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    The effectiveness of a guided low intensity cognitive behavioural therapy programme with adult Māori experiencing low mood in a community-based setting : 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, 2022) Elkington, Angus Marangai Brons
    Common mental health disorders such as depression is a leading cause of ill health and disability. The global problem is underscored by a lack of access to evidenced based psychotherapy and under resourced workforce. Low intensity Cognitive Behavioural Therapy (LI-CBT) within a stepped care approach is one way to alleviate the burden of mental health and increase service delivery. LI-CBT Studies have been conducted in New Zealand and were effective at treating mild to moderate depression with non-Māori groups and across individual and group formats. However, studies investigating the effectiveness of Cognitive Behavioural Therapy (CBT) with Māori are sparce considering that Māori are at increased risk of poor mental health outcomes. This study investigated the effectiveness of an unadapted individually delivered telephone guided LI-CBT programme, Living Life to the Full with Māori adults using longitudinal multilevel modelling. The current study monitored change in low mood, psychological distress and quality of life enjoyment and satisfaction across 13 time points, which consisted of three weekly baseline measures, eight weekly measures during the intervention and one a six- and twelve-weeks post programme. A total of 20 participants of Māori descent were recruited in which 18 participants completed the Living Life to the Full programme. Multilevel modelling and the variable of time explained a significant portion of variance to provide more conclusive evidence to suggest that on average participants experienced significant improvement in low mood, psychological distress, and quality of life enjoyment and satisfaction comparative to similar LI-CBT studies. The current study fills a void in the literature and supports the effectiveness of low intensity Cognitive Behavioural Therapy (CBT) for Māori experiencing low mood, when delivered by a Māori facilitator. Therefore, the implementation of LI-CBT programmes such as Living Life to the Full can provide greater access, preference, and choice to evidence-based interventions for Māori experiencing low mood.
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    Metabolising bigger-than-self distress through nondual enactive wisdom development : a layered autoethnographical study of embodied embedded psychological responses to biospheric and civilisational crises : 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, 2022) Laurence, Nicholas Clyde
    The current thesis explores the question of how psychologists and other mental health professionals might assist clients experiencing bigger-than-self distress. Bigger-than-self distress is defined as psychological distress that relates to what I describe as the biospheric-civilisational meta-crisis, which comprises a compounding and interlinked set of social and environmental issues, some of which pose time-bound existential threats to the stability of our civilisation and the biosphere’s capacity to sustain it. The thesis begins with looking at the cognitive behavioural tradition and mindfulness-based interventions (MBIs) and explores what further psychological assistance might be given for those whom these interventions are not enough. The thesis takes an autoethnographic approach, drawing on the author’s own experience of responding to bigger-than-self distress, and blends this with an enactivist theoretical account that seeks to link more closely together mindful understandings of experience with cognitive scientific theory and empirical literature. The author’s experience of engaging in mindfulness training broadened and deepened his perspective on bigger-than-self distress and the seeming necessity of an expanded container within which to hold and process it. This expanded container is expounded in the form of the Big History, Systems View of Life, and Theory of Knowledge perspectives, which provide an evolutionary, scientific, and cosmological account of history within which to situate the biosphere, humanity, and the civilisational-biospheric meta-crisis that is related to bigger-than-self distress. An updated view of cognition is also provided, which views cognition as self-organising, based on principles of relevance realisation, free energy minimisation, predictive processing, and which is profoundly embodied and embedded within its environment. From this expanded base, wisdom traditions from Western, Eastern, and Indigenous cultures are discussed with a view to being able to draw from these for novel interventions within the cognitive behavioural tradition that align with this updated version of cognition and context of cosmos, biosphere, humanity, and biospheric-civilisational meta-crisis. From there, interventions within clinical psychology and coaching (IFS and Aletheia Coaching, primarily) are presented as prototypical novel cognitive behavioural interventions that are aligned with this view of cognition. The novel ways of working with psychological content are applied to bigger-than-self distress via a new term that I label metabolisation. This overall way of working can be understood as enactive nondual wisdom development for bigger-than-self distress and helps to provide a cognitive scientific vocabulary for understanding psychological responses to bigger-than-self distress. Importantly, nondual enactive wisdom development is something that can only be enacted in real-world praxis, and so to guide clients through it requires clinicians to go through it experientially ahead of their clients: a philosophy that overall fits well with the reality of bigger-than-self distress and the meta-crisis being something that clinicians and clients alike are subsumed within.
