Beating the blues after cancer : randomised control trial of a tele-based psychological intervention for high distress patients and carers

Background : The diagnosis and treatment of cancer is a major life stress such that approximately 35% of patients experience persistent clinically significant distress and carers often experience even higher distress than patients. This paper presents the design of a two arm randomised controlled trial with patients and carers who have elevated psychological distress comparing minimal contact self management vs. an individualised tele-based cognitive behavioural intervention.

Methods/design : 140 patients and 140 carers per condition (560 participants in total) will been recruited after being identified as high distress through caller screening at two community-based cancer helplines and randomised to 1) a single 30-minute telephone support and education session with a nurse counsellor with self management materials 2) a tele-based psychologist delivered five session individualised cognitive behavioural intervention. Session components will include stress reduction, problem-solving, cognitive challenging and enhancing relationship support and will be delivered weekly. Participants will be assessed at baseline and 3, 6 and 12 months after recruitment. Outcome measures include: anxiety and depression, cancer specific distress, unmet psychological supportive care needs, positive adjustment, overall Quality of life.

Discussion : The study will provide recommendations about the efficacy and potential economic value of minimal contact self management vs. tele-based psychologist delivered cognitive behavioural intervention to facilitate better psychosocial adjustment and mental health for people with cancer and their carers.

Enablers and barriers to accessing mental health services for adults with high prevalence psychological disorders in South West Victoria

Knowing what services are available and how to access them can be challenging in rural areas. The aim of the South West Mental Health Mapping project was to identify the level, accessibility and effectiveness of mental health services for high prevalence psychological disorders amongst the adult population in the South West region of Victoria. This study includes data from a number of sources: regional records of the number and location of health professionals; a telephone survey of 1297 people in five Local Government Areas in the region; and a social network analysis of contact points. Additional qualitative interviews and surveys were conducted with 25 service recipients and 37 health professionals to identify issues from different perspective. This paper will focus on the social network analysis of the project. It highlights the relative prominence of each type of service provider within the overall network. The social network map shows the centrality of the General Practitioner and the wide range of agencies that become involved in supporting people with mental health issues. The discussion identifies primary contact points for people seeking help and places of referral. The main barrier acknowledged by people requiring assistance was lack of knowledge about where to go for help. Enablers included Medicare Better Access funded schemes. The findings show that there is a reasonable range of mental health professionals across the region, although there are challenges with recruitment and retention of staff. Even with available services, a major problem is communicating this information to potential consumers

Extreme surfing : personal and psychological aspects of big wave riders

This qualitative study investigated personal and psychological aspects of big wave riders. A cross-sectional design with non probability purposive sampling was used to gain personal interviews with 32 elite surfers who regularly ride big, life threatening waves. Each athlete was asked three open questions: 1. What do you think are the most important qualities and attributes a surfer needs for riding big waves? 2. What type of mindset is best for riding big waves?, and 3.What motivates you to ride big waves? Content analysis of the taped interview transcripts revealed seven key qualities and attributes including having a thrill seeking, confident and goal oriented personality, a high level of mental strength and control, and an intimate relationship with the ocean. The best mindset included an individually defined arousal level, a committed attitude, and a simple, yet highly aware, focus. Motivations were primarily intrinsic, though drives indicative of a behavioral addiction to the act of riding big waves also emerged. Evidence of common developmental stages for riding big waves also arose from the interviews. Optimal mental approach and preparation techniques are discussed that will enable big wave riders, and other extreme athletes, to more safely and successfully manage extreme situations.

Australia's strengths and weaknesses in technology transfer and R&D exploitation : GEM survey "experts" views compared with public policy and other published data

There has been increasing public debate in Australia in recent years about research culture in universities and other publicly funded research agencies such as CSIRO and its impact on Australia's performance in generating economic, social and environmental benefits to the Australian community from the large amount of public funding for R&D. This is the supply side issue. On the demand side there is equally concern about the technology absorptive capacity of Australian. business as illustrated by the low proportion of gross business research expenditure (GERD) spent by business (BERD). Against this background, this paper has explored the views of abut 100 "experts" interviewed in the Australian Global Entrepreneurship Monitor (GEM) studies in the years 2000, 2001, 2002 and 2003 on the issues, strengths and weaknesses of Australia's technology transfer performance as it applies to new technology small firms. The paper has also explored evidence for any longitudinal change over this period.

Association between weight perception and psychological distress

Background: Obesity is a well-known cause of cardiovascular disease burden and premature death, but effects on depressive symptoms remain equivocal. Depressive symptoms may be more common among the obese individuals who perceive themselves as overweight, rather than those who perceive themselves as having an acceptable weight. Our aim was to determine whether weight status and weight perceptions are independently associated with psychological distress.

