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Item Traumatic brain injury and substance use disorder in Aotearoa New Zealand : characteristics, correlates, and the role of social cognition in an inpatient addictions treatment sample : a thesis presented in partial fulfilment of the requirements for the qualification of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand(Massey University, 2025-11-25) Marshall, Hannah L. M.Traumatic Brain Injuries (TBIs) and Substance Use Disorder (SUD) often cooccur, yet the underlying mechanisms linking these conditions remain unclear. One potential explanation is that TBI disrupts neuropsychological functioning, particularly Social Cognition, thereby increasing the risk of SUD. The overall objective of this thesis is to explore these relationships in depth. To achieve this, the first study aimed to gather a detailed history of head-injury characteristics among individuals with SUD in Aotearoa, including TBI with loss of consciousness (LOC). By ascertaining these characteristics, the second study aimed to examine their association with neuropsychological outcomes. Third, our final study aimed to explore the potential role of Social Cognition in explaining the relationship between TBI and SUD. A total of 77 adults (aged 18-64) engaged in residential treatment for SUD, participated in the current research. During their residential treatment program, participants completed self-report questionnaires to ascertain head-injury, TBI and SUD history, mental health, and TBI-related symptom severity. Of this sample, 70 went on to complete neuropsychological tasks. Study 1 revealed that one hundred percent of the sample endorsed one or more lifetime head-injury events. 81.8% of the sample had experienced a self-reported TBI featuring LOC, with the remaining 18.2% having a history of a ‘possible TBI’ where they sustained a head-injury event without LOC. Overall, 91% sustained multiple lifetime head-injuries (either with or without LOC). Compared to the general New Zealand population, this sample featured a higher rate of TBIs of moderate severity, and most events were untreated. Many individuals sustained head-injuries at a young age and sustained repeated injuries into adulthood. Study 2 found that individuals who had a high number of lifetime head-injuries showed significantly lower scores on executive functioning and self-reported experiencing more cognitive difficulties. Study 3 found that within Social Cognition, the interpretation of complex social cues, particularly those involving deception and subtle social intentions, may mediate the relationship between TBI and SUD. This research contributes to identifying unique rates, patterns, and outcomes of head-injury including TBI among treatment-seeking substance users and highlights factors which may increase individuals’ vulnerability. Social Cognition appears to be a mechanism worthy of future exploration as it may explain the relationship between TBI and SUD. Implications of these results for treatment and rehabilitation and directions for future research are discussed.Item The relationship between loneliness and quality of life in informal dementia caregivers : a thesis submitted in partial fulfilment of the requirement for the degree of Doctor of Clinical Psychology at Massey University, Auckland, New Zealand(Massey University, 2024) Jenkins, BrieonieBackground Informal caregivers are an essential part of dementia support in New Zealand. The number of people affected by dementia is increasing. Previous studies have indicated that informal caregivers are at risk of poor mental and physical health outcomes, due to the stressors in the caregiving role. These stressors have been identified as risk factors for loneliness. Research in other populations highlights strong links between loneliness and poor health outcomes. This research explored the relationship between primary caregiving stressors, loneliness, isolation and quality of life (QOL) within the framework of the Stress Process Model. Methods This research investigated hypothesised factors leading to loneliness and quality of life in a New Zealand sample of informal dementia caregivers (n= 134). It used a cross-sectional survey design and structured questionnaire to explore background and context factors (care duration, hours per week caregiving, relationship length and help hours per week), primary stressors (Activities of Daily Living dependency, frequency of challenging behaviour, caregiver reaction and relational deprivation), loneliness, isolation, and quality of life. Descriptive analysis, correlational analysis, confirmatory factor analysis and path analysis were used to examine the relationships between variables and conduct mediation analyses. Results The findings indicated that QOL was moderate, with the average rating between ‘neither good nor poor’ and ‘good’. The psychological domain was significantly lower than all other domains. Within the sample there was a high prevalence of loneliness (88%) and lower prevalence of isolation (21%). Overall QOL and QOL domains were significantly associated with total loneliness. Among the primary stressors, only the frequency of challenging behaviour correlated to