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    An internet-delivered Cognitive Behaviour Therapy for clinical perfectionism : a thesis presented in partial fulfilment of the requirements of the degree of Doctor of Clinical Psychology at Massey University, Albany, New Zealand
    (Massey University, 2019) Miller, Emma
    Clinical perfectionism has been associated with a number of cognitive and behavioural difficulties including work strain, procrastination, burnout, sleep disturbance, and problems with rumination, intimacy, emotional expressiveness, and assertiveness. In addition, it has been recognised as a vulnerability factor for the development and maintenance of several psychological disorders, such as eating disorders, obsessive–compulsive disorder, social anxiety, and depression. Cognitive behaviour therapy (CBT) is a well-established treatment modality that has been demonstrated to be an effective intervention for clinical perfectionism. Recently, advances have been made in terms of the online delivery of effective CBT-based interventions. This study explored whether an eight-week online, guided self-help treatment for elevated clinical perfectionism produced clinically significant reductions in perfectionism, self-criticism, stress, low mood and anxiety, and increases in self-esteem within an adult New Zealand sample. The study included mixed methods, using a case series methodology with an AB plus follow-up design. It included both a reliable and clinically significant change (RCSC) analysis of repeated measures and a thematic analysis of module reflections and interviews completed at follow-up. Twelve participants completed weekly measures of perfectionism, mood, self-criticism and self-esteem over a four-week baseline phase andeight-week intervention, and then completed follow-up measures and an interview two months post-treatment. The intervention included eight weekly online self-help modules of CBT for clinical perfectionism (CBT-P) guided by the lead researcher. Interviews were completed individually with each participant to better understand how they experienced the treatment under investigation and changes to their clinical perfectionism and related difficulties. This study explored the hypotheses that: 1) the treatment would produce clinically significant reductions in clinical perfectionism, and 2) the treatment would also produce clinically significant reductions in low mood, anxiety, stress and self-criticism, and increases in self-esteem. The study also sought to answer the question regarding how the participants experience the guided ICBT-P. RCSC was achieved in clinical perfectionism for 90% of the participants. For selfcriticism and stress RCSC rates were 73% and 57%, respectively. Lower success rates were observed in the final three phenomena, with RCSC occurring in 27% of participants for self-esteem and 11% of participants for both depression and anxiety. The analysis of qualitative data resulted in two major clusters of themes. The first cluster described the participants’ experiences of the website and included four themes: 1) engagement with the treatment, 2) treatment delivery, 3) the website content, and 4) the guiding therapy. The second cluster of themes, which covered the participants’ perceived outcomes of treatment, included six themes: 1) a change in thinking, 2) developing insight, 3) an increase in self-love, 4) interpersonal improvements, 5) improved productivity and 6) a work in progress. This study provides initial evidence for the effectiveness of an eight-week online, guided self-help treatment for clinical perfectionism within a New Zealand sample. Participants perceived the treatment to be useful and reported experiencing a number of promising outcomes.
