Browsing by Author "Ross, Kirsty"

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    The "ACT-ive" pursuit of loss and gain : the impact of an acceptance and commitment therapy-based intervention on post weight-loss surgery individuals : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Auckland, New Zealand
    (Massey University, 2021) Damnjanovic, Natalija
    Obesity prevalence continues to increase at an alarming rate worldwide and poses serious health risks to those affected including increased morbidity, mortality, and psychosocial consequences. Weight-loss surgery is currently the best evidence-based treatment for obesity yet, substantial postoperative weight regain is reported within 2-5 years. Successful weight management is complicated when longstanding psychological difficulties are present, that often require psychological input to address. In response, a private weight-loss surgery clinic has developed an Acceptance and Commitment Therapy-based (ACT) Intervention entitled the Foundations of Healthy Living (FOHL) Retreat with the aim of improving weight-loss surgery outcomes by providing greater support to individuals in the post-operative period. In this thesis, an exploration of the efficacy of the FOHL Retreat is conducted. A quasi-experiment pretest posttest non-equivalent control group design is utilised to investigate the impacts of the intervention on weight-related experiential avoidance, eating behaviour, and body mass index (BMI) over time. An additional supplementary exploration into participants’ relationships with food, eating, and their bodies pre- and post-surgically is undertaken using open-text response format questions. Those who attended the Retreat were also asked to share their perspectives on how their participation in the intervention affected their psychological wellbeing. The main findings of the study showed that the ACT-based intervention demonstrated significant effects on several of the variables of interest, in particular, disordered eating and BMI. These effects were mediated by improvements in weight-related experiential avoidance, suggesting the importance of focussing on targeting experiential avoidance as a key mechanism of change in positive postoperative psychological and weight outcomes. The qualitative component of this study expanded on these findings, identifying several key themes present in the experiences of individuals both prior to, and following, weight-loss surgery. Additionally, qualitative responses provided further insight as to the psychological changes participants experienced. Taken together, these findings highlight firstly, the importance of addressing the psychological needs of weight-loss surgery individuals, and secondly, the value of ACT in augmenting surgical outcomes. The results presented here also offer suggestions for further development and future dissemination of such interventions for this population.
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    Babies and Babble : parents’ experiences of the neonatal unit and the role of the Babble app : a thesis presented in partial fulfilment of the requirements for the degree Doctor of Clinical Psychology at Massey University, Auckland, New Zealand
    (Massey University, 2020) Gibson, Charlotte
    Neonatal unit admission is commonly a highly distressing and difficult time for new parents, impacting their confidence in their parenting abilities and predisposing them to significant mental health difficulties (Ballantyne et al., 2017; Holditch-Davis & Miles, 2000). In response to admission, parents commonly report a need for clear, concise information and inclusion in neonatal care (Cleveland, 2008). Alongside the rise of technology and the prevalence of smartphones across the world, mobile health applications have been theorised as an effective method of delivering rapid, consistent and accessible information to health consumer populations. Within the neonatal sphere, such approaches have been growing in popularity, however, little research has focused on the development and efficacy of mobile health applications dedicated to needs of parents with an infant admitted to a neonatal unit. In response, MidCentral District Health Board has developed an informational mobile health application, Babble, for use in conjunction with traditional care formats and with the hopes of providing greater support to parents in neonatal units (Spargo & de Vries, 2018). Although utilised by parents, the Babble app is yet to be empirically evaluated and the impacts of its use are not well understood. In this thesis, an exploration as to parents’ experiences of the neonatal unit and the role of the Babble app is conducted in two parts. Study One explores the experiences of 449 parents with an infant admitted to a neonatal unit in New Zealand, across measures of distress, self-efficacy, how informed they felt during their infant’s admission, and their Babble app use. Study Two involved in-depth qualitative interviews with eight mothers from the Palmerston North neonatal unit, (where the Babble app originated), exploring their perspectives of their infant’s hospitalisation, and the Babble app itself. Study One showed that parents experienced moderate distress, felt reasonably informed and considered themselves to be somewhat confident in their parental role during their infant’s neonatal admission. The Babble app did not demonstrate any significant effect on any of the variables of interest. However, results indicated that the more informed parents felt, the less distress they experienced. This relationship was partially mediated by enhanced self-efficacy, suggesting the importance of information in supporting parental self-efficacy and reducing distress. Study Two expanded on these findings, identifying several key themes present in the experiences of mothers with infants admitted to a Level II+ neonatal unit. Firstly, findings indicated there were various ways in which mothers struggled with their parental role within a neonatal context, experiencing challenges related to managing their own expectations of the experience and asserting their role within the unit. Consistent and supportive relationships with staff, family, friends, and their partners, were seen as influential in the maternal experience. Most significantly, good communication and strong relationships with staff were seen to improve maternal confidence. Information was highly valued by mothers, with some variation in their interactions with information, depending on individual needs and styles. The Babble app was considered a useful adjunct to traditional care formats by mothers who identified that they were able to adapt and integrate its use in alignment with their individual preferences and needs. Taken together, these findings suggest that for families, neonatal admission is a challenging and diverse experience. Staff are essential, not only as sources of information, but as part of a supportive relationship with families. The importance of informational support cannot be understated and its value in building parental self-efficacy and reducing parental distress was evidenced across both studies. Ultimately, the findings presented here suggest that informational resources, such as Babble, can act supportively for parents and therefore, are worthy of further development and exploration.