loneliness. Both the frequency of challenging behaviour and caregiver reaction had significant correlations to QOL. Total loneliness partially mediated the relationship between primary stressors and QOL. Social loneliness was also found to partially mediate this relationship while emotional loneliness did not. Conclusions The findings show that there was a high prevalence of loneliness in the sample. They also show that primary caregiving stressors are associated with loneliness and that loneliness is associated with quality of life. This research highlights the importance of addressing loneliness in this population, suggests targeted loneliness interventions and recommends caregivers be screened for loneliness to increase access to appropriate support.Item An exploration of factors that have facilitated and constrained access, adoption and availability of mind-body therapies as adjunctive interventions to treat trauma-related conditions in Aotearoa, New Zealand : a thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University - Te Kunenga ki Pūrehuroa, Albany, Aotearoa New Zealand(Massey University, 2025-06-29) Standing, MeredithThis qualitative study explores factors that facilitate and constrain the use of mind-body interventions to treat trauma-related conditions in Aotearoa New Zealand (NZ). The phenomenon explored references mind-body therapies as an adjunctive treatment option with a focus on trauma-sensitive yoga. This study is intended to examine mind-body interventions as a complementary treatment approach and augmentation of interventions such as cognitive behavioural therapies and other validated, evidence-based approaches to treating trauma-related conditions. There is a significant body of literature that supports the use of talk therapies, such as cognitive behavioural therapy, to treat symptoms associated with trauma-related mental health conditions. Recent research has revealed that in many cases, trauma cannot be resolved through interventions that utilise talk therapies alone, as trauma, according to some theorists, is located not only in the core of the brain but also within the body. A practical treatment approach to mitigate individual experiences of trauma is to integrate Western psychological talk therapy approaches with those that focus on calming the nervous system, such as trauma-sensitive yoga, romiromi, mindfulness, and somatic experiencing. The current study highlights factors across the social system that have facilitated and constrained the access, adoption, and availability of mind-body therapies as complementary approaches for treating trauma-related conditions in the NZ context. Findings in the current study highlight that in the NZ context, few factors have facilitated access, adoption and availability of mind-body therapies as adjunctive interventions to treat trauma-related mental health conditions. A more significant number of factors, it appears, have constrained access, adoption and availability of mind-body therapies. Findings illuminate an overall positive attitude toward the utility of mind-body therapies as adjunctive treatments for trauma-related conditions, which highlights the potential for greater use of such interventions in the NZ setting.Item The development of a psychosocial intervention that supports siblings of children and adolescents with serious chronic health conditions in Aotearoa New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University(Massey University, 2024-11-12) Armstrong, KathleenDue to recent advances in medical care, many childhood chronic health conditions (CHCs) are less likely to be fatal and more able to be successfully managed. This has led to an increase in the prevalence of children living with CHCs, which presents the affected child, their parents, and their siblings with significant long-term consequences and challenges. Extant literature points to siblings of children with CHCs being a vulnerable population who are at increased risk of developing depression, anxiety, post-traumatic stress symptoms, lower quality of life, and disruption to academic and social functioning. Consequently, there have been calls for the development of sibling support services both in Aotearoa New Zealand (New Zealand) and internationally. Recent needs-based research on siblings of children with cancer and other serious CHCs in New Zealand reported critical unmet needs across the following domains: Information about the illness; Dealing with feelings; Time out and recreation; Support from friends and other young people; Understanding from their family; and Relationship with their affected sibling. These findings emphasise the necessity of a nationwide intervention that provides siblings with support close to the time of their brother’s or sister’s diagnosis. The aim of the present study was to develop a needs-based psychosocial intervention for siblings of children with serious CHCs, which protects and promotes the health and wellbeing of this vulnerable population and recognises their existing individual and familial strengths. A literature review was conducted to investigate the impact serious childhood CHCs have on siblings, and to establish whether the commonalities in sibling experiences