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    The co-design of a chat telepsychotherapy manual for Indonesians with minor depression : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Auckland, New Zealand
    (Massey University, 2024-04-08) Endro, Wisnu Tri Widodo
    The primary aim of this study was to address a gap found in the discipline of Psychology and mental health treatment in the Indonesian setting. Advances in technology and the changing lifestyle of Indonesians made distance mental health treatment a common practice. This study focuses on one of the few options for distance mental health treatment, Chat Telepsychotherapy, which has gained popularity among Indonesians, especially the Millennials and Gen Z in Indonesia. The main issue with the phenomenon was the unavailability of comprehensive, evidence-based guidelines on how to best execute such a therapy. Thus, this study aimed to create a manual that could help the community of Indonesian Clinical Psychologists to deliver Chat Telepsychotherapy to Indonesians. The study limits the scope to Indonesian Millennials and Gen Z who suffer from Minor Depression. This is because these generations are the primary users of such a service, and depression itself is found to be one of the most common mental health issues in Indonesia. To achieve the goal of this study, I used a qualitative method that used Collaborative Design with the help of online-focused group discussion. I collaborated with Indonesian clinical psychologists, Indonesian millennials, and Gen Z with minor depression to design the manual. Thematic analysis was used to analyse the participants' answers. The result of the study is a comprehensive manual that consists of nine chapters: 1) Introduction; 2) The Concept of Chat Telepsychotherapy; 3) Starting CT Practice; 4) General Guidelines for Conducting CT; 5) Specific Guidelines for Conducting CT; 6) Characteristics of Indonesian Millennials and Gen Z; 7) Minor Depressive Disorder; 8) Self-Harm; 9) CT Stages for Indonesian Millennial and Gen Z with Minor Depression. The main suggestion for future studies is to test the manual to assess its usability and effectiveness.
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    The impact of cumulative trauma and self-regulation on posttraumatic stress symptoms, depression, and suicidal ideation in a sample of New Zealand firefighters : 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) Bertram, Jeannette
    This thesis presents a research study that aimed to explore the levels of psychological distress in a sample of New Zealand (NZ) firefighters. While there is a growing body of literature that recognizes the importance of first responders’ psychological distress, there is still a paucity of research, especially on firefighters and in particular firefighters in NZ. A thorough search of literature did not reveal any quantitative research on NZ firefighters and factors contributing to and alleviating psychological distress. This study aimed to build on previous international findings and examine the presence of posttraumatic stress symptoms (PTSS), depression, and suicidal ideation (SI) in a sample of NZ firefighters, as well as investigate the impact of potentially traumatic events (PTEs) and self-regulation on this presence. First, a scoping review was undertaken of the existing evidence of the precursors to SI in firefighters. A questionnaire was developed incorporating these factors. Then, data was collected from 220 NZ firefighters through an online survey. As predicted, PTSS, depression, and SI were found to be significantly higher in NZ firefighters than in the general population. While career firefighters were found to be exposed to significantly higher cumulative trauma exposure than volunteer firefighters, no significant differences were found in the levels of psychological distress between the two groups. PTSS and depression showed a significantly positive relationship with SI. Multiple significant positive correlations were found between psychological distress and demographic and occupational characteristics. Lastly, better self-regulation skills were found to be associated with less psychological distress and moderated the relationship between cumulative trauma exposure and psychological distress.
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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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    “If medication isn’t helping me, maybe it’s just me” : narratives of treatment resistant depression : 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, 2021) Kroch, Ella
    A significant proportion of people with depression do not experience expected improvement following treatment and are considered to have treatment resistant depression. Despite this, there is relatively little research exploring the experiences of this group, who represent a significant minority of those who experience depression. The current study explored how people with treatment resistant depression make sense of depression that has not resolved following adherence to professional advice and treatment. The accounts of nine people with treatment resistant depression recruited from a private psychiatry practice in Auckland, New Zealand were analysed using narrative analysis. The participants told stories about what it was like to experience depression that persisted over many years using two narratives: that of order and of disorder. The narrative of order was used to organise and make predictable their experiences. The narrative of disorder was used to describe the ways their depression defied predictability and management. The participants also told stories to account for why they had remained depressed long-term despite receiving treatment. At times, participants attributed their persistent distress to having a treatment resistant brain or personality. There were also two alternative accountings - a narrative of bad patient behaviour and a narrative of it just taking some time to find a suitable medication. These accounts were strongly shaped by narratives of mental distress and recovery that suggest that depression follows predictable patterns and that treatment results in resolution of symptoms. Today, these narratives are increasingly encompassed by powerful and pervasive narratives of neoliberalism. The participants in this research emphasised personal accountability and self-management, and self-blame when they did not achieve the desired and expected outcome of resolution of symptoms. The implications of these findings for those experiencing persistent distress, such as TRD, as well as for health professionals working in mental health domains are discussed.
