Browsing by Author "Norrie, Joan"

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    Energy crisis : prevalence, severity, treatment and persistence of fatigue after mild traumatic brain injury : a dissertation presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Palmerston North, New Zealand
    (Massey University, 2012) Norrie, Joan
    The objectives of this research were to investigate the prevalence and severity of post-mild traumatic brain injury (MTBI) fatigue in a non-litigant New Zealand sample and to evaluate the effectiveness of a treatment programme. Subsequently, a third objective evolved – the investigation of the natural history of post-MTBI fatigue and the degree to which reliable clinically significant change occurred over time regardless of intervention type. The research took the form of two studies where analysis was based on group data followed by analysis of the Study Two data at an individual participant level. Study One, a longitudinal prospective study examined fatigue prevalence, severity, predictors and co-variates over six months post mild traumatic brain injury (MTBI). Participants completed the Fatigue Severity Scale (FSS), Rivermead Postconcussion Symptoms Questionnaire (RPSQ), Hospital Anxiety and Depression Scale (HADS) and the Short Form 36 Health Survey-Version 2 (SF-36v2). Complete data were available for 159 participants. Key measures; prevalence - RPSQ Item 6: severity - FSS. The effect of time on fatigue prevalence and severity was examined using ANOVA. Multiple regression analysis identified statistically significant covariates. The study found post-MTBI fatigue prevalence was 68%, 38% and 34% at 1 week, 3 and 6 months respectively. There was a strong effect for time over the first three months and moderate to high correlations between fatigue prevalence and severity. Early fatigue strongly predicted later fatigue. Depression, but not anxiety, was a predictor. Fatigue was seen as laziness by family or friends in 30% of cases. Conclusions for Study 1 were that post-MTBI fatigue is a persistent postconcussion symptom, exacerbated by depression but not anxiety. It diminishes in the first three months and then becomes relatively stable, suggesting the optimum intervention placement is at three months or more post-MTBI. Study Two was a quasi-experimental longitudinal prospective controlled study which had a two by three, treatment by time, repeated measures research design. Participants with a history of MTBI were recruited from three Concussion Clinics. Post-MTBI fatigue was identified through Item 6 of the Rivermead Postconcussion Symptoms Questionnaire (RPSQ) and the outcome measures were the FSS, Fatigue Assessment Scale, RPSQ, Hospital Anxiety and Depression Scale and Sydney Psychosocial Re-integration Scale. All treatment group participants (N = 18) came from the same Concussion Clinic as the principal researcher, and control participants (N = 23) came from other Concussion Clinics. The question of whether the participants thought their significant others perceived them as lazy was also explored in Study Two. A 12 week manualised programme (PERT) was developed specifically for Study Two and was delivered by either a clinical psychologist or occupational therapist through a combination of personal and phone sessions. No significant time by group effect was found for any of the outcome measures. A time effect was found for all of the outcome measures. During the search for explanations for these findings it was discovered that the two conditions were more similar than expected. The majority (85.7%) of the control group had, in accordance with current rehabilitation practice, engaged in exercise and/or received interventions similar to the treatment group which presented a confound to the study. The data from the two groups was combined and analysed for information regarding reliable clinically significant change RCSC in individual participants. No significant correlations with demographic variables such as time since injury, age, gender, level of education, work type and injury type were found. Female gender was related to positive RCSC at three months post-baseline but not at six months post-baseline. Fatigue severity was significantly positively related to participants’ belief that relatives perceived them as lazy. Study Two provided no evidence to support this treatment for post-MTBI fatigue. Prevalence and severity of post-MTBI fatigue reduced over the six months of Study Two, however on examination of individual data the majority of the participants showed no reliable clinically significant change, supporting the need for further research into finding an effective post-MTBI fatigue treatment. The small sample size and the similarity of the treatment and control group conditions were major factors in confounding the findings of the study. There is a comparatively large percentage of individuals reporting prevalence and severity of post-MTBI fatigue in New Zealand samples and, although the combined psychoeducation and aerobic exercise approach could not be evaluated, the postconcussion and general literature suggests there is merit in continuing research into its effectiveness in treating post-MTBI fatigue.
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    Factors which influence the decision of sexual offenders against children to attend a sex offender treatment programme at Te Piriti or Kia Marama : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 1998) Norrie, Joan
    Treatment of individuals who sexually offend against children has been shown to be associated with reductions in recidivism both in New Zealand, (Johnston, 1996) and overseas (Gendreau, 1996). Laven (1993) and Jury (1993) found in two New Zealand studies of incarcerated child sex offenders that when they were offered treatment to help them address their offending they more often than not declined. Barbaree (1991) noted that offenders often present as denying, minimising, rationalising or being vague about their sexual offending behaviours. Treatment for incarcerated individuals who have sexually offended against children is provided by the New Zealand Department of Corrections Psychological Service specialist prison-based Child Sex Offender Treatment Programme at Auckland (Te Piriti) and Christchurch (Kia Marama). However, participation in the programme is voluntary. The main purpose of the study was to examine the effects of a motivational and educational pretherapy intervention, First Step, on factors such as Stage of Change and Victim Empathy which were believed to be associated with the decision to seek entry to the Sex Offender Treatment Programme. A secondary purpose was to investigate which factors the child sex offenders considered while making their decision to seek or decline treatment in the programme. The subjects were 104 male incarcerated offenders convicted of sexual offences against children under the age of sixteen years. They were resident in one of three minimum security prisons, Tongariro/Rangipo, Ohura and Waikeria, New Zealand. All of the subjects were referred by the prison Case Management Committee to Department of Corrections, Psychological Service for assessment when they arrived in the prison. Of the total of 104 participants, 39 attended First Step. The other 65 were involved in a related study (Knowles, 1997) at Waikeria Prison. They were included to provide additional information on select issues related to helpseeking. Participation was voluntary and access to the First Step programme was not contingent on participation in the study. Also, there were no custodial consequences (e. g., temporary paroles or early release) contingent on participation in the study. The design for the treatment portion of the study was a two by two factorial, repeated measures design with two conditions, a wait-list control and a treatment condition (First Step). An assessment of treatment readiness and victim-specific empathy was made using the University of Rhode Island Change Assessment (URICA) questionnaire based on Prochaska, DiClemente et al's (1982, 1985, 1989, 1991, 1995) Transtheoretical Stages of Change model and Marshall et al's (1995) Person Specific Empathy Scale which were administered at pre and post wait-list and treatment conditions. The results of this study provide important data for enhancing our understanding of the effects of a pre therapy intervention on motivation and of the factors that influence the incarcerated child sex offender's decision to seek entry to a Sex Offender Treatment Programme. There was evidence that the motivational and educational intervention, the First Step programme, had an influence on the way that the offenders thought about their offending behaviour. In particular, this was supported by a general pattern of movement through the Stages of Change as illustrated by changes in the numbers of offenders in identified Stages of Change clusters. The support for First Step further buttresses Barbaree (1991) and O'Donohue and LeTourneau (1993) proposals for the necessity, particularly in cases where the problem is denied, for a pre-treatment intervention designed to encourage a frame of mind that is more amenable to treatment entry and compliance. Some positive treatment produced changes were also noted on the empathy scale. Apart from a motivational intervention, other factors identified by the sample as being influential in the treatment-seeking decision-making process included both internal (e. g., desire for self improvement, acceptance of responsibility for the offending, denial of offending, fear and shame) and external (e. g., awareness of treatment procedures at the Sex Offender Treatment Programme, family support and custody conditions) factors. The discussion focuses on future use of pretherapy, motivational interventions and the integration of such factors.