• The Finding My Way UK Clinical Trial: Adaptation report and protocol for a replication randomised controlled efficacy trial of a web-based psychological programme to support cancer survivors

      Hulbert-Williams, Nicholas J; Leslie, Monica; Hulbert-Williams, Lee; Koczwara, Bogda; Watson, Eila K; Hall, Peter S; Ashley, Laura; Coulson, Neil S; Jackson, Richard; Millington, Sue; et al. (JMIR, 2021-07-12)
      Background: Cancer survivors frequently report a range of unmet psychological and supportive care needs; these often continue after treatment has finished, and are predictive of psychological distress and poor health-related quality of life. Online interventions demonstrate good efficacy in addressing these concerns and are more accessible than face to face interventions. Finding My Way is an online, psycho-educational and cognitive behaviour therapy intervention for cancer survivors developed in Australia. Previous trials have demonstrated Finding My Way to be acceptable, highly adhered to, and effective in reducing the impact of distress on quality of life, whilst leading to cost-savings through health-resource use reduction. Objectives: Our study will adapt the Australian Finding My Way website for a UK cancer care context, and then undertake a single-blinded, randomised controlled trial (RCT) of Finding My Way UK against a treatment-as-usual waitlist control. Methods: As much as possible, our trial design replicates the existing Australian RCT of Finding My Way. Following a comprehensive adaptation of the web-resource, we will recruit 294 participants (147 per study arm) from across clinical sites in North West England and North Wales. Participants will: (i) have been diagnosed with cancer of any type in the last six months, (ii) have received anti-cancer treatment with curative intent, (iii) be over 16 years of age, (iv) be proficient in English and (v) have access to the internet and an active email address. Participants will be identified and recruited through the NIHR Clinical Research Network. Measures of distress, quality of life, and health economic outcomes will be collected using a self-report online questionnaire at baseline, mid-treatment, post-treatment and both three- and six-month follow-up. Quantitative data will be analysed using intention-to-treat Mixed-Model Repeated Measures analysis. Embedded semi-structured qualitative interviews will probe engagement with, and experiences of using, Finding My Way UK and suggestions for future improvements. Results: Website adaptation work was completed in January 2021. A panel of cancer survivors and healthcare professionals provided feedback on the test version of Finding My Way UK. Feedback was positive overall, though minor updates were made to website navigation, inclusivity, terminology and the wording of the Improving Communication and Sexuality and Intimacy content. Recruitment for the clinical trial commenced in April 2021. We aim to report on findings from mid 2023. Conclusions: Replication studies are an important aspect of the scientific process, particularly in psychological and clinical trial literatures, and especially in different geographical settings. Prior to replicating the Finding My Way trial in the UK setting, some content updating was required. If Finding My Way UK now replicates Australian findings, we will have identified a novel and cost-effective method of psychosocial care delivery for UK cancer survivors.
    • Brief Engagement and Acceptance Coaching for Hospice Settings (the BEACHeS study): Results from a Phase I study of acceptability and initial effectiveness in people with non-curative cancer.

      Hulbert-Williams, NJ; Norwood, S; Gillanders, D; Finucane, AM; Spiller, J; Strachen, J; Millington, S; Kreft, J; Swash, B; University of Chester; The University of Edinburgh; Marie Curie Hospice Edinburgh (BMC, 2021-06-25)
      Objectives: Transitioning into palliative care is psychologically demanding for people with advanced cancer, and there is a need for acceptable and effective interventions to support this. We aimed to develop and pilot test a brief Acceptance and Commitment Therapy (ACT) based intervention to improve quality of life and distress. Methods: Our mixed-method design included: (i) quantitative effectiveness testing using Single Case Experimental Design (SCED), (ii) qualitative interviews with participants, and (iii) focus groups with hospice staff. The five-session, in-person intervention was delivered to 10 participants; five completed at least 80%. Results: At baseline, participants reported poor quality of life but low distress. Most experienced substantial physical health deterioration during the study. SCED analysis methods did not show conclusively significant effects, but there was some indication that outcome improvement followed changes in expected intervention processes variables. Quantitative and qualitative data together demonstrates acceptability, perceived effectiveness and safety of the intervention. Qualitative interviews and focus groups were also used to gain feedback on intervention content and to make design recommendations to maximise success of later feasibility trials. Conclusions: This study adds to the growing evidence base for ACT in people with advanced cancer. A number of potential intervention mechanisms, for example a distress-buffering hypothesis, are raised by our data and these should be addressed in future research using randomised controlled trial designs. Our methodological recommendations—including recruiting non-cancer diagnoses, and earlier in the treatment trajectory—likely apply more broadly to the delivery of psychological intervention in the palliative care setting.
    • Reforming masculinity: the politics of gender, race, militarism and security sector reform in the DRC

