Дисертації з теми "5203 Clinical and health psychology"

This thesis comprises three interconnected chapters: a systematic literature review (chapter one); empirical paper (chapter two); and an extended discussion (chapter three) which incorporates an accessible version of the research findings, and a future research proposal. The systematic review aims to find, describe and critique the empirical evidence for the impact of mental health service user involvement on the design, delivery, commissioning or evaluation of mental health services. Secondary objectives are to ascertain whether any attempts have been made to apply psychological theory and whether clinical psychologists are involved in the research. The review implements a comprehensive, replicable search strategy and identifies 11 studies published between 1997 and 2014. The included studies highlight both positive and negative impacts at individual (e.g., for service users and service providers) and strategic (e.g., for services and organisations) levels. Process issues, barriers and resistance to the implementation of involvement were also found. No studies applied psychological theory. Clinical psychologists were involved in a small portion of the studies. The review does not support previous reports that user involvement lacks an evidence base. A small empirical evidence base for involvement was found. However, the majority of studies were poorly reported and had significant methodological flaws. None of the 11 studies included in the review had applied psychological theory to its findings. Therefore, this review applied psychological theories of power and empowerment, attitudes, stigma and intergroup contact to the impact and barriers reported in the included studies. The methodological limitations of the included studies and the review process were discussed. The review concludes with a discussion of the clinical implications, implications for clinical psychologists and areas for future research. It is important that the findings of the systematic review are considered in light of the numerous implications and limitations and, therefore, interpreted tentatively. The empirical paper provides empirical research designed and conducted to investigate the attitudinal and organisational barriers to involvement. In utilising the psychological therapist-client dyad, the research aims to ascertain whether there are relationships between psychological therapists’ explicit attitudes to mental illness, implicit attitudes to service user involvement, and perceptions of organisational culture. It establishes whether there are relationships between these and the quality of the client-rated therapeutic alliance. The research employs a cross-sectional design comprising 28 psychological therapist-client dyads within two North West NHS Trusts in the UK. The study found that therapists’ explicit attitudes to mental illness and implicit attitudes to service user involvement were, on the whole, positive. Most therapists perceived the organisational culture of the NHS as market-driven and results-orientated. Counter to expectation, no significant relationships were found between therapists’ explicit attitudes to mental illness, implicit attitudes to service user involvement, and client-rated alliance, and the hypotheses were unsupported. The empirical paper concludes with a discussion of the possible reasons for the lack of significant findings, with reference to methodological, theoretical, and ethical considerations, and clinical implications. The extended discussion initially provides a brief overview of the preceding chapters. It then discusses methodological and ethical considerations, research paradigms and the nature of evidence, clinical psychology, leadership and user involvement and policy. It suggests that clinical psychologists’ skills as scientist-practitioners make them well placed to research, formulate, theorise and provide psychological understandings of user involvement and its impacts and barriers. It concludes with the suggestion that the input of clinical psychologists into service user involvement strategy at individual, organisational and strategic levels could be synonymous with a recently proposed paradigm-shift for the profession of clinical psychology.

The purpose of writing Pastoral Health and Burnout: Spiritual Maturity, Emotional Health, and Physical Environment is to integrate biblical and psychological insights to test three suspected factors of burnout among senior pastors. This is accomplished through the creation of the Ream Pastoral Health Scale (RPHS), a 60-question Likert scale survey designed to assess the health of a senior pastor according to spiritual maturity, emotional health, and physical environment. The RPHS was validated using the Maslach Burnout Inventory (MBI). The MBI is a nationally recognized assessment tool for measuring burnout in the secular word. Eighty-three Christian and Missionary Alliance senior pastors from various districts in the United States were surveyed with the Ream Pastoral Health Scale and the Maslach Burnout Inventory. Strong correlations were found between the RPHS and the MBI.

Bibliography: leaves 65-68.
South Africa has embarked on a range of health sector reforms since the start of the democratic government in 1994. The Primary Health Care approach has been accepted as a way of delivering cost effective, efficient and accessible comprehensive health care at the primary care level. The district health system has been promoted as the best model for the delivery of primary health care because it decentralizes power to the local, district level and it is able to integrate fragmented primary care services under one management and governance structure. In the absence of a formal, legal district health system, provincial and local government authorities have made efforts towards functional integration in primary health care. The establishment of shared health facilities with the aim of providing integrated, comprehensive health care is part of the effort towards functional integration. This study investigates the level of functional integration in joint health facilities between Local Authority (LA) and the Provincial Administration of the Western Cape (PAWC).

This portfolio explored issues that are relevant to the judgements routinely made by clinical psychologists. The first chapter provides a theoretical overview of relevant issues. In this chapter, firstly, the debate over the relative merits of ‘clinical’ and ‘statistical’ approaches to clinical judgement (Meehl, 1954) is reviewed. It is noted that, although much of the empirical evidence supports the greater accuracy of statistical approaches to making judgements (where appropriate methods exist), they are rarely routinely used, and clinical approaches to making judgements continue to dominate in the majority of clinical settings. Secondly, common sources of errors in clinical judgement are reviewed. These include the misuse of cognitive heuristics, the presence of clinicians’ biases, the limitations to human information-processing capacities and the over-reliance on clinical interviews. Finally, some of the basic strategies that can be useful to clinicians in improving the accuracy of clinical judgement are described. These include undertaking advanced level training programs, using quality instruments and procedures, being wary of over-reliance on theories, adhering to the scientist-practitioner approach and being selective in the distribution of professional efforts and time. In the subsequent chapters these strategies are explored further through four clinical case studies. These cases were collected during the university placement program and they have been selected to illustrate some of the approaches as clinician may use in attempting to optimise the accuracy of judgements necessary in the context of clinical psychological practice. The final chapter provides a brief overview and discussion of these cases in relation to the issues identified in Chapter One,

Background: When a loved one is admitted to intensive care it can be a traumatic experience for the patients’ relatives. Poor communication and lack of information from intensive care unit (ICU) staff members can have a negative impact on how relatives cope on an ICU and in the months following the experience. There is a need for interventions to improve these aspects and prepare relatives for what to expect on the ICU using a combination of written and verbal information. Aims To conduct two separate but overlapping qualitative studies. Study 1: To explore how patients’ relatives experience an ICU, their needs during this time, their knowledge and understanding regarding decision making for patients who lack capacity, and their psychological needs on ICU. Study 2: To develop and pilot an intervention for patients’ relatives on the Critical Care Units (CCUs) at King’s College Hospital (KCH), to help them cope with the experience. Method and Design: In study 1 data was obtained from semi-structured interviews with ten ex-ICU patients’ relatives recruited via a national charity, and ten nurses and consultants from the CCUs at KCH. In study 2 data was obtained via a focus group of nine senior nurses, from KCH. Data generated from both studies was used to develop the intervention which comprised an information booklet and verbal guide. The intervention was delivered by nurses to patients’ relatives on the Medical and Surgical CCUs for two weeks. Ten CCU staff members were interviewed about how the intervention had been received by patients’ relatives. Data was analysed using thematic analysis. Results: Study 1 identified themes related to the importance of good communication with staff, the need for relatives to receive clear and honest information about their loved one, and about the ICU. Findings suggest that relatives lack knowledge and understanding about decision-making for patients who lack capacity and may need to be informed of this process at an early stage preferably in written form. Relatives and staff may also benefit from an ICU based counselling service. The focus group in Study 2 provided feedback on appearance, content and delivery of the booklet which informed the final draft. After the pilot, staff reported positive feedback from relatives and provided encouraging and constructive feedback about the booklet. Findings suggest the booklet has the potential to help patients’ relatives cope on the ICU but continued use and testing would better determine its efficacy. Patients’ relatives need to feel supported, well informed, and involved on the ICU. Including information about the decision making process in an information booklet may improve relatives’ understanding and acceptance of this issue. The booklet should be an adjunct to verbal communication from staff and be one of a range of resources accessible to patients’ relatives on the ICU. Keywords: intensive care; critical illness; patients’ relatives; communication; information provision; coping; decision-making; mental capacity; intervention; psychology.

