Applied Psychology - Doctoral Theses
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- ItemAgeism in healthcare(University College Cork, 2019) Concannon, Louise; Murphy, Mike; Wall, JudyJournal Article 1 - Background: Ageism was first introduced in the literature in the 1960s, gaining increasing recognition in the decades since. Ageism can impact a range of domains, including physical, emotional and mental well-being. Ageism in healthcare can influence older adults’ access to screening opportunities, information sharing and treatment availability. With an increasing aging population, requiring access to a wide range of healthcare services, it is crucial to identify and understand healthcare professionals’ attitudes towards older people, to ensure access to fair and impartial healthcare provision. Methods: An electronic search of 3 databases was performed (Medline, CINAHL Plus and PsycINFO) in September 2018 for studies published between 2012-2018. The quality and overall findings of the studies were assessed. Results: Twelve studies were included in the review. Attitudes ranged between neutral and positive, in line with previous reviews of the literature. More positive attitudes were evident in countries consistent with Westernised cultural value systems. No demographic variables were strongly related to attitudes with the exception of level of education which was demonstrated to be strongly associated to attitudes. Studies primarily focused on nursing staff and physicians with lower attitudes demonstrated in long-term care facilities. Conclusions: This review highlights the need for methodologically robust research aimed at capturing a range of health-professional’s attitudes. Efforts to increase education and training may act as a buffer in developing ageist stereotypes. Further research is required to better understand cultural influences with regard to ageism and attitudes.
- ItemAssessing the impulse control of violent offenders using computer-based cognitive performance tasks(University College Cork, 2013) Fox, Siobhán; Hammond, SeanThe topic of this thesis is impulsivity. The meaning and measurement of impulse control is explored, with a particular focus on forensic settings. Impulsivity is central to many areas of psychology; it is one of the most common diagnostic criteria of mental disorders and is fundamental to the understanding of forensic personalities. Despite this widespread importance there is little agreement as to the definition or structure of impulsivity, and its measurement is fraught with difficulty owing to a reliance on self-report methods. This research aims to address this problem by investigating the viability of using simple computerised cognitive performance tasks as complementary components of a multi-method assessment strategy for impulse control. Ultimately, the usefulness of this measurement strategy for a forensic sample is assessed. Impulsivity is found to be a multifaceted construct comprised of a constellation of distinct sub-dimensions. Computerised cognitive performance tasks are valid and reliable measures that can assess impulsivity at a neuronal level. Self-report and performance task methods assess distinct components of impulse control and, for the optimal assessment of impulse control, a multi-method battery of self-report and performance task measures is advocated. Such a battery is shown to have demonstrated utility in a forensic sample, and recommendations for forensic assessment in the Irish context are discussed.
- ItemAttachment based early interventions: an examination of the impact on the attachment related behaviour of parents and caregivers(University College Cork, 2022-05) O'Byrne, Emma; Mccusker, Chris; Murray, Deirdre M.There were two research articles included in this thesis with two separate abstracts. Systematic Review: “Attachment and Biobehavioural Catch-Up” (ABC) is a 10 session home visiting programme, grounded in attachment theory. It aims to improve child emotion regulation, attachment and behavioural outcomes through changing caregivers’ attachment related behaviours. There is increasing evidence with respect to the efficacy of ABC, but the interventions direct effect on parent behaviour remains unclear. This review examined ABC’s association with parent behaviour (the putative mechanism of change). The PubMed, EMBASE, PyscINFO and SCOPUS databases were searched for relevant studies in August 2021, and again in April 2022. The eligibility criteria for included studies were (1) infants aged 0-27 months at time of the ABC intervention, (2) “at-risk” parents, (3) controlled trials published in peer-reviewed journals, and (4) measure of attachment related parent behaviour included. Eleven eligible studies were included, nine of which were rated as having good methodological quality. The findings showed ABC had a significant small to medium effect on a variety of attachment-related parent behaviours amongst parents’ with multiple psychosocial risk factors. “Sensitivity” was measured most frequently, with small to medium main effect sizes recorded at follow-up compared to controls. Implications for the clinical effectiveness of the ABC programme in community settings are discussed. Future research should clarify whom ABC is most effective for, and how it compares to similar attachment based interventions. Major Research Project: Infant massage has been shown to positively influence maternal wellbeing and the mother-child attachment in clinical samples and up to a 1 year follow-up period. The present study examined, in a longitudinal randomised controlled trial (RCT), whether such benefits may be accrued in non-clinical, community samples and across a 4 year period. Participants were recruited from a maternity hospital in Ireland. They were mostly educated to third level (93%), in employment (88%) and identified as Irish (88%). At baseline participants were randomised to an infant massage or control condition (N=269). Qualitatively mothers from the intervention group recalled their experience of infant massage from almost 4 years earlier in surprising detail. Four main themes emerged describing the infant massage experience as a positive opportunity for bonding and relaxing with a newborn. Quantitative data pertaining to maternal wellbeing and dyads attachment were collected at baseline, 4-months, 18-months and 48-months post-intervention. Overall, analyses showed no significant difference between groups with respect to maternal mental health or parent-child relationship factors at 4, 18 or 48-months. We concluded that, in a non-clinical sample, infant massage is (a) subjectively experienced in a positive way with personal and infant relationship benefits, yet (b) this did not translate into objective benefits on clinical scales related to maternal or relational outcomes in the short or long-term. Clinical implications and suggestions for research adaptations in this area are outlined.
