Dissertations / Theses on the topic 'Cognitive-Behavioural'
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Turkington, Douglas. "Cognitive-behavioural therapy (CBT) for schizophrenia." Thesis, University of Newcastle upon Tyne, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.271209.
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Aquan-Assee, Jasmin Soylin Elizabeth. "Induced pain : cognitive and behavioural correlates." Thesis, University of British Columbia, 1988. http://hdl.handle.net/2429/28574.
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Cognitive processes have recently received considerable attention in studies of pain. Belief systems, coping mechanisms, perceptions of control and self-efficacy, and other cognitive systems appear to play a central role in determining individual differences to painful events (Rollman, 1983; Turk, Meichenbaum & Genest, 1983; Weisenberg, 1984). The present investigation sought to examine the cognitive and behavioural relationships that are associated with individual differences in responses to painful stimuli. Sixty female undergraduate psychology students participated in the experimental pain induction procedure which used the cold pressor test as the noxious stimulation. To gain a broad assessment of the different factors that may be characteristic of differences in response to pain, tolerant subjects were contrasted with less tolerant subjects on a variety of self-report, cognitive and behavioural - facial expression - measures. As part of the assessment procedure, subjects completed measures of state anxiety, self-efficacy to withstand pain, and a questionnaire involving a retrospective analysis of cognitive techniques. Half of the subjects were interviewed regarding their cognitions concerning the cold pressor task both pre and post their immersion, and the other half were interviewed post only. Transcriptions were coded independently of pain tolerance status. Subjects' facial expressions were videotaped during the cold pressor task and coded using the Facial Action Coding System (FACS) developed by Ekman and Friesen (1978).
It was hypothesized that dysfunctional cognitions, lack of effective coping activity, amplification of sensory intensity and affective discomfort and high levels of facial activity would characterize subjects who were less tolerant of the induced pain.
The distribution of the endurance times to the cold pressor task confirmed past observations that subjects cluster into two major groups of high and low tolerance (Turk et al. 1983). The results confirmed the major hypotheses that there are cognitive and self-report differences between pain tolerance groups. In comparison to tolerant subjects, less tolerant subjects had lower scores of perceived self-efficacy to withstand pain, higher scores for both sensation and discomfort ratings, retrospectively reported having experienced more pain, and made more accurate estimates of their duration in the cold water. Less tolerant subjects also reported more dysfunctional cognitions during the cold pressor task and reported using effective coping techniques to a lesser extent than tolerant subjects. Major differences between the tolerance groups also appeared in the length of post-test interviews. Tolerant subjects had much lengthier interviews at the post-test than less tolerant subjects. A discriminant analysis revealed that self-efficacy beliefs during the experimental task and the length of the post-test interviews were the most important discriminators between the groups. These results highlight the role of cognition in individual differences in pain tolerance. These results also suggest that low pain tolerance subjects may be better conceptualized as being ineffective and overwhelmed in their attempts to cope with pain which supports the current notion that cognitive based therapies may be the key in managing and alleviating pain states. No support was found for the hypothesis that subjects of differing pain tolerance thresholds would be characterized by differences in facial activity. Facial actions associated with pain in the present study were similar with facial expressions in previous studies (cf. Craig & Patrick, 1985; Hyde, 1986; Swalm, 1987). Contrary to previous results (Craig & Patrick, 1985), measures of facial expression increased over exposure time similarly to self-report. High levels of facial expression were associated with low levels of self-report of coping cognitions assessed at the post-test and with shorter post-test interviews.Arts, Faculty of
Psychology, Department of
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Farrelly, Robert. "Clients experinces of cognitive behavioural therapy." Thesis, University of Oxford, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.531832.
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Williams, Clare Anne. "Belief change in cognitive-behavioural therapy." Thesis, University of Southampton, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.326777.
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Germond, Sean Alan. "Rheumatoid arthritis : a cognitive-behavioural intervention." Master's thesis, University of Cape Town, 1991. http://hdl.handle.net/11427/13551.
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Bibliography: leaves 190-206.This study investigated both the mediating role of psychological adjustment in determining pain experience, disease · status, and immune function in Rheumatoid Arthritis (RA), and the value of cognitive-behavioural intervention in improving the overall health status of such patients. Two related hypotheses were tested in a matched-random assigned two-groups design, with pre-, mid-, and post-intervention assessment. Fourteen (N = 14) female RA outpatients, selected along established inclusion criteria, were allocated to either treatment (n=8) or control (n=6) groups after being matched on date of disease onset and ratings, of coping efficacy. The treatment group received an eight week Stress Inoculation and Pain Management Training programme (sixteen 2-hour sessions) based on the conceptual approach of Meichenbaum (1985) and adopted from a program by O'Leary, Shoor, Lorig and Holman (1988). The program included educational material, instruction in palliative and cognitive pain management strategies and the application thereof in daily living, goal setting to improve activity function, and group discussion. The program was designed to nurture and develop existing coping skills, and to impart new strategies to cope with daily stress and pain. Pre-intervention correlational analyses tested the extent to which mood disturbance, self-perceptions of coping efficacy, health locus of control and stressful life experience were related to intensity and quality of pain, disease activity, functional status and lymphocyte proliferation rate. Intra- and inter-group analyses were conducted to determine treatment effects in terms of change scores .on the dependent measures, and case studies were conducted to evaluate individual response both to disease and cognitive-behavioural intervention.
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Rimes, Katharine Amber. "Cognitive and behavioural processes in health anxiety." Thesis, University of Oxford, 1996. http://ora.ox.ac.uk/objects/uuid:249d20d8-b7c9-47a0-b207-3752105ac52e.
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In this thesis a cognitive-behavioural model of health anxiety is used to investigate the psychological effects of bone densitometry, a health test which can provide an indication of future risk for osteoporosis. The cognitive-behavioural model of health anxiety proposes that people will experience relatively high levels of anxiety about their health if they have a tendency to make particularly negative interpretations of bodily variations and information which may be relevant to health. It was therefore predicted that people who have a pre-existing tendency to worry about their health would react more negatively to the results of bone density measurement. Consistent with this prediction, after a low bone density ("high risk") result, women who reported high levels of pre-existing health anxiety gave higher ratings of anxiety about osteoporosis and perceived likelihood of developing osteoporosis in the near future than women with low levels of preexisting health anxiety. (The two groups did not differ significantly in these ratings before the scan). Differences in the reactions of women with high and low levels of pre-existing health anxiety were still apparent 14 months after the scan. Women receiving a low bone density ("high risk") result showed a "minimization" of the seriousness of low bone density; when individual differences were investigated, it was found that women with very high levels of pre-existing health anxiety did not show minimization. Furthermore, after a "low risk" result, women with high levels of health anxiety were only temporarily reassured. It thus appears that the new measure of health anxiety which was used in this thesis may be useful in helping to identify people who are vulnerable to experiencing distress after health screening. More specific pre-scan measures of beliefs about osteoporosis (derived from the cognitive-behavioural model) also predicted reactions to bone density screening. For example, pre-scan beliefs about the seriousness or burden of low bone density / osteoporosis were stronger predictors of anxiety about osteoporosis three months after the scan than the actual scan result. Factors such as the type of interpretation the woman makes of her scan result, and whether the woman is having her first or second scan, were also found to influence psychological reactions.