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    An exploration of the effects of the built environment on depression in the Wellington Region, New Zealand : a thesis submitted in fulfilment of the requirements of the degree of Master of Public Health at Massey University, Wellington, New Zealand
    (Massey University, 2019) Mwipiko, Rosemary
    Background: Depression is a major epidemic affecting millions of people globally. One of the most widely recognised contributors to this global epidemic is the decline in active transport and physical activity. To address this issue research has focused considerably on quantifying the walkability of neighbourhood areas in an attempt to measure the influence of the built environment on active transport and physical activity. A large proportion of this research has exclusively focused on adults, leaving a significant gap in knowledge in terms of the influence of the built environment on young people’s mental health. Young people are highly susceptible to the effects of their built environments as they can have restricted mobility due to those under 16 years being unable to drive. The aim of this research was to investigate the relationship between the built environment and depression amongst adolescents aged 12 to 18 years in the Wellington Region, New Zealand (NZ). Methods: A measure of the built environment was obtained by developing a walkability index, based on previously developed indices and measures. The measures used in this research were dwelling density, intersection density, mean normalized difference vegetation index (NDVI), average traffic volume and land-use mix. Both Euclidean and network buffer methods were employed as measures of the neighbourhood area, using a weighted population centroid with a distance of 800m. Depression was measured using the Reynold Adolescent Scale, sourced from the Youth’12 National Youth Health Survey by The University of Auckland Adolescent Health Research Group. Zero-inflated negative binomial regression was used to investigate any possible associations. Sex, age, prioritised ethnicity and household deprivation were included in the analysis as confounders. Results: The results obtained from the index validation process indicate that the built environment is associated with an increased likelihood of active travel to work for the 800m Euclidean buffer after accounting for sex, age, ethnicity, and socioeconomic factors. While the network-based buffer showed no significant association for both the count and zero-inflated models. Findings from the regression analysis between walkability (Euclidean buffer) and adolescent depression suggest that as walkability increases depressive symptoms in adolescent decrease. These suggest that living in a walkable neighbourhood results in lower depressive symptoms. Conclusions: The results add to the body of evidence that improving walkability has a positive impact on young people’s mental health.
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    Depression and field dependence : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Psychology at Massey University
    (Massey University, 1978) Drury, Nicholas
    A psychophysiological analysis of the development of psychological differentiation is presented and compared with the psychophysiological state of self-actualization. The psychological state associated with self-actualization is presented as the baseline for measuring all human behaviour. The analysis of psychological differentiation suggests that both ends of this continuum represent a deviation from the baseline of the self-actualized state. It is suggested that one of the possible consequences of this deviation is the pathological state of depression. Thirty-one depressed patients from three hospitals were examined using a battery of tests which produced a number of significant correlations. The most important of these was that a significant difference existed between field-dependent and field-independent patients on comparison with psychiatric diagnosis suggesting that field-independence is closely related to exogenous depression and field-dependence to endogenous depression. A critical review is made of contemporary theories of depression and a new model is presented. This model suggests the people develop habitual apperceptual modes of perceiving the world and fail to recognize a change of context. Reactive depression can be accounted for by a model of a subject who habitually perceives the world as an instrumental learning context and is placed in a passive avoidance context. A therapeutic strategy is suggested for treatment of the patient which consists of altering the informational component of behaviour encouraging the motivational component.
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    What people think about medicines : the relationship between medication beliefs and adherence to antidepressant therapy : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Psychology at Massey University
    (Massey University, 2006) Russell, Judith Catherine
    Major depressive disorder is a common mental disorder seen in primary care and treatment with antidepressant medication has been shown to be an effective treatment. Non-adherence to treatment regimens is considered by many to be the most serious challenge facing medical practice today. Research on medication adherence has more recently shifted its focus to the cognitive factors (i.e., patient beliefs) that determine adherence. Prior research has shown that pre-treatment perception of benefits and barriers to medication predict initial medication adherence. To contribute to this emerging literature, the present study assessed 85 depressed primary care patients about their beliefs in the necessity for and concerns about antidepressant therapy, and reported adherence using validated questionnaires (BMQ, Home, Weinman, & Hankins, 1999; MARS. Home & Weinman, 2002). The results of the present study showed no relationship between patient beliefs about the necessity of antidepressant therapy for their health and reported adherence. As predicted, participants holding stronger concerns about the potential adverse effects of the medication and stronger necessity beliefs, compared to concerns beliefs, reported increased rates of adherence. Depression severity was found to be associated with reported adherence, but was independent of the relationship between medication concerns and adherence. The present study replicated previous research and added further support for the theoretical basis of medication adherence by showing that there are similar theoretically based, determinants of adherence among patients with chronic physical health issues and those with mental health issues.
