PhD Thesis

Computerized Cognitive Behavior Therapy for Managing Panic Disorder in Bangladesh

2024-04-30T00:00:00Z

Computerized Cognitive Behavior Therapy for Managing Panic Disorder in Bangladesh Akhter, Saima Technological advancement has created an opportunity to demonstrate psychological service into another level of innovation to meet the need for accessibility. The objective of the present study was to assess the suitability of computerized cognitive behavior therapy (CCBT) for managing symptoms of panic disorder in Bangladesh. An exploratory sequential mixed method design was applied to achieve the objectives. In the first phase, a qualitative study was done to understand the most effective techniques and the nature of panic disorder in Bangladesh. The second phase was focused on developing the website with the integration of relevant experts. In the third phase, suitability was checked based on the findings of the quantitative study. The total number of enrollments in the first session was 64. Among them, 30 (51.56%) participants completed the entire session. They used the website fosr three to four months. Three standardized measurements were used to see the suitability. Those were the severity measure of panic disorder- adults, panic disorder severity scale, and anxiety scale. Besides, the satisfaction with the treatment scale was translated, and a checklist of subjective ratings for panic symptoms was developed from the finding of the desk review. CCBT significantly reduced the severity of the panic disorder, panic symptoms, and associated anxiety symptoms. The severity of panic symptoms changed significantly post-intervention (t=, p<.001). A significant change in post-intervention was also shown in the severity of panic disorder ((t=, p<.001). Besides these changes, the severity of anxiety level is also significantly changed ((t=, p<.001) in post intervention. Self-reported rating of symptoms also showed changes in cognitive symptoms, physiological reactions, emotions, and safety behaviors in the post-intervention phase. In the treatment satisfaction scale, Participants rated the CCBT package as credible and satisfactory regarding presentability, effective strategies, personal development, and program evaluation. Participants also criticized CCBT for the therapist's absence. This research also suggested areas of improvement, factors to maintain the program, and barriers to the availability of the service. An effective study, including follow-up sessions, is required to ensure further development of the CCBT package. This thesis submitted for the degree of Master of Philosophy.

Exploring attribution style and metacognitive process in borderline personality disorder

