Theses
http://hdl.handle.net/10034/623049
2024-03-29T09:01:41ZTherapeutic Residential Interventions for Harmful Sexual Behaviour - A Theory of Change
http://hdl.handle.net/10034/628233
Therapeutic Residential Interventions for Harmful Sexual Behaviour - A Theory of Change
Gallagher, Kevin N.
The numbers of children who are removed from their families and looked after by the state is rising in the UK. Whilst approximately 90% of these are eventually placed in foster care, the remainder are a very diverse population with complex needs that often require care delivered in a residential setting, usually with therapeutic input and purpose. Some of these young people will have extensive experiences of trauma and abuse and will have engaged in Harmful Sexual Behaviour (HSB). Therapeutic residential interventions to meet the needs of this group come at an especially high cost to the public purse, but despite this, outcomes for this group of looked after children are statistically poor. This is across primary and mental health, employment, education, housing and welfare, and offending measures.
In this context identifying and promoting good practice is important but a challenge in this regard is assessing the effectiveness of residential interventions when there are so many confounding and competing variables in play. The individual pathway into residential care means that young people have very different starting points and needs; young people might receive a range of different therapies and interventions during their time in care; there are often ongoing and dynamic forces in the wider system around a young person; and continuation of resources or timing of moves might be driven by economic reasons rather than need or the precepts of good practice.
Conversely, theory-based approaches offer a potential route to defining and evaluating practice by shifting the focus from ‘what works’ to required activities and how these are expected to work. In response, this study draws on the field of theory led evaluation, specifically Mayne’s (2001) Contribution Analysis (CA) to create a Theory of Change (ToC) to explain how capacity, opportunity and motivation to change behaviour can be promoted in therapeutic residential settings for children and young people who have engaged in HSB Drawing on interviews with service providers and adult males who received interventions, it providers an account of the activities and processes that are considered to have generative potential in terms of promoting good outcomes in therapeutic residential settings for boys who have engaged in HSB.
Haigh’s (2013) ‘quintessences’ (attachment, containment, open communication, participation and agency) and Kennard’s (1998) ‘common features of a therapeutic community’ emerge as key theoretical frameworks to understand data from staff and former resident interviews. Within the ToC that is finally developed there is a focus on the role, relevance and contribution of relationships to better outcomes and how structures and processes can be used to underpin therapeutic change. This is the first time that a model like this has been created to describe and navigate a therapeutic residential journey. The model provides the foundation stage for theory-based evaluation of such services and for further iterations and adaptation for use in other complex relational systems and interventions.
2023-06-01T00:00:00ZAcceptance and Commitment Coaching for Oncology Healthcare Professionals
http://hdl.handle.net/10034/627241
Acceptance and Commitment Coaching for Oncology Healthcare Professionals
Kent, William
Oncology nurses are an occupational group that experience high stress, increasing risks of chronic outcomes such as burnout and compassion fatigue. This negatively affects staff absenteeism/turnover and the quality of patient care. Current oncology nurse stress-management interventions offer varied insight regarding effectiveness, with little information on how intervention
packages are tailored for this population, and how the intervention mechanisms bring about positive change. Acceptance and Commitment Training (ACT) provides a viable platform from which to offer stress management techniques, given both the relevance of mindfulness and values based behaviours to this context, and the availability of process measures to understand mechanisms of change. This thesis aimed to develop and test an ACT-based oncology nurse stress-management intervention following the MRC guidance, given the limited published research using ACT.
Online cross-sectional survey research (chapter two) revealed that acceptance, mindfulness and values-based processes are important in shifting work-related wellbeing outcomes in UK nurses, given the large amounts of variance explained by these components. This empirically guided the development of ACTION; a three-session (90 minutes each), group-based ACT intervention. ACTION was tested in three single-case experimental design (SCED) studies (chapters four to six). Intervention acceptability was demonstrated in the first SCED study, with qualitative data informing future development. Systematic changes to each of these trials, such as piloting alternative measures, a lengthier follow-up phase and the inclusion of eligibility
screening provided insightful results. ACTION demonstrated effectiveness for psychological flexibility, with improvements mainly observed at follow-up, even for participants receiving an online version of ACTION in response to COVID-19 pressures. Effects on stress were also promising. The implications of using SCED methodology in this context is discussed (e.g. the impact of extraneous factors on stress scores).
Qualitative data highlighted the potential utility of ACTION for promoting stress-management self-efficacy. The general self-efficacy scale was, thus, included as an outcome in studies three and four to capture this construct. Lack of sensitivity to change and frequent ceiling effects made demonstrating effectiveness on this variable a difficult process. It highlighted the importance
of using a domain-specific self-efficacy measure to test this potential secondary outcome of ACTION, but, to knowledge, no measure existed.
To address this gap, the final study of this thesis developed a stress management self-efficacy scale that aimed to reduce the risk of ceiling effects prevalent in previous self-efficacy scales. This study used an item-selection process that combines Classical Test and Item Response Theory. Forty items were reduced to sixteen, offering a scale that cannot only be used in future
trials of ACTION, but in any stress-management intervention trial from any occupational context.
Various recommendations are outlined in the final chapter, from advice for implementing ACTION in the applied setting, to methodological recommendations for a future Phase II trial.
2022-07-01T00:00:00ZMeasuring and Exploring LGBTQ+ Stigma Reduction from a Contextual Behavioural Science Perspective
http://hdl.handle.net/10034/626720
Measuring and Exploring LGBTQ+ Stigma Reduction from a Contextual Behavioural Science Perspective
Norwood, Sabrina
This thesis is comprised of five empirical studies which were designed to measure and explore lesbian, gay, bisexual, transgender, and queer/questioning+ (LGBTQ+) stigma reduction, through a Contextual Behavioural Science (CBS) lens. This thesis offered unique contributions to the field via its introduction of a novel stigma measure, its empirical testing of the euphemism treadmill effect, and its introduction of a novel form of perspective-taking.
