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Item Shining a light on recovery : investigating the effectiveness of bright light therapy in mitigating fatigue after mild traumatic brain injury : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, New Zealand(Massey University, 2023) Connolly, Kathryn MarieFatigue is a common and debilitating symptom experienced by individuals following a mild traumatic brain injury (mTBI). Despite its prevalence, post-mTBI fatigue remains a challenging, and at times misunderstood condition, with a scarcity of scientifically evidenced treatment approaches. The complexity of fatigue's underlying causes in this population calls for further research. Recognising its significant impact on individuals' quality of life emphasises the need to identify effective interventions and enhance symptom management. This study aims to investigate the potential effectiveness of daily bright light exposure as a non-invasive intervention to alleviate fatigue in the post-mTBI population. While existing research has shown positive outcomes for bright light therapy in managing fatigue in broader traumatic brain injury populations, the current study focuses on individuals with injuries at the mild end of the spectrum, offering valuable insights into the efficacy of this treatment in a more targeted context. The primary objective of the research was to investigate whether daily bright light exposure effectively reduced fatigue symptoms in individuals with mTBI. Additionally, the study aimed to explore the impact of light exposure on secondary outcomes, including daytime sleepiness, sleep quality, depression, anxiety, stress, and circadian rest-activity cycles. To address recruitment challenges, a randomised multiple baseline controlled trial design was adopted. The results revealed that all nine participants consistently experienced significant fatigue throughout the study. Fatigue levels appeared to decrease during the bright light therapy sessions suggesting a potential positive impact of bright light exposure on fatigue, although this reduction was not statistically significant across the group. Due to limitations in data, the ability to confidently demonstrate efficacy was low and this prompted a shift in focus towards assessing the feasibility of conducting research of this nature. Moving forward, future studies can benefit from an understanding of the complexities involved in implementing intensive intervention protocols. The current study demonstrates a need for close collaboration with participants to monitor adherence and potential side effects, alongside coordination with colleagues in the mTBI field to ensure access to a sufficient participant pool for achieving statistically significant results. Overall, this research provides some limited evidence of positive effects from bright light therapy for select individuals and contributes to the expanding body of evidence investigating light as a potential intervention for alleviating fatigue symptoms post-mTBI. More importantly, by shedding light on the hurdles in implementing such interventions among individuals with mTBI, it contributes to the development of targeted and potentially effective interventions for improving the quality of life for individuals affected by this condition. It is hoped that this study contributes to the broader literature aimed at facilitating better outcomes for individuals with mTBI and related fatigue symptoms.Item 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, MarikeThe 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.Item The surviving emotional storms programme : a service user informed programme developed from an exploratory study of help-seeking experiences of NZ tertiary students with Borderline Personality Disorder : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Auckland, New Zealand(Massey University, 2023-04-11) Beckett, Jennifer JeanIn this qualitative thesis, 14 university students were interviewed about their lived experience of having Borderline Personality Disorder. Participants discussed arduous journeys in search of effective treatment and described their increasing risk while trying to access help, alongside their experiences when able to access publicly funded treatment. Results from thematic analysis highlighted a super-theme of a continuous invalidation loop, discussed from an ecological and attachment perspective. This started with early help-seeking invalidation in participants’ microsystems, with the loop then broadening across systems over time, and help seeking attempts. This included contact with the mental health system, which was suggested to be a perpetuating factor in the development and maintenance of Borderline Personality Disorder. The help-seeking invalidation loop was briefly interrupted when participants were diagnosed, which occurred for most, directly after a suicide attempt. Diagnosis brought temporary relief, when participants armed themselves with knowledge about the condition including prognosis and treatment. The validation from informed diagnosis aided an externalisation process to occur, enhancing connections with self and others. However, accessing treatment proved difficult, crisis and respite was perceived as invalidating and when in treatment participants’ attempts at connection were often thwarted. Results from the thematic analysis guided the design and delivery of a group intervention. The intervention was administered using an action research methodology to university students either diagnosed with Borderline Personality Disorder or with borderline traits. The intervention, an adaptation from traditional dialectic behavioural therapy, integrated the results from the thematic analysis. To address the super-theme findings, attachment