Methods: We conducted a cross-sectional study using data from the Australian National Health Survey 2004–2005 (N=17 253). All variables were collected by self-report. Adjusted multinomial logistic regression analysis was conducted to generate prevalence odds ratios with 95% confidence intervals (95% CI) for medium (Kessler Psychological Distress Scale (K10) scores of 20–29) and high (K10 scores of 30–50) psychological distress (compared with K10 scores of 10–19 as the reference) associated with weight status (standard body mass index (BMI) cutoffs for underweight, overweight and obesity vs normal weight), weight perception (perceived underweight and overweight vs acceptable weight) and weight misperception (incorrect with BMI vs correct with BMI) adjusting for numerous important covariates.

Results: Overweight and underweight perception increased the odds of medium (40 and 50%) and high (50 and 120%) psychological distress, whereas weight status and weight misperception were not associated with psychological distress in adjusted analysis. Gender, alcohol consumed per week and post-school education were not significant covariates (at P<0.10 level).

Conclusions: Overweight and underweight perception rather than weight status or weight misperception are significant risk factors associated with medium and high psychological distress prevalence and effects appear to be uniform for men and women. Well-designed prospective studies are still needed to determine whether weight perceptions cause psychological distress, and if so, whether symptoms are significantly reduced following effective intervention.

Microstructures and bond strengths of the calcium phosphate coatings formed on titanium from different simulated body fluids

Calcium phosphate (Ca-P) coatings were deposited on Ti substrates by a biomimetic method from m-SBF and 10× SBF, respectively. Comparative study of microstructures and bond strengths of the Ca-P coatings deposited from those different SBFs was carried out. Effect of the surface roughness of the substrates on the bond strength of the Ca-P coatings was also studied. Scanning electron microscopy (SEM), X-ray diffractometry (XRD), Fourier transformed infrared spectroscopy (FTIR), inductive coupled plasma spectrometry (ICP) and thermogravimetry (TG) were used to characterize the Ca-P coatings. The bond strengths between the coatings and Ti substrates were measured using an adhesive strength test. Results indicated that the ionic concentrations of the SBFs and the surface roughness of the substrate had a significant influence on the formation, morphology and bond strength of the Ca-P precipitates. The induction period of time to deposit a complete Ca-P layer from the m-SBF is much longer, but the Ca-P coating is denser and has higher bond strength than that formed from the 10× SBF. The Ti with a surface roughness of R_a 0.64 µm and R_z 2.81 µm favoures the formation of a compact Ca-P coating from the m-SBF with the highest bond strength of approximately 15.5 MPa.

Police stress : the role of psychological contract and perceptions of fairness

Purpose – The overall purpose of this paper is to examine the extent to which breaches in psychological contracts and perceptions of organizational fairness account for variations in job stress experienced by operational police officers (as measured by psychological distress and employee performance), after controlling for the variance associated with more established job stressors (i.e. job demands, job control and social support).

Design/methodology/approach – This study is based on data collected through a self-report survey involving operational members of a large Australian police force (n=582).

Findings – Results of hierarchical multiple regression analyses indicate that vast majority of explained variance in psychological distress and extra-role performance is attributed to the additive effects of demand, control, and support. Furthermore, only one of the social exchange dimensions (interpersonal fairness) is predictive of either target variable.

Research limitations/implications – The limitations that need to be taken into account are the cross-sectional nature of the study design and the focus on a single police service.

Practical implications – Despite the generally weak support for the social exchange variables, there are signs that dimensions of justice (particularly interpersonal justice) should be included in future police-stress investigations. The results also suggest that job characteristics such as job demand, job control and social support should be taken into account when developing strategies to prevent and/or reduce chronic job stress in policing services.

Originality/value – This is one of the first studies to examine the relationships between psychological contract breach, perceptions of fairness and police stress.

Should partial least squares be used for analysing psychological constructs?

This paper critically examines an analytical tool - partial least squares regression, or P LS - that is increasingly being used in the academic business literature to validate measures of psychological constructs, and to test hypotheses based on these. The paper provides a contextual and historical review of the resurgence of P LS, and explores several of the claims made by its developers and supporters when it was first promoted in the 1980s, and, more recently, when it reappeared in the information systems literature. Many claims appear plausible but rest on non-mainstream uses of terms and concepts taken from the psychometric field. The paper also canvasses why P LS is a poor analytical tool for research that involves psychological constructs.

