Applied Psychology - Doctoral Theses

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Psychological justice: addressing drug-related deaths as a health and social risk for families, communities, and services
(University College Cork, 2024) O'Callaghan, Daniel; Lambert, Sharon; Murphy, Raegan
Drug-related deaths represent a significant practice concern for global public health, and a continual increase in associated fatalities presents acute social and health challenges for families, communities, and services worldwide. Amid the urgent requirement for adaptive state policy responses to address rising death figures, each number represents the loss of human life that embodies a social identity as somebody’s loved one. Behind the statistics, countless individuals grieve the untimely loss of a child, a parent, a client, a sibling, or a friend. Lamentably, many are forced to grieve in silence, as drug-related bereavement can foster a disenfranchised grief that requires therapeutic intervention but concurrently inhibits access to support through shame, isolation, and self-blame. If unprocessed, people who grieve a drug-related death are at increased risk for harmful short- and long-term health outcomes, including increased risk of death. People who use drugs navigate a range of social, health, and justice contexts, forming various levels of sustained personal and professional relationships. When a person dies, people within this social context are left to mourn the loss of life and the loss of potential represented by a premature and preventable death. However, grief can manifest differently dependent on several interpersonal, relational, and contextual factors. To appropriately target grief supports, it is important to discern how drug-related determinants interact with, and influence, bereavement processes. Thus, this doctoral thesis addresses a gap in the literature, identified within a scoping review (Chapter 2), by examining the grief experiences of three subgroups who are at risk for experiencing a drug-related death: peers in active addiction, families, and healthcare professionals. Through a series of peer-reviewed academic articles, this thesis shares the voices of 38 drug death bereaved individuals who represent family members, staff within various healthcare professions, and people who experienced the death of a peer during their own active addiction. Theoretically grounded within the dual process model of coping with bereavement, each study employs an in-depth qualitative methodology to explore complex and multifaceted grief experiences. Chapter 4 conveys the experience of posttraumatic growth for families, identifying key facilitators of resilience. Chapter 6 and Chapter 8 address bereavement for healthcare professionals, spanning occupations in social work, addiction, and emergency medicine. Chapter 6 explores their complex grief reactions, while Chapter 8 identifies the challenges of working with clients who died during the COVID-19 pandemic. In Chapter 9, people who were in active addiction report how their grief experiences were shaped by stigma following the death of a peer. This research identifies the drug-related death of a loved one as a critical period for intervention where suitably targeted supports are currently profoundly limited. The work presented in this thesis contributes to the validation and recognition of diverse grief experiences for groups that grieve in silence, providing a more holistic understanding of complex inter- and intra-group grief processes. In providing actionable recommendations, this thesis aims to improve standards of evidence to support the implementation of adaptive and heterogenous drug-related bereavement policy and practice responses. Tailoring evidence-informed bereavement supports to address the specific needs of the bereaved is crucial, potentially lifesaving, particularly as social positioning and relational capital play a significant role in the manifestation of grief responses.
The measurement of parental mentalisation: psychometric properties of the parental reflective functioning questionnaire (PRFQ) and a qualitative exploration of parental mentalisation in asylum-seeking mothers
(University College Cork, 2024) O'Connor, Molly; Larkin, Fionnuala; Veale, Angela; Murphy, Mike
Systematic Review: Parental Reflective Functioning (PRF) is a parent’s ability to reflect on their mental states, the mental states of their child, and to appreciate how they may influence each other. The Parental Reflective Functioning Questionnaire (PRFQ) offers a brief, self-report assessment of PRF that can be administered to parents of children 0-5 years of age. This systematic review explored the psychometric properties of the PRFQ with special attention to its use in different cultures. A systematic literature search yielded 1,742 independent records for abstract sift and 174 records were sifted at full text review. There were 60 papers which met our inclusion criteria, representing 62 individual studies. Descriptive data were extracted from each included study and synthesised narratively. Included studies spanned a wide range of countries and included both clinical and community populations. There was substantial variation in how the scores on PRFQ subscales were interpreted to reflect PRF across studies, with some studies engaging in scoring transformations and re-coding of the scores in line with their interpretation. Results also showed large variability in the internal consistency of the PRFQ which transcended potential cultural differences, particularly concerning the pre-mentalisation (PM) subscale. The original item loadings of the PRFQ were supported in two studies excluding the validation studies by PRFQ developers. In seven studies, the PRFQ items underwent changes and omissions to better fit the population of interest. Some challenges implementing the PRFQ in parents of children beyond 0 – 5 years old and high-risk populations were noted. Together, the findings paint a mixed picture of the psychometric properties of the PRFQ across a range of populations, providing insight into the validity and reliability of the PRFQ in