      Massey, Rachel; University of Chester (Taylor & Francis, 2021-06-23)
      Conflict-related sexual violence has become an increasingly visible issue for feminists as well as various international actors. One of the ways global policy makers have tried to tackle this violence is through addressing the violent masculinity of security sector forces. While such efforts have their roots in feminist analyses of militarized masculinity, this article seeks to contribute to the critical discourse on ‘gender-sensitive security sector reform’ (GSSR). There are three dimensions to my critical reading of GSSR. Firstly, I ask what gendered and racialized power relations are reproduced through efforts to educate male security agents about the wrongs of sexual violence. Secondly, I offer a critique of how GSSR normalizes military solutions to addressing sexual violence and strengthens the global standing of military actors. Finally, I bring these themes together in an analysis of the United States-led military training mission Operation Olympic Chase in the DRC. Here, I reveal the limitations of attempting to address sexual violence within the security sector without more radically confronting how gender, race and militarism often work together to form the conditions for this violence. I conclude with some reflections on feminist complicity in upholding military power and the possibilities for developing global solidarity.
    • Lockdown Scrapbook

      Bennett, Julia; University of Chester (York University, Canada, 2021-06-20)
      The Covid-19 lockdown in England began on 23rd March 2020, when people were told to stay at home and only go out for essential purposes, which included an hour’s daily exercise. These measures were originally scheduled to last for three weeks, but were then extended for a further three weeks. On 17th April, shortly after the three week extension began, I started to record my daily walks. For just over a month I chose a word which signified the current moment in some way and took photos related to my chosen theme. I posted four pictures per day, most days, on Twitter (@drjuliabennett). This is a description of the photos, the walks and news media during this period.
    • Violence, control and restraint: The harms to young adults particularly upon transition

      Price, Jayne; University of Chester (Wiley, 2021-06-15)
      The transition into the young adult/adult estate at age 18 years is marked by a significant loss of provision and shift in institutional treatment. One of the many harms endured is the change in restraint which is harmful and damaging yet prevailing. The data presented here shows how the distinct needs of this vulnerable population are widely overlooked. This article extends the literature regarding young adults and argues that there should be greater exploration and understanding of their behaviour and the impacts of transitions. This in turn leads to recommendations for changes to practices within the young adult/adult estate.
    • Transformation hidden in the sand; a pluralistic theoretical framework using sand-tray with adult clients

      Fleet, Doreen; Reeves, Andrew; Burton, Amy; DasGupta, Mani; University of Staffordshire; University of Chester (Taylor and Francis, 2021-06-14)
      Jungian sandplay predominates the existing literature on sand-tray therapy. Although there is a small volume of literature on alternative approaches of using sand-tray with adults, most primarily focuses on children and adolescents. The study aimed to establish a sand-tray therapy framework to be utilized by practitioners who are not Jungian trained and intend to use this intervention with adult clients. The grounded theory (Strauss and Corbin, 1990, 1998) multiple case study involved six client-participants receiving six sand-tray therapy sessions. The pluralistic model established incorporates inter-relational and intra-psychic dimensions. Concepts include phenomenological shift and two sand-tray specific mechanisms of phenomenological anchor and phenomenological hook, aiding ‘edge of awareness’ and unconscious processing. In this study, pluralistic sand-tray therapy was deemed successful based on improved CORE-10 clinical scores and the various participant feedback collected.
    • Journey to wholeness: The psychotherapeutic role of Celtic spirituality