2024-04-25T00:00:00Z

Exploring attribution style and metacognitive process in borderline personality disorder Gayen, Tarun Kanti Introduction Borderline Personality Disorder is a complex mental health problem where affective instability and interpersonal relationship of the person is markedly disrupted. Various biological, developmental, psychological and contextual factors are indicated for this disruption along with other signs and symptoms of BPD. This study explored metacognition and attributional style in Borderline Personality Disorder (BPD). Both metacognitive ability and attribution style impacts an individual‘s quality of social interaction and mental health and these two have been found to be impaired in different psychiatric conditions including personality disorders. A comprehensive literature review identified some gap in knowledge regarding the role of these two variables in the cases of borderline personality disorder. Rationale: The present study is conceived to address the generic knowledge gap regarding the relation between cognitive constructs (such as, metacognitive process, and attribution style) (see Semerari, et al., 2014) as well as contextual knowledge gap from a low resourced Asian culture that is Bangladesh. Objective: The present study aims to understand the attribution style and metacognitive process in borderline personality disorder. To achieve this overarching objective, several specific objectives were formulated as follows: 1) To assess metacognitive skills in BPD; 2) To assess attribution styles in BPD; 3) To explore relation between different metacognitive skills and four BPD sectors of psychopathology that is to say, affective, interpersonal, behavioral and cognitive/self; 4) To explore the relation between internal, personal and situational attribution style and four sectors of BPD psychopathology that is to say, affective, interpersonal, behavioral and cognitive/self; 5) To explore relation between different metacognitive skills and attribution styles in BPD. Method Design: Mixed method sequential approach using both quantitative and qualitative methods was employed to investigate the objectives of the present research. Participants: 40 diagnosed with BPD and 40 screened as without BPD took part in the research. Both groups were matched on the basis of age (average age being bpd=25.96 years and normal =26.68 years), sex (male=31, female=9) and education (average years of education, bpd=13.72 years; normal=13.92 years). Inclusion and Exclusion Criteria: Status of diagnosis of BPD was the key inclusion criteria for the two groups of participants. While to be included in the Group 1 i.e., the BPD patient, the participants needed to have a confirmed diagnosis of BPD while to be included in the Group 2 i.e., the normal control, the participants needed to be screened out of BPD. Ethical clearance: For data collection ethical clearance was obtained from the respective Ethics Committees of the Department of Clinical Psychology, University of Dhaka and National Institute of Mental Health and Hospital, Bangladesh. Measures: The metacognitive self-assessment scale (MSAS) and Internal Personal and Situational Attribution Questionnaire (IPSAQ) were used to assess the metacognition and attributional style of the participants respectively. Both the scales were translated in bangla following the forward-backward translation procedures. Cronbach‘s alpha ranged between 0.623 and 0.830 for all MSAS subscales and for overall metacognitive function as measured behavioral and cognitive/self; 5) To explore relation between different metacognitive skills and attribution styles in BPD. Method Design: Mixed method sequential approach using both quantitative and qualitative methods was employed to investigate the objectives of the present research. Participants: 40 diagnosed with BPD and 40 screened as without BPD took part in the research. Both groups were matched on the basis of age (average age being bpd=25.96 years and normal =26.68 years), sex (male=31, female=9) and education (average years of education, bpd=13.72 years; normal=13.92 years). Inclusion and Exclusion Criteria: Status of diagnosis of BPD was the key inclusion criteria for the two groups of participants. While to be included in the Group 1 i.e., the BPD patient, the participants needed to have a confirmed diagnosis of BPD while to be included in the Group 2 i.e., the normal control, the participants needed to be screened out of BPD. Ethical clearance: For data collection ethical clearance was obtained from the respective Ethics Committees of the Department of Clinical Psychology, University of Dhaka and National Institute of Mental Health and Hospital, Bangladesh. Measures: The metacognitive self-assessment scale (MSAS) and Internal Personal and Situational Attribution Questionnaire (IPSAQ) were used to assess the metacognition and attributional style of the participants respectively. Both the scales were translated in bangla following the forward-backward translation procedures. Cronbach‘s alpha ranged between 0.623 and 0.830 for all MSAS subscales and for overall metacognitive function as measured behavioral and cognitive/self; 5) To explore relation between different metacognitive skills and attribution styles in BPD. Method Design: Mixed method sequential approach using both quantitative and qualitative methods was employed to investigate the objectives of