justify taking a transdiagnostic approach in the development of a sibling intervention. This was followed by a systematised review of existing sibling interventions and an evaluation of their efficacy. Informed by the two major reviews and existing needs-based sibling research, a manualised intervention was developed to meet the self-reported unmet needs of siblings, using a combination of evidence-based therapeutic modalities.Item Exploring the narratives of people with lived experiences of eating-related distress and their stories of recovery : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology, Massey University, Auckland, Aotearoa, New Zealand(Massey University, 2023) Amarasekara, Natasha AmriniA significant portion of the eating disorder literature prioritises a clinical perspective informed by diagnostic classification and clinical markers of recovery. Yet, research into the perspectives of people’s lived experiences provides very different accounts of eating-related distress and personal recovery. The personal recovery model privileges lived experiences, where symptom remission is not necessary to recover/y, but instead “recovery in” as opposed to “recovery from” is better aligned. Broad qualitative analyses cite factors in alignment with the recovery model; however, these studies often abstract from the daily, lived recoveries. In this study, I examined the narratives of recovery among 15 adults with lived experiences of eating-related distress. Specifically, those who self-identified challenges related to food, weight, body shape, and/or exercise, and identified as doing better currently relative to one’s own past experiences. A day in the life questioning approach allowed for a micro-contextualised view of recovery, exploring what it means to be “in” or “enacting” recovery across daily practices. A narrative analysis was conducted which attuned to complex social, cultural, and relational contexts, grounded within a social constructivist epistemological approach. Narratives included: Re-Appraising Body, Image and Identity, Neutrality and Nourishment, Routine and Structure, and Media and #Recovery. Participants formed intentional daily practices in recovery, largely described as an active process requiring continued re-appraisal. Daily practices centered around energy, function, pleasure, accomplishment, comfort, control, self-development, visibility, and routine. Participants described alignment, resistance, and opposition to master narratives and sociocultural prescriptions on recovery, offering a counter narrative to the clinician and researcher recovery perspectives that have traditionally dominated the literature and guided service provision to date. Overall, these multi-layered narratives align with critical feminist perspectives and may importantly inform evidence-based practice from the “inside out”.Item A new test of semantic association for use in awake craniotomy : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand(Massey University, 2023) Chapman, JoThis project aimed to develop and validate a new test of non-verbal semantic association to replace the Pyramids and Palm Tree Test (PPTT) in mapping the Inferior Fronto-Occipital Fasciculus (IFOF) during awake craniotomy surgery. Research and clinical experience identified a range of problems with the PPTT, especially in its performance across cultures, and no other existing semantic test met all requirements for effective use in IFOF mapping. A new test was developed based on theoretical and clinical understandings of semantic association, using a novel item format. The final test metrics were an improvement upon the PPTT on all preselected measures of item quality. A total of 707 healthy adult participants were then recruited to complete the new test via an online survey. A final pool of 58 items were selected, all of which performed consistently as intended. Analyses of subgroup performance found there were no clinically significant gender, culture, age, or education effects on scores. These results again suggested the new test improved upon existing tests and achieved its initial design objectives. Validation then proceeded to clinical groups, but recruitment challenges meant too few participants were recruited to permit any analyses. While its validity could not be determined with this study’s data, the test and its general population norms will be available for further research and then clinical use if indicated.Item The use of telephone communication between nurse navigators and their patients(Public Library of Science (PLoS), 2020) Heritage B; Harvey C; Brown J; Hegney D; Willis E; Baldwin A; Heard D; Mclellan S; Clayton V; Claes J; Lang M; Curnow VBackground Hospitals and other health care providers frequently experience difficulties contacting patients and their carers who live remotely from the town where the health service is located. In 2016 Nurse Navigator positions were introduced into the health services by Queensland Health, to support and navigate the care of people with chronic and complex conditions. One hospital in Far North Queensland initiated an additional free telephone service to provide another means of communication for patients and carers with the NNs and