      Gubi, Peter; West, William; Smith, Andrew J. (University of Chester, 2021-06)
      Celtic spirituality, the Christian spirituality of Britain and Ireland which flourished in the middle of the first millennium CE, has enjoyed a modest revival at the turn of the current millennium. Existing literature focusses on theology, history and culture. This research asks the original question: “what is the psychotherapeutic role of Celtic spirituality?” It aims: to contribute to wider literature on spirituality and counselling by going deeper than previous studies of ineffable experiences through creative forms of inquiry; to find out whether and how Celtic spirituality helps participants’ wellbeing, growth and alleviation of distress; and to look psychotherapeutically at a form of spirituality, which as a holistic worldview that is optimistic about human nature, has some common ground with person-centred theory. Ten people pursuing an interest in Celtic spirituality each made a collage to represent their experience prior to, and as a starting-point for, a semi-structured interview. The data analysis comprised four stages: collage inquiry (beginning with participants’ own explanation of their picture and its elements); immersive listening to the interview recordings, briefly noting the content of each interview and what lay at the edge of their awareness; poetic inquiry, using symbolic or resonant words and phrases from each interview to re-tell the experience; and interpretative phenomenological analysis (IPA) to find themes. This original methodology of holistic qualitative inquiry concluded with summative work: a collage of the collages, word clouds of the immersive listening notes and a summative poem, “Journey to wholeness (God enfolding me, God in everything)”, comprising words and phrases from every interview, capturing every IPA theme and key words from the word clouds. The overarching, unifying IPA theme reveals Celtic spirituality to be an experience of integration and wholeness. This aligns with the actualising and formative tendencies of person-centred theory. From twenty-three subordinate themes I abstracted five superordinate themes, which also align well with aspects of person-centred theory: loving others and connection through community both particularly evidence unconditional positive regard and the latter also empathic understanding; feeling “at one with creation”, participants strongly experience the actualising and formative tendencies; being self both in the moment and through life both exhibit congruence.
    • OVPSYCH2: A randomized controlled trial of psychological support versus standard of care following chemotherapy for ovarian cancer

      Frangou, E; Bertelli, G; Love, S; Mackean, MJ; Glasspool, RM; Fotopoulou, C; Cook, A; Nicum, S; Lord, R; Ferguson, M; et al. (Elsevier, 2021-05-29)
      Background: Fear of disease progression (FOP) is a rational concern for women with Ovarian Cancer (OC) and depression is also common. To date there have been no randomized trials assessing the impact of psychological intervention on depression and FOP in this patient group. Patients and methods: Patients with primary or recurrent OC who had recently completed chemotherapy were eligible if they scored between 5 and 19 on the PHQ-9 depression and were randomized 1:1 to Intervention (3 standardized CBT-based sessions in the 6 -12 weeks post-chemotherapy) or Control (standard of care). PHQ-9, FOP-Q-SF, EORTC QLQ C30 and OV28 questionnaires were then completed every 3 months for up to 2 years. The primary endpoint was change in PHQ-9 at 3 months. Secondary endpoints were change in other scores at 3 months and all scores at later timepoints. Results: 182 patients registered; 107 were randomized; 54 to Intervention and 53 to Control; mean age 59 years; 75 (70%) had completed chemotherapy for primary and 32 (30%) for relapsed OC and 67 patients completed both baseline and 3-month questionnaires. Improvement in PHQ-9 was observed for patients in both study arms at three months compared to baseline but there was no significant difference in change between Intervention and Control. A significant improvement on FOP-Q-SF scores was seen in the Intervention arm, whereas for those in the Control arm FOP-Q-SF scores deteriorated at 3 months (intervention effect= -4.4 (-7.57,-1.22), p-value = 0.008). Conclusions: CBT-based psychological support provided after chemotherapy did not significantly alter the spontaneously improving trajectory of depression scores at three months but caused a significant improvement in FOP. Our findings call for the routine implementation of FOP support for ovarian cancer patients.
    • How to persuade and influence people: The art of effective geographical debate

      Healey, Ruth; Leatham, Chloe; University of Chester (Routledge, 2021-05-27)
      This article supports students to prepare to participate in a debate. We consider thorough preparation as the foundation for effective debate. Here we provide guidance on one approach to preparing as effectively as possible. We outline this before considering three key elements to this method of preparation: 1) substance: your knowledge and understanding of the debate topic; 2) style: how to present your points clearly and succinctly; and 3) persuasion: how through both substance and style you effectively persuade people of your argument. We conclude by summarising the key points raised in this guide and identifying how they apply to other assignment contexts. The discussion that follows uses the debate topic ‘Should an additional charge be applied to all single-use plastics?’ to demonstrate the approaches we suggest.
    • Tears Evoke the Intention to Offer Social Support: A Systematic Investigation of the Interpersonal Effects of Emotional Crying Across 41 Countries