The resurgence of prayer and glossolalia (speaking in tongues) within Protestant denominations in the United States of America has stimulated widespread psychological and theological debate. Previous research has indicated that religiosity has both a negative and positive effect on mental health functioning. However, there remains an important gap in the current literature regarding the relationships between specific religious practices and mental health. Therefore the purpose of the proposed study is to report on the growing number of religious persons who pray/glossolate and the conflicting messages in the literature regarding the relationship between religiosity and mental illness. A total of 10 Protestants (5 with and 5 without mental health treatment experience) from a large urban area in southeastern Michigan were interviewed. The key research questions were the participants' prayer life, coping skills, participation in mental health services, and perception of their mental health providers' comfort level. To identify themes, the participants' responses were classified, placed into clusters of meaning, reflected upon, and then described. Identified themes included using prayer/glossolalia to resolve interpersonal conflicts and a preference for Christian identified counselors when seeking mental health services. Findings from this research clarify a need for further study regarding mental health services that are delivered to glossolates and nonglossolates. This is an important contribution to the existing literature and enhances social change initiatives through advocating training for mental health providers in the positive impact of religious practices on mental health.

The purpose of this dissertation is to examine licensed mental health professionals' attitudes towards rape survivors. Research indicates that the attitudes of police officers, mental health professionals, and the general public may influence the psychological adjustment of rape survivors and, consequently, whether or not that person seeks mental health treatment after the assault (Vincent, 2009). The negative impacts of rape on a person may not be specific only to the act of violence, but may also include secondary victimization from the survivors' negative experiences with authorities such as legal and mental health professionals (Campbell & Raja, 1999) who may hold negative beliefs about sexual assault and rape survivors (Nagel, Matsuo, McIntyre, & Morrison, 2005). Exposure to these negative beliefs held by others may be associated with negative secondary emotions in the survivor, such as guilt; guilt associated with actions taken or not taken in the context of rape has been observed to be positively correlated with posttraumatic stress disorder, depression, low self-esteem, social anxiety, and suicidal ideation (Kubany, Abueg, Owens, Brennan, Kaplan, & Watson, 1995). It is therefore important to examine the attitudes licensed mental health workers hold towards rape survivors, as these rape survivors may seek services from mental health professionals, and the clinicians' attitudes towards these clients' experiences may significantly impact survivors' recovery from a sexual assault. In addition to measuring the acceptance of rape myths in licensed mental health providers, this study aims to explore how demographic variables in mental health professionals, such as gender, type of graduate degree, or participant rape survivor status, are related to the attitudes participants report about sexual assault. It was hypothesized that male study participants would attribute greater responsibility to survivors than female study participants would, based on the results of the updated Illinois Rape Myth Acceptance Scale, and congruent with published research highlighting this gender difference (Grubb & Harrower, 2009). It was hypothesized that mental health providers who have had more years of training in their graduate degree program would report lower levels of rape myth acceptance compared with those who had a shorter degree program. It was also hypothesized that participants who themselves identified as a rape survivor or who had a close friend or family member who is a survivor would attribute less responsibility to rape survivors, as research supports the observation that those who identify as survivors or friends of survivors may reject negative biases towards sexual assault survivors.

After completing both independent t-tests and Mann-Whitney U statistical analyses, gender identity was the only demographic for which statistically significant mean differences were seen in total rape myth acceptance scores (p = .012). This finding is not surprising, as much of the current literature supports that men, in general, attribute more blame to rape survivors than women. Prior to the current study there was no published research using licensed mental health providers as participants in a study using the updated Illinois Rape Myth Acceptance Scale. Data gathered from the current study will therefore offer a valuable contribution to the literature on this topic. Further, it is hoped that this data can be used in the development of graduate programs, continuing education courses, and didactic seminars that debunk rape myths and promote competency around rape survivor issues.

Recent research has suggested that mental health problems are over-represented in the homeless population. Currently mental health services are under-utilised by this group in proportion to need. It is often assumed that psychological intervention is unlikely to be helpful with a client group where basic needs are often not met. The Transtheoretical Model of Change is used as a framework to describe the complex, dynamic processes that are likely to impact on a homeless person with mental health problems' ability to seek help for their mental health difficulties. This model is also applied to services. The empirical evidence for Maslow's Hierarchy of Needs as a help or hindrance to help-seeking behaviour is examined. This study asked homeless people to identify their own needs and explored current working practices of the few clinical psychologists who work with them directly. Interpretative phenomenological analysis (IPA) was used to explore the role for clinical psychology for homeless people. A pilot study was conducted. In the main study, nine men from two day centres/night shelters (one rural and one inner city) were recruited opportunistically. Five clinical psychologists working within the homelessness field were recruited. Psychopathology of the homeless participants was measured using the GHQ-12 and BPRS. Within a user-designed approach a semi-structured interview was developed for the main study from the pilot study.

Research suggests that people who experience mental health problems and people who hear voices are likely to experience stigmatising attitudes and discrimination. This portfolio considers the experiences and impact of disclosing these stigmatised experiences, both to immediate family, friends, and partners, and to people in wider society. The portfolio has three parts. Part one is a systematic literature review which considers the impact/effect of disclosing mental health problems by reviewing the literature base. Twelve articles which aimed to answer the research question were quality assessed, then compared and contrasted in order to provide conclusions and offer recommendations for future research and clinical practice. Part two is an empirical study which enquires into the personal experiences of people who hear voices using Interpretative Phenomenological Analysis (IPA). Six participants were interviewed about their experiences of talking about hearing voices with family, friends, and other people they considered close to them. Themes were developed from the interviews and conclusions were drawn about future research and clinical implications. Part three of this portfolio contains the appendices, consisting of supporting documents from the literature review and empirical study, along with both epistemological and reflective statements.