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    Emotions in the classroom : exploring relationships between students' perceptions of teachers' practices and students' strengths and difficulties : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Palmerston North, New Zealand
    (Massey University, 2020) Edwards, Amy
    Despite recognition of the importance of schools as a zone of social-emotional development, there is a gap in knowledge regarding students’ perceptions of teachers’ social-emotional practices and how these perceptions relate to students’ strengths and difficulties. This thesis addresses this gap through three studies. Students’ conceptual understandings of 88 social-emotional practices were examined using Multidimensional Scaling (MDS), creating a three-dimensional map depicting item relationships. Study two used this map as a lens for analysis of survey data collected from 335 students, focussing on both student-perceived teachers’ practices and student variables including psychological flexibility, connectedness, and emotional, social, and behavioural strengths and difficulties. Findings indicated positive correlations between perceptions of social-emotional practices and students’ connectedness, which in turn was associated with fewer social-emotional difficulties. Existing social-emotional strengths of teachers were highlighted; students reported frequently perceiving teachers’ use of social-emotional practices. Importantly, however, these perceptions were not always related to students’ strengths. Study three sought to deepen insights into the findings of study two by investigating potential differences in the relationships between perceived teachers’ practices and students’ strengths and difficulties according to student gender, in recognition of common views that social-emotional variables are affected by student gender. Findings revealed few gender differences in the relationships observed between perceived teachers’ practices and student variables.
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    Globalisation: The Experience of Malay Adolescents with Conduct Problems
    (School of Psychology, Massey University, 2012) Daud, Mohd Najmi; Coombes, Leigh; Venkateswar, Sita; Ross, Kirsty
    This paper attempts to explore the experiences of Malay ado-lescents with conduct problems within the Malaysian context of globalisation. It is undeniable that to some extent globalisation offers opportunities for a country to progress to be a greater and more competitive nation. In fact, the Malaysian government is highly inspired by the concept of globalisation in progressing towards the vision of becoming a developed nation by the year 2020. Nevertheless, globalisation as a process is very demanding requiring a lot of changes in the Malaysian political, cultural, economic, educational and social landscape. In addition, many of the changes require inculcating foreign cultural values that tend to be inconsistent with local practices. Without adequate preparation, such inconsistency potentially affects the locally defined well-being among vulnerable groups, especially adolescents. There is consistent evidence that shows a significant relationship between changes with respect to globalisation and conduct problems among adolescents. However, how far the affected adolescents understand and adapt with the globalisation process, particularly in the Malaysian context remains elusive. Therefore, it is essential to explore their understandings and experiences on different aspects of globalisation that significantly affect their lives.
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    An investigation of the factors relating to attendance of psychological appointments : a thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Auckland, New Zealand
    (Massey University, 2021) Yelavich, Brooke
    Background Psychological therapy is an important tool to improve mental health concerns. However, the high prevalence of mental health concerns is not reflected by mental health service use. Many individuals who are referred to a service do not attend or do not complete therapy. Methods A quantitative cross-sectional survey design was used to investigate psychological and practical factors which may impact attendance of psychological appointments. The factors investigated included: therapy anxiety, safety behaviours, intrinsic motivation, stigma, fear of disclosure, cultural safety, and practical factors. One qualitative method using an open ended question at the end of the survey was used to elicit further factors beyond the main survey questions that may predict non-attendance. Following exclusions, 669 participants were included in the final sample from Australia, New Zealand, Canada and the United Kingdom. Results The results of the study found statistically significant relationships between non-attendance and the following factors: therapy anxiety, safety behaviours, intrinsic motivation and self-stigma. Among the practical factors investigated, three of the 12 factors demonstrated statistically significant relationships with non-attendance these included, part-time employment, forgotten appointments, and family commitments. The results of the qualitative analysis highlighted five main categories of factors identified by participants. These categories included: psychological factors, practical factors, clinical factors, other commitments, and service factors. Conclusions Of the factors investigated in this study, therapy anxiety was the strongest psychological predictor of not attending therapy across the statistical models. Furthermore, therapy anxiety was one of the most self-reported reasons for not attending psychological appointments. While therapy anxiety was the strongest predictor, the study demonstrated a range of factors which related to individuals’ likelihood of attending psychological appointments. The findings of the current study may suggest that interventions that target a range of the most commonly identified factors would be more effective than trying to target just one of the various factors that cause non-attendance.