different contexts. Major Project: Parental mentalisation is the process by which parents try to make sense of themselves and their children in terms of their mental states, which is measured through assessments of Parental Reflective Functioning (PRF). Asylum-seeking mothers can experience various stressors which may influence parental mentalisation and the parent-child relationship. This study used reflective thematic analysis (TA) to explore how parental mentalisation is evidenced in asylum-seeking mothers, with consideration of the cultural and contextual factors that may impact it. Six mothers participated in semi-structured interviews, which focused on how they made sense of their child’s mind and behaviour, themselves as a parent, and the parent-child relationship. Four main themes were identified. The theme of “Understanding the Child’s Mind” shed light on the various strategies participants used to understand the mental states of their children, as well as the emotional impact of the uncertainty they often experienced. The bidirectionality of emotional states between parent and child was discussed in the theme of “A Dyad Intertwined: The Interplay of Parent and Child Emotions”, while “Navigating a New Context and Culture” referenced the shift in parenting expectations, with attention to possible influences on parental mentalisation. Finally, “Ghosts in the Nursery: The Impact of Trauma” captured the mothers’ reflections on their own childhood histories and traumatic experiences, which influenced their interactions with their children and the motivation for their children to have different lives than they themselves had. The results from this study provide insights into understanding parental mentalisation in an asylum-seeking context and offer recommendations for clinical practice and future research.
An examination of the role of sustained attention and regulatory focus in stereotype threat and older adults and experiences of perceptions of ageing
(University College Cork, 2023) Fawsitt, Feargus; Setti, Annalisa; Dockray, Samantha
The ageing process is largely thought of as a purely biological process but there are consequential psychological and social aspects of ageing. Perceptions of ageing are how individuals see older adults and the ageing process. These perceptions can have powerful direct and indirect effects on the experiences and lives of older adults. In the short term, being exposed to negative stereotypes about ageing can impact the performance of older adults on tests, such as those to detect cognitive decline. This effect appears to be caused by individual’s concern being negatively evaluated due to an aspect of their identity. This phenomenon is known as stereotype threat. In the long-term, holding negative views of ageing has been linked with serious health conditions and decreased lifespan. The mechanisms for this are unclear but it has been suggested by Levy’s (2009) Stereotype Embodiment Model that there are several pathways these negative views act through, including biological, behavioural, and psychological. Although these concepts appear related, research exploring the potential connections between stereotype threat and perceptions of ageing is scarce. This thesis explores theoretical and practical connections between these two areas while working on building our understanding of the experiences of Irish older adults’ perceptions of ageing. Chapter 1 introduces the background, concepts and literature on perceptions of ageing and stereotype threat in older adults, in the context of an ageing Western society, where negative stereotypes of older adults are still present and operating. Chapter 2 is a targeted literature review which proposes an update of Levy’s 2009 Stereotype Embodiment Theory on the mechanisms through which perceptions of ageing influence outcomes over the lifespan. Our updated model more concretely connects stereotype threat and potential mechanisms to the short-term pathways of the model. This model makes several testable predictions which are explored later. Chapter 3 provides updated evidence since the publication of the paper based on Chapter 2. Chapter 4 uses a cross-sectional methodology to explore correlational relationships between perceptions of ageing and trait regulatory focus, a key explanatory idea in the stereotype threat literature. Existing research findings support a connection between negative perceptions of ageing and a prevention focus providing early evidence these areas could be related which supports the updated model from Chapter 2. Chapter 5 uses reflexive thematic analysis to explore qualitative data from a sample of Irish older adults about their experiences and perceptions of ageing. Participants identified both positives and negatives to ageing as well as a complex perspective on how to age well in Irish society. Chapter 6 further tests predictions made in Chapter 2 on the mechanisms underpinning stereotype threat in older adults. Specifically testing two explanations for stereotype threat in older adults in a test of sustained attention. These findings support executive interference, a specific account of a mechanism potentially underpinning stereotype threat, but stereotype threat may act differently in certain circumstance such as the nature of the assessment, the surroundings, and the specific age range. Finally, Chapter 7 discusses how these findings build our understanding of perceptions of ageing, stereotype threat, and ageing in older adults. Each set of findings and theories is also contextualised with more current research and knowledge. Future directions and limitations are also discussed. Taken together this thesis links perceptions of ageing and stereotype threat by exploring the dominant models in Levy’s Stereotype Embodiment Theory, The Executive Interference model by Schmader, and Barber’s work on Regulatory Focus as explanations for stereotype threat in older adults. By including qualitative data and analysis, an understanding of the unique situation of older adults in Ireland is recognised and more insight is gained into their perceptions of growing older, both positive and negative.
