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Start date: 2023Subject: search.filters.subject.520301 Clinical neuropsychology

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    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.
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    An evaluation of the neurosequential model of therapeutics to guide trauma-informed foster care in the New Zealand context : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Albany, New Zealand
    (Massey University, 2024-05-12) de Bruin, Marike
    The health and well-being of children in foster care remain a clinical, as well as public health concern, both internationally and in Aotearoa/New Zealand. Children in care often have histories of significant trauma exposure, in particular to abuse, neglect and domestic violence. The link between adverse childhood experiences and poor adult outcomes in physical, mental, emotional, and social health, is well established in the literature and necessitates further research on responding to and treating children exposed to complex trauma in early life. Trauma-informed foster care has emerged in recent years as an intentional therapeutic approach to responding to the complex needs of children in care. The objective of this present study is to contribute to the field of evidence-based family trauma-informed foster care in the New Zealand context. The focus of this dissertation is on evaluating the use of a neurodevelopmental clinical problem-solving tool, the Neurosequential Model of Therapeutics (NMT), developed by Dr Bruce Perry from The Neurosequential Network, to guide a trauma-informed and therapeutic approach to family foster care standards within the context of a New Zealand social service organisation. A mixed-method research design was used to explore the experiences of foster parents and frontline staff involved in using and implementing this model, as well as conduct an initial outcome evaluation of its impact on children’s mental health difficulties and behavioural functioning. The results of the study suggest that the NMT is a useful and relevant tool to guide trauma-informed care in the New Zealand foster care context, and is associated with promising positive outcomes.
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    Is the maternal 'babybrain' adaptive? : examining theory of mind, emotional state, and the association with attachment over pregnancy and the postpartum : a thesis presented in partial fulfilment of the requirements for the degree of Doctorate in Clinical Psychology, Massey University, Wellington, New Zealand
    (Massey University, 2023) Spill, E. Kate
    Pregnancy is a time of great maternal neuroplasticity with associated cognitive and behaviour change. Cognitive decrements are seen in memory, executive functioning, and overall cognitive functioning, and cognitive enhancements in facial and affect processing. It has been proposed that cognitive enhancements may come at the cost of cognitive decrements, due to the brain restructuring in a manner which prioritises adaptive caregiving-related functions. Hoekzema et al. (2016) found significant reductions in the grey matter (GM) volume of first-time pregnant women in the Theory of Mind (ToM) network. On the basis that reduced GM is an indicator of better processing efficiency and specialisation, they proposed that pregnancy may be a sensitive period where ToM may be enhanced to support the maternal-infant attachment relationship. ToM is a multidimensional construct which describes the capacity to understand the mental state of ourselves and others. It has been investigated in maternal-infant attachment as maternal mind-mindedness and parental reflective function. There are very few studies which have investigated individual differences in ToM over the perinatal period and its link to attachment. Objective: The primary aim of this research is to investigate ToM capacity over the perinatal period and its relationship to attachment. Method: Study 1 was a quasi-experimental, between-groups design comparing third trimester primiparous women’s performance on four ToM tasks with that of nulliparous control women. Participants (n=133; 68 pregnant) completed four computer-based ToM tasks: Reading the Mind in the Eyes-Revised (RMET), Hinting, Mind-mindedness, and the Reflective Functioning Questionnaire (RFQ). Prenatal attachment was measured with the Prenatal Attachment Inventory-Revised (PAI-R) and emotional state with the Depression, Anxiety and Stress Scale (DASS-21). It was hypothesised that: ToM would be enhanced in pregnancy; ToM would be associated with pre-natal attachment; emotional state (depression, anxiety, stress) would be negatively associated with both ToM and attachment. Results: Study 1 found no between group differences between pregnant and control participants on ToM performance. In the presence of greater depression and stress (both groups) and anxiety (pregnancy only) there was significantly more uncertainty about the mental states of self and others, an aspect of reflective function ToM. ToM in pregnancy was not consistently associated with prenatal attachment. Method: Study 2 compared ToM measured in pregnancy with caregiving ToM (Parental Reflective Functioning Questionnaire; PRFQ) and maternal-infant attachment (Maternal Postnatal Attachment Scale; MPAS) when mothers and babies were 4-6 months postpartum (n=55). It was hypothesised that ToM in pregnancy would predict parental reflective function and attachment; and that parental reflective function in the postpartum would be concurrently associated with maternal-infant attachment. Emotional state was expected to be negatively associated with both parental reflective function and attachment. Results: ToM in pregnancy had no consistent relationship to postpartum ToM (PRFQ) or attachment (MPAS). In postpartum women, the presence of poor and rigid caregiver ToM (PRFQ-Pre-Mentalising Modes) was associated with poorer quality of attachment and greater hostility in attachment (both MPAS subscales; r > .3). To explore this relationship further two mediation models were computed. These revealed that under conditions of greater depression or stress, mothers were more likely to use poorer, more rigid, and inappropriate ToM when they reflected on the inner experiences of their baby and themselves and, taken together, these factors were linked to significantly greater levels of hostility in the attachment relationship and poorer overall attachment. For each mediation model, stress and depression accounted for over a third of the basic relationship between caregiver ToM and attachment. Conclusions: (1) Contrary to Hoekzema et al. (2016), there is no evidence of general ToM enhancement in late pregnancy nor of a consistent relationship between ToM capacity in pregnancy and postpartum attachment. However, given that pregnant women were also no worse than control women, this might offer preliminary support for a cognitive prioritisation of ToM over general cognition in pregnancy. (2) In postpartum women there was a significant moderate positive relationship between parental reflective function and aspects of maternal-infant attachment. Levels of depression and stress were linked to poorer reflective function and attachment and accounted for over a third of the variance. This research is the first to examine ToM over the perinatal period using multiple measures and to examine the relationship to attachment mediated by mood state.