the present research. Participants: 40 diagnosed with BPD and 40 screened as without BPD took part in the research. Both groups were matched on the basis of age (average age being bpd=25.96 years and normal =26.68 years), sex (male=31, female=9) and education (average years of education, bpd=13.72 years; normal=13.92 years). Inclusion and Exclusion Criteria: Status of diagnosis of BPD was the key inclusion criteria for the two groups of participants. While to be included in the Group 1 i.e., the BPD patient, the participants needed to have a confirmed diagnosis of BPD while to be included in the Group 2 i.e., the normal control, the participants needed to be screened out of BPD. Ethical clearance: For data collection ethical clearance was obtained from the respective Ethics Committees of the Department of Clinical Psychology, University of Dhaka and National Institute of Mental Health and Hospital, Bangladesh. Measures: The metacognitive self-assessment scale (MSAS) and Internal Personal and Situational Attribution Questionnaire (IPSAQ) were used to assess the metacognition and attributional style of the participants respectively. Both the scales were translated in bangla following the forward-backward translation procedures. Cronbach‘s alpha ranged between 0.623 and 0.830 for all MSAS subscales and for overall metacognitive function as measured by total MSAS score was 0.898. Cronbach‘s alpha for the IPSAQ Bangla from the current sample was 0.754. For qualitative part indepth interview was conducted following a topic guide, which were recorded and transcribed for analysis. Analysis: For quantitative part of the study, analysis of data comprised of both descriptive and inferential statistical procedure using SPSS. The analysis of qualitative part consisted of open coding, followed by focused coding and finally extracting of themes. Result Quantitative: Results showed that total metacognitve ability of the participants with BPD (M = 31.40, SD = 8.136) was found less than the total metacognitve ability of the participants without BPD (M = 42.07, SD = 5.070). An independent t-test showed that the difference between ability scores was significant and effect size was large (t = 7.042; df=65.326, p = 0.000, two-tailed, d=0.80). In all subscale scores of metacognition, viz., monitoring, integration, differentiation, decentration and mastery, with BPD was low compared to the without BPD sample, and the differences were significant in all sub-scales scores except decentration. As for Attribution style BDP group showed greater tendency towards internal attribution style for negative events than without BPD group and also attributed the cause of negative events to others and situational factors significantly less. As regards internalizing bias BPD group scored less and as regards personalizing bias, for with BPD and without BPD on average more than half the attributions for negative events were ascribed to other people which in other words is blaming others for negative events. Pearson Correlation among SCID score, Metacognition and Attributional Style scores were calculated. Total score on SCID of the BPD group has showed a significant negative correlation with Monitoring and Decentration; and affect domain on SCID has a significant negative correlation with Decentration. Whereas, SCID Interpersonal Sector has a significant positive correlation with Personalizing Bias. Other results inform about significant correlation between different metacogntive abilities with attribution style of the BPD. Thus Negative-internal attribution has negative correlation with Decentration and Mastery. Whereas, Negative-situational has positive correlation with Decentration and Mastery. On the other hand Personal Bias has significant negative correlation with Monitoring, Decentration and Mastery. All these correlations hint to BPD‘s characteristic thinking and behavior patterns, like self and other blaming, hostility and depression etc. As regards severity of BPD psychopathology, affective domain has found to be the highest followed by Interpersonal, behavioral and self/cognitive domains. Qualitative: Five core themes themes were extracted which were as follows: ―prioritization of emotion‖; ―thought emotion fusion‖; ―failed subtle communication‖; ―primacy of personal view‖; ―loop of self-criticism and rumination.‖ Discussion The findings gives a cognitive profile consisting of two significant variables that explains some difficulties of the borderline people in self and relational context. Qualitative findings have further supported and elucidated the findings. Findings of this study is supported in many ways by similar research for different disorders, and further the findings has implications for clinical intervention in BPD. Thus training the BPD patients on enhancing metacognitive skills and educating to deal with negative attribution style seem to have good prognostic outcome in BPD intervention. Limitation & Conclusion: Non-probabilistic sampling, small sample size, and drawing the sample only from urban, educated and middle and upper socioeconomic strata, are some limitations of the present study. However, being a research of first of its kind on Bangladeshi BPD population further studies addressing different aspects of metacognition and attribution is deemed necessary. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Clinical Psychology, University of Dhaka.