Includes bibliographical references.
This study explores the illness experiences of twenty one patients who presented for treatment at primary health care settings in Mamre, a small "coloured" community approximately 50km from Cape Town, with the aim of investigating the possible contribution of psychological factors to presentation for primary health care. It also attempts to investigate how, psychologically, we may understand the process of illness identification and help-seeking. Selected literature on psychological issues in primary health care is reviewed. A hermeneutically-oriented medical anthropological approach to the study of illness and health care is outlined. The participants for the study were selected from all patients presenting at general practitioners in Mamre and for O.P.D treatment at Wesfleur hospital over a period of one week. A semi-structured interview, consisting mainly of open-ended questions aild focussing on their illness explanations, experiences of treatment, and their understanding and/or experience of "nerves", was conducted within ten days, in their own homes. The analysis of the interview material drew on both quantitative and qualitative methodologies. The quantitative analysis provides indications of the frequency of types of illness and patient responses to treatment. The qualitative analysis draws on Kleinman's (1980) explanatory model/ framework with the aim of understanding the illness experience of each participant. The participants' understanding and/or experience of nerves is also described. This study provides additional insights in understanding the process of illness identification r and help-seeking and the contribution of psychological issues in the presentation for , primary health care.

Ten to fifteen per cent of women from affluent countries, utilising private health care services are diagnosed with Postnatal Depression (PND) annually. Despite the high prevalence and the negative consequences for mother, child and partner, PND remains largely undiagnosed. Thus, this study explored health practitioners' experience of and attitude towards screening for postnatal depression to explore the barriers to screening as well as potential mechanisms to improve the rate of detection.

Approximately three percent of incarcerated individuals in Canada are veterans with unique mental health needs. The purpose of the current study was to examine incarcerated Canadian veterans’ mental health challenges and understand their perceptions of these challenges including perceived barriers and potential solutions. Each interview involved a demographic questionnaire, semi-structured interview, and the SCID-5-CV. Sixteen male inmates participated in the study, five identified as Aboriginal and eleven identified as Caucasian. Eleven served in the Army, three in the Navy, and two in the Air Force. Sixty eight percent were serving time for a violent offence, 62% reported a TBI, 18% had seen combat and 43% had completed peacekeeping tours. PTSD, mood disorders, and substance abuse were the most reported mental health difficulties. Themes that emerged include: adjustment difficulties, mental health difficulties-related to military service and familial/early influences, masculinity, stigmatization, and peer support. Proposed solutions to barriers included: mandatory treatment, integration of mental health into military activities, increasing anonymity, promotion of services, accessible services, and peer-based interventions. These results suggest that incarcerated veterans have unique mental health needs which may be contributing to their incarceration. Integrating veterans’ views into programming is a potential area of further study.

The portfolio has three parts: Part One: A systematic literature review, in which the literature relating to the assessment and identification of mental health problems in looked after children is reviewed. Part Two: A mixed methods empirical research study which qualitatively explores foster carer’s perceptions of screening measures used with looked after children and the ability of these to capture need. Clinicians’ views regarding the same issue are also explored both quantitatively and qualitatively. Part Three: Appendices including all relevant documents related to the systematic literature review and empirical papers and a reflective statement from the researcher on the process of completing the portfolio.

This thesis portfolio comprises of three parts: Part one: a systematic literature review, in which the available research into personality disorders during the perinatal period is reviewed. A systematic search identified 11 studies for inclusion, the findings of which are reviewed in a narrative synthesis incorporating methodological critique. Conclusions are drawn and related to the wider literature, and implications for research and practice are highlighted. Part two: a qualitative study, in which the views of perinatal mental health staff were gathered to provide an insight into understanding of perinatal mental health problems and care. Three staff teams were interviewed using focus groups and thematic analysis was used to analyse the data, from which six themes emerged. These themes are discussed in relation to implications for practice and the wider research into perinatal mental health problems. Part three: appendices supporting the systematic literature review and qualitative study, including an epistemological statement and a reflective statement.

Understanding and assessing the needs of Emergency Medical Service (EMS) personnel and other first responders is crucial for providing these individuals with the resources needed within their community. The literature discusses how EMS personnel are at risk for psychological impairment due to routine exposure to traumatic events and occupational stressors within EMS organizations. Additionally, the research has supported the importance of positive coping abilities, organizational belongingness, and social support within the lives of EMS personnel to enable them to resiliently handle the occupational stress of their job. This study investigated the occupational needs of EMS providers to determine if they are receiving resources within their organization to cope with occupational stressors. Participants for this study comprised (n=153) paramedics and fire-fighters from the Tidewater EMS Council organization. A needs assessment was conducted to explore correlations between quality of life, resiliency, years of service, level of education, burnout, secondary traumatic stress, interpersonal support, positive and negative religious coping, and the occupational needs of EMS personnel. The results revealed that burnout (r=4.27**) and secondary traumatic stress (r.215*) were important factors for determining occupational turnover among EMS personnel. Furthermore, EMS providers reported occupational needs such as easier access to mental health, improved staff relations, adequate staffing, and improved shift hours are needed within their organization. Future research should explore differences in occupational needs with EMS providers among EMS organizations in metropolitan and rural communities. Keywords: Emergency Medical Services (EMS), Burnout, Occupational Stress, Traumatic Critical Incidents

To improve how healthcare is being provided, many states have focused on enhancing patients' health experiences and outcomes and reducing the per capita cost of care. Even though appointment follow-up is an important part in outpatient treatment programs, not much is known about practical methods to help individuals with mental illnesses into ongoing treatment. The purpose of this quantitative study was to determine to what extent patient appointment follow-up adherence at a family health center in New York predicts negative health outcomes and hospitalizations among patients receiving psychological treatment. The theoretical foundation that framed this study was the theory of planned behavior. Two research questions measured whether there was statistically significant difference between the dependent variable (number of emergency room visits) and the independent variables (number of follow-up appointments and caseworker status). A causal-comparative research design was used to examine archival data, and multiple linear regression analysis was done to analyze the data. Findings indicated that the number of mental health visits and having a caseworker are important factors in appointment follow-up. The findings of this study have organizational and societal implications for social change. Government agencies as well as mental health advocates may benefit from the findings of this study, which can encourage more attention on the quality of care for those with mental health diagnoses. Thus, the findings may lead to developing improved care.