Guideline-based programs in the treatment of complex PTSD

The term “post-traumatic stress disorder” (PTSD) is a relatively new diagnostic label, being formally recognized in 1980 in the Diagnostic Statistical Manual for Psychiatric Illness – Third Edition (DSM-III) of the American Psychiatric Association (APA, 1980). Complex Post-Traumatic Stress Disorder (CP) is a more recently discussed, and newly-classified, phenomenon, initially discussed in the early 1990s (Herman, 1992a). Thus, as research into effective treatments for CP is sparse, the treatment of CP is the topic of this study, in which a guideline-based treatment program developed by the researcher for the treatment of CP is implemented and evaluated. Ten individuals participated in this study, undertaking individualized, guideline-based treatment programs spanning a period of six months. In providing background information relevant to this study, an explanation is provided regarding the nature of CP, and the reasons for its consideration as a separate phenomenon to PTSD. The adequacy of the PTSD formulation in enabling effective assessment and treatment of CP is also explored, with endorsement of previous researchers’ conclusions that the CP construct is more useful than the PTSD construct for assessing and treating survivors of long-term and multiple forms of abuse. The PTSD classification is restrictive, and not necessarily appropriate for certain forms of trauma (such as prolonged trauma, or multiple forms of trauma), as such trauma experiences may lead to specific effects that lay outside those formerly associated with PTSD. Such effects include alterations in affect regulation, consciousness, self-perception, interpersonal relationships, and in systems of meaning. Following discussion regarding the PTSD/CP classification, an examination of treatment methods currently used in the treatment of PTSD, and a review of treatment outcome studies, takes place. The adequacy of primary treatment methods in treating CP symptoms is then examined, with the conclusion that a range of treatment methods could potentially be useful in the treatment of CP symptoms. Individuals with a diagnosis of CP may benefit from the adoption of an eclectic approach, drawing on different treatment options for different symptoms, and constantly evaluating client progress and re-evaluating interventions. This review of treatment approaches is followed by details of an initial study undertaken to obtain feedback from individuals who had suffered long-term/multiple trauma and who had received treatment. Participants in this initial study were asked open-ended questions regarding the treatment approach they had experienced, the most useful aspect of the treatment, the least useful aspect, and other strategies/treatment approaches that may have been useful – but which were not used. The feedback obtained from these individuals was used to inform the development of treatment guidelines for use in the main study, as were recommendations made by Chu (1998). The predominant focus of the treatment guidelines was “ego strengthening”, a term coined by Chu (1998) to describe the “initial (sometimes lengthy) period of developing fundamental skills in maintaining supportive relationships, developing self-care strategies, coping with symptomatology, improving functioning, and establishing a positive self identity” (p.75). Using a case study approach, data are then presented relating to each of the ten individuals involved in the treatment program: details of his/her trauma experience(s)and the impact of the trauma (as perceived by each individual); details of each individual’s treatment program (as planned, and as implemented); post-treatment evaluation of the positive and negative aspects of the treatment program (from the therapist’s perspective); and details of the symptoms reported by the individual post-treatment, via psychometric assessment and also during interview. Analysis and discussion of the data relating to the ten participants in the study are the focal point of this study. The evaluation of the effectiveness of each individual’s treatment has been based predominantly on qualitative data, obtained from an analysis of language (discourse analysis) used by participants to describe their symptoms pre- and post-treatment. Both blatant and subtle changes in the language used by participants to describe themselves, their behaviour, and their relationships pre- and post-treatment have provided an insight into the possible changes that occurred as a result of the treatment program. The language used by participants has been a rich source of data, one that has enabled the researcher to obtain information that could not be obtained using psychometric assessment methods. Most of the participants in this study portrayed notable changes in many of the CP symptoms, including being more stable and having improved capacity to explore their early abuse. Although no direct cause-effect relationship between the participants’ treatment program and the improvements described can be established from this study, the participants’ perception that the program assisted them with their symptoms, and reported many aspects of “ego strengthening”, is of major importance. Such self-perception of strength and empowerment is important if an individual is going to be able to deal with past trauma experiences. In fact, abreactive work may have a greater chance of succeeding if those who have experienced long-term or multiple trauma are feeling more empowered, and more stable, as were the participants in this study (post-intervention). In concluding this study, recommendations have been made in regard to the use of guideline-based treatment programs in the responsible treatment of CP. Strengths and limitations of this study have also been highlighted, and recommendations have been made regarding possibilities for future research related to CP treatment. On the whole, this study has supported strongly other research that highlights the importance of focusing on “ego strengthening” in assisting those who have suffered long-term/multiple trauma experiences. Thus, a guideline-based program focusing on assisting sufferers of long-term trauma with some, or all, of the symptoms of CP, is recommended as an important first stage of any treatment of individuals who have experienced long-term/multiple trauma, allowing them to develop the emotional and psychological strength required to deal with past traumatic events. Clinicians who are treating patients whose history depicts long-term or multiple trauma experiences (either from their childhood, or at some stage in their adult life) need, therefore, to be mindful of assessing individuals for symptoms of CP – so that they can treat these symptoms prior to engaging in any work associated directly with the past traumatic experiences.

