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    Multi-modal sleep intervention for community-dwelling people living with dementia and primary caregiver dyads with sleep disturbance: protocol of a single-arm feasibility trial
    (PeerJ Inc., 2023-01-01) Verma S; Varma P; Brown A; Bei B; Gibson R; Valenta T; Pietsch A; Cavuoto M; Woodward M; McCurry S; Jackson ML; Keogh J
    Background. Disturbed sleep is common among people living with dementia and their informal caregivers, and is associated with negative health outcomes. Dyadic, multi-modal interventions targeting caregiver and care-recipient sleep have been recommended yet remain limited. This protocol details the development of a singlearm feasibility trial of a multi-modal, therapist-led, six-week intervention targeting sleep disturbance in dyads of people living with dementia and their primary caregiver. Methods. We aim to recruit 24 co-residing, community-dwelling dyads of people living with dementia and their primary informal caregiver (n D 48) with sleep concerns (Pittsburgh Sleep Quality Index ≥5 for caregivers, and caregiver-endorsed sleep concerns for the person living with dementia). People who live in residential care settings, are employed in night shift work, or are diagnosed with current, severe mental health conditions or narcolepsy, will be excluded. Participants will wear an actigraph and complete sleep diaries for two weeks prior, and during the last two weeks, of active intervention. The intervention is therapist-led and includes a mix of weekly small group video sessions and personalised, dyadic sessions (up to 90 min each) over six weeks. Sessions are supported by a 37-page workbook offering strategies and spaces for reflections/notes. Primary feasibility outcomes are caregiver: session attendance, attrition, and self-reported project satisfaction. Secondary outcomes include dyadic self-reported and objectively-assessed sleep, depression and anxiety symptoms, quality of life, and social support. Self-report outcomes will be assessed at pre- and postintervention. Discussion. If feasible, this intervention could be tested in a larger randomised controlled trial to investigate its efficacy, and, upon further testing, may potentially represent a non-pharmacological approach to reduce sleep disturbance among people living with dementia and their caregivers.
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    Brief cognitive-behavioural therapy for children with anxiety disorders : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 2000) Girling-Butcher, Robyn Denise
    The aim of the present study was to determine the efficacy of a shortened version of an efficacious cognitive-behavioural programme for anxiety in children. Four children (aged 8-11 years) diagnosed with anxiety disorders, and one or both of their parents participated in the study. Pre-treatment and post-treatment measures including structured diagnostic interviews, parent report, teacher, and self-report were administered. In addition, weekly measures of the child's trait anxiety and coping ability were obtained from the child and the parents. The programme led to marked changes in the children's functioning. All four children showed improvement on child self-report, parent report and independent clinician's ratings following treatment. Specifically, internalising and externalising behaviours, as well as their ability to cope with specific anxious situations improved in the four participants. Additionally, in most cases, parents involved in the programme showed slight improvement in their own anxiety and depressive symptoms at post-treatment. Moreover, scores for some participants had reduced to within a non-deviant range indicating clinically significant change following intervention. Most importantly, these gains were accompanied by all four children no longer receiving an anxiety diagnosis at post-treatment. Findings are discussed in terms of methodological issues (i.e., comorbidity, critical components of treatment, and duration of treatment), implications for clinical practice, and relevance for future treatment outcome research. Limitations of the research are highlighted and recommendations for future research directions are outlined. Suggestions for future research include testing the effectiveness of the programme on a large and diverse sample of children, investigating the long-term effects of treatment, and bridging the research-practice gap. Additional research is also required to find out to what extent parental involvement in the programme enhances the impact of treatment. Overall, the findings provide preliminary support for the effectiveness of a brief cognitivebehavioural programme for treating anxiety disorders in children.
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    Awareness : facilitating the therapeutic dance along the path of growth and change ; evaluating the psychometric properties of a therapist schema questionnaire : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Albany, New Zealand
    (Massey University, 2013) Phin, Rebekah Jenny
    The importance of the therapeutic relationship and the therapist’s contribution to the interpersonal processes, have been increasingly recognized as important factors in Cognitive Behavioural Therapy change and outcome. More specifically, the therapists’ understanding and awareness of their own beliefs, assumptions and schema, and the potential effect that they can have on therapy, has been increasingly emphasized. Leahy’s (2001) Therapist Schema Questionnaire (TSQ) is a potentially useful screening measure designed to identify Therapist Schema. No research has evaluated the psychometric properties of the TSQ. This study investigated the underlying factor structure and reliability of the TSQ in a therapist sample (N = 269). An exploratory factor analysis suggested a 7 factor structure and a 37 item scale that included 4 of the original 15 schema factors, as well as 3 additional factors, each containing a theoretically meaningful combination of original schema factors. The 3 most commonly identified Therapist Schemas revealed in the study were ‘self-sacrifice’, ‘demanding standards’, and ‘sensitive/rejection’. The identified factors and the 37 item scale were found to have adequate to good internal consistency. Implications of these findings are discussed and recommendations are made for further research.