- ItemAutism: identity formation and experience of eye-contact(University College Cork, 2022-05-06) Garvey, Alison; Ryan, Christian; Murphy, MikeOne of the characteristic hallmarks of Autism Spectrum Disorder (ASD) includes an atypical response to eye-contact. Experimental research has contributed significantly to the extant literature on eye-contact in ASD; however, there is a dearth of qualitative research exploring the phenomenological experience of eye-contact for autistic individuals. The current study aimed to explore the subjective experience of deliberate and self-conscious adaptation of eye-contact by autistic participants using Interpretative Phenomenological Analysis (IPA). Nine autistic adults were interviewed. Group experiential themes included; (1) Eye-contact: Awareness and motivation, (2) Phenomenology of eye-contact, and (3) Strategies to make eye-contact. This study makes an important and novel contribution to understanding the experience of eye-contact for autistic individuals, and highlights factors influencing effective eye-contact, which may have implications for psychological intervention.
- ItemBroken connections – what processes challenge interpersonal relationships after acquired brain injury?(University College Cork, 2021-05-07) Browne, Niall; Mccusker, Chris; Ward, MarciaThis thesis was submitted as part of a Doctorate in Clinical Psychology at the University College Cork. It is comprised of six chapters. Chapter 1 provides a detailed overview of the current literature base on social functioning following Acquired Brain Injury (ABI), highlighting some of the drivers that underpinned this thesis. Chapter 2 consists of a meta- ethnography synthesising the existing qualitative literature on social relations following ABI. Chapter 3 is used to provide further information and an extended discussion of the methodological and analytical considerations in conducting the meta-ethnography. In Chapter 4 an empirical study is presented which employed a dyadic qualitative design to explore the lived experience of social changes from the perspectives of ABI survivors and their partners. This is then followed by further discussion in Chapter 5 of the methodological and analytical considerations involved in conducting the empirical study, before presenting concluding remarks in Chapter 6 to summarise the overall findings and contributions of this thesis.
- ItemClient and clinician experiences of eye movement desensitisation and reprocessing (EMDR) therapy(University College Cork, 2022-05) Hammond, Michaela; Ryan, Christian; Dwyer, AoifeSystematic Review Abstract: This mixed methods systematic review aimed to provide insight into clinicians’ views and experiences of EMDR. Eight electronic databases [PsychINFO, PUBMED, CINAHL, SCOPUS, Web of Science, EMBASE, Applied Social Sciences Index] and grey literature [ProQuest and Google Scholar] were searched systematically from inception to October 2021. Quality was assessed using the Mixed Methods Appraisal Tool (MMAT) and a convergent integrated approach was used to synthesise and integrate data. In total, 14 studies were included: seven qualitative, five mixed-methods and two quantitative, encompassing 1,065 participants. Thematic synthesis generated two overarching themes and seven subthemes. The first theme related to the facilitators and barriers clinicians experience in adopting and implementing EMDR, including the role of organisational support, clinician confidence, primary theoretical orientation, and client suitability and preparedness. The second theme related to perceived advantages of EMDR, including rapid results and positive outcomes, client empowerment, and getting to the root of the issue. This review provides a helpful insight into the factors which influence the dissemination and implementation of psychological therapeutic approaches. Main Empirical Paper Abstract: This study aimed to explore clients’ unique phenomenological experiences of eye movement desensitisation and reprocessing (EMDR) and their meaning-making regarding this therapeutic approach within the context of an adult mental health service. Interpretative Phenomenological Analysis (IPA) was employed to collect and analyse data from six individual interviews with individuals who had completed an EMDR intervention. Three Group Experiential Themes were identified: “Trapped in trauma – self-disorganisation”, “Being ‘in’ the process of processing” and “Moving on – adaptive resolution of trauma”. The study provides an in-depth insight into client’s experiences of EMDR in terms of the many processes and outcomes. The results are discussed in relation to clinical implications.