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Morland, Rebecca. "Expanding the cognitive behavioural perspective of psychosis." Thesis, City University London, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.434594.
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Jenkins, Hannah. "An exploration of cognitive behavioural therapy training." Thesis, Cardiff University, 2017. http://orca.cf.ac.uk/104375/.
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This thesis contains an exploration of Cognitive Behavioural Therapy (CBT) training. Paper one consists of a systematic review of 13 studies exploring the experience of CBT training. Findings were categorised into four themes; the exploration of Self-practice/Self-reflection, internal processes throughout CBT training, perceived effective components of CBT training, and general satisfaction with CBT training. Overall the findings concluded that CBT training is experienced in a relatively positive way, however, the journey can be difficult for students at times. The review revealed a clear gap in the literature regarding the general experience of CBT training, with no imposed focuses or pre-conceived themes. Implications for students, training course providers and commissioners are discussed. Paper two describes an empirical study conducted on eight students pre and post their postgraduate Diploma in CBT. Personal construct theory and the repertory grid technique were employed to capture students’ experience of training and their construal of their personal and professional development. Findings reported that whilst participants construed themselves as closer to ‘desirable’ elements post training, these differences were not statistically significant. A statistical difference was observed however, in participants’ perception of an ‘Ideal therapist’ post training. Implications for CBT training programmes are discussed and findings related to the political context both in Wales and the rest of the UK. Paper three presents a critical reflection and evaluation of the first two papers, including the authors’ personal reflections on the research process overall and her own experience of postgraduate, professional training in Clinical Psychology.
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Svensson, Idor. "Phonological dyslexia : cognitive, behavioural and hereditary aspects /." [Göteborg] : Dept. of Psychology, Göteborg University, 2003. http://catalogue.bnf.fr/ark:/12148/cb399169814.
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Borragan, Pedraz Guillermo. "Behavioural bases and functional dynamics of cognitive fatigue." Doctoral thesis, Universite Libre de Bruxelles, 2016. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/237311.
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La fatigue cognitive représente un phénomène auquel nous sommes tous familiers. Nous en faisons quotidiennement l'expérience, celle-ci étant associée à une réduction de productivité, une augmentation de risques professionnels et une diminution de notre qualité de vie. Malgré l’importance sociétale de ces implications, qui ont fait de l'étude de la fatigue cognitive une de plus investiguées dans le domaine des sciences cognitives, il subsiste un manque de vision commune ainsi qu'une théorie unifiée de la fatigue cognitive, déterminant son origine et ses fonctions, tandis que son caractère stochastique continue à diviser le milieu scientifique. La présente dissertation présente une approche multimodale combinant des données comportementaux et de neuroimagerie spectroscopie proche infrarouge (fNIRS) pour investiguer les facteurs à l’origine du déclenchement du phénomène ainsi que les dynamiques cérébrales associées. Nos résultats suggèrent que la fatigue cognitive ressentie associée à la chute de performance est une fonction de la charge cognitive définie par le Time Based Shared Resources Model (TBRS). Au niveau neural, nous discutons la présence des systèmes de compensation et les changements de connectivité cérébrale dans ce déclenchement. et comment les possibles mécanismes responsables de la maintenance de performance durant des demandes attentionnelles soutenues y sont associées.Doctorat en Sciences psychologiques et de l'éducation
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Haenen, Marie-Anne. "Hypochondriasis examining aspects of a cognitive-behavioural model /." [Maastricht : Maastricht : Universiteit Maastricht] ; University Library, Maastricht University [Host], 1998. http://arno.unimaas.nl/show.cgi?fid=8404.
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Newell, Robert. "Facial disfigurement and avoidance : a cognitive behavioural approach." Thesis, University of Hull, 1998. http://hydra.hull.ac.uk/resources/hull:3764.
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Mohd, Moklas Mohamad Aris. "Behavioural and cognitive effects of Delta-9-tetrahydrocannabinol." Thesis, University of Nottingham, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.441014.
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Sauvage, Magdalena. "Corticosteroids and cognitive function : behavioural and neuroanatomical studies." Thesis, Open University, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.247040.
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Rode, Sibylle. "Cognitive-behavioural factors in pain and health anxiety." Thesis, King's College London (University of London), 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.420273.
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Brown, Shona Lynsey. "Cognitive behavioural therapy for non-cardiac chest pain." Thesis, University of Edinburgh, 2013. http://hdl.handle.net/1842/9722.
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Objectives: This thesis aims to explore evidence for the effectiveness of cognitive behavioural therapy (CBT) for non-cardiac chest pain (NCCP). Design: The systematic review aimed to evaluate evidence for CBT as an effective intervention for anxiety in the NCCP population. Study one describes the chest pain characteristics, illness beliefs and prevalence of anxiety in a NCCP sample in a cross-sectional design. Study two explores the acceptability and clinical effectiveness of a CBT-based self-help intervention for NCCP patients, using a between subjects, repeated measures design. Methods: A systematic review was completed via a comprehensive literature search for comparative studies examining CBT-based interventions for NCCP including a measure of anxiety. In the empirical study, participants completed measures of anxiety, illness beliefs and indices of chest pain (self-reported frequency, severity and impact on activities) at baseline. Comparisons between illness beliefs and anxiety were undertaken using descriptive statistics and Pearson correlations. Participants were randomised to receive a CBT-based self-help intervention booklet or treatment as usual, with questionnaires re-administered at three-month follow-up. ANOVAs were used to evaluate whether the intervention led to improvements in anxiety levels, or increased belief in participants’ personal control of symptoms. Results: Ten studies met inclusion criteria for the systematic review, with four studies showing evidence regarding the effectiveness of CBT for anxiety. Approximately two thirds of the thesis research sample reported on-going pain following clinic attendance, for the majority this was ‘very mild’ or ‘mild’ pain. Almost half (47%) reported experiencing clinically significant anxiety. Stress was the most common causal attribution advocated by the sample to explain their chest pain. Anxiety scores were significantly associated with psychological attribution scores, but not with personal control or illness coherence beliefs. In study two, 87 participants completed the study and ITT analyses were completed on 119. There were no significant differences between the groups in terms of reduced anxiety or self-reported belief in personal control of symptoms. The intervention booklet was evaluated largely positively by those who reported reading it. Conclusions: CBT-based self-help appears an acceptable intervention for those diagnosed with NCCP. Further research is needed to identify those who are most likely to benefit from such self-help intervention.
