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    Affect recognition training after traumatic brain injury : a thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand
    (Massey University, 2013) Yim, Jackki Hoon Eng
    Impairment in facial affect recognition is prevalent after moderate to severe traumatic brain injury (TBI), and may underlie some problems in social functioning. Tentative work indicates that emotion recognition can improve with training, but the effectiveness of these programmes remains unclear. Little is known about whether broader cognitive deficits underlie facial affect recognition impairment. Less is known about baseline cognitive variables that predict treatment response and the relationship between changes in cognitive functioning and improvement in facial affect recognition after treatment. The present research formed part of a multi-centre randomised controlled trial examining the efficacy of two affect recognition training programmes designed to improve emotion recognition in adults with moderate to severe TBI. Study One reports outcome data from the main trial. Seventy people with TBI and facial affect recognition difficulties were randomly assigned to nine sessions of one of three treatments: Faces, focusing on facial affect recognition, Stories, determining emotions from social context, and a control group. Participants completed tests assessing cognition, emotion recognition, community integration, interpersonal behaviour and empathy, and informants completed interpersonal and social functioning measures. Participants were assessed five times: initial screening, pre- and post-treatment, and at three- and six-month follow-up. Significant improvement was seen in the Faces group on the primary facial affect recognition outcome measure (DANVA2-Adult Faces). These gains were sustained at six months. No significant differences between treatment groups and the control group were found on interpersonal and social functioning measures. Study Two had 75 participants with facial affect recognition difficulties and investigated the relationship between facial affect recognition impairment and cognitive functioning. Greater facial affect recognition failures were related particularly to working memory, processing speed, and nonverbal memory. No relationship was found with executive functioning. Study Three explored the relationship between baseline cognitive variables, changes in cognitive functioning, and long term treatment response. Only older age was predictive of a better long-term response to Faces treatment. Improvement of facial affect recognition was not mediated by changes in cognitive functioning. This research provides further evidence that retraining is possible for affect recognition difficulties after traumatic brain injury.
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    Assessing cognitive functioning in older adults and its relationship to quality of life : a thesis presented in partial fulfilment of the requirements for the degree of Doctorate of Clinical Psychology at Massey University, Wellington, New Zealand
    (Massey University, 2013) Callow, Lauren May
    Cognitive impairment of any magnitude carries an undetermined societal and individual cost. The desire to accurately predict cognitive decline at an early stage is sought-after as robust cognitive health and function in later life is desirable. Knowing who is at risk and what those risks may be is imperative for targeting interventions to those in need. The lack of nationally representative information regarding cognitive functioning means that there is little information about base rates of cognitive functioning. This represents a problem in terms of gauging the incidence of cognitive impairment and difficulties related to planning for social and health expenditure for the ageing population. This thesis explores the validity and reliability of the Addenbrooke’s Cognitive Examination-Revised and develops New Zealand norms for the measure using data from the New Zealand Longitudinal Study of Ageing. These demographically stratified norms will help to determine those people who may be more vulnerable to a dementing process. The information is applied in the context of examining the impact of cognitive functioning on quality of life; an important concept to consider in research. In article one, a pilot study of the use of the Addenbrooke’s Cognitive Examination-Revised (ACE-R) with older community dwelling adults, the utility of the measure was supported. In article two, the ACE-R was integrated into a nationwide longitudinal study of older adults. Stratified demographic norms were created. This is the first known nationally representative New Zealand study to provide evidence of the impact of age, gender and ethnicity on measures of cognitive functioning. In article three this information was applied in the study of the relationship between cognitive functioning and quality of life. Results suggested that cognitive functioning has a small significant association with quality of life in older age and a much larger association in those who display cognitive functioning difficulties. This research adds to the research base in New Zealand by providing representative norms from which older adults can be compared in a meaningful and specific way.