      Zickfeld, Janis H.; van de Ven, Niels; Pich, Olivia; Schubert, Thomas W.; Berkessel, Jana B.; Pizarro, José J.; Bhushan, Braj; Mateo, Nino Jose; Barbosa, Sergio; Sharman, Leah; et al. (Elsevier, 2021-04-13)
      Tearful crying is a ubiquitous and likely uniquely human phenomenon. Scholars have argued that emotional tears serve an attachment function: Tears are thought to act as a social glue by evoking social support intentions. Initial experimental studies supported this proposition across several methodologies, but these were conducted almost exclusively on participants from North America and Europe, resulting in limited generalizability. This project examined the tears-social support intentions effect and possible mediating and moderating variables in a fully pre-registered study across 7,007 participants (24,886 ratings) and 41 countries spanning all populated continents. Participants were presented with four pictures out of 100 possible targets with or without digitally-added tears. We confirmed the main prediction that seeing a tearful individual elicits the intention to support, d = .49 [.43, .55]. Our data suggest that this effect could be mediated by perceiving the crying target as warmer and more helpless, feeling more connected, as well as feeling more empathic concern for the crier, but not by an increase in personal distress of the observer. The effect was moderated by the situational valence, identifying the target as part of one’s group, and trait empathic concern. A neutral situation, high trait empathic concern, and low identification increased the effect. We observed high heterogeneity across countries that was, via split-half validation, best explained by country-level GDP per capita and subjective well-being with stronger effects for higher-scoring countries. These findings suggest that tears can function as social glue, providing one possible explanation why emotional crying persists into adulthood.
    • Evaluating process and effectiveness of a low-intensity CBT intervention for women with gynaecological cancer (the EPELIT Trial)

      Hulbert-Williams, Nicholas J.; Hulbert-Williams, Lee; Flynn, Ryan J.; Pendrous, Rosina; MacDonald-Smith, Carey; Mullard, Anna; Swash, Brooke; Evans, Gemma; Price, Annabel; University of Chester; North Wales Cancer Treatment Centre; Ysbyty Gwynedd; Addenbrooke's Hospital Cambridge (F1000Research, 2021-03-29)
      Background: Improving survival from gynaecological cancers is creating an increasing clinical challenge for long-term distress management. Psychologist-led interventions for cancer survivors can be beneficial, but are often costly. The rise of the Psychological Wellbeing Practitioner (PWP) workforce in the UK might offer a cheaper, but equally effective, intervention delivery method that is more sustainable and accessible. We aimed to test the effectiveness of a PWP co-facilitated intervention for reducing depression and anxiety, quality of life and unmet needs. Methods: We planned this trial using a pragmatic, non-randomised controlled design, recruiting a comparator sample from a second clinical site. The intervention was delivered over six-weekly sessions; data were collected from participants at baseline, weekly during the intervention, and at one-week and three-month follow-up. Logistical challenges meant that we only recruited 8 participants to the intervention group, and 26 participants to the control group. Results: We did not find significant, between-group differences for depression, quality of life or unmet needs, though some differences at follow-up were found for anxiety (p<.001). Analysis of potential intervention mediator processes indicated the potential importance of self-management self-efficacy. Low uptake into the psychological intervention raises questions about (a) patient- driven needs for group-based support, and (b) the sustainability of this intervention programme. Conclusions: This study failed to recruit to target; the under-powered analysis likely explains the lack of significant effects reported, though some trends in the data are of interest. Retention in the intervention group, and low attrition in the control group indicate acceptability of the intervention content and trial design; however a small baseline population rendered this trial infeasible in its current design. Further work is required to answer our research questions, but also, importantly, to address low uptake for psychological interventions in this group of cancer survivors.
    • The Emotional Face of Anorexia Nervosa: The Neural Correlates of Emotional Processing