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    Will the needle make me bleed to death? : The development and evaluation of a cognitive-behavioural therapy for chronically ill children with needle-related distress : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Wellington, New Zealand
    (Massey University, 2011) McIvor, Jessica Anne
    For some chronically ill children, having an injection is a regular occurrence and can result in distress and avoidance behaviour for the child and their family. There can also be negative health implications of these children not having their injections. Research supports the effectiveness of cognitive-behavioural therapy for childhood needle-related distress (NRD), although there are significant gaps in the literature that need to be addressed. The aim of the present study was to develop and evaluate a six-session cognitive-behavioural therapy to alleviate NRD among chronically ill children. The research was designed to pilot this manualised approach, which was based on an existing therapy utilised at the Massey Health Conditions Psychology Service, relevant theory and empirical research. The therapy programme known as the “Coping Kids Treatment Manual” differed from previous research by incorporating cognitive components, carer involvement and multiple exposure sessions. A single-subject multiple-baseline across participants design was used to assess the effectiveness of the treatment manual. Four chronically ill children (aged 6-14 years) of New Zealand European descent diagnosed with NRD and their carers participated in this study. Child and carer self-report measures were collected during baseline, treatment and once at one month follow-up. Results showed that, compared to pre-treatment levels, the majority of children and their carers demonstrated a reduction in distress and increase in coping behaviours related to needle injection situations. Follow-up data showed treatment gains were maintained and/or improved at one month. Most importantly, these gains were accompanied by three of the four children successfully receiving an in-vivo needle injection during session five of the intervention. Findings are interpreted in terms of previous literature, and implications are discussed according to theory, research and clinical practice. Limitations of the present study are highlighted and recommendations for future research directions are outlined. Suggestions for future research include evaluating the effectiveness of the treatment manual with a larger and more diverse group of children, extending follow-up periods and utilising more rigorous measures. Additional research is also required to investigate what components are most critical in producing meaningful change and to what extent carer involvement enhances treatment outcomes. Overall, preliminary findings offered support for the effectiveness of the Coping Kids Treatment Manual in treating four chronically ill children with NRD.
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    An investigation of early sudden gains in cognitive-behavioural therapy for depression : client and within-therapy predictors of change : 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, 2011) Foster, Nicole Anne
    Research into discontinuous change patterns across therapeutic treatment has indicated that clients who experience non-linear change patterns (e.g., „depression spikes‟, „transient worsening‟, and „sudden gains‟) have comparatively better outcomes in therapy (Haas, Hill, Lambert & Morrell, 2002; Hayes, Laurenceau, Feldman, Strauss & Cardaciotto, 2007; Illardi & Craighead, 1994; Thompson, Thompson & Gallagher-Thompson, 1995). The focus of the current study is on the discontinuous change patterns that have been identified as sudden gains, where a client shows a large symptom improvement from session to session of therapy (Tang & DeRubeis, 1999). Research into the phenomena of sudden gains has indicated that they are associated with better outcomes within therapy and post therapy; they may help identify clients who will respond favourably to therapy; and that they may provide further clarification around change mechanisms and processes within therapy. The current study had two aims: (1) to investigate the client factors that may predict sudden gains in Cognitive Behavioural Therapy (CBT) for depression; and (2) to investigate the within-therapy factors that may be associated with sudden gains within CBT for depression. Through an overarching depression study at the School of Psychology, Massey University, a final sample of 28 clients experiencing their first episode of Major Depression (MDE) were recruited. They participated in 20 free sessions and two follow-up sessions of CBT for depression. Depression severity was measured at every session using the Beck Depression Inventory – Second Edition (BDI-II). Attributional style was measured at six time points using the Attributional Style Questionnaire (ASQ). Homework was measured at up to 18 time points using the Homework Rating Scale – Second Edition (HRS-II) – Client Version. A longitudinal multi level design method was used to analyse the data. 42.9% (n=12) of the clients experienced a sudden gain and these clients experienced a faster rate of improvement in depression severity across treatment. Clients‟ attributional style at intake moderated the relationship between sudden gains and rates of change in depression severity across treatment. No moderating relationship was found with either initial symptom severity or co-morbid status at intake and sudden gains and improvement in therapy. Within therapy variables such as attributional style change and homework beliefs across therapy did have a moderating effect on the relationship between sudden gains and improvement in depression severity across treatment. Clinical considerations and implications for future research are discussed.