Clinicians are often required to make judgments regarding clients on the basis of relatively limited information. These judgments can have a substantial effect on the client's own self-perception and on the perceptions of others about the client. This study was designed to investigate the effect of demographic information on clinical judgments.A preliminary study was utilized to determine which demographic variables to vary in the demographic combination presented in the case study. A cluster analysis found that undergraduates reported differences in their perceptions of demographic combinations based on the age and socioeconomic status which was included. As only one part of the demographic combination was to be varied, age was selected.In the main study, graduate student clinicians were presented a case study. The gender, race and socioeconomic status of the client presented in the case study remained constant while the age of the client was varied. Half of the students received a case study where the demographic information represented a 74 year old and half received a case study where the demographic information represented a 35 year old. It was hypothesized that graduate student clinicians' ratings would vary based on the age of the client presented.In addition, it was hypothesized that placing demographic information at the beginning of the case study would result in different ratings than when demographic information was placed at the end of the case study. Half of those presented with the 74 year old client demographic information received that information early in the case study and half received that information near the end of the case study. The same manipulation was made for those presented with the demographic information representative of the 35 year old client.It was also hypothesized that those without demographic information would rate clients differently than those with demographic information. None of the hypotheses were supported; however, an effect for the time of rating was found. Later ratings were found to be more lenient than earlier ratings. Clinical implications and suggestions for future research are discussed.
Department of Counseling Psychology and Guidance Services

This portfolio thesis is divided into three parts: a systematic literature review, an empirical study and a set of appendices. Part one is a systematic literature review, exploring the existing literature relating to the barriers men report when accessing mental health services. A total of 8 studies were critically reviewed, evaluated and assessed for quality. The results from these were then explored to consider the themes that men described in the barriers they experienced. The findings from this review are discussed regarding the clinical implications of barriers to care. Part two is an empirical paper exploring the constructions of masculinity in the language Army veterans use around accessing mental health services. The study utilised a combination of grounded theory and Foucauldian discourse analysis to explore the discourses used by the five veterans. Results looked at the different positions the men took in their discourse and the different actions this allowed them, as well as how they negotiated their masculinity when accessing support. The findings are considered and discussed in relation to their clinical implications. Part three contains a comprehensive set of appendices from parts one and two; this also contains epistemological and reflective statements to add context to the research that was undertaken.

Significant research efforts have focused on examining the effect of patient factors on providing diagnoses across clinical settings; however, the influence of clinician demographics have received less attention. This study aimed to understand the impact of nonclinical factors such as clinician characteristics and response time on diagnostic accuracy. The study used data from a WHO field study of the ICD-11 development (n = 1822) that required clinicians to diagnose two case vignettes. Clinicians’ slower response times had a significant positive impact on their rates of diagnostic accuracy. However, there was no evidence that clinicians’ demographic features were directly related to their diagnostic accuracy. Rather, clinicians’ age, years of experience, world region, and their clinical profession indirectly predicted accuracy through their overall response time. Contradictory to decision-making theories, older clinicians and clinicians with more years of experience had higher rates of diagnostic accuracy when they spent more time completing the study. Additionally, clinicians in South America with slower response times had higher accuracy compared to clinicians in North America. Clinicians in Asia had faster response times that negatively impacted their accuracy rates compared to North America clinicians. These findings suggest differences in response time and the applicability of the ICD-11 across cultures. Consistent with previous research, medical professionals with quicker response times had the lowest rates of accuracy compared to psychologists and other clinical professionals. These findings highlight the need for researchers and clinicians to consider the role their dispositional features have in the diagnostic process. Moreover, it is crucial that future research into diagnostic decision-making and accuracy should consider additional mediating factors such as response style, culture, and experience.

Throughout the United States are institutions abundant with violent offenders who have been found not guilty by reason of insanity (NGI). The decision to release these insanity acquittees into the community is a vital one, both for the patient and the larger community. While these decisions should be informed by evaluations that combine clinicians’ opinions with validated tools of assessment, no standard of care regarding such evaluations exists. Forensic specialists are thus often left to base discharge decisions on clinical judgment alone. This dissertation assumed a critical review of the theoretical and empirical literature relevant to conditional release decisions of NGI patients, including the research on structured assessment of risk of future violence. Based on this critical review, the author proposed recommendations for five standards to enhance conditional release decision-making for violent offenders in forensic settings: (a) Adherence to professional and ethical conduct; (b) documentation of patient progress; (c) incorporation of empirically-validated risk assessment tools; (d) creation of a comprehensive release plan; (e) verification of patient’s commitment to successful reintegration. This dissertation additionally examined the strengths and limitations of the critical review strategy, as well as delineated areas for research to empirically evaluate the recommended standards and promote improved quality of conditional release evaluation for NGI acquittees.

This portfolio thesis comprises of three parts. The first part is a systematic literature review, in which empirical literature relating to the use of Facebook groups in health conditions is explored. It aims to provide an understanding of how individuals with health conditions use Facebook groups. The review concludes with recommendations for future research. Part two is an empirical report of a study that used a qualitative approach of content analysis to explore the use of Facebook groups by those with a diagnosis of Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (M.E.). Participants completed an online survey and data was extracted from a single Facebook group. Results were considered in relation to the Shifting Perspectives Model of Chronic Illness (Paterson, 2001). Methodological limitations, potential clinical implications and areas of future research are also identified. Part three comprises the appendices and reflective statement. These include a statement reflecting on the research process and supplementary information pertaining to the literature review and empirical study.

This thesis explores the phenomenon of mind-brain dualism in contemporary Western psychiatry from an anthropological and social psychological perspective. In a first chapter, it reports on an empirical study involving 127 staff psychiatrists and psychologists at McGill University who responded to a questionnaire based on clinical vignettes. Results revealed a latent process of judging patients' responsibility for illness, where the more a behavioural problem was seen as 'psychological,' the more the patients tended to be viewed as responsible and blameworthy for their symptoms, while behaviours with 'neurobiological' causes showed the opposite tendency. A second chapter reviews the history of psychosomatic medicine and argues that specific biomedical and psychological sick roles exist for patients that determine the ways in which their actions are judged, as well as how the functions of the rational mind are commonly understood. Insights from evolutionary psychology are used in a third chapter to speculate on new models of mental illness that may provide new contexts for negotiating mind-brain dualism and judgements of responsibility.

Meditation is increasingly integrated into therapeutic interventions. Metta (loving-kindness) meditation, which cultivates compassion, is relatively unstudied. Metta’s emphasis on compassion has spurred speculation that metta meditation may benefit mental health professionals at risk for compassion fatigue, a condition characterized by depression-like symptoms that results from paying witness to others’ trauma. The current study employed psychological phenomenology—a qualitative research methodology which uncovers the essential meaning of an experience—to explore mental health professionals’ lived experiences of metta meditation. Moustakas’s recommendations for phenomenology guided data collection and analysis. Semi-structured interviews with 17 mental health professionals, clinicians and clinical supervisors, yielded 58 invariant components clustered into eight themes regarding metta meditation experience. These themes were used to write textural descriptions for each participant, from which a textural composite was created. Structural mechanisms interwoven into the composite created the essential description of participants’ lived experience of metta meditation. Implications are discussed.