      Halls, Daniel; Leslie, Monica; Leppanen, Jenni; Sedgewick, Felicity; Surguladze, Simon; Fonville, Leon; Lang, Katie; Simic, Mima; Nicholls, Dasha; Williams, Steven; et al. (Wiley, 2021-03-19)
      Social-emotional processing difficulties have been reported in Anorexia Nervosa (AN), yet the neural correlates remain unclear. Previous neuroimaging work is sparse and has not used functional connectivity paradigms to more fully explore the neural correlates of emotional difficulties. Fifty-seven acutely unwell AN (AAN) women, 60 weight-recovered AN (WR) women and 69 healthy control (HC) women categorised the gender of a series of emotional faces while undergoing Functional Magnetic Resonance Imaging. The mean age of the AAN group was 19.40 (2.83), WR 18.37 (3.59) and HC 19.37 (3.36). A whole brain and psychophysical interaction connectivity approach was used. Parameter estimates from significant clusters were extracted and correlated with clinical symptoms. Whilst no group level differences in whole brain activation were demonstrated, significant group level functional connectivity differences emerged. WR participants showed increased connectivity between the bilateral occipital face area and the cingulate, precentral gyri, superior, middle, medial and inferior frontal gyri compared to AAN and HC when viewing happy valenced faces. Eating disorder symptoms and parameter estimates were positively correlated. Our findings characterise the neural basis of social-emotional processing in a large sample of individuals with AN.
    • Development and usability testing of a web-based psychosocial intervention for women living with metastatic breast cancer: Finding My Way-Advanced

      Beatty, Lisa; Koczwara, Bogda; Butow, Phyllis; Turner, Jane; Girgis, Afaf; Schofield, Penelope; Hulbert-Williams, Nicholas J; Kaambwa, Billingsley; Kemp, Emma; Flinders University; Flinders Medical Centre; Sydney University; University of Queensland; University of New South Wales; Swinburne University of Technology; University of Chester (Springer, 2021-03-15)
      Purpose: Women living with metastatic breast cancer (MBC) face significant distress and unmet needs, yet few resources have been developed for this population. The current study aimed to develop and evaluate the usability of Finding My Way-Advanced (FMW-A), a web-based self-guided psychosocial program for women with MBC. Methods: FMW-A was co-designed through (a) adapting an efficacious online program for people with curatively treated cancer, and (b) receiving iterative rounds of input and feedback from a multidisciplinary co-design team including consumers, clinicians and academics. A think-aloud protocol was then implemented to test the usability of the resulting 6-module prototype, with women living with MBC accessing up to three modules with an interviewer sitting along-side. Participants were recruited until saturation of themes occurred. Data were analysed thematically. Results: Participants (n=8) were, on average, 65.3 years old, mostly partnered (n=5), retired (n=6), post-secondary school educated (n=6), with non-dependent children (n=7). Feedback fell into 6 themes. Positive feedback about FMW-A summarised the supportive and informative nature of the programme, supplemented by comments about broadly relatable content. However, one size clearly did not fit all: within themes, diverging experiences emerged regarding navigability, worksheets and layout. Participants noted that having/making time for the intervention would be important to program engagement. Conclusions: Usability testing indicated participants found content helpful and relatable, and identified significant pragmatic improvements to be made prior to further testing. Implications for cancer survivors: The development of FMW-A represents an important step in providing acceptable resources to support women living with MBC.
    • Benefits of musical training on implicit memory and learning in healthy older adults and individuals with dementia

      Cousins, Margaret; Bramwell, Ros; Thorpe, Lisa (University of Chester, 2021-03)
      Ageing is linked to a variety of health issues, but perhaps the most well documented feature of growing older is that it is associated with memory decline (Ward, Berry & Shanks, 2013). It is well established that explicit memory declines with age, with the rate of decline being an important predictor of the diagnosis of dementia (Ward et al., 2013). Implicit memory is involved in everyday tasks that, with practice, become largely automatic. The process of implicit learning is generally defined as the ability to acquire knowledge unconsciously. An effective way of improving health in older adults is through music. Making music is one of the essential skills that requires the use of implicit knowledge. Procedural learning is one type of implicit knowledge that focuses on the learning of a skill through repeated performance and practise. To become a professional musician takes years of skill training, for example, practising scales improves finger patterns in pianists, which over time becomes an implicit motor skill that helps with musical performance. Previous research that has looked at implicit memory in musicians, has focused on young adults and found that both musicians and non-musicians performed equally on implicit knowledge tasks (Bigand et al. 2001). This thesis aimed to look at whether musical training is associated with better performance in implicit memory in healthy older adults and individual with dementia. To do this implicit memory tasks including an adaptation of the Phoneme Monitoring Task (Bigand et al., 2001), Serial Reaction Time Task (Nissen & Bullemer, 1987) and The Word Completion tasks (Tulving, Schacter & Stark, 1982), were completed by healthy older adults and individuals with dementia both musicians and non-musicians. Overall, results showed that musicians, both older adults and individuals with dementia, performed better than non-musicians on procedural learning tasks (Serial Reaction Time Task) but there was no difference on implicit tasks such as priming. Although both musicians and non-musicians with dementia showed reaction times that would suggest procedural learning for repeated sequences, only musicians showed a significant difference between repeated and novel sequences, suggesting that musical training benefits procedural learning. Overall, both health older adult musicians and musicians with dementia performed faster than non-musicians on both the Serial Reaction Time Task and the Adapted Phoneme Monitoring task. However, results did not reach significance on the Adapted Phoneme Monitoring Task. The results suggest that musical training benefits procedural learning in musicians, which could have positive implications for future learning in older adults and individuals with dementia.
    • Addressing Gaps in Cognitive Dissonance Theory and Relational Frame Theory – Research on Coherence and Ambiguity