IMPACT OF TRAUMATIC BRAIN INJURY ON GENERAL RELATIONSHIP AND SEXUALITY

2023-11-23T00:00:00Z

IMPACT OF TRAUMATIC BRAIN INJURY ON GENERAL RELATIONSHIP AND SEXUALITY Hossain, Md. Shahanur Cognitive rehabilitation is the main focus within the traditional approach of Traumatic Brain Injury (TBI) management. To what extent post-TBI sexuality might be incorporated within this rehabilitation program, was the main focus of the current study. In order to investigate intimate relationships, sexuality and associated factors following TBI in Bangladesh, a total of 165 TBI patients, 53 intimate partners (IP) and 43 family members (FM) of TBI survivors were studied between October 2019 and December 2020. To compare the findings, 71 normal control (NC) sample was also recruited using an online survey. Mean age for TBI was 32 years and there were 156 males and 9 females. Mean age for NC was 36 years, and there were 42 males and 29 females. The TBI sample rated frontal system, relationship and sexuality questionnaires for themselves. The IP sample gave proxy ratings on frontal system and sexuality but self-rating on relationship and burden questionnaire. The FM sample gave self-ratings on burden and proxy ratings on the frontal system questionnaire. Compared to pre-injury levels, Post TBI intimate relationship satisfaction (IRS) significantly declined both for TBI [t (80)=3.71 , p< .001] and IP [t (49)=6.47 , p< .001] group. Current IRS of IP was significantly lower than that of the TBI group (p= .04) and NC group (p= .02). Current IRS of IP group was significantly correlated at the .01 level with the patient’s apathy [(A) r= -.424], disinhibition [(D) r=-.595], executive dysfunction [(ED) r=-.485], and theory of mind [(ToM) r=-.493]. Sexuality decreased among 49% of patients but also increased among 18%. Patients underwent neurosurgery experienced significantly more problems with sexuality [t (95.907) = -2.17, p = .038]. Compared to NC overall sexuality of TBI was significantly lower [t (164.97) = - 6.69, p <.001] and was significantly correlated with GCS (r=.337), cognitive ability (r=.355), A (r=.569), and ToM (r=-.404). Patients satisfied with sexuality showed significantly better prognosis on A (p<.001), ED (p=.002), ToM (p<.001), IRS (p=.01) and RTW (p=.008). Intimate partner’s level of burden was significantly correlated with patient’s sexuality (r=-.414) and behavior problems (r=.580). Therefore, the assessment, formulation and treatment of postTBI intimate relationships, sexuality and frontal system behavior problems should be undertaken within neurorehabilitation so as to promote quality of life and improve treatment prognosis. Thesis Submitted in partial fulfillment of the requirements for Doctor of Philosophy (PhD) in Clinical Psychology awarded by University of Dhaka.

Influence of parental rejection on borderline personality disorder

2023-10-11T00:00:00Z

Influence of parental rejection on borderline personality disorder Shahid, Shelina Fatema Binte Borderline personality disorder is a serious mental disorder that affects individuals' life adversely. An explanatory sequential mixed method research was employed to understand the influence of parental rejection on BPD in the Bangladesh context. The present study had two phases: Quantitative and qualitative phases. In quantitative phase 40 adult participants of diagnosed BPD patients were selected from the outpatient department of Psychiatry of five different hospitals and clinic of Bangladesh by purposive sampling technique. The researcher applied the Structured Clinical Interview for Diagnosis-II (SCID-II) - BPD questionnaire, a demographic questionnaire, and Adult version of Parental Acceptance-Rejection Questionnaire (PARQ) for Father and Mother on BPD patients. Result showed that 67.5% participants faced rejection from both parents and 32.5% faced rejection from at least one parent. Results also showed, maternal (r = .304, p = .028) and paternal (r = .210, p = .044) rejection were positively correlated with BPD. The hostility of mother was also significantly correlated with BPD (r = 0.489, p = .001). R 2 = .239 indicated 23.9% of the variance in BPD severity can be explained by mother’s hostility [F (1, 38) = 11.960; p < .001]. From quantitative phase, 22 participants were selected purposively for the next qualitative phase. A semi-structured in-depth interview was undertaken. The grounded theory approach was used to analyze the data through open coding, axial coding, and selective coding and data were analyzed by Nvivo-10 software. Qualitative findings explored 65 different types of subjective experiences of perceived parental rejection that are associated with BPD. Seven broad behavioral patterns of parents were explored that directly influence the development of BPD from the participants' perspectives. The behavioral patterns were authoritarianism, hostility, neglect, lack of affection, lack of validation, lack of acceptance and lack of protection. A theoretical model was developed that explain the process of BPD development due to parental rejection. Overall findings suggested that perceived parental rejection might have made an influence on BPD development. Employing the findings, mental health service providers might become aware of the parent's role about one of the risk factors of BPD that might contribute as a preventive measure. This Dissertation submitted for the Degree of Doctor of Philosophy in Clinical Psychology, Department of Clinical psychology, University of Dhaka.