theory was interspersed throughout the intervention, utilizing aspects of narrative and acceptance and commitment therapies. The intervention was adapted and evolved from participant feedback over six cycles of 12-session intervention groups. In each group participants reported reduced severity of borderline symptoms and increased mindfulness ability. The research took place prior to and during the global pandemic and Covid-19 mandatory lockdowns in NZ, during which the research was expanded to finish with an online intervention accessed by students across NZ.Item Exploring the narratives of people with lived experiences of eating-related distress and their stories of recovery : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology, Massey University, Auckland, Aotearoa, New Zealand(Massey University, 2023) Amarasekara, Natasha AmriniA significant portion of the eating disorder literature prioritises a clinical perspective informed by diagnostic classification and clinical markers of recovery. Yet, research into the perspectives of people’s lived experiences provides very different accounts of eating-related distress and personal recovery. The personal recovery model privileges lived experiences, where symptom remission is not necessary to recover/y, but instead “recovery in” as opposed to “recovery from” is better aligned. Broad qualitative analyses cite factors in alignment with the recovery model; however, these studies often abstract from the daily, lived recoveries. In this study, I examined the narratives of recovery among 15 adults with lived experiences of eating-related distress. Specifically, those who self-identified challenges related to food, weight, body shape, and/or exercise, and identified as doing better currently relative to one’s own past experiences. A day in the life questioning approach allowed for a micro-contextualised view of recovery, exploring what it means to be “in” or “enacting” recovery across daily practices. A narrative analysis was conducted which attuned to complex social, cultural, and relational contexts, grounded within a social constructivist epistemological approach. Narratives included: Re-Appraising Body, Image and Identity, Neutrality and Nourishment, Routine and Structure, and Media and #Recovery. Participants formed intentional daily practices in recovery, largely described as an active process requiring continued re-appraisal. Daily practices centered around energy, function, pleasure, accomplishment, comfort, control, self-development, visibility, and routine. Participants described alignment, resistance, and opposition to master narratives and sociocultural prescriptions on recovery, offering a counter narrative to the clinician and researcher recovery perspectives that have traditionally dominated the literature and guided service provision to date. Overall, these multi-layered narratives align with critical feminist perspectives and may importantly inform evidence-based practice from the “inside out”.Item Whānau Māori and their experiences of attention-deficit/hyperactivity disorder : implications for clinical practice : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Manawatū, New Zealand(Massey University, 2023-06-30) Tipene, Charlene MereanaHealth care in New Zealand (NZ) is based on the ideal of universal health coverage for all. However, for many Māori health inequities exist in health outcomes and in access to services which adequately meet the needs of whānau Māori. Researchers have considered explanations (and solutions) for this situation, including whether health services are able to meet the cultural needs of Māori clients through a more holistic approach. Rather than considering this generally for all services, this research considers this specifically in relation to Attention-Deficit Hyperactivity Disorder (ADHD). Alongside core symptoms of hyperactivity, impulsivity, and inattention, for there to be a diagnosis of ADHD there must be associated functional impairment and diffuse impact of behavioural symptoms in multiple domains of a person’s life. This means that ADHD is well suited to the application of holistic understandings of wellbeing, such as those that exist in mātauranga Māori. A lack of research about ADHD among Māori highlights a need for research which explores the experiences of tamariki Māori and their whānau as they navigate ADHD diagnosis and treatment. This research used a Māori-centred framework and throughout, was guided by He Awa Whiria (Gillon & Macfarlane, 2017) which emphasises the importance of drawing together cultural and clinical knowledge. There were three main objectives: to understand the experiences of whānau Māori with a child assessed and treated for ADHD; to describe how whānau understood and accommodated ADHD behaviours before diagnosis; and to identify any barriers or facilitators for whānau Māori in accessing assessment and/or treatment. Semi-structured interviews took place with 10 whānau members, representing 13 young people who had been diagnosed with ADHD. The interview responses were analysed using (codebook) thematic analysis. The main findings revealed firstly that there were different levels of knowledge about ADHD among caregivers and some whānau struggled to know where to begin, to get support; secondly, it was difficult to access the service, and there was a lack of ongoing support available other than medication; and thirdly, while in all cases medication was offered as treatment, whānau found this a difficult decision to make for their child, preferring a more holistic approach. Most whānau were not asked about their cultural background or beliefs during assessment and half of the participants would have accessed a kaupapa Māori service if available. The implications