Includes bibliographical references.
This explorative, qualitative study examines the perceptions of mental health workers about self-help groups with adult survivors of child sexual abuse. Given limited formal mental health services in South Africa, self-help represents one informal alternative which could supplement mental health service provision. The study thus arises from a perspective which values self-help groups and is informed by the urgency of community needs in this area, and takes seriously the idea that it is possible and desirable for mental health care workers to facilitate and foster community support systems. Twenty-two indepth interviews were conducted with a sample of convenience which included eleven clinical psychologists, five psychiatrists, three social workers and three non-professionals and included interviewees from organizations currently engaged in issues relating to child sexual abuse. A semi-structured interview schedule was used and interviews were audio-taped. Interview responses were systematically analysed and common themes extracted around awareness of self-help, perceived benefits and problems of survivor self-help groups and the role of professionals. Main themes have been illustrated by verbatim transcriptions from audiotaped material. Most participants have had limited exposure to self-help groups. Whilst there was openness towards self-help with survivors, caution was expressed about dangers to clients in survivor groups which are not monitored by formally trained and accredited professionals. Selfhelp was considered useful mainly as an adjunct to formal services. Limited knowledge of self-help groups is a major determining factor informing professional perceptions. Recommendations for education of professionals are made in order to promote self-help groups and collaborative professional attitudes.

Negative social reactions that sexual assault survivors receive upon disclosure have been correlated with psychological distress such as posttraumatic stress disorder, depression, and problem drinking. However, the impact of ethnicity in the relationship between unsupportive reactions to assault disclosure and the psychological sequelae remains unclear. Using hierarchical linear regressions and a sample of 665 African-American, Latina, and Caucasian female adult sexual assault survivors, the present study examined the role of ethnicity in that relationship. The results suggest that ethnicity moderates the influence of negative disclosure reactions on psychological symptoms, however, the moderation impact was not similar across races and psychological outcomes. With regard to posttraumatic stress disorder and depression, contrary to expectations, African-Americans were less impacted by negative reactions as compared to Caucasians. However, as predicted, more African-Americans and Latinas reported problem drinking upon receiving unsupportive responses than Caucasians.

Includes bibliographical references (leaves 77-90).
The relationship between low birth weight, behavioural inhibition and psychopathology was investigated in 65 seven to nine year-olds and their caregivers who were attendees of a community clinic in a low-income, urban suburb in Cape Town, South Africa. Significant relationships were found between key socioeconomic variables and birth weight status, behavioural inhibition and psychopathology respectively. Low birth weight children were more behaviourally inhibited in anxiety-provoking situations and their caregivers were less engaging than controls. High levels of psychopathology were found, independent of birth weight status and included emotional, hyperactivity, conduct and peer difficulties. Despite this, children had high levels of pro social skills. A model consisting of birth weight and a measure of socioeconomic status was an effective overall predictor of behavioural inhibition status.

Muscle Dysmorphia (MD) is a pathological preoccupation with muscularity, more common in men than in women. MD is estimated to affect several hundreds of thousands of individuals. There has been little research related to MD in the male adolescent population and the prevalence is unknown. The mean age of onset of MD is estimated to be 19 years, and sports participation increases the risk for developing MD as well as other psychological difficulties. The pilot study revealed a potential relationship between MD symptoms and athletic and academic performance, low levels of self-esteem, high levels of perfectionist qualities, and use of performance-enhancing drugs. This study was conducted to substantiate previous findings and to understand MD symptomatology among male adolescent student athletes and its relation to athletic and academic performance as well as media influence, low levels of self-esteem, high levels of perfectionist qualities, and the use of performance-enhancing drugs. Participants included 67 male student athletes ages 14 through 18 who completed a four-page questionnaire. Results showed that MD symptomatology is prevalent among male high school athletes and is positively correlated with perfectionism and media influence. Current findings indicate the need for school programs and treatments to address MD symptoms. Further, the results offer important implications for school psychologists to make meaningful contributions in the school system through professional development to staff, counseling for students, and collaboration with parents.

This parent training program was designed to be utilized within the Early Head Start Program. The proposed program is an eight-module program design to be implemented in eight sessions, two hours each, for a one-month duration. The aim of the parent training program is to increase parent participation in their child’s therapy sessions. The participants are parents of children with developmental delays who are found to be eligible for the Early Head Start Program. Through attending the parent training program, several outcomes are likely to occur including, increased social and emotional developmental outcomes for the child, a stronger parent-child bond, an increased awareness for the parent regarding how to effectively promote learning for their child with special needs, a more authoritative parenting style to be adopted by the parents, and a decreased likelihood of abuse and neglect for the child. The proposed parent training program provides a parent training implementation outline, an initial parent survey, and several quizzes to determine the parent’s competency throughout the modules. Suggestions for future research, discussions of strengths and limitations, and program evaluations were offered for discussion.

A workplace critical incident is any event which disrupts or impacts the functioning of a business, e.g., death of an employee, downsizing or robbery. Critical incident responders (CIRs) are specially trained licensed mental health professionals who respond to workplace critical incidents as support to both the employees and the business organization through applied crisis theory and as a business continuity resource. The goal of a workplace response is to return employees to their pre-crisis level of functioning. CIRs are required to become certified in a multi-component crisis intervention technique. Prior to this study, no data existed regarding how closely CIRs adhered to intervention models or what theoretical frameworks informed their practice. This study sought to understand, from the perspective of the workplace CIR, what practices they employ and why. The design was a two phased, sequential, mixed method explanatory design. Phase one was a quantitative internet based survey (n = 110) and phase two was a qualitative phone interview (n = 12) designed to enhance the understanding of phase one results and provide rich data on the experiences of workplace CIRs. The conceptual frameworks for this study were theories of crisis, crisis intervention and constructivism. The results found that CIRs demonstrate autonomy in deciding which interventions to apply during a response. Type and nature of the crisis as well as timing of response from the event influenced the CIRs’ approach. CIRs are informed by brief treatment modalities and even though CIRs have limited understanding of the phrase business continuity, they still provide the services. CIRs described modifying Mitchell’s CISD Model to address the needs of civilians in the workplace. Primary activities are assessing, normalizing and educating. Results will further the understanding of critical incident response and enhance the current best practice models.

Introduction: People with a learning disability are members of a stigmatised group and research has shown that stigmatisation can have a negative impact on psychological wellbeing. The process of social comparison has been shown to be important in the experience of stigmatisation and has been shown to have been used by people with a learning disability. This thesis aims to examine the perception of stigma in people with a learning disability and the relationship it has with their psychological wellbeing. The process of social comparison in this population will be explored and the possible moderating effect it may have on the relationship between stigma and psychological wellbeing will be investigated. Methods: The study involved a questionnaire-based interview with 43 adults with a mild to moderate learning disability who attended local adult resource centres. Participants completed four self-report measures of perception of stigma, self-esteem, symptoms of psychological distress and social comparison. The social comparison measure was completed twice: once in comparison with other service users and again in comparison with people in the community. Results: Correlational analyses revealed significant relationships between perception of stigma and self-esteem and symptoms of psychological distress. Perception of stigma was shown to be significantly related to negative social comparisons, and negative social comparisons were significantly related to low self-esteem and high symptoms of psychological distress. No difference was found between social comparisons made with other service users and those made with people in the community. Social comparison was not found to have a moderating effect on the relationship between stigma and self-esteem. Discussion: The results provide further evidence that greater awareness of stigma is related to lower self-esteem, higher psychological distress and more negative social comparisons. Furthermore, those that compare themselves negatively to others report lower self-esteem and higher psychological distress. Although there was no difference in the way people with a learning disability compared themselves to their peers versus the general population, the way they see themselves compared to others in general has implications for their wellbeing. The significance of this and the relevance for future research is discussed.

