30 (20,6%) with schizoaffective disorder. The other socio-demographic data were typical of populations within Portuguese mental health services. Of all patients (146), who started the program, 26 (18%) of patients left the program (program dropout rate). Of the regarding part A of the study, which focused on feasibility, the following is of note: all professionals who had been trained for this purpose (15) acted as case manager, 76% did the recommended minimum number of sessions / year per patient (≥18) and 44,9% did the minimum number of family sessions desired (≥ 3). For the more specific interventions the parameters set out were met for more than 75% of patients, with the exception of domiciliar interventions (19.4%), prevention of substance abuse (45.4%) and suicide risk prevention(34.3%). The individual care plan was done for 98% of patients and in 38,9% of cases this involved family participation. For this plan the mean objectives defined were 5 and in average was achieved 3 (p=0,001). On the first assessment, 42 patients (28.8%) were attending psychosocial rehabilitation structures and 12 months later that number rose up to 80 (74,1%). Regarding their employment status, in the first assessment 8 (7,4%) were in full time employment and in the second evaluation the number rise to 18 (16,7%). For part B of the study (impact program evaluation), in terms of psychopathology, global mean scores for the BPRS, decreased (p=0,001), as did the four sub scales: positive symptoms (p=0,003); negative symptoms (p=0,002); manic symptoms (p=0,002) and symptoms of depression/anxiety (p=0,001). Both in the evaluation of depression (p=0,001), as in the assessment of disability (p=0,003), the differences were significant. However, this was not the case with attitudes towards medication (p=0,690) and with insight evaluation (p=0,079). In relation to social and occupational functioning, quality of life and patient satisfaction there was a statistically significant improvement from the first to the second assessment. The most commonly unmet needs in the first assessment were daily activities, social contacts, intimate relationships, sexual relations, social benefits, psychotic symptoms,psychological distress, information about the disorder / treatment and money problems money management. Of these, in the second assessment, all of those nine unmet needs showed significant improvement, excepted intimate relationships, sexual relations and Money problems / money management. In the distribution of the three states of needs for all items, it happened a decreased in unmet needs and partially met needs and increased in the situations where relevant needs were no longer found. For other clinical indicators it is important to note, when we compared the year prior to this program and the year after, there were fewer hospitalizations (reduction of 64,1% of admissions) and in the mean number of admissions (p=0,001). Regarding the length of hospitalization in the year prior to the program, the 39 patients admitted had a total of 1522 hospital days, and in the year of the program for the 14 hospitalized patients, the total was 523 days. In absolute terms, there was a reduction of 999 days (65,6%). There was also a 45,6% reduction of relapses (p = 0,001). Discussion and Conclusions: The feasibility of the integrated care program allowed the application of the clinical case management model, with continuous follow-up. Each patient got a case manager and in 98% of the cases they also got an individual plan of care. Families continued to be the main support for patients but, difficulties occurred when it was claimed a more active participation. The decrease in the number and duration of admissions were important findings with implications not only in clinical terms but also in economic field. The achieved results for the different variables can also indicate the favorable impact of this program, at the level of psychopathology, needs, disability, social and occupationa functioning, quality of life and patient satisfaction. The same did not happen for the evaluation of insight and in the changes of attitudes towards medication. These data should also be considered for future readjustments of this program and for the developing of new programs.Finally, the two-overview conclusions are: 1) It was possible the feasibility of an integrated care program and initial implementation of this innovative program, for patients with schizophrenia or schizoaffective disorder, with the human and material resources available in the clinical context of the community mental health teams, in a psychiatry and mental health department of the national health service in Portugal; 2) In assessing the impact of the program, the results suggest potential application of this integrated care program, to improve clinical state and psychosocial variables for these patients. There should be done studies to replicate these results, however the results obtained are promising for the development of similar programs at nationally and internationally level, that could benefit a wider group of patients.

This research utilized heuristic methodology to explore how the art process can facilitate resilient traits in the lived experience of a developing art therapist with Attention Deficit/Hyperactivity Disorder, Obsessive Compulsive Disorder, and Anxiety. The protocol followed was based on the Moustakas model of heuristic research and followed the six steps in heuristic methodology. The Moustakas method of study was implemented to show how the nature of this study and the art process revealed the lived experience of the difficulties of adolescence. The art created during the immersion phase revealed the following six themes; (1) Conflict/Duality and conflicting relationships, (2) The notion of a central figure, (3) Framing/Blurring, (4) Progressive intricacy, (5) Identity/Lack of Identity, (6) Growth, Healing, and Resiliency. The art process was very effective in illuminating how resiliency was a part of the adolescent experience and assisted in assuring completion of the adolescent developmental process. It is evident that resiliency plays in important role throughout the process assisting with the navigation of the adolescent experience. The intentions of this study were to examine, reflect and explore the lived experiences of Attention Deficit/Hyperactivity Disorder, Obsessive Compulsive Disorder and Anxiety. The data exemplifies that even with expendable resources, supportive measures, and a loving, caring and supportive family the diagnosed adolescent can still be significantly affected. The results indicate an importance for further utilizing the art process in order to better understand and inherently inform the art therapist of the lived experiences and implications of resiliency on an adolescent living with mental illnesses. For youth at risk the resilience process is an important protective factor to be embraced, fostered, and promoted by individuals surrounding the adolescent.