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Linna, Sari J. "Therapist responsiveness in cognitive-behavioural therapy for depression." Thesis, University of Sheffield, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.680096.
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Valentim, Ana Maria Marques. "Behavioural effects of anaesthetics-risk of cognitive alterations." Doctoral thesis, Instituto de Ciências Biomédicas Abel Salazar, 2011. http://hdl.handle.net/10216/62271.
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Tully, Sarah. "The cognitive and behavioural consequences of psychotic experiences." Thesis, University of Manchester, 2017. https://www.research.manchester.ac.uk/portal/en/theses/the-cognitive-and-behavioural-consequences-of-psychotic-experiences(67902cbc-f19f-4ea6-a932-49b0f59675f8).html.
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This thesis explored the ways in which people experiencing psychosis respond to their distressing experiences. Mixed methodology was used to address the research questions. Chapter two included a thorough systematic review and meta-analysis to investigate the relationship between safety seeking behaviours and psychosis. This review concluded that safety seeking behaviours, avoidance and resistance were associated with increased distress whereas engagement was associated with reduced distress. The review also highlighted some conceptual difficulties with differentiating between safety seeking and coping in this population. Study one, a qualitative exploration of how people respond to the experience of psychosis is presented in chapter four. This study found three key themes relating to perceived importance of responses, accuracy of threat appraisals and perceptions of ability to control experiences. An overarching theme of fighting a daily battle to maintain functioning was also identified. This analysis provided some support for the model of safety seeking responses but also demonstrated additional complexities in the way that people respond to their distressing experiences. Chapter five presents study two, the development and validation of a measure of responses to psychosis. Principal Components Analysis identified three subscales: threat monitoring and avoidance, social control and reassurance seeking and conscious self-regulation attempts. The subscales were found to have good internal consistency and convergent validity. To build on this work, study three used Structural Equation Modelling to test an integrative cognitive and metacognitive model of voice hearing (chapter six). In support of this model, it was found that voice hearing predicted beliefs and beliefs predicted responses and negative affect. Responses were not predicted either by voice hearing or negative affect. It was also found that both schematic beliefs and meta-worry mediated the relationship between avoidance and negative affect. Finally, in study four, presented in chapter seven, the response styles of attentional avoidance and attentional focusing were manipulated in response to an ambiguous auditory task in an experimental study. It was found that the attentional avoidance response resulted in a significantly greater increase in words heard during the task. However, the manipulation did not have an impact on distress levels. This thesis has demonstrated significant relationships between response styles, distress, appraisals and voice hearing. This, therefore, confirms the important role of responses to unusual experiences in models of psychosis. It appears that avoidance is likely to be unhelpful however, it should not be assumed that other responses are either helpful or unhelpful as this is likely to be person and context specific. The clinical and research implications of this are discussed.
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Valentim, Ana Maria Marques. "Behavioural effects of anaesthetics-risk of cognitive alterations." Tese, Instituto de Ciências Biomédicas Abel Salazar, 2011. http://hdl.handle.net/10216/62271.
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Stubbings, Daniel R. "The effectiveness of videoconference-based cognitive-behavioural therapy." Thesis, Curtin University, 2012. http://hdl.handle.net/20.500.11937/2111.
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The purpose of this research was to expand scientific understanding regarding the use of videoconferencing technology to administer psychological services. The primary study in this thesis is a randomised-controlled trial comparing in-person to videoconference-based Cognitive-Behavioural Therapy (CBT). This study is, to the author’s knowledge, the largest clinical trial investigating the effectiveness of CBT via videoconference that has been conducted on an adult population in Australia. Twenty-nine clients were recruited who had a primary DSM-IV diagnosis of anxiety and/or depression. Participants were randomly assigned to receive 12 sessions of either in-person or videoconference-based treatment. Participants in both conditions received treatment at a university clinic in Perth Western Australia.The intervention provided was based on CBT manualised treatments but individualised to suit the unique needs of each client. Primary symptomology and quality of life was measured pre, post and 6-weeks following treatment. Secondary outcome measures included working alliance, credibility of therapy and client satisfaction. Overall, retention in both treatment conditions was similar. Statistical analysis using multi-level linear modelling indicated a significant reduction in client symptoms across time but no significant differences between treatment conditions. There were also no significant differences between conditions on working alliance, credibility of therapy and client satisfaction ratings. The findings of study one suggest that CBT via videoconference can be effectively provided in a real-world clinical practice context.The second study in this thesis is an in-depth case study of a client with severe and complex obsessive-compulsive disorder who received forty sessions of psychotherapy administered through a mix of videoconference and text-chat. Session recordings, transcripts and therapists notes were analysed using thematic analysis to explore how the technology influenced client engagement. The results indicated that the mixture of videoconferencing and text-chat might have facilitated client engagement by helping to reduce interpersonal anxiety, thus allowing the client to continue disclosing and discussing issues that were espoused in shame, guilt and embarrassment. To the author’s knowledge, the methods of engaging the client via combined videoconference and text-chat reported in study two have not been reported in the literature before.
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Currie, Shawn R. "Cognitive-behavioural treatment of insomnia secondary to chronic pain." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0010/NQ38779.pdf.
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Robichaud, Melisa. "Gender differences in worry and associated cognitive-behavioural variables." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp03/MQ54280.pdf.
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Marino, Alfonso. "Treating chronic insomnia, a cognitive-behavioural group therapy approach." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/NQ63577.pdf.
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Thomson, Lisa, and University of Lethbridge Faculty of Arts and Science. "Sickness-induced cognitive dysfunction : molecular, physiological, and behavioural correlates." Thesis, Lethbridge, Alta. : University of Lethbridge, Faculty of Arts and Science, 2004, 2004. http://hdl.handle.net/10133/623.
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Searson, Ruth. "Cognitive-behavioural therapy for bipolar disorder : a case series." Thesis, University of Manchester, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.505523.
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Bryant, Danielle Louise. "Developing optimism : a cognitive-behavioural intervention to reduce stress." Thesis, University of Edinburgh, 2011. http://hdl.handle.net/1842/7904.