Anxiety disorders are the most prevalent mental health concern in the United States. Yet, many who suffer from anxiety do not receive treatment or fail to respond to well-established cognitive and behavioral interventions. Mindfulness- and values-based strategies are possible alternatives for these individuals. However, values-based approaches have not been adequately studied in anxious populations and it is unclear how they may interact with mindfulness-based approaches. Moreover, little is understood about the mechanisms of action underlying behavioral changes resulting from mindfulness meditation (MM) practices. Acceptance and Commitment Therapy (ACT) is one approach that employs values clarification (VC) and mindfulness to bring about improvements in quality of life (QOL). ACT also provides a behavioral account of human vitality that may increase specificity of mediating and moderating variables that are critical for good outcomes following mindfulness-based treatment. The present investigation aimed to evaluate the effects of MM and VC on QOL and anxiety symptomology and to elucidate significant mediators and moderators of the relations between MM and VC and positive outcomes. In so doing, highly anxious participants (N = 120) were randomly assigned to a 10-min MM practice + control task or a 10-min MM practice + VC task. Pre, post, and daily diary assessments were employed over the course of 16 days and included several well-established process and outcome measures. Results suggest that 2-weeks of MM practice leads to decreases in anxiety symptom frequency and increases in QOL during the previous 24-hour cycle. VC did not significantly affect primary outcomes. Acceptance appears to be the most important mediator assessed herein of the daily effects of mindfulness on anxiety symptoms, though valued action was a numerically stronger mediator between mindfulness and QOL. Practice quality was related to daily reductions in anxiety symptoms and improvement in daily QOL. However, it did not moderate response to MM. Surprisingly, MM practice time, when controlling for average practice quality, was related to worse QOL outcomes for those who participated in VC. Results are discussed in terms of enhancing the impact of psychological treatments for the anxiety disorders, in addition to implications for personal mindfulness meditation practices.

Research on microaggressions has consistently lacked focus on microaggressions experienced by persons with mental illness. What little research has been conducted has examined microaggressions as reported by the victim. The current study aimed to explore mental illness microaggressions by examining the view of the committer (i.e., the person enacting the microaggression), the role specific prejudicial beliefs (i.e., authoritarianism, social restrictiveness, benevolence) play in microaggressive behavior, and whether level of intimacy of interpersonal contact is related to reduced mental illness microaggressions. Participants for this study were recruited using Amazon’s Mechanical Turk; they completed a series of questionnaires and were compensated for their work. Results indicated there is a positive relationship between the likelihood of mental illness microaggression perpetration and the prejudicial beliefs authoritarianism and social restrictiveness while there is an inverse relationship between mental illness microaggression enactment and the prejudicial belief benevolence. This study determined that social restrictiveness accounts for the most variance when predicting potential perpetration of mental illness microaggressions. Additionally, results of this study determined there is a negative relationship between mental illness microaggression enactment and level of intimacy of interpersonal contact with mentally ill individuals, suggesting that interpersonal contact may be an effective strategy for reducing mental illness microaggressions.

Throughout history, people suffering from a mental illness or emotional crisis have been treated quite differently. The accepted treatments of the day could be cruel, and sometimes deadly. Within these times, there have also been people who questioned treatment-as-usual, particularly when they viewed that treatment as either unhelpful or dangerous. Alternative treatment programs have been developed with varying success. CooperRiis is a therapeutic healing community in North Carolina that opened in 2003. It is providing an alternative to treatment-as-usual to inpatient psychiatric hospitalization. This case study aimed to investigate whether there was a flexibility within the organization that allowed it to adapt to the changing needs within its own community, as well as to continue operating within the larger mental health community, to remain operational. The findings resulted in different revelations. It was discovered that the process of how decisions are made impact the community differently. Also, whether a leader is connected or disconnected from the community has a significant impact on it. These aspects, in particular, can influence feelings of empowerment or disempowerment within the community. Recommendations are provided both for where CooperRiis could benefit from more focus, as well as aspects of the programming it is doing well. In many of the alternative programs that are developed, a common thread is the focus on connection, as well as finding the humanity within both the providers and recipients of help. CooperRiis is yet another example of how this community, connection, and humanity is the therapy that heals.

This study brings attention to the growing body of literature examining the role of culture and context in the study of generation-status differences in cross-cultural coping and physical well-being among immigrants to the United State. Prior literature on the unique challenges, stressors, coping strategies, and health outcomes for immigrants provides a basis for hypothesized generation status differences on cross-cultural coping (collectivistic, avoidance, and engagement) and physical well-being (health, safety, and environmental). A sample of 118 male and female first, 1.5, and second-generation immigrants of non-European backgrounds, between the ages of 18 and 35, were recruited from the local community to complete an online questionnaire. Results from the cross-sectional study did not yield support for the hypothesized generational status differences. However, exploratory analyses yielded several significant correlations including a positive relationship between collective coping and the safety dimension of physical well-being. Within-generation exploratory analyses yielded several significant correlations and differences on measures of coping strategies and physical well-being for demographic/contextual factors such as religiosity, age, SES, English fluency, connection to the U.S. culture, education, and ethnicity amongst 1.5 and second-generation immigrants. The empirical investigation of cross-cultural dimensions of coping and physical well-being among immigrants represents a new direction for research. This study also has potential implications for more nuanced understandings of the immigrant paradox, the socioecological perspective of acculturation, collective coping, and inclusion of both objective and subjective experiences of the environment. Implications for theory and practice, methodological limitations, and suggestions for future research are also discussed.

Objective: The primary goal of the current study was to characterize perceived social support (PSS) and isolation longitudinally among people with chronic pain (CP) who were and were not receiving group psychosocial interventions for CP. The second goal of the study was to describe how PSS and isolation variables are associated with quality-of-life (QOL) variables over time for those same participants.

Background: Previous research has demonstrated that positive social support can predict better outcomes for people with CP and negative social support can predict poorer outcomes. Furthermore, CP is associated with decreased social support and greater isolation. Despite the knowledge that PSS can be an important coping resource for people with CP, research on the longitudinal patterns of PSS and isolation and their relationships to QOL variables over time is lacking, especially among people with CP.

Method: Social health and QOL data from 290 participants from the Learning About My Pain study (Eyer & Thorn, 2015) were used to examine longitudinal PSS and isolation with piecewise linear growth models using multilevel modeling. Participants were randomly assigned to participate in group cognitive-behavioral therapy (CBT), group pain psychoeducation (EDU), or medical treatment-as-usual (TAU) for 10 weeks followed by a 6-month post-treatment follow-up period. Participants were assessed pre-, mid-, and post-treatment, as well as at follow-up.