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    Helplessness or self care? : a study of nursing practice with depressed patients in an in-care setting : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing Studies at Massey University
    (Massey University, 1982) Butterfield, Shona
    This study was conducted to investigate the practice of nurses when working with depressed patients in an in care setting. A survey of the literature shows that the role commonly prescribed for nurses who work in psychiatric settings is one that emphasises a one-to-one relationship based on models of psychotherapy and focusses on individual illness, pathology, symptoms and psycho-dynamics. It is suggested that this is not a role which most nurses working in New Zealand psychiatric settings would be able to implement in practice. Three perspectives of nursing practice were explored in the study: what nurses were seen to do in practice; what they thought they should do as evidenced in results of an exercise to rank different possible interventions; and what patients said were helpful nursing interventions. A framework was developed for the study which depicts the process of helplessness (depression) as the negative 'mirror-image' of the process of self care. Results were analysed within this framework to determine whether or not nurses tended to support behaviours which were indicative of movement towards helplessness or encourage those which indicated progress towards self care. Results suggest that nurses in this study sample did not encourage progress towards self care by their interventions. There was little evidence of positive reinforcement for independent or coping behaviours with patients in the study sample. Further, the nursing practice showed little relationship to the role prescribed in the literature. The nurses did demonstrate a warm, caring, friendly approach that seemed to stem from a more traditional 'succouring' or 'mothering' view of the nurse's role.
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    Phototherapy as a treatment for depression : an analysis of the theory and research : a thesis presented in partial fulfillment for the degree of Master of Science in Psychology at Massey University
    (Massey University, 1988) Gibbs, Maureen Elizabeth
    The efficacy of phototherapy as a potential treatment modality for certain types of depression is examined. Phototherapy is suggested to be useful in relieving depressive symptoms in individuals exhibiting circadian rhythm disturbances. Particular attention is paid to the characteristics of endogenous and seasonal depressives. Endogenous depressives exhibit phase-advances in the sleep-wake cycle, REM-sleep, temperature, cortisol, and melatonin rhythms. Preliminary evidence indicates phase-delays in the rhythms of seasonal depressives. A possible physiological pathway through which light may act upon circadian rhythm generators to correct rhythm abnormalities is discussed. Theoretical positions which have been proposed to explain the underlying mechanisms of phototherapy are evaluated. Research findings are discussed within these frameworks. Major experimental weaknesses limit the usefulness of many research findings as support for the effectiveness of phototherapy in treating depression. An attempt is made to clarify some of these problems and to highlight the methodological shortcomings of research in this area. Strategies for future research methodology are recommended. Better experimental design which controls for placebo effects is needed in order to properly evaluate the antidepressant effects of phototherapy.
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    The blue brain : hemispheric asymmetry in depression as an explanation for working memory impairment : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Manawatu, New Zealand
    (Massey University, 2015) Campbell, Kathryn
    Due to substantial variability in past research regarding the cognitive and neurobiological correlates of depression, the current study investigated whether taking the possible relationship between asymmetric brain activity and cognitive impairment into account would help to clarify the matter. A total of 78 participants including 36 currently depressed, 11 previously depressed, and 31 never depressed participants, completed three mood questionnaires (Beck Depression Inventory, Hamilton Depression Inventory Short-Form, and the State-Trait Anxiety Inventory), and four working memory tasks (a spatial and verbal variant of both the N-back and complex span task). All participants had their resting brain activity recorded using an electroencephalogram. It was hypothesised that depressed participants would show relatively reduced left frontal activity, since left frontal activity is linked to positive affect and approach motivation, and that participants with depression but low levels of anxiety would show reduced right parietal activity while those with high anxiety would show increased right parietal activity due to the role of the right parietal area in arousal. These hypotheses were not supported as there were no differences in asymmetry scores between the currently depressed and the never depressed groups. However, investigation of this hypothesis was hindered by the high comorbidity of anxiety and depression making it impossible to disentangle the effects of depression and anxiety on parietal activity. It was also hypothesised that participants with depression would show impaired working memory with disproportionate impairment in the verbal working memory tasks that are thought to utilise left frontal brain activity. There was no clear support for this hypothesis. In fact, there was a trend toward improved performance possibly related to increased attention to detail due to activation of stress systems signalling a potential threat in the environment. A final hypothesis was that there would be an association between different patterns of brain activity and WM impairment but no association was found. These results highlight problems with research in this field including the conceptualisation and measurement of depression and cognitive performance as well as problems distinguishing between anxiety and depression. Future research needs to address these issues.