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    One parent’s advice to another : an exploration of self-care for parents of children with high-need disabilities and the development of a psychoeducational resource : a thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Manawatū, New Zealand
    (Massey University, 2020) Oskam, Jana Aria Dunlop
    Currently over 95,000 children are affected by a disability in New Zealand (NZ), making up 11% of the child population (Statistics New Zealand, 2013). Receiving a childhood disability diagnosis can be a life-changing event for the entire family. As current societal structures require parents to assume unforeseen caregiving roles (that typically last the course of their child’s lifetime), parents as informal caregivers make up a significant sector within NZ. Nevertheless, the dominant approach to research in the field of childhood disability has been based on the assumption that informal caregiving results in adverse outcomes for parents. Consequently, existing research has largely focused on the well-documented negative impact of caregiving for parents and their families. Although evidence suggests that effective self-care may act as a mediator against caregiver stress, few studies have approached informal caregiving from a positive psychology and health-promotion perspective. However, it can be argued that by adopting a positive health promotion perspective, we can improve understanding on how best to promote wellbeing for parents, and consequently, their children and families as well. Through two studies, this thesis explored the experience of self-care and wellbeing for parents of children with high-need disabilities (HND). Study One achieved this by interviewing 11 parents of children with high-need cerebral palsy or autism. Thematic analysis found that participants typically experienced and enacted self-care in four key areas, including parents’ Formal Supports and Resources, Informal Relationships, Values and Goals, and their use of Time. In line with a transformative framework, Study Two developed a psychoeducational resource, aimed at enhancing parents’ self-care and perceived wellbeing, by integrating findings from the first study with existing literature. Preliminary evaluation of the resource booklet was achieved by 14 participants completing a written questionnaire to obtain parents’ feedback. Descriptive statistics and thematic analysis of participants’ responses identified that the booklet appears to capture parents’ experiences of self-care when raising a child with HND. Two key themes included participants’ Positive Remarks and Ideas for Change. Overall, findings suggest that despite caregiving challenges, there are effective self-care strategies which parents use to mitigate these risks and improve wellbeing.
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    ‘A permanent scar’ : exploring the long-term experiences of parents/caregivers after their child’s cancer treatment : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Auckland, New Zealand
    (Massey University, 2023) Jennison, Olivia
    Due to medical advancements, the prognosis of childhood cancer has significantly improved. This means that more families are contending with life after cancer. Yet, research shows that some parents/caregivers continue to experience psychological distress for many years after the successful completion of their child’s cancer treatment. The present study employed a social constructionist lens to qualitatively explore the long-term experiences of parents/caregivers after their child’s cancer treatment. Semi-structured interviews were utilised to explore the experiences of ten parents/caregivers whose child had finished active cancer treatment and was at least five years post-diagnosis. The findings generated the fundamental idea that ‘The Cancer Experience Remains With You’. This idea reflected the cancer’s continued impact and significant disruption to parents’/caregivers’ belief systems and lives in the long-term. This central organising concept held three themes with several subthemes: ‘Views about One’s Self’ (‘identity’, ‘purpose and meaning’, ‘suffering from memories’), ‘Views about the World’ (‘isolation’, ‘connection’, ‘vulnerability’), ‘Views about the Future’ (‘uncertainty’, ‘loss of an imagined future’). These findings suggest that the experience of their child’s cancer was heavily integrated into parents’/caregivers’ long-term self-concept, biography, relationships in the world, and expectations for the future. This research highlights the lasting presence of the childhood cancer experience and how this conflicts with societal expectations, which contributes to an understanding of parents’/caregivers’ experiences in the long-term after their child’s cancer treatment. The findings can be used to improve connection and support to those affected by childhood cancer through the terminology used and psychosocial support provided, with the aim of lessening the burden of the “permanent scar”.