- ItemCoping strategies, distress and well-being of informal caregivers of people with borderline personality disorder(University College Cork, 2021-08-31) Hayes, Aoife Marie; Dempsey, Maria; Murphy, Mike; Kells, MaryAbstract for empirical study:Informal carers of people with BPD experience high levels of burden and psychological distress and may be facing even greater stress in the context of COVID-19. There is a scarcity of research evidencing the influence of modifiable factors on carer outcomes to inform interventions. This study aimed to investigate (i) the relationship between social support, coping strategies and psychological distress and positive mental well-being in carers of people with BPD and also (ii) the relationship between coping strategies and change in carer stress due to COVID-19. 1207 carers completed the McLean Screening Instrument for BPD-Carer Version, the Brief COPE, the Multidimensional Scale of Perceived Social Support, the Kessler Psychological Distress scale, the WHO-5 Well-being Index, the Coronavirus Anxiety Scale, and measures of change in use of coping strategies and change in caregiver stress due to COVID-19. Data for 863 participants who met the inclusion criteria were analysed. Carers reported low positive mental well-being, high psychological distress and a mean increase in caregiving stress due to COVID-19. Perceived social support and coping strategies were significant unique predictors of psychological distress and positive mental well-being. Perceived social support and the coping strategy of positive reframing were the strongest predictors of higher positive mental well-being and lower psychological distress. Self-blame, behavioural disengagement and substance use were the strongest predictors of adverse outcomes. Change in use of planning was the strongest predictor of change in caregiving stress due to COVID-19.The findings suggest that interventions that assist informal carers to decrease the use of self-blame, behavioural disengagement and substance use and to develop quality social support and skills to positively reframe caregiving situations may support improved caregiver outcomes. Abstract for systematic review: This systematic review aimed to identify the relationship between coping strategies and psychological distress and well-being in carers of people with schizophrenia. Electronic searches were conducted in PsycINFO, Pubmed, Scopus and CINAHL Plus. Reference lists of included studies and related published reviews were subsequently manually searched. A total of 1984 papers were screened. Fourteen studies conducted between 1996 and 2020, comprising 1987 carers of people with schizophrenia, met the inclusion criteria. All studies identified had cross-sectional designs. The quality of the studies, variation in carer samples, and heterogeneity of questionnaires and scales used to measure coping, psychological distress and well-being limited the strength and clinical utility of conclusions. Based on cross-sectional designs, there is preliminary evidence that carer coping strategies are associated with carer psychological distress and well-being. Further research is required to identify whether coping strategies buffer the impact of caregiving stress on carer outcomes and which coping strategies are most useful. Recommendations are made to optimise the research and clinical utility of future studies.
- ItemDevelopment of a general internet attitude scale and internet self-efficacy scale(University College Cork, 2013) Joyce, Mary; Kirakowski, JurekThe measurement of users’ attitudes towards and confidence with using the Internet is an important yet poorly researched topic. Previous research has encountered issues that serve to obfuscate rather than clarify. Such issues include a lack of distinction between the terms ‘attitude’ and ‘self-efficacy’, the absence of a theoretical framework to measure each concept, and failure to follow well-established techniques for the measurement of both attitude and self-efficacy. Thus, the primary aim of this research was to develop two statistically reliable scales which independently measure attitudes towards the Internet and Internet self-efficacy. This research addressed the outlined issues by applying appropriate theoretical frameworks to each of the constructs under investigation. First, the well-known three component (affect, behaviour, cognition) model of attitudes was applied to previous Internet attitude statements. The scale was distributed to four large samples of participants. Exploratory factor analyses revealed four underlying factors in the scale: Internet Affect, Internet Exhilaration, Social Benefit of the Internet and Internet Detriment. The final scale contains 21 items, demonstrates excellent reliability and achieved excellent model fit in the confirmatory factor analysis. Second, Bandura’s (1997) model of self-efficacy was followed to develop a reliable measure of Internet self-efficacy. Data collected as part of this research suggests that there are ten main activities which individuals can carry out on the Internet. Preliminary analyses suggested that self-efficacy is confounded with previous experience; thus, individuals were invited to indicate how frequently they performed the listed Internet tasks in addition to rating their feelings of self-efficacy for each task. The scale was distributed to a sample of 841 participants. Results from the analyses suggest that the more frequently an individual performs an activity on the Internet, the higher their self-efficacy score for that activity. This suggests that frequency of use ought to be taken into account in individual’s self-efficacy scores to obtain a ‘true’ self-efficacy score for the individual. Thus, a formula was devised to incorporate participants’ previous experience of Internet tasks in their Internet self-efficacy scores. This formula was then used to obtain an overall Internet self-efficacy score for participants. Following the development of both scales, gender and age differences were explored in Internet attitudes and Internet self-efficacy scores. The analyses indicated that there were no gender differences between groups for Internet attitude or Internet self-efficacy scores. However, age group differences were identified for both attitudes and self-efficacy. Individuals aged 25-34 years achieved the highest scores on both the Internet attitude and Internet self-efficacy measures. Internet attitude and self-efficacy scores tended to decrease with age with older participants achieving lower scores on both measures than younger participants. It was also found that the more exposure individuals had to the Internet, the higher their Internet attitude and Internet self-efficacy scores. Examination of the relationship between attitude and self-efficacy found a significantly positive relationship between the two measures suggesting that the two constructs are related. Implication of such findings and directions for future research are outlined in detail in the Discussion section of this thesis.