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    Schizophrenia (and other psychotic disorders) cognitive-behaviour therapy research programme : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 2006) Gillingham, Ruth
    The present study evaluated the effectiveness of a treatment that combined techniques from Cognitive-Behaviour Therapy (CBT) and Acceptance and Commitment Therapy (ACT) to alleviate the psychological distress and symptom severity resultant from psychotic-type disorders. This treatment (EVoLVE Therapy: an acronym for Exposing Virtues of Living Valued Existences) was designed to primarily target the psychological distress associated with psychotic disorders and secondarily to facilitate improvement in psychotic-type symptoms. Participants in this study were selected based on previous diagnoses of schizophrenia, schizoaffective, and other psychiatric disorders with psychotic features. Seven participants, who had each been long-term consumers of mental health services, completed 10 weeks of therapy. Post-graduate students, in training to become professional psychologists, delivered supervised therapy using a structured treatment manual written by the researcher. Pre-treatment, post-treatment and 5-week follow-up data were collected, using a variety of measures to assess the effectiveness of treatment. Results were quite positive overall, with some clients making considerable improvements in a number of domains. All 7 participants showed a decrease in symptom severity after treatment. In addition, 6 out of the 7 participants reported an improved quality of life following treatment. Marked improvement in negative affect was also evident, with a slight improvement in positive affect noted.
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    Group guided low intensity self-help for community dwelling older adults experiencing low mood : a dissertation presented in partial fulfillment of the requirements for the degree of Doctor of Clinical Psychology, Massey University, Albany, New Zealand
    (Massey University, 2017) Martyn, James
    Depression is amongst the most common health issues affecting older adults, however, access to evidence-based psychological treatments remains low amongst this age group. This is due, in part, to numerous barriers that surround current mental health treatment and delivery, which has contributed to discrepancies between treatment needs, availability, and uptake. To address such barriers, low intensity Cognitive Behavioural Therapies (LI-CBT) and in particular guided self-help interventions have emerged as promising, brief, cost-effective, and evidence-based alternatives to traditional high intensity therapies. Recently, interventions have begun to utilise the advantages of guided LI-CBT selfhelp within a group or class setting, thus providing both a cost-effective and time-efficient form of treatment delivery. Of these group guided approaches, Living Life to the Full (LLTTF) is the only intervention that primarily targets depression and has undergone randomised effectiveness testing. While early evidence lends support for the efficacy of LLTTF, further research is needed to extend the findings to different populations and age groups, particularly older adults. The current study examined the effect of the group guided version of LLTTF on community dwelling older adults’ ratings of depression, anxiety, and quality of life. Additionally, the relationship between older adults’ engagement with LLTTF and improvements in their reported ratings on all primary outcome measures was evaluated. Twenty-four older adult participants with symptoms of depression were recruited from a New Zealand community setting. Participants completed the intervention over eight sessions and data was collected at baseline, during each session, and at 1- and 6-week follow-up. Data was analysed using Multilevel Modelling, implementing a multilevel (2 level), repeated measure (11 waves), single group design. Results indicated significant improvements in participants’ symptoms of depression, anxiety, and quality of life over time. There was no evidence of an interaction between participants’ engagement and depression or anxiety ratings. Unexpectedly, engagement did however interact with quality of life, demonstrating that higher levels of out-of-class engagement with self-help content was related to significantly lower improvements in quality of life. Finally, supplementary analyses indicated greater reductions in anxiety symptoms amongst participants who lived with others compared to those who lived alone. These results endorse LLTTF as a viable and effective low intensity treatment option for depression in older adults, with additional benefits for symptoms of anxiety and quality of life. When delivered to older adults, LLTTF could increase treatment access and choice, contribute to the reduction of secondary mental health service load, minimise treatment barriers, and importantly support older adults’ to manage symptoms of depression and anxiety while remaining in communities of their choosing.