of the findings for clinical practice are discussed with recommendations for how to blend cultural and clinical knowledge to ultimately benefit whānau Māori and achieve the best possible outcomes.Item Non-inflammatory mechanisms in asthma : a thesis with publications presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health, Massey University, Wellington, New Zealand(Massey University, 2023-07-31) Ali, HajarUntil relatively recently asthma was considered to be an allergic disease characterised by airway inflammation. However, emerging evidence suggests that approximately 50% of asthmatics have no overt signs of inflammation. The pathophysiological mechanisms underlying disease in this group - non-eosinophilic asthma (NEA) - remain poorly understood. In 130 young-adults with generally well-controlled asthma and 79 non-asthmatics (aged 14-21 years), various non-invasive approaches were used to assess both inflammatory and non-inflammatory mechanisms in eosinophilic asthma (EA) and NEA. Studies focussed on: (i) neural mechanisms (including autonomic nervous system (ANS) activity, sensory nerve activity, and levels of neural mediators in induced sputum); and (ii) airway remodelling (measuring induced sputum levels of airway remodelling mediators), in different asthma phenotypes, whilst also taking into account clinical and inflammatory characteristics. In addition, the response to short acting β-agonist (SABA) and short acting muscarinic-antagonist (SAMA) treatment was compared between asthma phenotypes. Differences in some aspects of neural regulation were observed between EA, NEA, and non-asthmatics. In particular, airway sensory nerve reactivity was enhanced in NEA compared with non-asthmatics (p<0.05). Sensory nerve reactivity was also higher in NEA compared to EA, but this did not reach statistical significance (p=0.07). There was no evidence of an imbalance in ANS activity when comparing asthmatics and non-asthmatics, or EA and NEA. Increased levels of nociceptin were found in asthmatics and EA compared with non-asthmatics (P<0.05); nociceptin was positively associated with sputum eosinophils. Several inflammatory and remodelling mediators (including IL-1β, ECP, periostin, and VEGF-A) were elevated in EA but not NEA. There was no evidence of a differential response to SAMA between EA and NEA; however, a small subgroup of asthmatics responded better to SAMA. In conclusion, the studies described in this thesis suggest that sensory nerve reactivity may play an important role in the pathophysiology of NEA, but not EA, and may potentially represent a novel phenotype-specific treatable trait. Autonomic dysregulation does not appear to play a role in well-controlled asthma or specific asthma phenotypes. Findings suggest a potential involvement of nociceptin in asthma pathology, particularly in relation to airway eosinophilia. Finally, the identification of a small group of asthmatics who responded better to SAMA than SABA challenges current asthma treatment guidelines and suggests a need for a more personalised treatment approach. Further investigation of non-inflammatory mechanisms is warranted to improve understanding of other mechanisms underlying different asthma phenotypes, which will contribute to the identification of more specific treatable traits.Item ANZAED eating disorder treatment principles and general clinical practice and training standards(BioMed Central Ltd, 2020-11-10) Heruc G; Hurst K; Casey A; Fleming K; Freeman J; Fursland A; Hart S; Jeffrey S; Knight R; Roberton M; Roberts M; Shelton B; Stiles G; Sutherland F; Thornton C; Wallis A; Wade TIntroduction Eating disorders are complex to manage, and there is limited guidance around the depth and breadth of knowledge, skills and experience required by treatment providers. The Australia & New Zealand Academy for Eating Disorders (ANZAED) convened an expert group of eating disorder researchers and clinicians to define the clinical practice and training standards recommended for mental health professionals and dietitians providing treatment for individuals with an eating disorder. General principles and clinical practice standards were first developed, after which separate mental health professional and dietitian standards were drafted and collated by the appropriate members of the expert group. The subsequent review process included four stages of consultation and document revision: (1) expert reviewers; (2) a face-to-face consultation workshop attended by approximately 100 health professionals working within the sector; (3) an extensive open access online consultation process; and (4) consultation with key professional and consumer/carer stakeholder organisations. Recommendations The resulting paper outlines and describes the following eight eating disorder treatment principles: (1) early intervention is essential; (2) co-ordination of services is fundamental to all service models; (3) services must be evidence-based; (4) involvement of significant others in service provision is highly desirable; (5) a personalised treatment approach is required for all patients; (6) education and/or psychoeducation is included in all interventions; (7) multidisciplinary care is required and (8) a skilled workforce is necessary. Seven general clinical practice standards are also discussed, including: (1) diagnosis and assessment; (2) the multidisciplinary care team; (3) a positive therapeutic alliance; (4) knowledge of evidence-based treatment; (5) knowledge of levels of care; (6) relapse prevention; and (7) professional responsibility. Conclusions These principles and standards provide guidance to professional training programs and service providers on the development of knowledge required as a foundation on which to build competent practice in the