- ItemThe development of an idiographic method of measurement for use in dynamic assessment(University College Cork, 2019-12) Hurley, Emma; Murphy, Raegan; Hammond, SeanThe dynamic, multifaceted nature of humans requires an individuated, dynamic approach to evaluation and intervention. The primary purpose of this research is to address issues of evaluating dynamic assessment research and practice. Dynamic assessment (DA) is, broadly, a psycho-educational approach to maximising potential in people, in particular marginalised, disenfranchised people or people not flourishing within their learning environment. In order to usefully consider a methodology of measurement which aligns with the philosophical foundations of DA it was necessary to propose a widening of the parameters or scope of reference within which DA is situated. The situation of DA within a copasetic framework – Integrated Social Learning Theory (ISLT) clarifies the theoretical paradigm for research and practice. The novel idiographic methodology developed for this thesis Individual Dynamic Evaluation and Assessment (IDEA) uses open card-sorts to capture the participant’s self-concept. Multidimensional scaling analysis of card-sort data renders a graphical representation of that self-concept in relation to others in the form of a life-space map. General Procrustes analysis of these life-space maps over time allows the evaluation of movement in self-concept for a person over time. DA is primarily concerned with the mediation of learning between the expert and novice. The focus of DA is the person, and the examination of movement or change for that person. Drawing from development and social learning theories which align with this position bolsters the grand theories of dynamic DA posited by Vygotsky, Luria (Luria, 1976; Luria & Cole, 1976; Luria, Cole & Cole, 2006; Luria & Yudovich, 1956, 1959), Haeussermann (1956), Feuerstein (1990, 2003; Feuerstein, Rand & Hoffmann, 1979; Feuerstein, Feuerstein, Falik & Rand, 2002 ) Bruner (1956, 1960) & Rey (1938). The ISLT framework allows for the useful consideration of intraindividual methods of evaluation and measurement. A position has been taken – namely that nomothetic methods of measurement are not best suited to the goal of usefully examining change over time in therapeutic practice contexts. ISLT and IDEA-1 consider the person as a complex, dynamic system. Learning and psychological support are inextricably linked within this paradigm. This has ramifications for practice. A holistic approach to psycho-educational support is recommended, the basis for which is provided within the ISLT framework. This thesis presents a novel N=1 case study design which is wholly idiographic in nature. The methodology for evaluation described here provides a basis for evidence-based practice while maintaining a focus on the progress of the individual under targeted intervention. The repeated measures design described here is one which has a format with which practitioners and researchers are familiar. It stands separate from the intervention procedure unlike integrated scoring systems and is idiographic in focus unlike nomothetic sandwich study designs. The results from the sixteen studies presented here provides the beginnings of an evidence-base for the use of this approach in intraindividual contexts.
- ItemDialectical behaviour therapy skills training for substance use disorders and dual diagnosis(University College Cork, 2020-05-06) Warner, Niamh; Murphy, Mike; Flynn, DanielBackground: People with Dual Diagnosis (DD) present with different intervention needs and respond differently to clients with a single diagnosis. Quantitative research suggests that Dialectical Behaviour Therapy Skills Training (DBT-ST) can produce positive outcomes for people with DD. However, little is understood regarding the mechanisms which produce this change. Aim: This study aimed to explore the experience of people with DD who participated in an adapted DBT-ST intervention in the context of an Irish addiction service. The study focused on identifying aspects of DBT-ST which were perceived as producing or impeding change. Procedure: Four participants who completed a 24-week, adapted DBT-ST intervention for DD were recruited via purposive sampling. Data were gathered using semi-structured interviews. Anonymised transcripts were analysed using Interpretative Phenomenological Analysis. Five superordinate themes and 11 subthemes were identified on analysing the entire data set. Conclusions: Findings bring us closer to understanding the perceived intervention needs of people with DD in Ireland. Participants viewed DBT-ST as supporting relapse prevention by enhancing capacity to manage emotions and problem solve in high risk situations. Findings suggest that a non-judgmental environment, enhanced assertiveness skills and rediscovering meaningful activities also promoted change. Findings have implication for service provision for this cohort.
- ItemEating disorders: sibling experience and implementing externalisation in FBT(University College Cork, 2020-05-07) Lonergan, Katie; Ryan, Christian; Whyte, Aileen1. The Experience of Healthy Siblings of People with Eating Disorders: A Systematic Review and Thematic Synthesis Background: Within the area of eating disorders (EDs), research on carers has predominantly focused on the experience of parents and partners of those diagnosed with EDs. This led to siblings being referred to as the “forgotten” kin. Sibling relationships play an important and often long-standing role in peoples’ lives. Having a sibling with an ED can impact on healthy siblings in many ways including negatively affecting their quality of life, their sibling bond, and their physical, mental and emotional health. Aim: A meta-synthesis of qualitative studies was conducted to explore the experiences of healthy siblings of people who have EDs. Method: Seven databases (MEDLINE, PsychINFO, psycARTICLES, Psychology & Behavioural Sciences Collections, CINAHL, Social Sciences Full Text (H.W Wilson) and SocINDEX with Full Text) were searched for qualitative studies reporting on the experience of healthy siblings who have a brother or sister with a diagnosed ED. Thematic synthesis was used to analyse the studies included in this review. Results: 10 studies were included. Five core themes and twelve subthemes were identified. Themes related to the impact of the ED on both interpersonal and intrapersonal aspects of the healthy siblings’ lives. This included disruption to the sibling relationship and family life, experiencing difficult emotions, changes in the healthy sibling’s relationship with their own body, and coping skills. Conclusions: These findings are discussed in relation to the existing literature within the area and the implications for clinical practice. 2. Mental Health Clinicians’ Perspectives on Implementing Externalisation in Family-Based Treatment Objective: Family-Based Treatment (FBT) is a first line intervention for the treatment of adolescent eating disorders (EDs). FBT consists of a number of phases and interventions, including the use of externalisation, a therapeutic technique which aims to separate the person from the problem through the use of language and metaphor. There is a paucity of scientific research on this technique and consequently, little is known about how clinicians understand, conceptualise and support families to externalise the ED in the context of FBT. This research aimed to gain a deeper understanding of how clinicians employ this technique in the context of FBT. Method: Using thematic analysis, eight semi-structured interviews were conducted with FBT trained clinicians working in child and adolescent mental health services. Results: Three major themes emerged which related to how clinicians use externalisation, the impact it has on family functioning, and the barriers which make externalisation difficult to implement with families. Conclusion: Externalisation is a therapeutic technique which can support a family and young person’s (YP’s) recovery from an ED when used in conjunction with other therapeutic skills. Clinicians should be aware of potential barriers to the implementation of externalisation such as the YP’s problem awareness, age, and duration of ED symptomatology.