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Optimistic explanatory style refers to the way in which individual’s routinely attribute cause to the events in their lives (Ambramson et al., 1978) and can be successfully enhanced through the use of cognitive behavioural therapy (CBT) group-based workshops (Buchanan et al., 1999; Seligman et al., 2007). It has been successfully measured via the self-report Attributional Style Questionnaire (ASQ: Peterson et al., 1982) and has been associated with better performance and lower levels of state anxiety following negative feedback (Martin-Krumm et al., 2003), a lower incidence of stress-related physical illness (Jackson et al., 2002; Buchanan et al., 1999), and lower levels of job-related emotional distress (Hershberger et al., 2000). In 2005, teaching was identified as the second most stressful job undertaken within the UK (Johnson et al., 2005) and two independent reviews of the teacher-stress literature both concluded that further research is required to develop effective stress-management interventions (Kyriacou, 2000; Jarvis, 2002). Furthermore, Jarvis (2002) specifically highlights CBT-based interventions as an avenue which requires research within the teacher-stress domain. In 2005, Bryant (unpublished MSc thesis) highlighted a link between optimistic explanatory style and lower levels of stress in student Physical Education (PE) teachers who were undergoing the practicum element of their one-year postgraduate diploma of education. The current thesis explored the effectiveness of a CBT-based optimism training programme in developing optimism and reducing stress in student and neophyte PE teachers. A longitudinal, repeated-measures, mixed methods design was employed in a naturalistic setting. Using a pre-test, intervention, post-test design, the effects of CBT-based training were shown to enhance optimism and positive affectivity, and reduce cognitive stress in student teachers during the practicum element of their professional training. To strengthen causal links, a dose-response design was used to provide enhanced training to a sub-group of student teachers. Although differences in optimism and perceived cognitive stress were present in the results, they were not significant. Finally, a qualitative interview based follow-up study identified that participants who had received the prolonged CBT-based optimism training exhibited higher levels of optimistic explanatory style, lower levels of stress and more dispositional optimism than participants who received either the initial or no optimism training. Theoretical and practical implications of the current findings and directions for future research are discussed.
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Ruobing, Shao. "The neural, cognitive and behavioural mechanisms of EGM play." Thesis, University of Oxford, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.568070.
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BACKGROUND: Electronic Gaming Machine (EGM) play may be particularly addictive. However, we know little about the relationships between near-misses, illusions of control, impulsivity and people's attitudes and behaviours towards the game, as well as changes in neural systems as people acquire more experience with EGM play. METHODS: Experiment 1 used the indirect Functional Magnetic Resonance Image (fMRI) technique to examine the neural signals of dopaminergic reinforcement circuitries evoked by playing a simple slot-machine among practiced participants who had previous game experience and unpracticed participants who had no such experience. Experiment 2 examined the influence of impulsivity and illusions of control on Blood Oxygen Level Dependent (BOLD) signals elicited by slot-machine outcomes. Experiment 3-5 investigated the effect of near-miss frequency on people's valuations of slot-machine games, indicated mainly by purchasing of optional plays, when co-occurring with different frequencies of wins. We also tested how the interactive influence of near-miss and winning frequencies on game valuations was associated with gambling-related cognitive biases. Experiment 3-5 also tested a novel card-guessing game designed to provide valid behavioural measure of illusions of control. RESULTS: Prior slot-machine experience was associated with shift of dopaminergic signals in the ventral striatum from the rewarding outcomes to the reel-spins. Impulsivity enhanced dopaminergic responses to wins but suppressed signals to near-misses. Illusions of control potentiated neural signals to near-misses in the practiced participants. Winning slot-machine outcomes exerted principle influence on game valuations, whereas the effect of near-misses was weak. However, some evidence indicated that the influence of near-miss frequency on game valuations depended on the frequency of wins. Individuals holding more positive gambling expectancies showed buying behaviours that were under less positive interactive influence of winning and near-miss frequencies. Our card-guessing game was successful in eliciting behavioural patterns indicative of illusions of control. CONCLUSIONS: A dopaminergic neural mechanism is implicated in the acquisition of slot-machine experience. Near-misses may not simply act as 'mini-wins'. The effect of near-misses on game valuation is subtle and may depend on the frequency of co-occurring wins.
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Otto, Philipp Erik. "Cognitive finance : behavioural strategies of spending, saving, and investing." Thesis, University College London (University of London), 2007. http://discovery.ucl.ac.uk/1444969/.
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Research in economics is increasingly open to empirical results. The advances in behavioural approaches are expanded here by applying cognitive methods to financial questions. The field of "cognitive finance" is approached by the exploration of decision strategies in the financial settings of spending, saving, and investing. Individual strategies in these different domains are searched for and elaborated to derive explanations for observed irregularities in financial decision making. Strong context-dependency and adaptive learning form the basis for this cognition-based approach to finance. Experiments, ratings, and real world data analysis are carried out in specific financial settings, combining different research methods to improve the understanding of natural financial behaviour. People use various strategies in the domains of spending, saving, and investing. Specific spending profiles can be elaborated for a better understanding of individual spending differences. It was found that people differ along four dimensions of spending, which can be labelled: General Leisure, Regular Maintenance, Risk Orientation, and Future Orientation. Saving behaviour is strongly dependent on how people mentally structure their finance and on their self-control attitude towards decision space restrictions, environmental cues, and contingency structures. Investment strategies depend on how companies, in which investments are placed, are evaluated on factors such as Honesty, Prestige, Innovation, and Power. Further on, different information integration strategies can be learned in decision situations with direct feedback. The mapping of cognitive processes in financial decision making is discussed and adaptive learning mechanisms are proposed for the observed behavioural differences. The construal of a "financial personality" is proposed in accordance with other dimensions of personality measures, to better acknowledge and predict variations in financial behaviour. This perspective enriches economic theories and provides a useful ground for improving individual financial services.
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Berry, Emma Louise. "Cognitive impairment in Parkinson's disease : behavioural and neuroimaging investigations." Thesis, University of Sheffield, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.340149.
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Williams, Amanda Clare de Coetlogon. "Cognitive-behavioural management of chronic pain : models and outcomes." Thesis, King's College London (University of London), 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.406221.
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Waite, Jane. "The behavioural and cognitive phenotype of Rubinstein-Taybi syndrome." Thesis, University of Birmingham, 2012. http://etheses.bham.ac.uk//id/eprint/3548/.
