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Item Group treatment of anxiety-related insomnia using cognitive-behavioural therapy : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand(Massey University, 2013) de Lacerda Mottin, FernandaInsomnia affects 25% of the New Zealand population and up to 33% of the population worldwide. Untreated it incurs high economical costs to society and takes its toll on the people’s mental health, physical health, and quality of life. Psychological treatments for insomnia have developed over the decades to reflect the scientific literature’s knowledge about the causal and maintaining factors of insomnia (i.e., maladaptive behaviours and cognitions about sleep and the consequences of insomnia and physiological and cognitive arousal). The critical review found that although physiological and cognitive arousal play a significant role in the development and maintenance of insomnia and there is some evidence that anxiety disorders predict the development of insomnia, few published treatment programmes targeted all causal and maintaining factors as described in the literature. The current main clinical study investigated the effectiveness of a group therapy programme that targeted all the main factors described in the literature. Twenty-eight participants suffering chronic insomnia and at least subclinical anxiety or stress were randomly assigned to one of two treatment interventions, administered through five treatment groups. Each group had 5-6 participants. Two groups received the insomnia first intervention (n = 11) and three groups received the anxiety first intervention (n = 17). Within- and between-subjects analyses were performed. Follow-up assessment took place about three months after the end of each treatment group. The main study found that targeting anxiety (i.e., physiological and cognitive arousal) directly improved participants’ insomnia, t(1708) = 3.574, p <.001, d = .86. At three months post-treatment, both treatment conditions had large effect sizes on measures of insomnia severity (insomnia first d = 3.35; anxiety first d = 1.17) and sleep efficiency (insomnia first d = 1.09; anxiety first d = 1.17). However, in examining the outcome trajectories, the anxiety first intervention produced more consistent improvement across the course of the therapy sessions, which might be more desirable for both clients and clinicians. This study provided evidence that a cost-effective group intervention is beneficial for symptoms of insomnia and anxiety, and it also significantly improves participants’ quality of life. While some findings need replication (e.g., order of interventions), this study showed not only that insomnia can and should be treated, but also that its assessment and treatment must address anxiety as well as sleep. Given the high occurrence and co-morbidity of insomnia, and its detrimental effects for the individual and the society, psychological interventions for insomnia should be more readily available in New Zealand.Item Individuals' perspectives of causes and influences on their diagnosed anxiety disorders : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Albany, New Zealand(Massey University, 2013) Birrell, LynAnxiety disorders are the most common type of mental disorder in New Zealand, as they are in the Western world. However, little research has been done on how persons with anxiety disorder conceptualize their respective diagnoses. This small community based, qualitative study interviewed seven individuals diagnosed with anxiety disorders and tried to capture the content and complexity of their disorder. Volunteer participants responded to a flyer placed at an anxiety disorders clinic, located in Auckland, New Zealand. Participants included one male and six females, aged from mid 20 to early 40s. Criteria for participation included being diagnosed with an anxiety disorder by a health professional. Participants generally spoke in terms of their problems in living, as well as the development and course of their disorder. All participants reported that (1) their disorder was chronic and pervasive; (2) their condition was debilitating at times; (3) their condition was complicated by depression; and (4) dysfunction or disruption was present in their early family life. Most participants talked about the early onset of disorder. Recognizing and acting on the need for help was problematic for most participants. Thematic analysis was undertaken to best account for the data, which unfolded as a coherent, consistent and holistic narrative. Three common broad developmental themes were identified: traumatic early life, troubled school life and problems with living. Two broad themes were created to capture participants’ thoughts and feelings following diagnosis: rationalisation and post-rationalisation. Discussion specifically suggested the need for further research into the aetiology of anxiety disorders, including the role of maternal controlling behaviour and early onset of the disorder. Further research is also needed to understand and facilitate the help-seeking process for persons suffering from anxiety disorders. A need was identified for the accurate detection of anxiety disorders, particularly when masked by a presentation of depression or other symptoms. Findings suggest that a developmental/ social/contextual model may be most useful in conceptualizing and guiding prevention, intervention and treatment plans. In addition, the impact and meaning of the diagnostic event on people with anxiety disorders requires examination to fully understand all the dynamics and ramifications. Implications from this study include the need for initiatives to aid early recognition and generally to educate people about the nature of anxiety disorders, including the fact that they are common, serious and treatable.