- ItemThe effect of positive psychological interventions on psychological and physical well-being during pregnancy(University College Cork, 2015) O'Leary, Karen; Dockray, Samantha; Di Blasi, ZeldaPrenatal well-being can have significant effects on the mother and developing foetus. Positive psychological interventions, including gratitude and mindfulness, consistently demonstrate benefits for well-being in diverse populations. No research has been conducted on gratitude during pregnancy; the few studies of prenatal mindfulness interventions have demonstrated well-being benefits. The current study examined the effects of gratitude and mindfulness interventions on prenatal maternal well-being, cortisol and birth outcomes. Five studies were conducted. Study 1 was a systematic review of mindfulness intervention effects on cortisol; this highlighted potential benefits of mindfulness but the need for rigorous protocols in future research. In Study 2 a gratitude and a mindfulness intervention were developed and evaluated; findings indicate usefulness of two 3 week interventions. Study 3 examined the effects of these interventions in a randomised controlled trial (RCT) of non-pregnant women, before examining a pregnant group. No significant intervention effects were found in this study, potentially due to insufficient power and poor protocol adherence. Changes in expected directions were observed for most outcomes and the potential utility of a combined gratitude and mindfulness intervention was noted. In Study 4 a gratitude during pregnancy (GDP) scale was developed and the reliability of an existing mindfulness measure (MAAS) was examined in a pregnant group. Both scales were found to be suitable and reliable measures in pregnancy. Study 5 incorporated the findings of the previous four studies to examine of the effect of a combined mindfulness and gratitude intervention with a group of pregnant women. Forty-six participants took part in a 5-week RCT that examined intervention effects on prenatal gratitude, mindfulness, happiness, satisfaction with life, social support, prenatal stress, depression and sleep. Findings indicated that the intervention improved sleep quality and that effects for prenatal distress were approaching significance. Issues of attrition and non-compliance to study protocols were problematic and are discussed. In summary, the current thesis highlights the need for robust measurement, and intervention and cortisol sampling protocols in future research, particularly with pregnant groups. Findings also demonstrate tentative benefits of a gratitude and mindfulness intervention during pregnancy.
- ItemEnhancing foster carers’ capacity to promote placement stability: initial development and early stage evaluation of fostering connections: the Trauma-informed Foster Care Programme(University College Cork, 2019-10) Lotty, Maria; Bantry White, Eleanor; Dunn Galvin, Audrey; Tusla; University College CorkThe research was motivated by a desire to make a contribution to reducing placement instability, particularly placement breakdown owing to its impact on children and the families who foster. The research emerged from a perceived gap in the training provision for foster carers in Ireland. The purpose of the research was to design, develop and evaluate a psychoeducational intervention for foster carers, that enhanced their capacity to provide children with trauma-informed care. The Development Stage involved completion of a narrative literature review of the effects of current trauma-informed care interventions for foster carers. It also involved a pre-intervention qualitative study that assessed the current practice climate and support for implementation of this intervention. The narrative review suggested that trauma-informed care could inform foster carers’ responses when caring for children who have experienced trauma. Participants in the pre-intervention study expressed the need for such a programme and a willingness to support its implementation in the current context of foster care in Ireland. A mixed method approach was used to synthesise the results of the narrative review and pre-intervention study to develop the group-based intervention, Fostering Connections. The Feasibility Stage involved a programme review by the local Fostering Team. At Evaluation Stage, a quasi-experimental study with a control group and a post-intervention qualitative study were completed. These two studies were combined using a triangulated analytical strategy to complete an early stage evaluation. A Stakeholder Group was established at the outset of this research to provide expert review to the research process. Preliminary evidence is promising and suggests that Fostering Connections may be an effective intervention for increasing foster carers’ capacity to provide children with trauma-informed care and in turn, is associated with improvement in child regulation and reduce peer problems over time. The study concludes that this intervention is likely to make a significant contribution to the training provision for foster carers in Ireland, supporting their capacity to care for children with trauma-related difficulties. The intervention is likely to, in turn, reduce child difficulties and thus, support placement stability.