Results: PSS was relatively stable over the treatment and follow-up periods except for small decreases in emotional and informational support among TAU and social isolation among EDU during the follow-up period. Companionship was associated with decreasing pain interference, disability, and depression, and emotional support was associated with decreasing pain interference and depression, whereas instrumental support and isolation were associated with worsening QOL. The Buffering Hypothesis of PSS was not supported in the current sample.

Conclusions: A potential benefit of participating in psychosocial group treatments for CP appears to be the lack of deterioration of emotional and informational support for CBT and EDU and decreasing isolation for EDU participants. Social health was predictive of QOL. Future research and treatment of CP should account for PSS and isolation and the ways in which they interact with pain and QOL.

Research has shown that being a mental health therapist (MHT) is an extremely stressful vocation and often leads to burnout (Gibson, 2009). Evidence supports that humor and mindfulness assist in mitigating the negative effects of stress and burnout (Malinoski, 2013; Brown & Ryan, 2003). It is also known that the effective use of humor (McGhee, 2010a) and mindfulness practices (Hayes, 2005) can be learned, practiced, and integrated into daily interactions across the lifespan. This research examined humor styles, trait mindfulness, and burnout of 94 licensed MHTs in community mental health centers located in Western Massachusetts in an attempt to add to research regarding burnout and protective factors that may minimize the impact of burnout.

Results found that MHTs with higher scores of trait mindfulness reported reduced levels of burnout, which supports existing research. Additionally, those reporting higher frequency of maladaptive styles of humor tend to report higher levels of Depersonalization. MHTs who reported the regular use of affiliative types of humor reported a lower rate of Emotional Exhaustion. These findings may be used to inform future pre-service and in-service training of MHTs to include attention to the possible protective factors of adaptive humor styles and trait mindfulness in an effort to prevent burnout among practicing MHTs thereby improving longevity in the field.

The necessity of providing health care professionals with tangible tools to manage stress and safeguard their own well-being has become increasingly apparent. Rates of burnout in the helping professions are rising; the consequences of clinician distress for patient care have been highlighted in recent literature. Past research has examined the potential for Mindfulness-Based Stress Reduction (MBSR) to act as an adjunctive intervention for various clinical problems, including but not limited to chronic pain, for over 25 years. Presently, the applications of this program are burgeoning with health care professionals, for whom the intervention holds the promise of promoting both personal and clinical benefits. Past research has examined outcomes of MBSR in health care professionals such as burnout, empathy, perceived stress, as well as medical and psychological symptoms such as depression or anxiety. The current program of research sought to expand on existing research by examining positive psychological outcomes such as well-being, as well as potential mechanisms of change such as mindful attention, and self-compassion. Quantitative and qualitative methods were employed to provide a broad portrait of how change is experienced by health care professionals engaged in the program. This dissertation comprises three manuscripts that collectively contribute to the literature. The first manuscript provides a focused literature review, summarizing the empirical literature on MBSR for health care professionals specifically. The second manuscript utilized self-report measures to explore benefits of engaging in Mindfulness-Based Medical Practice (MBMP), an adapted version of MBSR for health care professionals which includes training in mindful communication. The program was completed by a sample of 51 physicians, psychologists, social workers, nurses, and other health care professionals in two cohorts during the spring of 2008 and 2009. Findings provide initial evidence of the effectiveness of MBMP as demonstrated by significant decreases in perceived stress, and increases in mindful attention and awareness and self-compassion. Bootstrapped hierarchical regression analyses failed to reveal a moderating effect of either mindfulness or self-compassion on the negative relationship between perceived stress and well-being. The third manuscript presents a study which investigated participants' experiences of the 8-week course through focus group interviews (n = 27). A grounded theory analysis yielded a model highlighting unique change processes for practicing health care professionals in relation to enhanced awareness of perfectionism, self-criticism, and orientation to others. Participants described achieving personal outcomes such as changes in self-care attitudes and practices, as well as implications for clinical encounters with patients. This study provides one of the first in-depth qualitative investigations of practicing health care professionals' experiences of an MBSR program. Taken together, the three manuscripts provide a solid rationale for future research on the potential for MBSR to enrich the lives of health care professionals and the patients they serve.
La nécessité de fournir aux professionnels de la santé les bons outils pour gérer le stress et améliorer leur mieux-être apparaît de plus en plus criante. Le taux d'épuisement des professionnels de la santé est en hausse et les conséquences de la détresse des médecins se réflètent également auprès des soins prodigués aux patients. Cette réalité est d'ailleurs largement documentée dans les récentes publications scientifiques.Depuis plus de 25 ans, plusieurs recherches ont examiné le potentiel de Mindfulness-Based Stress Reduction (MBSR) qui consiste à prendre pleine conscience de son stress afin de le réduire. Ce programme agit comme un moyen d'intervention d'appoint devant plusieurs problèmes d'ordre clinique, incluant de façon non limitative la douleur chronique. Actuellement, la mise en application de ce programme est en plein essor auprès des professionnels des soins de santé et les résultats leur apportent des avantages à la fois personnels et médicaux. Des recherches antérieures ont examiné les résultats du MBSR auprès des professionnels de la santé atteints d'épuisement, ou de leur attitude face à la perception du stress, de l'empathie, ainsi que des symptômes médicaux et psychologiques comme la dépression ou l'anxiété. Le programme actuel de recherche a cherché à s'étendre sur la recherche existante en examinant les résultats positifs psychologiques tels que le mieux-être, ainsi que les mécanismes potentiels de changement tels que l'attention consciente et l'autocompassion.Des méthodes quantitatives et qualitatives ont servi à fournir un portrait général sur la façon dont le changement est vécu par les professionnels de la santé inscrits à ce programme. Cette étude est documentée en trois ouvrages qui contribuent à enrichir la publication scientifique. Le premier ouvrage met en évidence à travers la publication scientifique un résumé des publications empiriques du MBSR particulièrement pour les professionnels des soins de santé.Le second ouvrage a étudié des mesures d'auto-évaluation pour explorer les avantages de s'investir dans une version adaptée de MBSR soit le Mindfulness-Based Medical Practice (MBMP), qui comprend une formation en communication consciente. Le programme a été suivi par des médecins, psychologues, travailleurs sociaux, infirmières et autres professionnels de la santé par deux groupes au cours du printemps 2008 et 2009 (n = 51 [m1]). Les résultats ont prouvé l'efficacité de MBMP comme en témoignent la baisse significative du stress ressenti et une augmentation marquée de l'attention consciente et de l'autocompassion. Les analyses de régression hiérarchique avec un bootstrap ont omis de révéler l'effet modérateur de pleine conscience ou d'auto compassion sur la relation négative entre le stress perçu et le mieux-être.Le troisième ouvrage a observé les expériences des participants à un cours de 8 semaines au moyen d'entrevues auprès de groupes cibles (n = 27). Une analyse théorique bien fondée a fait apparaître un modèle mettant en lumière des processus de changement particuliers chez les professionnels de la santé en fonction d'une sensibilisation accrue du perfectionnisme, l'auto-critique et de l'orientation envers les autres. Les participants ont exprimé avoir atteint certains buts personnels telle l'importance de prendre davantage soin d'eux-mêmes au niveau de l'attitude et du comportement, ainsi que durant les rencontres cliniques avec les patients. Cette étude fournit une des premières enquêtes qualitatives en profondeur sur la participation des professionnels des soins de santé dans un programme MBSR. L'ensemble de ces trois ouvrages fournit une justification solide pour de futures recherches sur le potentiel de MBSR visant à enrichir la vie des professionnels de la santé et des patients qu'ils soignent.