Research shows that anxiety disorders are common and problematic in children. Treatment studies demonstrate that cognitive-behavioural interventions for children can successfully minimise these problems. Further, when implemented as early intervention or prevention programs, these interventions can prevent the onset of anxiety problems in 7 to 14 year olds and reduce existing levels of anxiety. This type of preventive approach has enormous potential for improving community mental health in a low cost model of service delivery. Yet, to develop this as a viable service model, these programs need to be evaluated under 'real world' conditions as opposed to specialist university clinical teams. In this research, the long-term effectiveness of an ecological model of the prevention of anxiety disorders for children was conducted. In the first study, teachers (N = 17) were trained intensively in the principles of anxiety and the FRIENDS anxiety prevention program (Barrett, Lowry-Webster & Holmes, 1999). Measures were taken of the PROXIMAL effects of training on the knowledge and self-efficacy of participating teachers at two points in time. Compared to teachers in a control group (N= 17) and a group comprised of psychologists regarded as experts in the FRIENDS anxiety program (N= 22), trained teachers demonstrated significant increases in the levels of knowledge and self-efficacy at time two. These increases approached levels exhibited by experts in terms of knowledge, and were not significantly different from experts in their levels of self-efficacy to implement the FRIENDS program following training. This study also explored the quality or fidelity of program implementation by these trained teachers (INTERMEDIATE EFFECTS). Results demonstrated that trained teachers implemented the program with high levels of integrity in accordance with the FRIENDS intervention manual. The second study sought to investigate the outcomes for participating children in terms of actually preventing and reducing existing levels of anxiety. Also of interest was the impact this intervention had on levels of depression. Participants were 594 children aged 10-13 years from 7 schools in Brisbane Australia. Children, and parents reported on children's social, emotional and behavioural characteristics at three-assessment points over 12 months. Results were examined universally (for all children) and for children who scored above the clinical cut-off for anxiety at pre-test. Results revealed that children in the FRIENDS intervention group reported fewer anxiety symptoms regardless of their risk status at posttest. In terms of reported levels of depression, only the high anxiety group who completed the FRIENDS intervention evidenced significant improvements at posttest. The results indicated that intervention gains were maintained over a period of 12 months, as measured by self-reports and diagnostic interviews. Moreover, evidence of a prevention effect was also demonstrated, with a significantly greater percentage of children in the control group progressed to "at risk" or "remained at risk" compared to children in the intervention group. Additionally, 85% of children in the intervention group who were scoring above the clinical cut-off for anxiety and depression were diagnosis free in the intervention condition at 12-month follow-up, compared to only 31.2% of children in the control group. Implications of these findings are examined, alongside limitations of the study and directions for future research.

Background: Occupational therapists, as part of the multi-disciplinary psychiatric team, frequently include activity and or discussion groups in an attempt to reduce the symptoms of the MHCUs with MDD and to improve their functional ability. The evidence to support occupational therapy group interventions seems to be limited. Aim: To compare a Standard Care Plus (SCO) occupational therapy group programme, which included tangible activities in each of nine sessions with a Standard Care (SCN) group programme, which included tangible activities in only five of nine group sessions and to explore the participants’ experiences of either the SCO or the SCN group programmes. Research design: A concurrent embedded mixed methods intervention research design was employed. A qualitative strand was embedded in a comparison pre-test post-test study. Methods: One hundred participants, 50 from each programme, were pre- and post-treatment tested in order to compare the interventions in respect of cognitive, performance and affective functioning, social interaction and severity of MDD symptoms. Their experiences of the intervention were established. The study took place at the psychiatric wards of two private general hospitals in South Africa. Results: The SCO significantly improved the total outcome (p<0.005) in comparison to the SCN on the MDD symptom reduction (PHQ-9) and social interaction (Client Response by Situation) (p<0.004). Five themes emerged, viz. happiness, social interaction, self-esteem, learned coping skills and being part of the solution. Conclusion: The results suggest that the SCO, which included tangible activities in each group session , was superior to the SCN.<br>Thesis (PhD)--University of Pretoria, 2017.<br>Occupational Therapy<br>PhD<br>Unrestricted

Syftet med studien var att genom en litteraturöversikt beskriva erfarenheter hos personer med psykisk ohälsa av att delta i Supported Employment och dess betydelse för dem. Designen innebär ett systematiskt urval av vetenskapliga artiklar som analyserats och presenterats och metoden valdes då författaren hade för avsikt att kartlägga aktuellt kunskapsläge inom området. Data insamlades genom sökning i databaser samt genom citation tracking. 11 kvalitativa artiklar valdes ut att ingå i litteraturöversikten. Artiklarna analyserades vilket resulterade i 4 huvudkategorier: behov av förberedande praktiskt stöd i att söka arbete, arbetsmiljöns inverkan på arbetsförmågan, vikten av individanpassat stöd samt betydelsen av arbete för det psykiska välmåendet. Resultatet visar på vikten av att deltagaren får rätt stöd och medel för att möjliggöra anställning. Resultatet speglar även deltagarnas erfarenheter av arbetsmiljöns inverkan på arbetsförmågan samt vikten av att deltagarna fick individanpassat stöd av specialisten. Slutligen visade resultatet på arbetets betydelse för det psykiska välmåendet för deltagarna. Slutsatsen var att arbetsterapeuter med sin unika kompetens om aktivitet är lämpliga kandidater för titeln supported employment specialist men att mer studier behöver göras för att tydligare koppla ihop arbetsterapi med Supported Employment.

Wildnerness therapy is becoming increasingly popular as a treatment for adolescents. It has been established as an efficacious treatment in previous literature, but the mechanisms as to why have thus far remained a mystery. This research is looking at the connection between wilderness therapy and DBT, another evidence-based treatment. This study will examine 156 adolescents, comparing the efficacy of wilderness therapy to traditional inpatient and intensive outpatient. Pre-treatment assessments of suicidal ideation, emotional regulation, and distress tolerance will be taken. It is expected that there will be main effects for each of the treatments, but that wilderness therapy will be strongest. Additionally, it is expected that emotion regulation and distress tolerance will act as mediators, and their effect on suicidal ideation will be even greater than that of treatment.