- ItemAn evaluation of autism spectrum disorder traits and the social and emotional cognition of adolescents with anorexia nervosa(University College Cork, 2021) Mulligan, Shane; Ryan, Christian; Dáibhis, AoifeThe purpose of the present dissertation is to investigate Autism Spectrum Disorder (ASD) traits and aspects social and emotional functioning consistent with ASD among young people with Anorexia Nervosa (AN). This dissertation is made up of four sections; (1) Literature review: The literature review will consider the aetiology of AN and ASD, their clinical presentation, overlap between the disorders and the theories underlying the aetiology of both conditions. Literature relating specifically to ASD and associated traits with respect to social and emotional functioning in AN will be examined. This will be followed by the theoretical positions proposed to explain the presence of traits consistent with ASD in AN which frame the research questions. (2) Systematic review and meta-analysis: Title: Using the Autism-Spectrum Quotient to Measure Autistic Traits in Adolescents and Young People with Anorexia Nervosa: A Systematic Review and Meta-Analysis The principal focus of the systematic review and meta-analysis is to understand the prevalence of ASD traits as measured by one of the most commonly used screening measures of Autism traits in AN, the Autism Quotient (AQ) and AQ short version, the AQ10. The systematic review and meta-analysis was limited to studies conducted with adolescents and young people under the age of 25 with AN to assess the prevalence of ASD traits prior to prolonged periods of nutritional deprivation. This is presented through a specific journal article format. (3) Empirical research written in specific journal article format: Title: An Evaluation of Autism Spectrum Disorder Traits and the Social and Emotional Cognition of Adolescents with Anorexia Nervosa The empirical research is presented in two parts, the first of which is in a journal article form tailored to the format of a specific academic journal. This incorporates the most relevant aspects of the literature review in addition to the methodology, results and discussion of the present empirical research study. The second part presents the empirical research through a supplementary methodology, results and discussion section which follow sequentially from the literature review (Section 4). The original empirical research section of the dissertation seeks to investigate traits consistent with ASD and related aspects of social and emotional cognition among young people with AN. ASD is proposed to exist on a spectrum where more pronounced ASD traits are often associated with functional impairment in social functioning, language, communication and restricted/repetitive interests. At the less pronounced end of the spectrum ASD traits are considered more subtle and not generally associated with functional impairment. Research with AN groups has indicated that a considerable percentage of these research samples meet the criteria for ASD. Prior research has also indicated that among those individuals with AN not meeting the full criteria for an ASD diagnosis commonly have increased levels of ASD traits as compared to control populations. The purpose of the present research is to understanding if commonly reported ASD traits and difficulties with social and emotional cognition with ASD are present in the early stages of AN prior to prolonged nutritional deprivation. Within previous literature, traits associated with ASD have been studied individually among groups with AN. This study is the first to examine ASD traits, theory of mind, alexithymia and empathy simultaneously in an adolescent group with AN. The study assumes a cross-sectional design where participants consist of two adolescent groups; individuals with AN attending a specialist eating disorder service and a healthy control group recruited from the community through secondary schools. The study collected participant demographic, clinical symptoms and illness-related variables in addition to self-reported ASD traits, a theory of mind task, and measures of alexithymia and empathy. Data were analysed by comparing group means across dependent variables. AN group-specific analyses were conducted using correlational analyses to examine relationships between dependant variables. Findings are presented in the context of prior literature. (4) Empirical research study supplementary chapters: The supplementary chapters present the empirical research through supplementary methodology, results and discussion sections.
- ItemAn examination of the underlying trait structure of psychopathy: applications for screening and measurement(University College Cork, 2013) Leahy, Patricia; Hammond, Sean; O'Sullivan, DavidThis thesis seeks to clarify the faceted organisation of psychopathy with a view to developing a comprehensive protocol for the assessment of core psychopathic personality traits. The framework developed will, as best as possible, be free of sample bias. The Self-and Informant-report Deviant Personality Screen (DPS) is introduced and a series of empirical studies are conducted to examine the psychometric properties and construct validity of these measures in general and offender populations. Findings from these studies provide strong support for the utility of the DPS scales for the appraisal of psychopathy across diverse population samples. In addition to this, the utility of cognitive based performance measures for the assessment of emotional deficits in psychopathy is evaluated. Results from this study suggest limited correspondence between these measurement techniques and self-report psychopathy measures. Finally, research conducted on offenders suggests that information obtained from DPS reports may be useful within a broad framework of risk assessment. Further empirical and theoretical implications of the research are discussed.
