http://hdl.handle.net/2123/345 Search the Channel search http://ses.library.usyd.edu.au/simple-search http://hdl.handle.net/2123/5734 Title: The impact of nature of onset of pain and posttraumatic stress on adjustment to chronic pain and treatment outcome<br/><br/>Authors: Tadros, Margaret<br/><br/>Abstract: Despite the demonstrated efficacy of cognitive-behavioural therapy for chronic pain, recent research has attempted to identify predictors of treatment outcome in order to improve the effectiveness of such treatments. This research has indicated that variables such as the nature of the onset of the pain and psychopathology are associated with poor adjustment to chronic pain. Accordingly, these variables might also be predictive of poor response to treatment. Individuals who experience a sudden onset of pain following an injury or accident, particularly when the instigating event is experienced as psychologically traumatic, may present for treatment with high levels of distress, including symptoms consistent with a posttraumatic stress response. The impact of this type of onset of pain and posttraumatic stress symptoms on adjustment to chronic pain and treatment outcome is the focus of this thesis. Three studies were conducted to clarify and extend earlier research findings in this area. Using 536 patients referred for treatment in a tertiary referral pain management centre, the first study examined the psychometric properties of a widely used self-report measure of posttraumatic stress symptoms (the PTSD Checklist, or PCL), modified for use in a chronic pain sample. This study provided preliminary support for the suitability of the PCL as a self-report measure of Posttraumatic Stress Disorder (PTSD) symptoms in chronic pain patients. However, the study also highlighted a number of issues with the use of self-report measures of posttraumatic stress symptoms in chronic pain patient samples. In particular, PCL items enquiring about symptoms which are a common aspect of the chronic pain experience (e.g. irritability, sleep problems) appeared to contribute to high mean scores on the PCL Avoidance and Arousal subscales. Furthermore, application of diagnostic cut-off scores and an algorithm recommended for the PCL in other trauma groups suggested that a much larger proportion of the sample was identified as potentially meeting diagnostic criteria for PTSD than would have been expected from previous research.The second study utilised the modified PCL to investigate the impact of different types of onset of pain (e.g. traumatic onset) and posttraumatic stress symptoms on adjustment to chronic pain in a sample of 196 chronic pain patients referred to the same centre. For patients who experienced the onset of pain related to a specific event, two independent experts in the field of PTSD determined whether these events satisfied the definition of a traumatic event according to DSM-IV diagnostic criteria. Adjustment was assessed through a number of validated measures of mood, disability, pain experience, and pain-related cognitions. Contrary to expectations, comparisons between patients who had experienced different types of onset of pain revealed few significant differences between them. That is, analyses comparing patients presenting with accident-related pain, or pain related to other specific events, to patients who had experienced spontaneous or insidious onset of pain revealed no significant differences between the groups on measures of pain severity, pain-related disability, and symptoms of affective distress after adjustment for age, pain duration, and compensation status. Similarly, comparisons between patients who had experienced a potentially traumatic onset of pain with those who had experienced a non-traumatic or spontaneous or insidious onset of pain also revealed no significant differences on the aforementioned variables. In contrast, compensation status, age, and a number of cognitive variables were significant predictors of pain severity, pain-related disability, and depression.The final study investigated the impact of type of pain onset and posttraumatic stress symptoms on response to a multidisciplinary cognitive-behavioural pain management program. Unlike the previous study, this treatment outcome study revealed a number of differences between onset groups. Most notably, patients who had experienced an insidious or spontaneous onset of pain reported greater improvements in pain severity and maintained these improvements more effectively over a one month period than patients who had experienced pain in the context of an accident or other specific incident. There was also limited evidence that improvements in depression favoured patients who had experienced an insidious or spontaneous and non-traumatic onset of pain. Consistent with this, posttraumatic stress symptoms were a significant predictor of treatment outcome, with higher levels of symptoms being associated with smaller improvements in pain-related disability and distress. Notably, this study also revealed that certain cognitive variables (i.e. catastrophising, self-efficacy, and fear-avoidance beliefs) were also significant predictors of treatment outcome, consistent with previous findings in the pain literature. This provided some perspective on the relative roles of both PTSD symptoms and cognitive variables in adjustment to persisting pain and treatment response. These findings were all consistent with expectations and with previous research. Implications for future research and for the assessment and treatment of chronic pain patients who present with posttraumatic stress symptoms are discussed.