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    The surviving emotional storms programme : a service user informed programme developed from an exploratory study of help-seeking experiences of NZ tertiary students with Borderline Personality Disorder : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Auckland, New Zealand
    (Massey University, 2023-04-11) Beckett, Jennifer Jean
    In this qualitative thesis, 14 university students were interviewed about their lived experience of having Borderline Personality Disorder. Participants discussed arduous journeys in search of effective treatment and described their increasing risk while trying to access help, alongside their experiences when able to access publicly funded treatment. Results from thematic analysis highlighted a super-theme of a continuous invalidation loop, discussed from an ecological and attachment perspective. This started with early help-seeking invalidation in participants’ microsystems, with the loop then broadening across systems over time, and help seeking attempts. This included contact with the mental health system, which was suggested to be a perpetuating factor in the development and maintenance of Borderline Personality Disorder. The help-seeking invalidation loop was briefly interrupted when participants were diagnosed, which occurred for most, directly after a suicide attempt. Diagnosis brought temporary relief, when participants armed themselves with knowledge about the condition including prognosis and treatment. The validation from informed diagnosis aided an externalisation process to occur, enhancing connections with self and others. However, accessing treatment proved difficult, crisis and respite was perceived as invalidating and when in treatment participants’ attempts at connection were often thwarted. Results from the thematic analysis guided the design and delivery of a group intervention. The intervention was administered using an action research methodology to university students either diagnosed with Borderline Personality Disorder or with borderline traits. The intervention, an adaptation from traditional dialectic behavioural therapy, integrated the results from the thematic analysis. To address the super-theme findings, attachment theory was interspersed throughout the intervention, utilizing aspects of narrative and acceptance and commitment therapies. The intervention was adapted and evolved from participant feedback over six cycles of 12-session intervention groups. In each group participants reported reduced severity of borderline symptoms and increased mindfulness ability. The research took place prior to and during the global pandemic and Covid-19 mandatory lockdowns in NZ, during which the research was expanded to finish with an online intervention accessed by students across NZ.
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    Whānau Māori and their experiences of attention-deficit/hyperactivity disorder : implications for clinical practice : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Manawatū, New Zealand
    (Massey University, 2023-06-30) Tipene, Charlene Mereana
    Health care in New Zealand (NZ) is based on the ideal of universal health coverage for all. However, for many Māori health inequities exist in health outcomes and in access to services which adequately meet the needs of whānau Māori. Researchers have considered explanations (and solutions) for this situation, including whether health services are able to meet the cultural needs of Māori clients through a more holistic approach. Rather than considering this generally for all services, this research considers this specifically in relation to Attention-Deficit Hyperactivity Disorder (ADHD). Alongside core symptoms of hyperactivity, impulsivity, and inattention, for there to be a diagnosis of ADHD there must be associated functional impairment and diffuse impact of behavioural symptoms in multiple domains of a person’s life. This means that ADHD is well suited to the application of holistic understandings of wellbeing, such as those that exist in mātauranga Māori. A lack of research about ADHD among Māori highlights a need for research which explores the experiences of tamariki Māori and their whānau as they navigate ADHD diagnosis and treatment. This research used a Māori-centred framework and throughout, was guided by He Awa Whiria (Gillon & Macfarlane, 2017) which emphasises the importance of drawing together cultural and clinical knowledge. There were three main objectives: to understand the experiences of whānau Māori with a child assessed and treated for ADHD; to describe how whānau understood and accommodated ADHD behaviours before diagnosis; and to identify any barriers or facilitators for whānau Māori in accessing assessment and/or treatment. Semi-structured interviews took place with 10 whānau members, representing 13 young people who had been diagnosed with ADHD. The interview responses were analysed using (codebook) thematic analysis. The main findings revealed firstly that there were different levels of knowledge about ADHD among caregivers and some whānau struggled to know where to begin, to get support; secondly, it was difficult to access the service, and there was a lack of ongoing support available other than medication; and thirdly, while in all cases medication was offered as treatment, whānau found this a difficult decision to make for their child, preferring a more holistic approach. Most whānau were not asked about their cultural background or beliefs during assessment and half of the participants would have accessed a kaupapa Māori service if available. The implications of the findings for clinical practice are discussed with recommendations for how to blend cultural and clinical knowledge to ultimately benefit whānau Māori and achieve the best possible outcomes.