The thesis begins with a literature review chapter, followed by the first phase of experimentation. This involved the creation of a new psychometric scale to measure others’ stigmatising attitudes. Data were collected from a total of 429 participants, measuring attitudes toward two different populations. Exploratory factor analysis and item-reduction was undertaken using data from one sub-set of participants resulting in a unidimensional scale. Parallel forms were created using an odd-even split. The resultant factor was compared against the second sub-set of participants using a confirmatory factor analysis. The one factor, 24-item structure was confirmed and retained.
The second phase of experimentation involved exploring a previously employed reduction technique (i.e., language and the euphemism treadmill effect) using both a methodologically robust approach and ecologically valid approach, across two studies. The first study used a technique familiar to CBS, match-to-sample, while the second used a more ecologically valid approach, a vignette. Both contained the same three hypotheses. Results from the first study indicated some significant correlation between pre-intervention and post-intervention scores, but no significant effect within the gay condition specifically. Results also showed that word valence was a significant moderator between pre- and post-intervention scores. Results from the second study indicated no significant change in scores from pre- to post-intervention labels, with pre-intervention scores and post-intervention scores showing a strong positive correlation. Word valence was not a significant moderator between pre- and post- scores.
The third phase of experimentation involved exploring both a previously utilised perspective-taking intervention, and the creation of a novel form of perspective-taking, across two studies. For the first study, 280 participants were randomly assigned to one of six different conditions varying in requirements expected and type of perspective-taking. Each
ix
condition also varied in participant burden, across three levels ranging from least burdensome to most burdensome. The second study utilised 235 participants who were randomly assigned to one of three different perspective-taking conditions. Attitudes toward gay people were measured pre- and post-intervention as well as after a two-week follow-up period and compared both within and between subjects. Results from the first study showed no significant effect of change scores nor of type of intervention, as well as level of participant burden, on two of the three measures utilised. Results for the second study found no significant effect of condition on change scores. However, attitudes were shown to have significantly changed from pre-intervention to post-intervention on all three measures, and this significant change remained between pre-intervention to follow-up on two of the three measures utilised.
The general discussion chapter gives an overview of the key findings that emerged from this thesis as well as a discussion of implications, limitations, and future directions as a whole and complete work.
2022-02-01T00:00:00ZAddressing Gaps in Cognitive Dissonance Theory and Relational Frame Theory – Research on Coherence and Ambiguity
http://hdl.handle.net/10034/625610
Addressing Gaps in Cognitive Dissonance Theory and Relational Frame Theory – Research on Coherence and Ambiguity
Ashcroft, Samuel P.
The aim of this thesis was to build a body of evidence to address several gaps in Cognitive Dissonance Theory (Harmon-Jones, E. & Harmon-Jones, C., 2007) and Relational Frame Theory (Hayes et al., 2001), relating to relational coherence, incoherence, and particularly ambiguity. These gaps included a lack of: theory and research on ambiguity; robust definitions of coherence, incoherence and ambiguity; research on the relative appetitiveness of coherence versus incoherence and ambiguity; multiple-stimulus research in Cognitive Dissonance Theory; technical experimentation in Cognitive Dissonance Theory; and clarity
about the stimulus-specific lower boundary conditions of coherence-related phenomena. An overview of theory and research pertaining to coherence, incoherence and ambiguity was given (Chapter 1), including discussion regarding the gaps highlighted. Then, working definitions of coherence, incoherence and ambiguity were offered (Chapter 2). The ambiguity-coherence study by Quinones and Hayes (2014) was conceptually replicated and expanded (Chapter 3), discovering that participants spontaneously generate A-C relationships on ambiguous A-C blocks involving nonsense stimuli. A design issue regarding patterns of
reinforcement was identified in Chapter 3, and this was discussed and resolved (Chapter 4), alongside an assessment of the appetitive properties of coherence. Participants displayed no preference towards completing a coherent versus an ambiguous A-C block again. Physiological measures of Heart Rate and Galvanic Skin Response were measured in response to coherence and ambiguity (Chapter 5), further evidencing spontaneous generation of relationships in response to ambiguity. No difference in physiological measures was found between coherent and ambiguous A-C blocks. Incoherence was incorporated into the design
(Chapter 6), which provided corroborative evidence of the spontaneous generation effect and also demonstrated the validity of the experimental design by matching predictions from Relational Frame Theory. An updated assessment of the appetitive properties of coherence was completed (Chapter 7), with real words as stimuli and discriminatives. Spontaneous generation of relationships in response to ambiguity also occurred using these alternative stimuli. Differences were broadly not found between coherent and ambiguous A-C block types, indicating that there appears to be a stimulus-specific lower boundary condition for various coherence phenomena such as changes in affect and arousal. However, the spontaneous generation of A-C relationships indicates no stimulus-specific lower boundary condition for coherence-related behavioural responses. Finally, the effect of experimental design on spontaneous generation of relationships was assessed (Chapter 8), identifying that
spontaneous generation of relationships is moderated by the complexity of the cognitive task at hand. Findings from this thesis were synthesised with literature on coherence, particularly that of Cognitive Dissonance Theory and Relational Frame Theory (Chapter 9), with limitations, implications and future research directions given. This thesis: evidences the importance of ambiguity in any theory relating to coherence; identifies a possible stimulus-specific lower boundary condition for affective but not behavioural coherence-related responses; shows that the spontaneous generation of relationships effect could potentially be considered a fundamental aspect of human relational behaviour; and demonstrates that such spontaneous generation effects appear moderated by the complexity of the cognitive task at hand.
2021-03-01T00:00:00Z