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In a series of studies, repetitive behaviour, executive function development and the links between these constructs were explored in Rubinstein-Taybi syndrome (RTS). An overview of these constructs provided evidence that executive dysfunction might underpin repetitive behaviour and justified the use of a developmental trajectory approach. Repetitive behaviour was explored in RTS in relation to Autism Spectrum Disorder (ASD), Down and Fragile-X syndromes. Body stereotypy and repetitive questioning occurred at a similar frequency in RTS and ASD, but repetitive phrases occurred less frequently in RTS. A test battery was compiled and administered to profile the developmental trajectories of executive functions in RTS relative to typically developing children. Executive function development was delayed in RTS relative to mental age. Finally, the relationships between executive function development and repetitive behaviour were explored in RTS using correlational analyses. Repetitive questioning was related to poorer scores on verbal working memory and inhibition measures. Adherence to routines was related to poorer scores on a measure of shifting and emotional regulation, and completing behaviour was related to poorer scores on shifting measures. These findings highlight the merit of studying executive function development in disorder groups and that pathways can be mapped between cognition and behaviour. The implications of these findings for research and practice are discussed.
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Wilde, Lucy Victoria. "The behavioural and cognitive phenotype of Smith-Magenis syndrome." Thesis, University of Birmingham, 2012. http://etheses.bham.ac.uk//id/eprint/3698/.
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Background: Attention-seeking and impulsivity are reported to be problematic in Smith-Magenis syndrome (SMS) and have been linked to other challenging behaviours including self-injury and aggression. However, limited research has directly examined these aspects of the SMS behavioural phenotype. Method: A survey study refined descriptions of atypical social behaviour. Two further studies directly observed social behaviour, in both naturalistic settings and structured social situations manipulating familiarity of interacting adults and level of attention. A final study evaluated whether response inhibition, measured using cognitive assessments, underpins impulsive behaviour in SMS. Results: Caregivers reported elevated ‘attachment’ to particular people, but not generally elevated sociability. Natural observations revealed preferences for adult attention and manipulations of social variables indicated preference for familiar adults. Impulsivity was not associated with inhibition deficits, however emotional control was. Conclusions: Reports of atypical social behaviour were supported, characterised by seeking attention from familiar adults. Associations between impulsivity and emotional control implicate specific deficits in delay of gratification (whereby delay causes aversive emotional responses). Considering these findings in an integrated model of the SMS behavioural phenotype, including pathways from genetic difference to behaviour and environmental influences, may facilitate targeted interventions for challenging behaviours.
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McKenna, Ian. "Cognitive behavioural therapies for social anxiety disorder (SAnD) review." Thesis, University of Exeter, 2013. http://hdl.handle.net/10871/13623.
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Background: Social anxiety disorder (SAnD) is a highly prevalent condition, characterised by an intense fear of social or performance situations where individuals worry about being negatively evaluated by others. An up to date systematic review of the effectiveness of cognitive behavioural therapies for SAnD is required to guide practice. Objectives: To assess the efficacy and acceptability of cognitive behavioural therapy (CBT) compared with treatment as usual/waiting list (TAU/WL) for individuals with SAnD. Search methods: We searched the Cochrane Depression, Anxiety and Neurosis Group (CCDAN) Controlled Trials Register and conducted supplementary searches of MEDLINE, PsycInfo, EMBASE, and international trial registers (ICTRP; ClinicalTrials.gov) in October 2011 and CINAHL in October 2012. We also searched reference lists of retrieved articles, and contacted trial authors for information on ongoing/completed trials. Selection criteria: Randomised and quasi-randomised controlled trials undertaken in out-patient settings, involving adults aged 18-75 years with a primary diagnosis of SAnD, assigned either to CBT or TAU/WL. Data collection and analysis Data on patients, interventions and outcomes were extracted by two review authors independently, and the Risk of bias in each study was assessed. The primary outcomes were social anxiety reduction (based on relative risk (RR) of clinical response and mean difference in symptom reduction), and treatment acceptability (based on RR of attrition). Results: Thirteen studies (715 participants) were included in the review, of which 11 studies (599 participants) contributed data to meta-analyses. Based on four studies, CBT was more effective than TAU/WL in achieving clinical response at post-treatment (RR 3.60, 95% CI 1.35 to 9.57), and on eleven studies (599 participants) it was more effective than TAU/WL in reducing symptoms of social anxiety. No significant difference was found between CBT and TAU/WL for attrition. No significant difference was demonstrated for social anxiety at follow-up and no studies examined follow-up data for clinical response or attrition. Authors' conclusions: The available evidence suggests that cognitive behavioural therapy might be effective in reducing anxiety symptoms for the short-term treatment of SAnD. However, the body of evidence comparing CBT with TAU/WL is small and heterogeneous.
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Prag, Anita. "Cognitive behavioural hypnotherapy and obesity : a single case study." Thesis, Stellenbosch : Stellenbosch University, 2007. http://hdl.handle.net/10019.1/18649.
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Thesis (MA)--University of Stellenbosch, 2007.ENGLISH ABSTRACT: This case-based research of Mrs K, a 39 year old, white woman who has been facing weight problems since the age of six sheds light on the effectiveness of a Cognitive-behavioural hypnotherapy intervention as an aid to weight loss and the enhancement of body image and satisfaction. Literature is provided to contextualise the research question and both a quantitative and phenomenological approach to conducting the research is employed in this case study. The results are also discussed from both these perspectives. The subject’s body image improved over the eight session period and she was better able to understand and challenge her food cravings. At the start of the program she experienced thirty two cravings a week and by session eight they had reduced to 10. It was also found that the frequency of her five main self defeating cognitions (monitored and reported weekly on a cumulative basis) decreased from one hundred and twenty-one to eighty-two. While her actual weight-loss was not significant, the intervention assisted in her overall sense of well being facilitating self acceptance. The phenomenological section of this paper partially follows a model conceptualised by Fishman (2005), one of the leading founders of the journal Pragmatic Case Studies in Psychotherapy (PCSP). He advocates that as part of the study a clinical assessment and formulation be included so as to elucidate the subject’s context. It was found that Mrs K had experiences in life relating to themes of unworthiness and inadequacy. These experiences could have thus impacted on her eating behaviours resulting in negative and self defeating diet patterns to develop.