Mood disorders are often linked with concurrent partner relational distress. The present study compared the cost effectiveness of treating mood disorder alone versus when the condition is comorbid with partner relational distress. Cigna, a leading health insurance management company in the US, provided outpatient data. Participants included patients with solely a mood disorder diagnosis (n = 72,712) and those with both a mood disorder and a comorbid partner relational distress diagnosis (n = 113, including 69 females and 44 males). These participants were treated in outpatient settings throughout the US. These numbers are surprisingly low considering the extensive literature showing a strong relationship between mood disorder and partner relational distress. A multivariate general linear model and binary logistic regressions were used to analyze the data. Results indicate that having a mood disorder present with a partner relational distress disorder significantly increased the average cost of care by about $471 per person compared to having solely a mood disorder. For mood disorders alone, there were also differences in cost effectiveness and readmission for mood disorders by professional license type, age, and gender with counselors being the most cost effective and medical doctors being the least (60% more costly). The treatment modality used impacted readmission rates, with family therapy having the lowest (8.54%) and mixed therapy having the highest (33.54%). Due to the small sample size, we were unable to determine the significance of subsequent analyses for comorbid disorders. Clinical implications and future directions for research will be discussed.

My passion as a student at the Claremont Colleges is to help children with Autism Spectrum Disorder grow and learn as normal children and to help prepare them for life outside the Autism Center at Claremont McKenna College. In my thesis project, I am exploring the concept of silhouettes through photography and my perceptions of the stories told to me by the children I teach. Esthetically, I am inspired by Kara Walker’s installation of large cutout silhouettes but I am using different mediums to accomplish my project: Artistically, I am inspired by the detailed descriptions of the obsessive stories and information provided to me by the children at the Autism Center. Primarily, I will be using photographs that I have taken of the children and creating silhouetted images of them through Photoshop. Afterwards, I will paint my perceptions of the detailed and creative descriptions of the different information relayed to me by each individual child. Secondary, there will be some life size black cutouts, on black paper, of different imagined scenarios with the children. In the spring, I see this as an installation with many separate pieces that contain different sizes, depth, and simplicity.

Made available in DSpace on 2016-04-27T18:12:43Z (GMT). No. of bitstreams: 1 Beatriz Paiva Bueno de Almeida.pdf: 2073175 bytes, checksum: 32ea5f7bb9b915603a19f3f0278e4af7 (MD5) Previous issue date: 2010-02-25<br>Coordenação de Aperfeiçoamento de Pessoal de Nível Superior<br>The objective of this work is to characterize and analyze the speech developed at the Integrated Healthcare of Santa Rita do Passa Quatro - SP (CAIS-SR), an institution whose history was marked by the process of institutionalization of mental patients and then by Psychiatric Reform. The research is designed as a case study, with emphasis on research for a project of care group (group / choir Sabiá na Laranjeira ) conducted by the Speech Therapy in CAIS-SR. The research method combines survey of speech-language record of the activities carried out, which occurred between 2001 and 2006, interviews with professional teams of CAIS-SR and group patients Sabiá na Laranjeira about the presence of speech therapist throughout this period, and especially analysis of the group work done with patients of Sabiá na Laranjeira . To put the analysis the work of Speech Therapy in CAIS-SR, is presented key issues to care of patients with mental disorders, namely: the marks that isolation makes the life history of these subjects, the composition and relevance of inter-and multidisciplinary teams in mental health; social exclusion and the search for activities that help in building a new and more satisfactory social conditions for such subjects. In this sense, the dissertation points to the fact that the speech therapist, participating in teams of CAIS-SR, beyond to identify and treat speech pathology, should value and encourage communication and discursive circulation among patients and those with family members and society by increasing the use of language (verbal and nonverbal) and shedding light on the importance of communication, among other things: biopsychosocial rehabilitation; training of interpersonal bonds; legitimacy and social belonging of the subjects with mental disorders, which aligns public policies with anti-psychiatric ward and social reintegration<br>O objetivo da dissertação é caracterizar e analisar o trabalho fonoaudiológico desenvolvido no Centro de Atenção Integral à Saúde de Santa Rita do Passa Quatro SP (CAIS-SR), instituição cuja história foi marcada pelo processo de institucionalização de portadores de transtornos mentais e, posteriormente, pela Reforma Psiquiátrica. A pesquisa se configura como um estudo de caso, com ênfase na investigação de um projeto de atendimento grupal (grupo/coral Sabiá na Laranjeira ) conduzido pela Fonoaudiologia no CAIS-SR. O método da pesquisa conjuga levantamento dos registros das atividades fonoaudiológicas realizadas, que ocorreram entre 2001 e 2006; entrevistas com profissionais das equipes do CAIS-SR e com pacientes do grupo Sabiá na Laranjeira sobre a presença do fonoaudiólogo ao longo desse período; e, especialmente, análise do trabalho grupal efetuado com os pacientes do Sabiá na Laranjeira . Para contextualizar a análise do trabalho fonoaudiológico no CAIS-SR, são apresentadas questões básicas ao atendimento do portador de transtornos mentais, a saber: as marcas que o isolamento deixa na história de vida destes sujeitos; a composição e a relevância das equipes inter e multidisciplinares na saúde mental; a exclusão social e a busca por atividades que auxiliem na construção de uma nova e mais satisfatória condição social para tais sujeitos. Nesse sentido, a dissertação aponta para o fato de que o fonoaudiólogo, participando de equipes do CAIS-SR, além de identificar e tratar alterações fonoaudiológicas, deve valorizar e estimular a comunicação e a circulação discursiva entre os pacientes e destes com familiares, profissionais e sociedade, intensificando o uso da linguagem (verbal e não-verbal) e lançando luz sobre a importância da comunicação para, entre outros aspectos: reabilitação biopsicossocial, formação de vínculos interpessoais, legitimação e pertencimento social dos sujeitos portadores de transtornos mentais, o que se alinha com as políticas públicas antimanicomiais e de reintegração social