Childhood trauma and trauma-informed care in early intervention in psychosis
(University College Cork, 2024) Hunt, Evan; Lambert, Sharon; Murphy, Mike; Lonergan, Edgar; O'Connor, Karen; Health Service Executive
This doctoral thesis explores the integration of Trauma-Informed Care (TIC) within Mental Health Services (MHS) and examines the prevalence and impact of childhood trauma in individuals experiencing First-Episode Psychosis (FEP). Through a systematic review, the research identifies core principles and practices of TIC in MHS, leading to the development of a framework that encompasses therapeutic environment, sociocultural responsiveness, and workforce development, providing a blueprint for operationalising TIC within mental healthcare. Building on this foundation, an empirical study establishes the demographic and clinical profile of service users accessing an Early Intervention in Psychosis (EIP) service in Ireland. Findings reveal the complex and diverse needs of the population, including significant gender differences in age of onset, substance use, and functional impairments, emphasising the necessity for tailored interventions in EIP services. Further research investigates the prevalence of childhood trauma among FEP service users, revealing a high rate of trauma exposure (78%), with emotional abuse and neglect being most common. Gender differences were also found, with females reporting higher severity and cumulative trauma. These findings highlight the importance of integrating trauma-informed approaches into EIP services to address the multifaceted needs of individuals with psychosis. Finally, the thesis examines the longitudinal impact of childhood trauma on clinical outcomes in FEP. While trauma severity was linked to self-harm, it did not significantly affect other baseline clinical characteristics. Over the course of 12 months of treatment, significant improvements in symptomatology and functioning were observed, regardless of trauma history, highlighting the effectiveness of EIP services in supporting individuals with FEP. This research collectively emphasises the need for trauma-informed, individualised care to optimise outcomes for individuals with early psychosis.
Positive psychology within the clinical context
(University College Cork, 2024) Cullen, Katie; Murphy, Mike; Di Blasi, Zelda
Background: Positive psychology is a subdomain of psychology concerned with the development and enhancement of well-being, strengths and conditions conducive to human flourishing. A plethora of research now supports the efficacy of positive psychology interventions in increasing well-being and reducing psychopathology amongst clinical populations, pointing to the utility of implementing strengths-based approaches when working with individuals with mental and physical health difficulties. However, less is understood about whether or not, and how, these approaches are used in clinical practice by clinical psychologists. Aims: The overarching aim of this thesis is to further explore the use and efficacy of positive psychology within clinical contexts. Two studies are reported addressing these aims. 1) Systematic Review: A narrative systematic review evaluating the evidence base on savouring interventions when applied to adult clinical populations is reported. Data were extracted from nine studies primary involving over 900 participants from mental and physical health clinical populations from seven countries. These specific interventions promoted some positive changes amongst participants, such as increasing levels of well-being and reducing levels of depression and anxiety. Both individuals with mental and physical health difficulties appeared to benefit. However, when comparing the results of these interventions against outcomes gained by participants in no intervention or active control groups, the efficacy of these interventions appears relatively weak. 2) Empirical Study: A mixed-methods study utilising an online cross-sectional survey and participant interviews exploring clinical psychologists’ use of positive psychology in their clinical work and attitudes towards same is reported. Findings revealed that clinical psychologists use an array of positive psychology interventions, however they are predominantly used in conjunction with other therapeutic approaches. Several barriers and facilitators to this implementation were noted, including therapist, client, and systemic factors. Results highlighted the many nuances involved in utilising positive psychology in clinical settings, given existing ambiguity surrounding knowledge and understanding of the approach, and specific therapeutic considerations needed for the approach to be implemented successfully and appropriately. Conclusions: Findings from this thesis portfolio support the far-reaching potential of positive psychology principles and interventions when applied to clinical settings. However, many factors appear to contribute to the implementation and successful use of these approaches, as reported by clinical psychologists actively working across numerous clinical settings. Clinical implications of this research are discussed. Future research should further explore systemic factors which impact on the integration of positive psychology within clinical contexts.

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