Relationship between analysis and insight in Mādhyamika Buddhism (a logico-psychological model)

This thesis investigates the relationship between analysis and insight in Prasarigika Madhyamika Buddhism. More specifically it asks whether analysis is a necessary and/or a sufficient condition for the generation of insight. The thesis is divided into six chapters which include an introduction, an appendix which outlines Prasangika and Svatantrika views regarding the syllogism (svatantra) and a conclusion. The remaining chapters seek to demonstrate that analysis for the Prasarigika and the Tibetan Geluk-ba school is a necessary, but not a sufficient condition for the arising of insight. Chapter one is an investigation of certain Western psychological theories which deal with the effects on the mind of cogitating upon contradictions. Though the psychological theories are only suggestive, this chapter will lend support to the claim a) of the Prasaiigika, that analysis generates an altered state of consciousness; and b) that analysis may be a necessary and sufficient condition for the generation of insight. Chapter two seeks to construct a logico-psychological model of how insight is generated. In this model it is argued that insight is a conceptual and intuitive experience: i.e. non-inferential, and that all thought comes via the intuition. This model argues that analysis is a necessary, but not a sufficient condition for the generation of insight. In chapter three an investigation of the writings of Dzong-ka-ba (Tsong-Kha-pa) is undertaken in order to ascertain how the Tibetan Geluk-ba (dGe lugs pa) school regard the relationship between analysis and insight. The model of chapter two will be compared with the Tibetan Geluk-ba accounts to gauge its explanatory power and correspondence with the Geluk-ba views. Chapter four is an investigation of the writings of certain Western scholars. This investigation seeks to ascertain how these scholars may have regarded the relationship between analysis and insight. The chapter then compares these views with the model developed in chapter two.

Employee psychological contracts

This thesis concerns the psychological contracts of employees. A psychological contract is an employee’s perception that: 1) an employer has certain obligations to them, and 2) in return, they have obligations as employees. A psychological contract is therefore a set of subjectively perceived reciprocal obligations. The psychological foundations of this construct are linked with cognitive schemas and social exchange theories. While the concept of psychological contracts was first proposed in the early 1960s, it has only been operationalised for empirical study in the last decade. The purpose of the thesis was to increase the understanding of the content and structure of employee psychological contracts and their links with career cognitions. The specific aims of the thesis were to: 1) examine the relational-transactional dimensions of psychological contracts, 2) develop a comprehensive set of workplace obligations for use with employees, 3) consider alternative dimensions of employee psychological contracts, 4) demonstrate reciprocity between obligations, and 5) determine whether psychological contracts directly affect career cognitions. The thesis contains four quantitative studies. Data were collected using self-report questionnaires that contained both established and new measures. Most participants were employees from a large insurance company, government vocational services or educational institutions. The analyses included canonical correlation, factor analysis, development of measurement models and structural analysis. The findings did not strongly support a distinction between relational and transactional obligations. Instead, a five-factor model of psychological contracts emerged from an expanded set of workplace obligations when it was used with two separate employee samples. This model demonstrated reciprocal relationships between the dimensions of employee and employer obligations. It was also found that alternative dimensions of the psychological contract have a direct influence on organisational commitment and career satisfaction. The thesis supports several general conclusions about the nature of employee psychological contracts, appropriate measures and future research. General workplace obligations that apply across different workplaces can be found, and these should continue to be refined. Such workplace obligations group in meaningful ways, and they can be usefully studied in terms of employer support and employee attitudes to work, rather than in terms of relational and transactional dimensions. Furthermore, this thesis shows that reciprocity in psychological contracts can be demonstrated by correlations between dimensions of employee and employer obligations. The measure used for studying reciprocity was new, and it requires further work. However, this measure is as reliable and valid as any currently available. Measurement is the single most urgent issue facing researchers. Finally, this thesis provides sufficient empirical evidence to support the claim that psychological contracts are an important variable for the understanding of careers.