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-05-20T12:20:13Z No. of bitstreams: 1 flaviaaltafdarochalima.pdf: 1162345 bytes, checksum: 18a62c489991ceea8aa434e2b2a63f89 (MD5)<br>Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-07-02T11:21:12Z (GMT) No. of bitstreams: 1 flaviaaltafdarochalima.pdf: 1162345 bytes, checksum: 18a62c489991ceea8aa434e2b2a63f89 (MD5)<br>Made available in DSpace on 2016-07-02T11:21:12Z (GMT). No. of bitstreams: 1 flaviaaltafdarochalima.pdf: 1162345 bytes, checksum: 18a62c489991ceea8aa434e2b2a63f89 (MD5) Previous issue date: 2012-08-14<br>FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais<br>Introdução: A dispepsia funcional (DF) representa um transtorno gastrointestinal frequente na prática clínica. Por apresentar mecanismos etiopatogênicos diversos, a terapia medicamentosa não se mostra totalmente eficaz, razão pela qual a busca por terapias complementares como a acupuntura é fundamental. Objetivo: avaliar a eficácia da acupuntura como terapia complementar ao tratamento medicamentoso convencional em pacientes com DF. Método: ensaio clínico randomizado, com portadores de dispepsia funcional, segundo os critérios de Roma III. Dois grupos foram formados: Grupo I (terapia medicamentosa e acupuntura específica) e Grupo II (terapia medicamentosa e acupuntura não específica). Foram avaliados o índice de sintomas gastrointestinais (Gastrointestinal Scale Related Symptoms – GSRS), a presença de transtornos psíquicos (Escala Hospitalar de Ansiedade e Depressão) e a qualidade de vida (Short-form Health Survey – SF 36) no início, no fim e três meses após o tratamento. Resultados: após 4 semanas de tratamento houve melhora dos sintomas gastrointestinais no Grupo I (55 ± 12 vs. 29 ± 8,8; p = 0,001) e Grupo II (50,3 ± 10,2 vs. 46 ± 10,5; p = 0,001). A qualidade de vida foi significativamente melhor no Grupo I (93,4 ± 7,3 vs. 102,4 ± 5,1; p = 0,001). Transtornos de ansiedade (93,3% vs. 0%; p = 0,001) e depressão (46,7% vs. 0%; p = 0,004) foram significativamente menores no Grupo I. Na comparação intergrupos os sintomas gastrointestinais (29 ± 8,8 vs. 46 ± 10,5; p < 0,001) e a qualidade de vida (102,4 ± 5,1 vs. 96 ± 6,1; p = 0,021) foram significativamente melhores no Grupo I. Três meses após o tratamento, os sintomas gastrointestinais permaneceram melhores no Grupo I quando comparados aos valores pré-tratamento (38 ± 11,3 vs. 55 ± 12; p = 0,001). Conclusão: em portadores de dispepsia funcional o tratamento complementar com acupuntura foi superior ao tratamento convencional. A acupuntura pode ser uma terapia complementar eficaz no tratamento de pacientes com DF.<br>Introduction: Functional dyspepsia (FD) represents a frequent gastrointestinal disorder in clinical practice. By presenting various etiopathogenic mechanisms, often the drug therapy is not entirely effective. Therefore, the search for complementary therapies such as acupuncture is essential. Objective: Evaluate the effectiveness of acupuncture as a complement to conventional treatment in functional dyspepsia patients. Methods: randomized clinical trial with functional dyspepsia patients in according with ROME III criteria. Two groups were created: Group I (drug therapy and specific acupuncture) and Group II (drug therapy and non-specific acupuncture). The gastrointestinal symptoms (Gastrointestinal Scale Related Symptoms – GSRS), presence of psychiatric disorders (Hospital Anxiety and Depression Scale – HADS) and quality of life (Short-form Health Survey – SF 36) were evaluated, at the end and three months after treatment. Results: After 4 weeks of treatment there was significantly improvement of gastrointestinal symptoms in Group I (55 ± 12 vs. 29 ± 8,8; p = 0,001) and Group II (50 ± 10 vs. 46 ± 10,5; p = 0,001). Quality of life was significantly better in Group I (93,4 ± 7,3 vs. 102,4 ± 5,1; p = 0,001). Anxiety and depression disorders were significantly lower in Group I (93% vs. 0%; p = 0,001 and 46% vs. 0%; p = 0,004; respectively). Inter-group, gastrointestinal symptoms comparison and quality of life were significantly better in Group I (29 ± 8,8 vs. 46 ± 10,5; p < 0,001 and 102,4 ± 5,1 vs. 96,4 ± 6,1; p = 0,021; respectively). Three months after the treatment, gastrointestinal symptoms remained best in Group I, when compared to the pre-treatment values (38 ± 11,3 vs. 55 ± 12; p = 0,001). Conclusion: In patients with functional dyspepsia the complementary acupuncture treatment was superior to conventional treatment. Acupuncture as a complementary treatment can be effective in treating patients with FD.