      Hulbert-Williams, Lee; Hulbert-Williams, Nick; Lafferty, Moira; Ashcroft, Samuel P. (University of Chester, 2021-03)
      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.
    • Setting an International Research Agenda for Fear of Cancer Recurrence: an online delphi consensus study

      Shaw, Joanne; Kamphuis, H; Sharpe, Louise; Lebel, Sophie; Smith, Allan Ben; Hulbert-Williams, Nicholas J; Dhillon, Haryana M; Butow, Phyllis; University of Sydney; University of Ottawa; University of New South Wales; University of Chester (Frontiers Media, 2021-02-22)
      Background: Fear of cancer recurrence (FCR) is common amongst cancer survivors. There is rapidly growing research interest in FCR but a need to prioritise research to address the most pressing clinical issues and reduce duplication and fragmentation of effort. This study aimed to establish international consensus among clinical and academic FCR experts regarding priorities for FCR research. Methods: Members of the International Psycho-oncology Society (IPOS) Fear of Cancer Recurrence Special Interest Group (FORwards) were invited to participate in an online Delphi study. Research domains identified in Round 1 were presented and discussed at a focus group (Round 2) to consolidate the domains and items prior to presentation in further survey rounds (Round 3) aimed at gaining consensus on research priorities of international significance. Results: Thirty four research items were identified in Round 1 and 33 of the items were consolidated into 6 overarching themes through a focus group discussion with FCR experts. The 33 research items were presented in subsequent rounds of the delphi technique. Twenty one participants contributed to delphi round 1, 16 in round 2 and 25 and 29 participants for subsequent delphi rounds. Consensus was reached for 27 items in round 3.1. A further 4 research items were identified by panellists and included in round 3.2. After round 3.2, 35 individual research items were ratified by the panellists. Given the high levels of consensus and stability between rounds no further rounds were conducted. Overall intervention research was considered the most important focus for FCR research. Panellists identified models of care that facilitate greater access to FCR treatment and evaluation of the effectiveness of FCR interventions in real world settings as the two research items of highest priority. Defining the mechanisms of action and active components across FCR/P interventions, was the third highest priority identified. Conclusions: The findings of this study outline a research agenda for international FCR research. Intervention research to identify models of care that increase access to treatment, are based on a flexible approach based on symptom severity and can be delivered within routine clinical care, were identified as research areas to prioritise. Greater understanding of the active components and mechanisms of action of existing FCR interventions will facilitate increased tailoring of interventions to meet patient need.
    • Shifting Models of Energy Companies towards Green Economy in Europe

      Fernandez, Rosa M; University of Chester (Cambridge University Press, 2021-01-21)
      The traditional model of European energy company has been characterised by big entities that usually play a relatively important role as national champions in terms of market share, assets value, vertical integration, political influence and employment volumes, among other factors. However, last decade has seen how these big dinosaurs are losing market power in favour of new actors. On one side Russian and Chinese competitors have started showing interest in the Western European energy sector, and they are developing purchasing strategies to acquire part of the business in different countries, taking advantage of the vulnerable financial position that many of these companies suffer. On the other side having been unable to change their business models away from the focus on fossil fuels into the renewable energies sector has made traditional companies lose market share in favour of a new model of companies, smaller in terms of assets but quite focused on a market segment with a privileged institutional support, particularly thanks to the European Union targets for 2020 on renewable energy. This chapter uses the framework of green economy as the one that approaches macroeconomic issues through innovative ways, promoting green investments through the most adequate regulatory measures, and considering green energy as one of the sectors where these investments should be focused. Bearing this in mind, the chapter will try to point out the existing constraints to reach the new model of development (sustainable development, as promoted by a green economy) and also the barriers that energy companies impose themselves through old fashioned strategies that do not take into consideration the wider demands from a much larger group of stakeholders in a changing society. It will also address the changing governance framework caused by recent political events such as Brexit and the shifting EU institutional discourse towards 2030 targets.
    • Laterality in Chimpanzees: Links with Behavioural Style and Social Networks