AFRIKAANSE OPSOMMING: In die enkelgevalstudie met Mev. K., ̛n 39 jarige blanke vrou wat sedert sesjarige ouderdom ̛n gewigsprobleem het, word die effektiwiteit van ̛n kognitiewe gedragshipnoterapeutiese intervensie, met betrekking tot gewigsverlies, liggaamlike selfbeeld en satisfaksie ondersoek. Kwantitatiewe sowel as ̛n kwalitatief fenomenologiese metode is gebruik om die navorsingsdata te ontleed. Tydens die agt sessies van die program het die persoon se liggaamlike selfbeeld verbeter en was daar ̛n verbeterende ingesteldheid teenoor voedsel – eetlus en kon sy dit beter verstaan en beheer. Aan die begin van die intervensie het sy 32 eetbegeertes ervaar wat afgeneem het na 10 aan die einde van die program. Die frekwensie van haar vyf hoof negatiewe gedagte-patrone (weekliks gerapporteer op ̛n kumulatiewe basis) het van 121 na 82 verminder. Terwyl haar fisiese gewigsverlies nie statisties noemenswaardig was nie, het haar oorkoepelende gevoel van algemene gesondheid haar selfaanvaarding gefasiliteer. Die fenomenologies-kwalitatiewe navorsingsgedeelte is gebaseer op die model van Fishman (2005), een van die stigterslede van die Pragmatic Case Studies in Psychotherapy (PCSP) Journal. Hy voer aan dat ‘n kliniese ondersoek en formulering in die intervensie ingesluit word om sodoende die persoon se konteks beter te skets. Die volgende temas, naamlik minderwaardigheid en ontoereikendheid, is fenomenologies geïdentifiseer. Laasgenoemde belewinge (temas) het ̛n negatiewe invloed op haar dieetpatroon gehad.
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Frzina, Jasmina. "Clients' experiences of relational depth within Cognitive Behavioural Therapy." Thesis, University of Manchester, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.632306.
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Background: Relational depth (RD) is gaining empirical attention as a well-articulated phenomenon within therapeutic relationship literature. Despite this, with the exception of a small number of client-focused studies, research of this issue is relatively sparse and predominantly reflects upon therapeutic work from a person-centred orientation. Aims and Methods: The aim of this research was to explore clients’ experiences of RD within individual Cognitive Behavioural Therapy. Eight clients, who had self-identified at least one helpful relational moment with their therapist, were interviewed about their experience. The interviews were transcribed and analysed employing Grounded Theory methods. Findings and Discussion: Four core categories emerged from the analysis. These were: (1) the experience of the therapist, (2) the experience of self, (3) the experience of the therapy relationship, and (4) the perceived impact/effects of the moment of RD. Each core category and the corresponding subordinate codes are described by illustrative quotes from the participants. Following this, each finding is discussed in relation to RD research and beyond. Conclusions: This research project ultimately demonstrates that clients who have worked with a cognitive behavioural therapist can and do experience RD during their individual therapy. The like-by-like comparison of the findings with previous RD research indicated a high degree of convergence. Nevertheless, when differences are present, clients’ RD experience is influenced and to some extent contained by dissimilarity in experience between therapist and non-therapist clients. This is also manifested through theoretical differences of the given therapeutic approach. No negative impact or effect was described by the clients as a result of their experience of a moment of RD. The implications of the findings are highlighted and future research is suggested.
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Burchardt, Francis. "Client experience of the formulation within cognitive behavioural therapy." Thesis, University of Sheffield, 2004. http://etheses.whiterose.ac.uk/14860/.
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Section I: Literature Review A literature review examining the relationship between the formulation and the therapeutic alliance in cognitive behavioural therapy. Various 'definitions' of the formulation are reported, and the relative roles and merits of 'nomothetic' and 'idiosyncratic' formulations considered. The function of the formulation is considered in relation to its development in conjunction with the therapeutic relationship and alliance. Research and clinical case reviews are critiqued. Section II: Research Report An Interpretative Phenomenological Analysis of clients' experience of the formulation within cognitive-behavioural therapy. A sample of(N=8) of clients with depression and/or anxiety were interviewed following the 'acute phase' ofCBT during 'follow-up'. Interviews provided five master themes: Somebody that listened and understood - trust in therapist; Understanding what happens; A Foundation and Direction - Something to start from, something to work on; Working to a plan; and Effectiveness and Self -efficacy. These master themes and associated sub-themes represent clients' experience of progress through therapy and the experience and process of formulation. Section III: Critical Appraisal A critical appraisal describing the origin, planning and process of the research, personal reflection and experience gained.
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Thompson, Ralph Richard James. "Cognitive and behavioural indicators of animal and human emotion." Thesis, University of Bristol, 2015. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.684361.
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Emotions guide action in the light of evolutionary imperatives, and provide subjective meaning to experiences and events. The extent to which the range of emotional responses familiar to humans is shared with other species is unclear. This thesis aimed to further the comparative understanding of emotional states, and seek new tools for research into subjective emotion. This was achieved using experiments aimed at exploring induced emotional states in animals, including humans. Firstly, a novel test of anxiety-like affect was developed for three-spined sticklebacks. Based on scototaxis (dark preference) and novel tank diving, the successful use of this test indicates potential future utility across a range of fish species. It was used, along with open-field and novel-object tests, to assess sticklebacks' emotional responses to handling stress. These tests showed reduced preference for dark and deep areas of the tank, and reduced distance from the novel-object, following handling with a net rather than a scoop. Results indicate for the first time that acute stress can have an anxiolytic effect on fish. Handling stress was further used as an affect manipulation in development of a novel cognitive-bias test for fish. Human experiments explored potential mechanisms for manipulating cognitive and subjective components of mood independently. Evidence for an impact of viewing triangles of differing orientation was found on explicitly stated, but not implicitly measured, emotion. A test of facial interpretive bias was used along with subjective report to examine the effect of unpredictable (compared to predictable) sound presentation on anxiety. This found inconsistent effects on both cognitive bias and felt emotion, indicating that they are similarly sensitive to low level affect. The effects that were found included sex differences with greater responses in female participants. Results are discussed in relation to future work which could be carried out to distinguish conscious and nonconscious emotion.
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Hsu, Chun-Wei. "A behavioural and cognitive neuroscience investigation of deceptive communication." Thesis, University of Plymouth, 2018. http://hdl.handle.net/10026.1/11984.
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There is a rich literature on how people tell lies and detect them in others, but the underlying mechanisms are still poorly understood. The first aim of this thesis was to elucidate key cognitive and neural processes underlying cued (i.e., instructed) and uncued lies. The second aim, based on recent research suggesting a link between dishonesty and creativity, was to determine whether creative cognition contributes to deceptive communication. In a first behavioural study, performance on generating and detecting lies was measured in a socially interactive setting involving cued and uncued lies. Results of a multiple regression analysis showed that creativity predicted lying generation ability: more creative individuals were better liars than less creative people. In contrast, the ability to detect lies showed no association with creativity measures, suggesting that generating and detecting lies are distinct abilities. A second event-related potential (ERP) study investigated the neural mechanisms underlying the generation of uncued lies using a novel bluffing paradigm where participants lied at will. Results showed no stimulus-locked differences between uncued lies and truths, suggesting that decision processes leading to both required comparable cognitive resources. Once the uncued decision has been made, it requires strategic monitoring to keep track of the responses in order to maximize the gains regardless of whether the outcome is a lie or the truth as indexed by no response-locked differences between uncued lies and truths. Finally, parallel functional magnetic resonance imaging (fMRI) and ERP studies were conducted to determine the role of creativity in countermeasure use in a concealed information paradigm requiring cued lying. Results showed that countermeasures degraded the neural signatures of deception and more so for more creative individuals. This work advances understanding of the cognitive and neural mechanisms underlying deception as well as their dependence on individual differences in creative cognition.