Since the government commissioned the Crossing Bridges programme in 1998 (Falcov, 1998) and through legislation and a number of government policies and initiatives since, there has been emphasis on addressing the needs of families where there are parental mental health problems. Furthermore, there is a fast-growing body of research pointing to the needs of these families. However, service structures, development and provision have lagged behind. Most often parents with mental health difficulties have access to services addressing their individual mental health needs while their needs as parents and the needs of their children remain largely invisible. One such need that has been highlighted repeatedly in the literature is the need for children to have information about and make sense of their parent’s mental health difficulties. Given the lack of services to respond to this need, it is most often left to the parent to make decisions about and respond to their child’s search for understanding. This study is a qualitative study that explores parents’ experiences of decision-making and responding to this need, and the social processes and dominant discourses that impact on these experiences. Fifteen parents with mental health difficulties were interviewed, using semi-structured individual interviews, which were transcribed, and interpretive Grounded Theory was employed to analyse and interpret the data. The grounded theory that was constructed suggest two main social processes that impact on parents’ talking with their children about parental mental health issues. Firstly, within a relational context, parents were Negotiating mutuality between themselves and their children. Secondly, within an identity context, parents had to navigate Holding on to self, holding on to life. These social processes indicate that both parents’ relationships with their children and also their own sense of themselves within the context of their mental distress powerfully shape telling, talking and keeping silent. Implications of these findings both in relation to clinical interventions and future research are considered. In particular, the importance of positioning the parent as active role-player in the healing of their child, and positioning the child as active role-payer in their own meaning-making, are highlighted. Furthermore, developing ‘double-stories’ beyond the mental health story and beyond ‘information’ is emphasised and the importance of a sense of continuity of self and identity over time for parent and child is accentuated. Finally, the importance of allowing for complex and ever-evolving understandings of mental distress is indicated, and the role of both talking and remaining silent in this process is stressed.

Background: Acceptance and Commitment Therapy (ACT) has shown promise as an effective intervention in the treatment of mental health disorders. In the last decade, the delivery of ACT has expanded to include various formats (e.g. groups, self-help, online and phone apps). Further research is needed to evaluate whether such delivery formats are a viable extension of ACT. Furthermore, the existing evidence base of certain alternative delivery formats have yet to be reviewed. This thesis portfolio sought to contribute to this area of research. Methods: A systematic review of the literature was conducted to investigate the efficacy of group-based interventions for mental health disorders using ACT. Five databases were systematically searched, manual searches were conducted and corresponding authors were contacted. Studies which used a randomised-controlled design, with adult samples and investigated group-based ACT interventions for mental health disorders were included. A meta-analysis of the included studies was conducted for post-intervention and follow-up data. In the empirical study, an ACT manual was trialled using a randomised-controlled design to investigate the efficacy of using ACT in a guided self-help context. Participants with anxiety/depression were randomly assigned to receive either the ACT intervention or treatment as usual (TAU). Those in the ACT group were posted an ACT manual and received two telephone calls. Outcome measures were analysed after the six-week intervention. Results: From the meta-analysis, 18 randomised-controlled trials were identified, 14 of which focussed on anxiety and depression. The findings suggest that ACT-based groups have a large effect on symptom reduction when compared to non-active comparisons at post-treatment and a moderate effect when compared to non-active comparisons at follow-up. Additionally, there was a small effect in favour of ACT when compared to active treatment controls at post-treatment and equivalent effects when comparing ACT to active treatment controls at follow-up. Similar effects were found when separately comparing the 14 studies which focussed primarily on anxiety and depression. The empirical study revealed that guided self-help was found to be no more effective in improving quality of life or reducing psychological distress than the TAU group. However, such results should be interpreted with caution as the small sample size and high attrition rate indicates that further research with larger samples and follow-up are needed before strong conclusions can be made. Conclusions: The findings of this research indicate that group-based ACT interventions may be a suitable alternative delivery format for service providers in the provision of common mental health disorders, particularly anxiety and depression. Further research is needed before any strong conclusions can be made regarding the efficacy of guided self-help for anxiety/depression.

Dominant narratives about psychosis portray individuals as lonely, dangerous and unable to contribute to society. Such views may be incorporated into an individual’s personal story and are associated with negative outcomes for personal and clinical recovery. Art-making is associated with personal meaning-making and alternative forms of expression. It is therefore considered potentially relevant to narrative modification. Adult service-users with psychosis participated in a gallery-based art-making intervention. At interview, participants used their self-created images to help tell their story. Literary, experience-centred and culturally-oriented lenses were used to analyse narratives. Turning-points as modifiers of stigmatised dominant narratives were explored, as was how the intervention supported recovery. Art-making was associated with achievement, challenge and satisfaction. Story-telling using visual and verbal means opened up stories and alternative perspectives for participants. Recovery-principles including hope and aspiration were supported, identified through goals and recognition of achievement. Sharing experiences with others with similar experiences was viewed as impacting positively on mental-health. The intervention represented effective partnership working between NHS services and a gallery in overcoming barriers to accessing the arts, for people with psychosis. Achievements in art-making and narrating experience using visual and verbal means offered alternatives to personally limiting and illness-dominated narratives.

Increasing numbers of children being referred for mental health services are exhibiting problematic behaviors that can be subsumed under the category of Disruptive Behavior Disorders. This study with its foundations in a post-positivist approach was designed to explore treatment effectiveness of cognitive behavioral intervention applied to adolescents at Oak Grove Institute, a residential treatment facility. This study hypothesized that Wexler's PRISM Model, with its integration of affect, would be instrumental in modifying disruptive behavior as measured at Oak Grove Institute. Although the small sample size precluded statistically significant findings, there were interesting results with respect to two dependant variables. Findings approached significance on measures of impulsivity and verbal aggression. That is, impulsivity and verbal aggression scores were lowered.