Decades of research attest to the psychological benefits of exercise, documenting improved psychological functioning for specific disorders as well as biological systems. Notable trends include reduction of psychological symptoms (e.g., anxiety, depression), increases in self-esteem, facilitation of neurogenesis, enhancement of cognitive functioning, and improvements in stress response. The majority of these studies call for increased utilization of exercise interventions within clinical practice. However, decades of exercise research and the two existing studies on practice habits suggest that exercise continues to be widely underutilized. The data suggest that clinicians believe exercise is beneficial; they report high confidence and rates of utilization in exercise interventions; however, they also report low levels of education in exercise psychology. It was hypothesized that one possible cause for this persistent research-practice gap may be mental health professionals' (MHPs) misperceptions of their own competence, namely the Dunning-Kruger phenomenon. Methods: An original, electronic survey was disseminated to MHPs via email, social media posting, and snowball sampling. Eighty-three clinicians completed the survey, which collected data on beliefs and practice habits; perceptions of confidence and competence; and research knowledge. Results: Findings supported previous observations, documenting high levels of confidence amongst MHPs despite low levels of exercise education. Knowledge of research was poor; data suggest that the Dunning-Kruger phenomenon is a factor in the ongoing research-practice gap within exercise psychology. Conclusions: This is the first study to measure fact-based competence of MHPs and offer an explanation for the longstanding underutilization of exercise. Findings suggest that clinicians may be at risk for overestimating their own abilities in areas that are less familiar. Further research is needed regarding MHPs’ exercise-related competence in order to elucidate the complex nature of factors examined here.

In face of the current economic-political changes facing the UK and its State institutions and of the new evidence about the impact of social inequality on human distress, this study attempts to understand the increasing practice of delivering psychological therapy by the British clinical psychology profession. A review of the critical histories of the profession in the UK identified the need for a more detailed study of the “history of the present” to reveal the discursive operations that construct professional practice. A discursive thematic analysis (DTA) based on the theoretical concepts of the late post-modern scholar Michel Foucault was used to explore public available documents produced by British clinical psychologists between 2010 and 2014. Two dominant professional discursive themes were identified: alternative and leadership. These themes were found to be supported by the discursive sub-themes of applied science, well-being, Cognitivism and therapy which align the aspiration of the profession with those of the State. The tension between the applied scientist and the therapist role - specifically the need to establish simultaneously the profession’s scientific credibility and its therapeutic abilities in order to respond to market pressures – showed recurrences of the conflicts of the early history of professionalization of clinical psychology. The positioning of clinical psychology against the use of functional psychiatric diagnosis and the challenges and opportunities identified by the opening of the NHS market to ‘any willing provider’ revealed how professional discourses operate to maintain the status quo. This study recommends that the socio-historical construction of the profession should be investigated further, in particular through the subjugated discourse identified here.

Existing stigma in the form of negative attitudes towards individuals with severe mental illness by mental health practitioners, has the potential to set barriers towards recovery. A survey of 72 mental health practitioners from three disciplines were surveyed, in an attempt to measure mental health practitioner attitudes towards individuals with severe mental illness, and how their attitudes impact their belief in client recovery. This was a quantitative study, based on two Likert Scale surveys and distributed both in paper form and using Survey Monkey. Participants were gathered through a snowball effect, and consisted of 42 social workers, 18 marriage and family therapists, and 12 clinical psychologists. The Opening Minds Stigma Scale for Mental Health Practitioners was utilized in an attempt to measure stigmatizing behaviors. The Consumer Optimism scale was also incorporated in an attempt to measure practitioner’s belief in recovery. Content analysis was conducted through Statistical Package for the Social Sciences (SPSS) version 20. The findings of the study were inconclusive and did not support the original hypothesis, as no relationship between mental health practitioner attitudes towards individuals with severe mental illness and their belief in recovery was found. However, two key finding emerged through further content analysis. A positive relationship was found between negative attitudes and the practitioner’s desire to be socially distant from individuals with severe mental illness. Practitioners from inpatient work settings showed higher levels of belief in client recovery, than those in outpatient and private practice. Further research can be conducted regarding the potential reasons that inpatient mental health workers have higher belief in client recovery, in order to help outpatient agencies and private practice individuals also achieve higher levels of optimism towards recovery. The findings of negative attitudes in mental health practitioners and their desire to remain socially distant from individuals with a severe mental illness can also be a key component in recent efforts to combat stigmatizing behaviors.

Depression and anxiety during pregnancy can have a host of negative effects on mothers and their infants, such as premature delivery and increased risk for postpartum depression. Few studies have examined whether levels of the sex hormones progesterone and estradiol, which rise dramatically over the course of pregnancy, are associated with depression and anxiety. This study examined whether higher salivary progesterone and estradiol levels were associated with self-reported depression and anxiety scores among a sample of 128 low-income pregnant women, and whether these relationships were moderated by social support. The results showed that only social support levels had significant negative associations with both depression and anxiety levels. Sex hormones were not significantly associated with depression and anxiety, and social support was not a significant moderator in these relationships. Future studies should continue to address the dearth of research on assessing the roles of sex hormones in relation to mental health during pregnancy.

Bibliography: leaves 76-82.
This study aims to explore the coping resources that community health workers (CHWs), providing home-based care to people with AIDS (PWAs), draw on in response to stressful work experiences. Furthermore, the study explores whether different coping mechanisms are utilised by health care workers at different points on the burnout continuum. CHWs were selected from a community outreach organisation in Cape Town. A Xhosa version of the Maslach Burnout Inventory (MBI) was administered to forty-five CHWs. From this group, twelve participants were selected for in-depth interviews, six from both the higher and lower ends of the burnout continuum. Thematic analysis of the interviews indicate that both the High and Low Burnout groups contront similar stressors as a result of going beyond the call of duty, community and familial stigmatisation and working in adverse conditions. In addition, CHWs from both groups have difficulty articulating their emotional needs. The groups differed on the number of HIV/AIDS caseloads, with the High Burnout group treating more PWAs than the Low EE group. Carers also differe in their coping styles: High Burnout participants rely more on emotion-focussed coping, denial and escape avoidance, and appear to have a limited repertoire of coping skills, while Low Burnout participants are more predisposed to using problem-focussed coping with the flexible inclusion of emotion-focused approaches. The study also highlights how the context of care affects coping. Limitations of the present study are discussed, and recommendations made for future research and practice in the field.