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    Increasing homework compliance by using the guiding model for practice : an analogue study : a thesis presented in partial fulfilment of the requirements for the Master of Arts at Massey University, Albany
    (Massey University, 2008) Connolly, Anna
    Homework assignments are considered a fundamental component of Cognitive Behavioural Therapy and are believed to be significant in assisting to produce and maintain treatment gains. However, gaining clients compliance to homework tasks remains a significant challenge. An analogue study of a single session relaxation intervention was conducted to test the guiding model for practice (Kazantzis, MacEwan & Dattilio, 2005); designed to provide therapists with a step-by-step guide of how to systematically administer homework in therapy. Forty four participants were randomly assigned to one of two conditions. The systematic condition (n = 21) was designed to administer homework following the guiding model, while the non-systematic condition (n = 23) followed standard therapy practice. Hypotheses posited that participants in the systematic group would display greater levels of engagement in homework; would have more positive beliefs in completing the homework; that greater adherence to the homework would correlate positively with reductions in anxiety; and that the systematic group would show a greater reduction in anxiety. In relation to engagement in homework the results found a statistically significant difference in the mean ranks of homework compliance between the two groups. The Mann-Whitney U result was 182 (z = -1.48) with an associated probability of .14, showing that participants in the systematic group did have higher levels of homework compliance. A MANOVA calculation was used to assess the systematic group for more positive beliefs in completing homework. The results found significant differences in two of the four Homework Rating Scale II (HRS) subscales; behaviour: F(1, 42) = 1.83, p = .184, partial eta squared - .042; and consequences/synthesis: F(1, 42) = 2.93, p = .094, partial eta squared = .065. The other two subscales of the HRS; beliefs and situation, were not administered differently between groups, providing further support for the difference of homework administration. Partial support was found for correlations between homework practice and anxiety. While three of the four correlations were significant, it was found that state anxiety actually increased as practice increased, however, trait anxiety was found to reduce as homework levels increased. No significant group differences were found in anxiety reduction. Implications of these findings are discussed.
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    Evaluating the effects of self-practice/self-reflection on cognitive flexibility, empathy, insight, self-compassion, self-monitoring, and stress in postgraduate cognitive behaviour therapy trainees : a thesis presented in fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Albany, New Zealand
    (Massey University, 2017) Hume, Fleur Alice
    There is considerable evidence to suggest that cognitive behaviour therapy (CBT) training programs can effectively enhance therapists’ CBT knowledge and skills. In response, research is now beginning to establish which specific training strategies are most effective in developing which CBT skills and competencies. Self-practice/self-reflection (SP/SR) is an experiential training strategy used to enhance CBT training and the ongoing professional development of CBT practitioners. Self-practice/self-reflection provides therapists with a structured experience of using CBT on themselves (self-practice) and reflecting on that experience (self-reflection). In order to build on previous SP/SR research, the aim of the current study was to explore the effects of SP/SR on six specific dimensions of CBT therapist competence: cognitive flexibility, empathy, insight, self-compassion, self-monitoring, and stress, among postgraduate CBT trainees. Seven students completing a SP/SR program as part of the Postgraduate Diploma in Cognitive Behaviour Therapy at Massey University were recruited to participate in the study. Quantitative data using six self-report measures of therapist competence was collected at five critical time points pertaining to the participants’ SP/SR program: baseline, pre-intervention, midpoint, post-intervention, and follow-up. Qualitative data was collected from participants’ written reflections. A mixed method design using descriptive quantitative and qualitative thematic analysis provided valuable quantitative (and some qualitative) support for the use of SP/SR as a CBT training and development strategy, particularly when targeting these six dimensions of CBT therapist competence.
