School refusal is an attendance problem characterized by a young person’s difficulty in going to school, accompanied by emotional distress on the part of the young person and parental attempts to... Show moreSchool refusal is an attendance problem characterized by a young person’s difficulty in going to school, accompanied by emotional distress on the part of the young person and parental attempts to return the young person to regular school attendance. Prolonged absence from school has serious short- and long-term consequences for young people, their families, and schools. Therefore, effective treatment of school refusal is essential. Numerous treatment outcome studies provide evidence for the efficacy of cognitive-behavioural therapy (CBT) for school refusal. Previous research has however indicated that adolescent school refusers may be particularly disturbed and harder to treat. An existing treatment for school-refusing children and adolescents was modified to better account for the impact of developmental variables on engagement in treatment. The studies presented in this dissertation describe the preparation, implementation, and evaluation of the resulting developmentally-appropriate CBT for adolescent school refusal. The treatment was associated with increased school attendance, reduced emotional symptoms, and increased adolescent and parental self-efficacy. Exploratory analyses revealed that several developmental factors were related to treatment outcomes, namely clinician developmental appropriateness, insight, and autonomy. Recommendations for research and clinical practice are made on the basis of these findings, and on the methodological strengths and limitations of the current research. Show less
This thesis describes the outcomes of a randomized controlled trial of a Cognitive Behavioural Therapy (CBT) intervention for patients who engage in Deliberate Self-Harm (DSH). The CBT intervention... Show moreThis thesis describes the outcomes of a randomized controlled trial of a Cognitive Behavioural Therapy (CBT) intervention for patients who engage in Deliberate Self-Harm (DSH). The CBT intervention was designed to supplement usual care following an episode of DSH. The study involved 90 people (95% females), aged 15–35 years, who were randomly assigned to CBT in addition to treatment as usual (TAU) or to treatment as usual only. The main study hypothesis, that CBT in addition to TAU would be more effective in reducing repetition of DSH than TAU only, was supported. Furthermore, those who received CBT in addition to TAU were shown to have significantly greater reductions in depression, anxiety and suicidal cognitions, and significantly greater improvements in self-esteem and problem solving ability. It is reasonable to assume that these positive findings are attributable to the effect of the CBT, given the random assignment as well as the absence of between group differences with respect to demographics, DSH, history of DSH, psychopathology and use of health care services. It is encouraging that these results are found for people with recurrent and chronic DSH, with high risk of repetition, and with high levels of psychiatric co-morbidity. Show less