This project presents dance as treatment for Orthorexia Nervosa, an eating disorder defined as an unhealthy obsession with healthy eating. Eating disorders disconnect body, mind, and spirit of an individual, and dance therapeutically connects these aspects. The specific effects of orthorexia on the body, mind, and spirit are analyzed; supported by evidence from research sources such as literature of books and scholarly journals, videos, an interview with board-certified dance/movement therapist Rachel Gonick-Mefferd, and a series of interviews with Dr. Thomas Doyle, in which he supplied a case study exemplifying dance as treatment for orthorexia. Conclusively, eating disorders and specifically orthorexia affect one’s entire being — physical, mental, emotional, social, spiritual health — and interfere with one’s entire life and daily functioning. Dance, as a holistic therapeutic approach, is effective in addressing and remedying every single one of these elements, healing one’s whole self. Therefore, it is suggested that dance may be an effective treatment for orthorexia.

Estudos realizados no campo teórico das redes sociais demonstram que as relações têm impacto significativo na vida das pessoas. Quando associadas à população com transtorno mental, as redes atuam como fator de proteção importante e gerenciador de recursos e suporte social. Entretanto, estudos apontam que as pessoas com transtorno mental apresentam redes sociais empobrecidas e poucas relações significativas. A eclosão do transtorno mental e as rupturas decorrentes de processos de institucionalização contribuem para a dinâmica de redução do número e qualidade de contatos, colocando a pessoa em situação de vulnerabilidade relacional. Neste trabalho, buscou-se caracterizar as redes sociais de 25 usuários do Núcleo de Atenção Psicossocial II (NAPS II), em Santo André, e discutir o papel desse serviço público no fortalecimento das relações sociais e enfrentamento da vulnerabilidade social. A pesquisa, de caráter qualitativo, foi metodologicamente orientada pela postura etnográfica, tendo realizado os seguintes procedimentos: pesquisa bibliográfica, entrevistas por pautas, observação participante e construção de caderno de campo. Foram entrevistados 25 usuários com transtorno mental severo em regime de tratamento intensivo. A coleta de dados foi desenvolvida durante o ano de 2006. Os resultados mostraram que os entrevistados possuem redes sociais empobrecidas, poucas pessoas dispõem de alguma relação significativa e o acesso a recursos materiais e afetivos é escasso. Também demonstraram que os projetos assistenciais desenvolvidos pelo serviço não são capazes de intervirem no âmbito das redes sociais pessoas assistidas e nem de enfrentar o problema de sua vulnerabilidade social. Neste sentido, concluímos que as redes sociais deveriam ser um dos principais alvos das intervenções promovidas pelos serviços de saúde mental e que a investigação sobre os processos de sociabilidade pode contribuir para a elaboração de novas estratégias capazes de complexificar o cuidado da população com transtorno mental, além de oferecer elementos para a construção de novos serviços e políticas públicas no campo da saúde mental.<br>Studies realized in the theoretical field of social network show that relations have a significant impact over people lives. When associated to people with mental disorders, networks act as a important protection factor and resources and support given. However, studies point that people with psychiatric suffering have impoverished social networks and few significant relations. The outburst of a mental disorder and the breakages caused by institutionalization processes contribute to the dynamics of reduction of quantity and quality of contacts, pushing the person to a situation of relational vulnerability. In this paper, it was tried to characterize the social networks of 25 users of NAPS II, in Santo André, and to discuss the place of the service on strengthening of social relations and on facing up to relational vulnerability. The research used methods from qualitative investigation, oriented by ethnographic posture: bibliographical research, semi-structured interviews, participant observation and field diary. It had been heard 25 users in intensive treatment program and the participant observation process had been taken through 2006. The results showed that the studied group has impoverished social networks, few people have some significant relation and the access to emotional and material resources is scarce. They also showed that the projects of assistance developed by the service have been incapable to intervene in the relational field of assisted people lives and to face the problems caused by the social vulnerability. On this way, we conclude that social networks might be an important target of interventions promoted by substitutive services and that the investigation about the sociability processes can contribute to the elaboration of new strategies able to turn the care of population with mental disorders more complex. Besides that, social networks offer elements to the construction of new services and public policies on mental health field

This study examined the effectiveness of training Head Start teachers and aides in child teacher relationship training (CTRT). CTRT is based on child parent relationship therapy (CPRT) (Landreth & Bratton, 2006), a filial therapy model based on the principles of child-centered play therapy, and was adapted for the classroom. In this quasi-experimental design, 12 teacher/aide pairs (n = 24) were assigned to the experimental (n = 12) or active control group (n = 12). Children who scored in the Borderline or Clinical range on at least one scale of the Child Behavior Checklist-Caregiver/Teacher Report Form (C-TRF) at pretest qualified for the study (n = 54). Nine hypotheses were analyzed using a two factor repeated measures multivariate analysis to determine if the CTRT group and the active control group performed differently across time according to pre-, mid-, and posttest results of the C-TRF. Additionally, effect sizes were calculated to determine practical significance. Five hypotheses were retained at the .05 level of significance. Post hoc analysis was conducted to analyze the effects of the two phases of treatment. Results indicated that children in the experimental group made statistically significant improvements in externalizing problems (p = .003). Children of focus made statistically significant improvements in externalizing (p = .003) and total behavior (p = .01) problems. Results are particularly significant for the non-children of focus, who only received the in-classroom intervention. The non-children of focus made statistically significant improvements in externalizing behavior problems (p = .04) and practical significance was large. Results indicate that a school based intervention such as CTRT is a viable treatment option for many children with externalizing behavior problems.