- ItemAn experience-centred design led examination of the struggle for recognition in dementia care(University College Cork, 2019) Foley, Sarah; McCarthy, John; Pantidi, Nadia; Irish Research CouncilThe experience of advanced dementia has been largely excluded from design work in Human-Computer Interaction (HCI), as the experience itself is viewed as ‘unreachable’ in terms of design engagement. This thesis aims to examine the experience of living with dementia in the care home context, with a view to implementing methods of Experience-Centred Design (ECD) to examine the relational and agentic abilities of people with dementia, particularly in advanced dementia. In order to examine the experience of advanced dementia and understand the political and social implications of inclusion of people with advanced dementia in design, this thesis draws on the social theory of recognition, a theory which emphasises the need for mutual engagement as a means of developing and sustaining a self-identity. Used as the basis of a design framework, this theory suggests a series of sensibilities for design in this context, which are presented in chapter 2. This framework informs the empirical design work presented in chapters 4, 5 and 6 to examine the needs for reciprocity through design in dementia care, paying particular attention to the ways of engaging with the experience of advanced dementia. The initial ethnography, presented in chapter 4, focuses on the nature of communication, care and participation with people with advanced dementia, with a view to informing recognition-based design work. Findings suggest ways to further support moments of recognition in care and design, such as embodied communication, challenges in recognising the needs of people with advanced dementia and reconfiguring the role of people with advanced dementia in design. Informed by the findings of the ethnography, and with a view to increasing moments of recognition through design, intergenerational design work with student volunteers and residents in care is presented in chapter 5. Discussed are two case studies; Life Story Box and History Club. In these design projects, students worked with residents to explore their personhood and engaged in the co-design of artefacts which represented the individual and collective life story of the people with dementia. Findings suggest how best to support students and people with dementia in the design process, as well as some of the ethical implications of supporting co-design in this context. The final study culminated in the design and evaluation of ‘Printer Pals’, a receipt-based media producing technology to increase access to media and encourage social engagement in the care home setting. This iterative design process involved prototype development, evaluation and implementation in collaboration with researchers from Open Lab, Newcastle University. Findings discuss the use of design processes to support agency in care homes, and the role of technology in creating opportunities for positive social engagement and cohesion. This empirical design work, informed by the theory of recognition and methods of ECD, proposes an approach to designing with and for people with advanced dementia that supports and engages in their agentic social presence. Design work in this context presents an opportunity to position the person with advanced dementia as active in the dialogical process of meaning-making, as well as their own care practices. Reconfiguring the role of people with advanced dementia in relational and social processes, requires careful re-visiting of cultural and social notions of agency and mutuality, and how they have failed to consider the abilities of people with advanced dementia. Design has a central role to play in supporting these abilities, encouraging creative and meaningful care practices in order to honour the needs and rights of the person with dementia to shape a meaningful and connected lived experience.
- ItemExperiences of older adults with anxiety and depression of the COVID-19 lockdown restrictions(University College Cork, 2022-05) Cashman, Alice; Murphy, Mike; Wall, JudyBackground: Research indicates that older adults and individuals with pre-existing mental health difficulties were among the groups particularly at risk of experiencing increased mental health difficulties due to the lockdown restrictions introduced during the COVID-19 pandemic. Older adults experiencing anxiety and depression may have been particularly vulnerable. Researchers have warned of potential long-term mental health consequences for these older adults and pointed out that the field of geriatric psychiatry is in uncharted territory given the confluence of a global viral pandemic and increased life expectancy. Aims: The aim of the current study is to explore how older adults with pre-existing anxiety and depression experienced and understood the COVID-19 lockdown restrictions. Participants and setting: Nine older adults, aged 65 years and over, with pre-existing anxiety and depression were recruited from the Older Adult Mental Health Services of the Irish Health Service Executive. Methods: Data were collected via semi-structured interviews. Interviews were audio-recorded and transcribed verbatim. Transcripts were analysed using Interpretative Phenomenological Analysis (IPA). Results: Six themes were generated, organised under two super-ordinate themes: ‘Sent to the Sidelines’ and ‘The End, or a New Beginning?’ Participants experienced a sense of lost purpose and belonging in society, and experienced feeling no longer needed by society. For some, there was a sense of hopelessness, and that this new way of life was permanent. While for others there remained hope that brighter days would follow. Conclusion: Findings highlight the importance of social connection and belongingness, purpose and meaning, and a sense of agency in the lives of participants.