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    Cognitive-behaviour therapy case conceptualisation and psychotherapeutic practice : the practitioner's perspective : 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, 2012) Küsel, Kim Brigitte
    Cognitive Behaviour Therapy (CBT) is the most-widely utilised therapeutic approach in New Zealand; with case conceptualisation identified as “the heart”, or “cornerstone”, of CBT practice. Yet, there is limited empirical support for CBT case conceptualisation; and an identified paucity of research regarding its real-world use. As such, the present study investigated the real-world, case conceptualisation practices, attitudes and experiences of 48 New Zealand CBT practitioners; with the primary aim of exploring CBT case conceptualisation within the context of the practitioners’ subjective perspective. The data set consisted of responses to a purpose-built survey, while data analysis took the form of a descriptive analysis, which in turn, informed a thematic based review of the themes within the data. The descriptive results revealed that almost all respondents are utilising CBT-specific, case-level conceptualisations in their practices; they appear to have a good understanding of the various components of case conceptualisation, and appear to mirror the recommended theory in both their theoretical understanding, and practical use of conceptualisation. Utilising the descriptive results as a context, a thematic analysis was used to identify the main and sub-themes embedded in the responses. “Conceptualisation as a Highly Valued Therapeutic Process” was identified as the single main theme. The first sub-theme, “The Indicators that respondents value case conceptualisation”; included the following additional sub-themes: The high level of conceptualisation use among respondents; the pursuit of further education about case conceptualisation; the use of conceptualisation-compatible therapeutic tools; and the qualities that respondents attributed to conceptualisation; and informed the overall theme of conceptualisation as a valued process. The second sub-theme, “The practitioner-perceived benefits of conceptualisation”, contained three sub-themes, each examining the benefits of CBT case conceptualisation to either the practitioner, the client, or, the therapeutic process; was informed by the main theme, and explores why respondents value conceptualisation. These findings; together with the limitations, implications and future directions, of this study are discussed in the context current literature and the research aims.
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    Using the concept of rule-governed behaviour to integrate the cognitive and behavioural therapies : a theoretical analysis : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 1999) Secker, David Leonard
    The concept of rule-governed behaviour (RGB) was introduced by B.F Skinner (1969) to allow complex verbal behaviour to be amenable to the same types of contingency analysis used in most other areas of applied behaviourism. Inherent in the concept of RGB is the notion that people formulate and follow rules created by themselves and others and that this constitutes a distinct class of operant functioning. As the process of cognitive therapy is primarily undertaken in a verbal fashion, the possibility of employing the concept of RGB to redefine aspects of cognitive therapy from an operant perspective has been considered by several researchers (e.g., Zettle & Hayes, 1982; Poppen, 1989). This form of paradigmatic integration, involving the transplantation of one set of therapeutic techniques into the theoretical body of another epistemological framework, can be termed assimilative (Lazarus & Messer. 1991). The present essay clarifies the aims and content of such an integration as it relates to the concept of RGB and cognitive-behavioural rapprochement, and offers several theoretical advancements in this direction. Errors in rule-following and rule-formulation are discussed in terms of the role they play in cognitive assessment, and the cognitive mechanisms involved in therapeutic change are also analysed in terms of RGB. It is also shown how RGB can be conceptualised as a reciprocally-determined system of responding, similar to that espoused by the cognitive theorist Albert Bandura (1977a). Finally, some of the problems associated with the concept of RGB and psychotherapy integration are reviewed in relation to the present analysis.
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    The construction and use of belief in cognitive therapy : a discursive analysis : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 2002) Jarden, Aaron John
    This research explores how the notion of belief is constructed and used within the cognitive therapy domain. Utilising a multi-media approach, in which cognitive therapy texts were gathered from instructional books, demonstration videos, and interviews with practicing psychotherapists, the transcripts were analysed using Jonathan Potter, Derek Edwards and Margaret Wetherell's model of discourse analysis. The analytic attention was on the linguistic resources and practices therapists had available and used in constructing and deploying different notions of belief. By approaching therapists' belief talk in this way and showing the contingent, socially constructed, and rhetorical nature of their discourse use, two main constructions of belief became evident. These were of 'a belief itself' and of 'a believing person'. In addition, Davies and Harrés' positioning theory was utilised which highlighted two main subject positions; the therapist as the 'expert' and the client as the 'layperson'. The findings tend to support the view that there are medium and therapist specific idiosyncratic aspects to belief, which are constructed and constituted in multiple repertoires and by various discursive strategies. This suggests a need for cognitive therapy to re-evaluate the notion of belief and its various uses, and highlights the benefits and pitfall of utilising a multi-media discursive approach.