eating disorder field. Implementing these standards aims to bring treatment closer to best practice, and consequently improve treatment outcomes, reduce financial cost to patients and services and improve patient quality of life.Item Navigating asthma—the immigrant child in a tug-of-war : a constructivist grounded theory : a dissertation presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing, School of Nursing, Massey University, Wellington, New Zealand(Massey University, 2022) Sudarsan, InduIndians constitute the second-largest immigrant group in New Zealand. Asthma symptoms are often underestimated among Indian immigrants in New Zealand and other Western countries, resulting in increased morbidity and avoidable hospitalisations. Indian immigrant children's asthma has received little attention in the literature. Furthermore, research rarely includes children's voices, despite Article 12 of the United Nations Convention on the Rights of the Child, which guarantees their freedom of expression. The current study addresses these gaps by exploring the asthma experiences of Indian immigrant children and their family caregivers. The researcher adopted a constructivist grounded theory design, with social constructionism as its theoretical framework. Children (8–17 years of age) and their family carers were recruited through general practices, schools, and various Indian cultural associations in the Greater Wellington region. Intensive, semi-structured interviews were conducted with participants in a setting of their choice. The interviewing of children under 14 years of age was facilitated by drawing and photography. Concurrent data collection and analysis took place, accompanied by memoing. “Navigating asthma—The immigrant child in a tug-of-war” was the resultant grounded theory, in which the tug-of-war was the basic social process. Two types of tug-of-war were observed: one between the Indian and New Zealand cultures, and another between children’s and their family carers’ preferences. The three major categories in this theory, which corresponded to the three phases of the child's asthma journey, included being fearful, seeking support, and clashing cultures. These phases followed a cyclic pattern. During their asthma battle, participants often reflected on their own experiences and modified their plans as they learnt more from their own lives and social networks. This helped them cope with varying levels of fear in different situations. The theory explains the complex interaction of multiple influences, such as sociocultural factors and acculturation, which may determine the participants’ shared values, beliefs, and priorities. Importantly, the study reveals numerous tensions regarding children's participation in their asthma-care decision-making. The study results add to scholarly knowledge by providing a comprehensive picture of Indian immigrant children's asthma and highlighting the barriers and facilitators for providing culturally safe healthcare to this group.Item 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 ClydeThe 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.Item Discovery of novel plant based compounds to address the drug resistance problem in nematode infested ruminants : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Chemistry at Massey University, Manawatū, New Zealand(Massey University, 2022) Gupta, ArkaIn this thesis, the discovery of novel compounds from plant extracts towards addressing the drug resistance issue in nematode infested ruminants is presented. The nematocidal efficacy of the plant extracts was tested against the L3 stage nematode larvae through bioassay-guided fractionation and chromatographic separation. Quebracho crude powder (QCP) is the only commercially available source of polyphenols. The efficacy of a separated fraction of the QCP was found to be higher (P<0.05) than the crude extract against batches of L3 larvae. However, the research with QCP encountered many challenges and attention was shifted towards medicinal plants found in New Zealand. From a screening study, the Māori plant Piper excelsum (Kawakawa) was found to be the most effective. Of its different components, the leaf component was found to have the highest nematocidal efficacy. Kawakawa (KK) leaf samples were collected over three seasons and the nematocidal efficacy of the leaf samples was found to be independent. From the bioassay-guided fractionation study, the Water and MeOH solvent fractions were found to be most effective, and they were subjected to further reverse-phase chromatographic separation. It was found that the separated fractions had better anthelmintic efficacy than the parent crude solvent fractions (P<0.05). An improvised separation technique named ‘Hand Controlled Countercurrent Separation’ (HCCCS) based on the principle of CCS was developed. It was found that the fractions obtained from the HCCCS study had better anthelmintic efficacy than the parent MeOH-Fraction-4 and the anthelmintic ivermectin (IVM) (P<0.05). A series of combination formulations were made with the separated fractions and IVM. It was observed that these formulations had better efficacy than IVM and the individual HCCCS Fractions (P<0.05). The HCCCS Fractions were subjected to LC-MS/MS investigation and 34 compounds were identified. Of which, 8 were reported in the literature from published KK research. However, the anthelmintic properties of these compounds were not previously reported. The cytotoxicity evaluation of a series of fractions did not reveal any toxic effect to mammalian epithelial cells. Therefore, there is further potential towards isolating leaf fractions into pure isolates which may possess higher nematocidal efficacy compared to the fractions presented in this thesis.