- ItemAn exploration of digital therapy: the therapeutic alliance online and psychologists’ experiences and reflections on offering online therapy(University College Cork, 2022-05-13) Geary, Christina; Linehan, Conor; Foley, Sarah; Health Service ExecutiveSystematic Review: Remotely delivered therapy for mental health disorders is increasingly adopted in health services worldwide. However, evidence of how the implementation of remote therapy affects the therapeutic relationship is disjointed. To synthesise international evidence exploring the sociotechnical features that may play a role in determining a strong therapeutic relationship in remotely delivered therapy for mental health disorders. A qualitative systematic review. A systematic review was conducted up until May 2022, including qualitative studies from EBSCO CINAHL, Medline - PubMed, Embase, PsychInfo and SCOPUS, which explored the therapeutic relationship and alliance of remotely delivered therapies. Twenty-three studies were included. The data were categorised into four themes: 1. Therapists’ enthusiasm for remote therapy facilitates service user buy-in, 2. It is possible to establish a therapeutic relationship in remotely delivered therapy 3. Remote therapy should be implemented as an adjunct to face-to-face therapy, and 4. Technical issues have the potential to disrupt the creation of a safe and trusting atmosphere in remote therapy. Sociotechnical components play a role in determining a strong therapeutic alliance in remotely delivered therapy, such as the characteristics of the therapist and the centrality of technology. Augmenting rather than replacing face-to-face, can assist in identifying areas for the improvement of remote therapy. Empirical Research: Digital technologies can transform healthcare services and may contribute to health system goals of accessibility, quality and equality of healthcare. However, this requires careful consideration of both the technical requirements needed to make online therapy work and sensitivity towards the relational factors required to build a therapeutic alliance. The current study uses Psychologists’ experiences during the Covid-19 pandemic and the associated move to online therapy as a critical incident to reflect on the future of digitisation. The socio-technical systems (STS) theory has been adopted as a lens that allows us to interrogate participants' social, technical, interpersonal and organisation experiences of the digitilisation of mental health services. Participants (N=10) were psychologists from Health Service Executive (HSE) Mental Health and Primary Care Services in Ireland who had provided therapeutic intervention online during the Covid-19 pandemic (F= 6, M=4) (age 25- 44). An inductive reflexive thematic analysis generated four themes: 1. Optimizing outreach and engagement through digital therapy; 2. Digital therapeutic disruptions; 3. Understanding what makes online therapy feel like a suboptimal offering; 4. Identifying the enablers to offering effective online therapy. Some psychologists indicated that engaging the online platform could convey a degree of protection and anonymity due to physical distance that was sometimes beneﬁcial to establishing a more intimate connection.
- ItemAn exploration of intergenerational narratives of resilience in families living with psychosis(University College Cork, 2022-08-31) Kearney, Ian; Veale, Angela; Murphy, Mike; Lonergan, Edgar; Health Service ExecutiveAim: The experience of psychosis can have devastating impacts on individuals as well as family members who are often integral to the caregiving process. There is a small but growing body of literature exploring the phenomenon of intergenerational resilience. However, little is known about this phenomenon in relation to families living with psychosis in Ireland. This study aimed to explore the development of intergenerational resilience through dyadic interviews with individuals with psychosis and a family member. Method: Individual semi-structured interviews were conducted with a total of eight participants (4 service users with a diagnosis of psychosis & 4 parents). Participants were recruited through adult mental health services within Ireland. Data were analysed using a multiperspectival Interpretative Phenomenological Analysis (IPA) approach. Results: The multiperspectival IPA yielded a temporal model of family life before, during, and after psychosis with nine overall subthemes generated. A sense of cohesion, optimism, and shared family values helped support families rally together in times of crises. Participants meaning making in the face of psychosis was supported through information and knowledge of the disorder. Separating the effects of psychosis from the person supported long-term commitment and perseverance for caregivers. Conclusion: Findings indicate the experience of psychosis can be traumatic for participants, yet despite this, salient accounts of family resilience were reported, and as such, this study contributes to the growing literature on intergenerational resilience. Professionals can play a vital role in strengthening existing resources within families following psychosis.
- ItemAn exploration of treatment decision making and psychological wellbeing of men with prostate cancer(University College Cork, 2021) Cunningham, Margaret; Murphy, Mike; Richards, HelenThis study aimed to explore the experiences of men with prostate cancer. Prostate cancer is the second most common cancer in men globally, and the most common invasive cancer in Ireland (National Cancer Registry Ireland, 2018; Rawla, 2019). A considerable amount of research has been conducted looking at various psychological aspects of diagnosis and treatment of prostate cancer. However, the profile of both the epidemiology and treatment of prostate cancer is constantly changing. In particular, the incidence of younger men (under age 55 years) being diagnosed with prostate cancer has risen sharply in recent years due to increases in screening for prostate cancer. Another consequence of the rise in screening, has been concerns about over-treatment of prostate cancer, and guideline recommendations to manage cases of localised prostate cancer with Active Surveillance. Although a number of studies have explored aspects of men’s decision making around Active Surveillance, no systematic review of qualitative studies had been conducted. Systematic reviews of qualitative studies can provide evidence to inform policy and practice, and guide intervention development. Therefore, a systematic review of qualitative studies was conducted to address the question ‘What factors influence the decision-making process of men with localised prostate cancer when considering Active Surveillance?’. There is a lack of literature pertaining to younger men’s experiences of prostate cancer. Research into men’s experiences of prostate cancer to date 2 have mainly been conducted with samples of older men. Quantitative research including samples of both older and younger men with prostate cancer found that younger age was a predictor of longer term distress in men with prostate cancer (Chambers et al., 2017). Specific interventions may benefit younger men in their prostate cancer journey to help alleviate distress. Guidance on developing interventions to improve health and healthcare suggest that all intervention development should start with understanding the problem, identifying needs, and identifying factors which are potentially modifiable (O’Cathain et al., 2019). Qualitative research is exploratory, and can provide a rich understanding of a phenomenon. A qualitative interview study was therefore conducted to explore the experiences of younger men with prostate cancer, in particular exploring the psychological impact of prostate cancer on younger men, and identifying unmet supportive care needs.