for off-campus health professionals to obtain details about a patient utilising the service. Calls made between 7am and 10pm, seven days per week are answered by a nurse navigator. Aim To report utilisation of the service by navigated clients and remotely located clinicians compared to use of navigators’ individual work numbers and direct health service numbers. We report the reason for calls to the free number and examine features of these calls. Methods Statistical analysis examined the call reason, duration of calls, setting from where calls originated and stream of calls. Interactions between the reasons for calls and the features of calls, such as contact method, were examined. Results The major reason for calls was clinical issues and the source of calls was primarily patients and carers. Clinical calls were longer in duration. Shorter calls were mainly non-clinical, made by a health professional. Setting for calls was not related to the reason. The most frequent number used was the individual mobile number of the NN, followed by the hospital landline. Although the free number was utilised by patients and carers, it was not the preferred option. Conclusion As patients and carers preferred to access their NN directly than via the 1800 number, further research should explore options best suited to this group of patients outside normal business hours.Item What contributes to alcohol and substance misuse recovery while parenting in integrated residential rehabilitation? : thesis submitted in partial completion of the requirements for the degree of Doctor of Clinical Psychology, Massey University, Auckland, New Zealand(Massey University, 2023) Stanley, LauraAlcohol and substance use recovery while parenting is a complicated endeavour. People in alcohol and substance misuse recovery while parenting have unique and complex needs, which mainstream treatment approaches cannot always meet. Treatment often focuses solely on substance misuse and fails to pay attention to parenting, and most often, parents and their children are separated during residential treatment. Parents often face the tough decision to either take care of themselves or take care of their children. Integrated treatment services, which include both drug and alcohol treatment and parenting support, have been developed to break the often intergenerational cycle of substance use and troubled parenting. These programmes have rendered successful outcomes in participants achieving and maintaining abstinence, improving their mental health, and supporting responsive parenting. However, little is known about what particular factors in integrated services support these positive changes made in recovery while parenting. The current research explores the unique factors that have contributed to parents’ recovery at the Family Centre, an integrated parent-child rehabilitation facility. The research additionally illustrates the needs of these individuals in recovery. Experiences of recovery and parenting were explored in semi-structured interviews and case studies with mothers undertaking a recovery programme. Through a reflexive thematic analysis, three themes were constructed: ‘The Construction of Self’ ‘The Therapeutic Milieu’, and ‘Relational Recovery’. The complex histories and recovery journeys of research participants were given context through the use of case vignettes. The findings highlight the complex and multifaceted nature of recovery while parenting, particularly the role that parenting plays in driving recovery-orientated change. The relational nature of recovery was a prevalent factor in recovery, providing a developing perspective on how recovery is viewed in research and practice.Item 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, NatalijaObesity 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.Item Stopping the progression towards type 2 diabetes mellitus : investigating the hypoglycaemic (glucose-lowering) potential of antioxidant-rich plant extracts : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nutritional Science, Massey University, Albany, New Zealand(Massey University, 2021) Lim, Wen Xin JaniceBackground: Prediabetes is a condition where the blood glucose levels are high but not high enough to be classified as having type 2 diabetes mellitus (T2DM). It is also considered a high risk for developing T2DM. There is increasing evidence that demonstrates antioxidant-rich plant extracts exhibiting hypoglycaemic effects in humans. Therefore the extracts may improve glycaemic control in individuals with prediabetes and help prevent or delay the progression of prediabetes towards T2DM. Overall Aim: To examine the acute hypoglycaemic potential of four antioxidant-rich plant extracts, namely the New Zealand pine bark, grape seed, rooibos tea and olive leaf extracts in humans. Methods/Design: The hypoglycaemic effects of the New Zealand pine bark was examined in healthy participants (n=25) in an acute, placebo-controlled, single-blind, crossover, dose-response (50 and 400 mg), exploratory study (Pine Bark study). Blood samples were collected via finger pricking using disposable lancet to measure glucose levels at -20, 0, 15, 30, 45, 60, 90 and 120 min during an oral glucose