Bakgrund Det uppskattas att 50 miljoner människor världen över lever med demens och år 2030 förväntas siffran stiga till 82 miljoner människor. Hos majoriteten av dessa förekommer beteendemässiga och psykiska symtom vilket orsakar lidande, sänkt livskvalitet och tidigare institutionalisering för personen. För personer med beteendemässiga och psykiska symtom ska icke-farmakologiska, personcentrerade omvårdnadsåtgärder prioriteras. Musiklyssnande är en relativt enkel icke-farmakologisk omvårdnadsåtgärd som kan utföras av allmänsjuksköterskan på såväl sjukhus som omsorgsboende.  Syfte Syftet var att beskriva hur musiklyssnande som omvårdnadsåtgärd påverkar personer med beteendemässiga och psykiska symtom vid demens.  Metod Metoden som användes var icke-systematisk litteraturöversikt. Resultatet baserades på 15 vetenskapliga artiklar av kvantitativ metod. Databaserna som användes för inhämtning avartiklarna var Cumulative Index to Nursing and Allied Health Literature och PubMed. Artiklarna kvalitetsgranskades utifrån Sophiahemmet Högskolas bedömningsunderlag. Resultatet sammanställdes genom integrativ analysmetod där resultatet delades in i lämpliga kategorier.  Resultat Musiklyssnande sågs ha en påverkan på flera av de beteendemässiga och psykiska symtomen samt välbefinnandet hos deltagarna. Majoriteten av studierna visade på en positiv påverkan. De mest framkomna resultaten var minskad agitation och ökat välbefinnande. Musiklyssnande hade oftast en omedelbar påverkan och det förekom även långsiktig påverkan i vissa studier.  Slutsats Sammanställningen av studierna visade att musiklyssnande kan ha positiv påverkan på personer med demens genom att minska beteendemässiga och psykiska symtom och öka välbefinnandet för personen, i synnerhet om musik används ur ett personcentrerat perspektiv. Det finns behov av vidare empiriska studier av kvalitativ metod för att få en djupare förståelse för ämnet, samt litteraturöversikter som inkluderar artiklar där valet av mätinstrument i studierna är mer konsekvent.<br>Background  It is estimated that 50 million people live with dementia worldwide, and by 2030, the number is expected to rise to 82 million people. Most people with dementia experiences behavioural and psychological symptoms which causes suffering, lowered quality of life and earlier institutionalisation for the person. Non-pharmacological, person-centered care is prioritized for people with behavioural and psychological symptoms of dementia. Music listening is a simple non-pharmacological act of care which can be executed by nurses in hospitals as well as nursing homes. Aim The aim was to describe how music listening as an act of care affects people with behavioural and psychological symptoms of dementia. Method The method was a non-systematic literature review. The result was based on 15 scientific articles of quantitative methods. The databases used for data collection were Cumulative Index to Nursing and Allied Health Literature and PubMed. The quality of the articles were assessed using Sophiahemmet Högskolas quality assessment tool. The result was compiled using integrative analysis where the result was divided into appropriate categories. Results Music listening affected several of the behavioural and psychological symptoms and well-being. The majority of the studies showed a positive impact. The most emerging results were decreased agitation and increased well-being. Music listening had an impact on the person immediately. A long-term impact was measured in some studies. Conclusions The compilation of the studies implied that music listening has a positive impact by decreasing behavioural and psychological symptoms and increasing well-being for people with dementia, especially when used from a person-centered perspective. There is a need for empirical studies of qualitative methods to gain a deeper understanding, as well as further literature reviews including studies that use the same assessment tools.

The aim of this phenomenological qualitative study was to capture and understand the essence of the lived experiences of individuals after participating in equine facilitated psychotherapy (EFP). In that the experiences of participants after exposure to EFP have not previously been examined, this study adds to the literature on this innovative therapy. Theoretical viewpoints on animal assisted therapy and solution-focused brief therapy (SFBT) were explored, as well as how the SFBT methodology compares to techniques used in EFP. Using interviews, the study involved capturing participants' experiences by collecting their descriptions of their involvement with EFP, identifying the specific experiences they noted, ascertaining what the participants did with these experiences, and discerning themes or patterns in the interview data. A purposive sample of 10 adults who had participated in EFP participated in interviews, the data from which were analyzed by hand coding. Analysis showed improved quality of life with improvements in overall well-being and in participants' relationships. The findings of this research study may lead to additional research in this area and may promote the establishment of consistent techniques in EFP, proper credentialing of those who use EFP, and applicable regulatory standards. By exploring the lived experiences of individuals who have participated in EFP, providers may be able to delve more deeply into the curative factors that may be at work with this type of therapy.