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Brown, Amy. "The role of therapeutic alliance and early behavioural change during cognitive behavioural therapy for anorexia nervosa." Thesis, University of London, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.583368.
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Cognitive behavioural therapy (CBT) is often the treatment of choice for the outpatient treatment of anorexia nervosa. However, little is known about which elements of the therapy bring about change. This study explored two potential change processes: early therapeutic alliance and early behavioural change. In Study 1, the temporal relationship between therapeutic alliance and weight gain during CBT for anorexia nervosa was examined in a cohort of 65 adults with a diagnosis of anorexia nervosa (or atypical anorexia nervosa). Patients completed a measure of alliance at session 6 (early therapeutic alliance) and at the end of treatment. Early behavioural change was defined as weight gain over the first six sessions. Early therapeutic alliance was associated with neither the likelihood of completing treatment norwith subsequent weight gain. Thus, no evidence was found that therapeutic alliance is a process that brings about change during CBT for this client group. The data indicated that it was vice versa: behavioural change (measured by weight gain) was predictive of subsequent alliance strength. Treatment completers had made more early behavioural changes (measured by weight gain) compared to those who prematurely discontinued treatment, but early weight gain was negatively associated with later weight gain. In Study 2, 100 clinicians who deliver CBT for anorexia nervosa completed a survey that explored beliefs and clinical practice related to therapeutic alliance and early behavioural change. Responses indicated that clinicians consider both processes to be important change processes, with particular emphasis placed on early therapeutic alliance. The gap between the clinicians' perspective and the empirical findings of Study 1 are discussed, with reference to the potential influences of the existing evidence base and information processing errors.
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Raylu, Namrata N. "Testing a cognitive behavioural theory and treatment of problem gambling /." [St. Lucia, Qld.], 2005. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe18390.pdf.
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Aspland, Helen C. "Resolving ruptures in the therapeutic alliance in cognitive behavioural therapy." Thesis, University of Oxford, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.275191.
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Hansen, L. K. "The influence of cognitive-behavioural therapy on suicidality in schizophrenia." Thesis, University of Southampton, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.416492.
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Webber, Carolyn. "Cognitive and behavioural characteristics of children with Smith-Magenis syndrome." Thesis, University of Leicester, 1999. http://hdl.handle.net/2381/31285.
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The study aimed to identify behavioural and cognitive characteristics in 29 children with Smith-Magenis syndrome. Cognitive assessments were undertaken on the children, and detailed interviews assessing sleep patterns, maladaptive behaviours, self-injury, hyperactivity and autism were carried out with their parents and teachers. The study identified high levels of sleep problems, aggression, self-injury, distractibility and autism in the sample, in comparison with rates reported for other groups of children with learning disabilities. These were associated with high levels of stress in the parents. It is concluded that the combination of difficulties and abilities identified in the present sample of children with SMS is indicative of a behavioural phenotype for the syndrome, and that there is an urgent need for intervention studies on the challenging behaviours posed by this group of children.
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Brennan, Leah, and leah brennan@rmit edu au. "Cognitive behavioural evaluation and treatment of adolescent overweight and obesity." RMIT University. Health Sciences, 2006. http://adt.lib.rmit.edu.au/adt/public/adt-VIT20080130.141227.
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Despite increasing prevalence, significant negative biopsychosocial consequences, and few treatment options, overweight and obesity in adolescence has received very little attention in the scientific literature. The major objective of this research program was to evaluate the efficacy of a cognitive behavioural (CBT) program in the treatment of adolescent overweight and obesity. Sixty three overweight or obese adolescents (28M, 35F) aged 11.5 to 18.9 years (M = 14.41, SD = 1.85) participated in a randomized controlled trial evaluating the efficacy of a CBT weight loss intervention. This comprehensive intervention program incorporated a range of CBT techniques aimed at assisting adolescents to establish and maintain healthy eating and physical activity habits. Treatment resulted in improved body composition post treatment and sustained or improved body composition following maintenance. Participation in a motivational interview (MI) prior to this CBT intervention did not influence treatment outcomes. Despite reductions in weight and body fat, lean body mass was not affected by the intervention, thus, treatment did not detrimentally effect linear growth and lean body tissue. Poor compliance with measurement protocols limits conclusions that can be drawn regarding the impact of treatment on eating and activity habits. However, results suggest that treatment resulted in a reduction in fat consumption, reduced saturated fat intake, and reduced time spent in sedentary activities. Increases in physical activity were not evident. The treatment seeking sample did not report elevated psychopathology levels and treatment did not impact on adolescent depression, anxiety, or stress. Adolescents receiving treatment reported improvements in disordered eating relative to those in the control condition. A secondary aim of this research program was to redress the limited information available on the behavioural and psychosocial factors associated with adolescent overweight and obesit y. These factors were explored in community samples of adolescents (n = 161, M = 16.3, SD = I .8) and their parents, and young adults (n = 292, M = 19.7, SD = 2.0). In comparison to both normal and overweight adolescents, treatment seeking adolescents reported greater body dissatisfaction and weight. discontent. Body weight was not associated with psychopathology in the community samples and treatment seeking adolescents did not differ from normal or overweight adolescents from the community sample in terms of psychopathology. However, young adults who reported being overweight during childhood reported greater psychopathology as young adults. These findings suggest that excess weight in adolescence may have longer term rather than immediate effects on psychopathology. A number of family factors were associated with body weight in both adolescents and young adults. Combined, results indicated that CBT is efficacious in the treatment of overweight and obesity in adolescents and MI does not improve the efficac y of CBT. The current findings suggest that the impact of excess weight on psychosocial functioning is limited to body discontent and dissatisfaction in adolescence but is associated with increased psychopathology in early adulthood. Results also highlighted the importance of parents and family in the treatment of overweight and obesity in adolescents.
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Keter, Elinor. "A thematic cognitive behavioural intervention with depressed chronic pain patients." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape15/PQDD_0004/MQ32153.pdf.
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Jones, Marc Vincent. "Cognitive-behavioural interventions for the control of emotions in sport." Thesis, Coventry University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.267157.
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Levi, Nina. "The power of the therapeutic relationship in Cognitive Behavioural Therapy." Thesis, City University London, 2010. http://openaccess.city.ac.uk/8703/.