tolerance test (OGTT) with 75 g of glucose. The hypoglycaemic effects of grape seed, rooibos tea and olive leaf extracts matched for antioxidant capacity were examined in an acute, placebo-controlled, crossover study (GLARE study) in participants with prediabetes (n=19). Blood samples were collected via cannulating the antecubital fossa region of the arm at -10, 0, 15, 30, 45, 60, 90 and 120 min during the OGTT with 75 g of glucose. Outcome glycaemic measures were analysed in both clinical studies (Pine Bark study and GLARE study). An in vitro mechanistic study investigating the potential inhibitory action of all four plant extracts (grape seed, rooibos tea, olive leaf and New Zealand pine bark) on digestive enzyme α-amylase and the dipeptidyl peptidase-4 (DPP4) enzyme were carried out using appropriate enzymatic assays of inhibition. Results: Prior to secondary analysis in the Pine Bark study, a significant reduction in the primary outcome mean glucose incremental area under the curve (iAUC) was only observed for the 400 mg dose of pine bark (21.3% reduction, p=0.016) compared to control. After stratification in the monophasic glucose curve shape group (n=12), 50 and 400 mg of pine bark significantly reduced the mean glucose iAUC compared to control (28.1% reduction, p=0.034 and 29.5% reduction, p=0.012), respectively. In contrast, mean glucose iAUC was not significantly different in the complex glucose curve shape group (n=13). In the monophasic group, 400 mg dose further improved glycaemic indices by reducing mean percentage increment of postprandial glucose (%PG) (33.9% reduction, p=0.010), mean glucose peak (11.2% reduction, p=0.025), and mean 2h postprandial glucose (2hPG) (8.9% reduction, p=0.027) compared to control. Within the complex group, there were no other significant changes except for reductions in mean %PG after 50 mg and 400 mg dose (33.8% reduction, p=0.012 and 41.4% reduction, p=0.025) compared to control, respectively. There were no significant differences between treatments in both subgroups (p>0.05). In the GLARE study, there were no overall significant changes in glucose and insulin responses between the extracts and control, or amongst the plant extracts (p>0.05). After secondary analysis, the less healthy subgroup (n=9), grape seed consumption showed significant reduction in mean glucose iAUC (21.9% reduction, p=0.016), mean 2hPG (14.7% reduction, p=0.034) and mean 2h postprandial insulin (2hPI) (22.4% reduction, p=0.029), whilst there was significant improvement in mean overall insulin sensitivity (ISIoverall) (15.0% increase, p=0.028) and mean glucose metabolic clearance rate (MCR) (16.7% increase, p=0.016) compared to control. Rooibos tea extract was shown to improve β-cell function measured by the mean oral disposition index (DI) (32.4% increase, p=0.031) in the less healthy subgroup compared to control. This was coupled with a non-significant improvement in insulin sensitivity measured by mean insulin-secretion-sensitivity-index-2 (ISSI-2) (18.3% increase, p=0.074). Olive leaf exhibited improved mean insulin sensitivity indices of insulinogenic index (IGI₃₀) (27.8% increase, p=0.078), Stumvoll first phase insulin sensitivity (ISIfirst) (17.8% increase, p=0.075) and Stumvoll second phase insulin sensitivity (ISIsecond) (15.6% increase, p=0.062) in the less healthy subgroup compared to control, although significance was not reached. Olive leaf extract was also consistently shown to elevate insulin levels in the study, with a higher mean 2hPI in the healthier subgroup (49.5% increase, p=0.030) and an elevated mean insulin iAUC in the less healthy (16.7% increase, p=0.040) subgroups. There were no significant changes in glucose and insulin responses in the healthier subgroup (n=10) compared to control nor between treatments in both subgroups (p>0.05). The mechanistic study demonstrated that the New Zealand pine bark extract exhibited the greatest inhibitory effects against digestive enzyme α-amylase (IC₅₀ 3.98 ± 0.11 mg/mL) and DPP4 enzyme (IC₅₀ 2.51 ± 0.04 mg/mL) compared to the other extracts (p<0.001). Both grape seed and rooibos tea extracts showed good inhibition of both enzymes tested. Rooibos tea was able to inhibit DPP4 enzyme to a greater extent than grape seed (p=0.018). In contrast, olive leaf extract showed minimal inhibition on α-amylase and no inhibition action against DPP4 enzyme. Conclusions: All four plant extracts (New Zealand pine bark, grape seed, rooibos tea and olive leaf) have shown acute hypoglycaemic potential in the Pine Bark study and the GLARE study by improving various indices of glucose and insulin responses in humans. The inhibitory action of the New Zealand pine bark, grape seed and rooibos tea extracts on DPP4 enzyme might have contributed to the hypoglycaemic effects observed in the clinical studies conducted. Whereas for olive leaf extract other underlying mechanisms on glycaemia remain to be elucidated. Our acute studies have indicated the need to investigate the chronic impact of these plant extracts in longer-term studies. Future studies in the prediabetes cohort should also look to target different metabolic profiles of varying degrees of dysglycaemia, as this may provide more meaningful results.