<br/><br/>Description: Doctor of Philosophy http://hdl.handle.net/2123/5710 Title: Metaphysics of modernity: The problem of identity and difference in Hegel and Heidegger<br/><br/>Authors: Sinnerbrink, Robert Sixto<br/><br/>Abstract: This thesis examines the problem of identity and difference in Hegel and Heidegger and thereby attempts to shed light on the relationship between the critique of metaphysics and the critique of modernity. Both Hegel and Heidegger, it is argued, investigate identity and difference in relation to the problem of self-consciousness or subjectivity within the historical context of modernity. Their respective critiques of modern subject-metaphysics can for this reason also be viewed as critiques of the philosophical foundations of modernity. Two paths or lines of inquiry can be identified: Hegel’s dialectical-speculative path, which attempts to supersede modern subject-metaphysics in favour of speculative philosophy, the form of thought adequate to the experience of freedom in modernity; and Heidegger’s ontopoetic path, which attempts to detach itself from metaphysics in order to usher in a ‘non-metaphysical’ experience of technological modernity. These two paths are explored through a critical dialogue between Hegel and Heidegger as a way of showing the relationship between the critique of metaphysics and the critique of modernity.Part I of the thesis considers the philosophical background to the identity/difference problem and its relation to the principle of self-consciousness within modern philosophy. The early Hegel’s encounter with Kant and Fichte is explored as an attempt to criticise the (theoretical and practical) deficiencies of the philosophy of reflection. Part II considers Hegel’s positive project in the Phenomenology of Spirit, in particular the theme of intersubjective recognition and its significance for theorising self-consciousness in modernity. Hegel’s critique of substance- and subject-metaphysics is examined in the Science of Logic, which integrates the logic of identity and difference within the threefold Conceptual unity of universal, particular, and individual. Part III then turns to Heidegger’s explicit confrontation with Hegel, discussing Heidegger’s project of posing anew the question of Being, and examining in detail Heidegger’s “Cartesian-egological” reading of the Phenomenology. The later Heidegger’s “non-metaphysical” or ontopoetic evocation of identity and difference is further explored in light of Heidegger’s critical engagement with the nihilism of technological modernity. In conclusion, it is suggested that the critical dialogue between Hegel and Heidegger can open up new paths for exploring the problem of freedom in modernity.<br/><br/>Description: Doctor of Philosophy (PhD) http://hdl.handle.net/2123/5709 Title: Ariadne’s Thread - memory, interconnection and the poetic in contemporary art<br/><br/>Authors: Fries, Katherine<br/><br/>Abstract: This Dissertation explores the metaphor of Ariadne’s thread in terms of interconnection, when an element from the everyday is used as a locus linking broader concepts of time and space.Such experiences and associations are reflected in the work of Louise Bourgeois, Eva Hesse, Doris Salcedo, Lucio Fontana, Richard Tuttle, Mona Hatoum, Simone Mangos, Anya Gallaccio and Yoshihiro Suda.In relation to my own work, the metaphor of interconnecting thread allows a sense of freedom and journey of discovery. My studio and related research are closely aligned in developing my understanding of interconnection, through my studio process of making and continuing experiences of looking at and interpreting others artists’ work.<br/><br/>Description: Master of Visual Arts http://hdl.handle.net/2123/5683 Title: Acquiring symbolic design optimization problem reformulation knowledge: On computable relationships between design syntax and semantics<br/><br/>Authors: Sarkar, Somwrita<br/><br/>Abstract: This thesis presents a computational method for the inductive inference of explicit and implicit semantic design knowledge from the symbolic-mathematical syntax of design formulations using an unsupervised pattern recognition and extraction approach. Existing research shows that AI / machinelearning based design computation approaches either require high levels of knowledge engineering or large training databases to acquire problem reformulation knowledge. The method presented in this thesis addresses these methodological limitations. The thesis develops, tests, and evaluates ways inwhich the method may be employed for design problem reformulation.The method is based on the linear algebra based factorization method Singular ValueDecomposition (SVD), dimensionality reduction and similarity measurement through unsupervised clustering. The method calculates linear approximations of the associative patterns of symbol cooccurrencesin a design problem representation to infer induced coupling strengths between variables,constraints and system components. Unsupervised clustering of these approximations is used to identify useful reformulations. These two components of the method automate a range of reformulationtasks that have traditionally required different solution algorithms. Example reformulation tasks that it performs include selection of linked design variables, parameters and constraints, designdecomposition, modularity and integrative systems analysis, heuristically aiding design “case” identification, topology modeling and layout planning.The relationship between the syntax of design representation and the encoded semantic meaning is an open design theory research question. Based on the results of the method, the thesis presents a set oftheoretical postulates on computable relationships between design syntax and semantics. The postulates relate the performance of the method with empirical findings and theoretical insights provided bycognitive neuroscience and cognitive science on how the human mind engages in symbol processing and the resulting capacities inherent in symbolic representational systems to encode “meaning”. Theperformance of the method suggests that semantic “meaning” is a higher order, global phenomenon that lies distributed in the design representation in explicit and implicit ways. A one-to-one localmapping between a design symbol and its meaning, a largely prevalent approach adopted by many AI and learning algorithms, may not be sufficient to capture and represent this meaning. By changing thetheoretical standpoint on how a “symbol” is defined in design representations, it was possible to use a simple set of mathematical ideas to perform unsupervised inductive inference of knowledge in a knowledge-lean and training-lean manner, for a knowledge domain that traditionally relies on “giving”the system complex design domain and task knowledge for performing the same set of tasks.<br/><br/>Description: Doctor of Philosophy (PhD)