Com o advento da Reforma Psiquiátrica no Brasil, novos espaços de assistência e tratamento vêm sendo constituídos e a família passa a ser entendida como um fator fundamental na recuperação do portador de transtorno mental. Desta forma, compete aos profissionais apoiá- la, orientá-la e fortalecê-la, por meio de ações educativas e de apoio emocional. No entanto, estudos atuais na área apontam que a inclusão da família no tratamento de portadores de transtorno mental ainda não é procedimento de rotina em muitos serviços. O presente estudo teve como objetivo identificar e analisar as possibilidades e barreiras percebidas pelos profissionais de saúde para implantar e manter, na rotina de um serviço de saúde mental, o cuidado às famílias de portadores de transtorno mental. Método: Trata-se de um estudo qualitativo. Para a coleta de dados, foram realizadas duas sessões de grupo focal com os profissionais envolvidos com a criação e manutenção do atendimento familiar em um serviço especializado de nível ambulatorial. Resultados: Os profissionais participantes ressaltaram a importância da família no início do tratamento, e suas necessidades neste momento. Porém, reconheceram que os pacientes e seus familiares participam pouco das atividades de intervenção familiar oferecidas. As barreiras para uma participação mais ativa identificadas nas discussões estão relacionadas à própria família, ao serviço, e aos profissionais, e são semelhantes aos achados de outros estudos nacionais e internacionais. A supervalorização do modelo biomédico está presente em todas as barreiras. Conclusão: Concluímos que o estudo reforçou nossa compreensão sobre a importância da inclusão da família no atendimento de pessoas no primeiro episódio psicótico, e contribui apontando barreiras para efetivar esta proposta<br>With the advent of the Psychiatric Reform in Brazil, new care spaces and treatment have been made and the family passed being understood how a fundamental factor in the recovery of mental health patients. Thus, compete to professionals supports it, guides it and strengthen it through educational and emotional support. However, current studies points that inclusion of the family for treatment of mental disorders carriers still is not procedure of many services routine. The present study aimed to identify and analyze as perceived opportunities and barriers by health professionals to deploy and maintain, in a mental health service routine, the care of the families of mental disorders carriers. Method: This is a qualitative study. Data collection, were conducted two focus group sessions with professionals involved with the creation and maintenance of familiar care in a specialized outpatient service. Results: The professionals participants stressed the importance of family in the outset of the treatment, and their needs in this time. However, recognized that the patients and their families does not participate much in family intervention activities offered. The barriers for a more active participation identified in discussions are related to own family, the service, and professionals, and are similar to findings in other national and international studies. The overvaluation of biomedical model is present in all barriers. Conclusion: We conclude that the study reinforced our understanding of the importance of family inclusion in the care of people on first episode psychotic, and contributes pointing barriers to accomplish this proposal

Although the profession of occupational therapy had its origins in the treatment of the mentally ill, and was among the pioneers in developing community-based programs to meet the social and emotional needs of children, a study of 28 therapists practicing in the public schools revealed that these occupational therapists did not serve students with behavioral disorders unless they also exhibited a neurological disorder. The results of this study revealed that occupational therapy is not recognized by the educational sector as an essential related service for students with behavioral disorders. Occupational therapy is viewed as a modality much akin to physical therapy in which the focus is on motor skill development.

Arbetsrelaterad psykisk ohälsa orsakar årligen en ansenlig mängd sjukskrivningar. Behovet av allt tidigare åtgärder, som fokuserar på att anpassa arbetskrav med arbetsförmåga samt samhälleliga strukturer som stödjer dessa har framlyfts. En utmaning är den otillräckliga kunskapen om tidiga arbetsplatsnära åtgärder. Arbetsterapi blir oftast inte aktuellt förrän de negativa konsekvenserna av både tillståndet och sjukskrivningen är betydande. Syftet i denna studie var att utforska och beskriva hur personer som drabbats av arbetsrelaterad psykisk ohälsa, men som inte är sjukskrivna, upplever sin arbetsmiljö samt att undersöka hindrande och stödjande faktorer i arbetsmiljön. Metod: Studien genomfördes med en Mixed Methods design. Data samlades in med Work Environment Impact Scale (WEIS). Analys av kvalitativa data kombinerade deduktiv och induktiv ansats. Kvantitativa data analyserades med deskriptiv statistik. Resultatet framlyfte en flerdimensionell och individuellt varierad miljöpåverkan både i och utanför arbetet som bidrog till upplevelsen av nedsatt arbetsförmåga. Detta är implikationer för behovet av att i ett tidigt skede stödja arbetsförmåga ur ett perspektiv som beaktar den drabbade individens vardagliga helhetskontext. Anpassning av arbetssituationen baserad på en analys av faktorer kopplade till individen, arbetet och miljön, behövs i större utsträckning. Arbetsterapeuters metoder och kompetens kan bidra till ökad kunskap om tidiga åtgärder samt till at stödja individer att undvika sjukskrivning. Denna kompetens berikar och kompletterar de arbetssätt som redan är praxis inom företagshälsovård. Arbetsterapeuters expertis borde i tidigare skede och högre grad finnas tillgänglig som stöd vid arbetsrelaterad psykisk ohälsa.<br>Work related mental disorders continue to cause significant amounts of work absenteeism. The need of matching working conditions to the individuals’ work ability has been emphasized. The lack of knowledge concerning early interventions is though challenging. Occupational therapy is often offered at too late a point when the negative consequences of the sick-leave or the condition already are significant. The aim of this study was two-fold. Firstly, to explore and describe how people affected by work related stress but not on sick leave, experience their working environment. Secondly, to investigate interfering and supporting aspects in the working environment. A Mixed methods design was chosen, and data collected using the Work Environment Impact Scale (WEIS). The qualitative content analysis employed both deductive and inductive approach. Descriptive statistics were used to analyse gradings. The results reflected a multidimensional environmental influence in and outside the work leading to an experience of decreased work ability. The results imply the necessity to early support of work ability embracing the general daily context of the individual affected. Matching the individual and the work to each other, based on an analysis of individual, environmental and work-related factors, should be more common. The methods and the competence occupational therapists possess can contribute to gaining knowledge concerning early interventions and also support individuals to avoid sick leave. This expertise enrichens customary occupational health services practice and should be more commonly provided.