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As the Cognitive Behavioural Therapy (CBT) model has developed in recent years, so has the role of the therapeutic relationship within that model. This portfolio aims to uncover aspects of the therapeutic relationship in CBT as it is practiced nowadays. The first section presents an overview in which the different parts included in this portfolio are briefly described, and the way in which they are linked together is outlined. The second section, the research component, explores qualitatively Counselling Psychologists' experience of the therapeutic relationship while practicing CBT. This section aims to provide the reader with insights from the therapists' perspective, which has been a largely neglected variable in the literature. The third section represents the clinical component and gives a vivid account of CBT with a client with anger issues. Finally, the fourth section, the critical literature review, presents the role of empathy in the cognitive behavioural treatment of depression. As a whole, the portfolio provides a broad view of different perspectives of the therapeutic relationship in CBT, and aims to increase awareness among researchers and therapists of how the research findings can be of use for clinical practice.
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Bergman, Nordgren Lise. "Individually tailored internet-based cognitive behavioural therapy for anxiety disorders." Doctoral thesis, Linköpings universitet, Psykologi, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-100969.
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Fear is an innate emotion and an adaptive response to provide protection from potential harm. When fear is excessive and out of proportion in relation to the confronted situation, it can lead to the development of an anxiety disorder. Many individuals feel anxious at some point, but not all experience clinical anxiety or meet the diagnostic criteria of an anxiety disorder. Still, anxiety disorders are the most prevalent form of psychiatric disorder in the general population. More often than not people suffering from one anxiety disorder also present other psychiatric conditions. As of today, cognitive and behavioural treatments have been tested and found to positively affect anxiety disorders, making them the treatment of choice. Nevertheless, many patients do not seek or receive adequate treatment. One common critique of the research trials from which the recommendations for treatments stem is the use of a single protocol targeting only one diagnosis. This is because many people suffer from comorbidities. Another problem connected to the recommendation that cognitive behavioural therapy (CBT) should be the treatment of choice for anxiety disorders is the lack of therapists with adequate training. One possible way of dealing both with the shortcoming of therapists and making CBT more accessible is the use of the Internet. Internet-based CBT (ICBT) has been tested in numerous trials during the last 15 years, showing positive outcomes for a large variety of disorders. Many ICBT trials also make use of a single protocol. Another way of dealing with comorbidities might be to tailor the treatment to let characteristics and preferences of the patient guide the design of the protocol. Little is known about possible effects of tailoring the ICBT, the effects of therapeutic relationships in ICBT, and the effectiveness and cost-effectiveness of these treatments. This thesis is based on three studies on two separate randomized controlled trials (RCTs) using the same set of modules accessible for the tailored protocol. Study I was an RCT investigating treatment effects up to two-year after completion, showing favourable outcomes of the treatment in a self-recruited sample at all measure points. Study II was a secondary analysis exploring possible relations between working alliance and treatment outcome for participants in the treatment group recruited for Study I indicating that working alliance predict outcome in this tailored treatment. The second RCT was an effectiveness trial (Study III) analysing treatment effects and cost-effectiveness of the treatment up to one year post treatment in a primary-care population. This study showed positive treatment effects both regarding symptom reduction and cost-effectiveness, and that effects were sustained at one year post treatment. Conclusions drawn from these studies are that individually tailored ICBT seems to be a feasible approach for patients with anxiety disorders regardless of comorbidities, and a responsible choice in terms of societal costs.Rädsla är en medfödd känsla och en adaptiv respons för att skydda organismen från potentiell skada. När rädslan blir överdriven och oproportionerlig i relation till den konfronterade situationen, kan det leda till utvecklandet av ångestsyndrom. Många personer upplever någon gång ångest, men inte alla upplever klinisk ångest eller uppfyller de diagnostiska kriterierna för något ångestsyndrom. Trots detta är ångest det vanligaste psykiatriska tillståndet i befolkningen i stort och oftast uppfyller personer som lider av ett ångestsyndrom även andra psykiatriska tillstånd. Till dags dato har både kognitiva och beteendeinriktade behandlingar testats och visat sig verksamma vid ångestproblem, vilket gjort dem till de behandlingar som rekommenderas för dessa tillstånd. Trots god effekt av behandling söker många patienter ändå inte hjälp, alternativt erhåller inte adekvat behandling. En vanlig kritik mot den forskning från vilka behandlingsrekommendationerna för ångestsyndrom stammar är att många använt en manual eller ett protokoll som riktar sig mot bara en diagnos. Detta på grund av den stora komorbiditeten. Ett annat problem kopplat till rekommendationerna att kognitiv beteendeterapi (KBT) ska vara förstahandsval vid behandling av ångest är bristen på behandlare med adekvat utbildning. Ett möjligt sätt att göra KBT mer tillgängligt är att använda Internet. Internet- förmedlad KBT (IKBT) har prövats i ett stort antal studier de senaste 15 åren dessa har visat positiva resultat vid ett stort antal psykiatriska tillstånd. Flertalet av dessa studier har dock använt ett enda behandlingsprotokoll. En annan möjlighet att hantera komorbiditet kan vara att skräddarsy behandlingen för att låta patientens egenskaper och preferenser vara med och styra utformningen av behandlingsprotokollet. Möjliga effekter av att skräddarsy IKBT är relativt lite undersökt, likaså effekterna av terapeutiska relationer i IKBT samt klinisk effektivitet och kostnadseffektiviteten för dessa behandlingar. Denna avhandling bygger på tre studier från två randomiserade kontrollerade studier med samma uppsättning av moduler tillgängliga för att skräddarsy behandlingsprotokollen. I Studie I undersöktes behandlingseffekter upp till två år efter avslutad behandling i en självrekryterad grupp patienter. Studie II var en sekundäranalys av behandlingsgruppen från Studie I där eventuella samband mellan arbetsallians och behandlingsresultat undersöktes. Den andra randomiserade kontrollerade studien var en prövning av huruvida denna behandling var effektiv för en klinisk population (Studie III) rekryterad via primärvården. Förutom behandlingseffekter undersöktes även kostnadseffektiviteten upp till ett år efter behandlingsavslut. De slutsatser som dras utifrån dessa studier är att skräddarsydd IKBT verkar vara en framkomlig väg för patienter med ångest oavsett komorbiditet, att arbetsalliansen kan vara en faktor som påverkar utfallet, samt att det är ett ansvarsfullt val vad gäller samhälleliga kostnader.
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Rayment, Laura. "Treating the untreatable? : cognitive behavioural group work with criminal psychopaths." Thesis, University of Surrey, 2006. http://epubs.surrey.ac.uk/888/.
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