      Murray, Lindsay; Rodway, Paul; Díaz González, Sergio (University of Chester, 2021-01)
      This thesis presents a series of studies investigating laterality in chimpanzees and its links with personality examined as behavioural style and social networks. The studies presented in this work were conducted by observing a group of 19 chimpanzees in captivity and present new findings in this species. However, this thesis has a broad evolutionary perspective, addressing important questions regarding personality and laterality that could prove helpful to the understanding of the evolution of laterality in vertebrates. Chapter 1 offers a general review of the three main areas of knowledge investigated: laterality, animal personality and primate social networks. Then, the first study of this project, presented in Chapter 2, began by exploring hand preference in the chimpanzee group, investigating spontaneous actions and unimanual tasks and expanding previous research by studying posture, between-task consistency and temporal stability. Chapter 3 investigated additional measures of motor laterality and proposed a novel way of measuring laterality in primates. Together, Chapters 2 and 3 directly examine laterality in chimpanzees and serve as the base from which to explore the links between laterality, personality and social networks in the subsequent studies. If lateralization is rooted in emotional processing and hemispheric lateralization, then individual differences in behaviour (particularly those that reflect emotional expression) would show a relationship with individual laterality. In order to address this question, Chapter 4 studies behavioural style in chimpanzees and its possible link with laterality. Simultaneously, if intraspecific coordination plays a role in the development of population level laterality, similarly lateralised individuals would likely have strong bonds to coordinate with each other. Chapter 5 introduces the approach and techniques of social network analysis and uses them to explore and describe the social structure of the group while describing the integration of a new adult chimpanzee. Chapter 6 applies social network analysis to explore if laterality plays a role in the way the group is structured. Lastly, Chapter 7 integrates all empirical chapters and presents the final discussion and conclusions of the thesis.
    • An investigation into the development of ACT-based approaches to increase physical activity

      Lafferty, Moira; Whalley, Anthony P. (University of Chester, 2021-01)
      It is well documented that regular physical exercise supports physical and mental wellbeing. Despite the promotion of physical activity by world health experts and governments, physical inactivity within the population remains a cause for concern and disorders associated with sedentary lifestyles have continued to increase. Evidence suggests that the uncomfortable private-events people experience during physical exertion can become psychological barriers to participation in physical activity and thus result in avoidant behaviours. Acceptance and commitment therapy (ACT) has been used to promote increased physical exercise by enhancing psychological flexibility in relation to private-events that are perceived as unpleasant. However, relationships between the individual ACT processes and the theories which underpin their use in interventions designed to promote physical activity have yet to be fully explored. Understanding the relationship between ACT processes and physical exercise is key for appropriate and robust intervention development. This thesis aimed to explore the theoretical and practical application of ACT processes in relation to exercise and inform further development of effective brief interventions designed to increase activity levels. The programme of work within this thesis had two phases. The first phase included two studies: a systematic review to explore the existing evidence; and a quantitative survey study to determine if associations exist between physical activity levels and the individual core processes of ACT. Results from phase one found that the reviewed literature failed to explore the use of Relational Frame Theory (RFT) critical to ACT, and a survey suggested that ACT processes of defusion, self-as-context and personal values were likely to play a significant part in activity levels. The second phase comprised of three interrelated quantitative intervention studies designed using RFT. Each explored the ACT processes by measuring task duration and the intensity of private-events experienced during exercise. The first intervention study combined defusion and self-as-context with no significant effects on an exercise task. The second combined defusion, self-as-context and value orientated cues to behaviour change. Exercise duration was significantly increased in the ACT intervention, while there was no decrease in the intensity of private-events. The final study tested a values clarification task with cues to behaviour change and reported significantly increased exercise duration. The thesis demonstrates that relational frame theory applied to ACT processes can influence the duration of exercise although the relationship with private-events remains uncertain. The robust, theory focused approach to this work represents a small but valuable contribution to the development of intervention strategies and has implications for future research. Strategies worked best using a combination of both deictic and hierarchical relations for training cognitive defuison and self-as-context, and especially for the clarification of personal values used as cues to behaviour change. Further research is needed to establish both the external validity and longevity of observed effects.
    • Professional Development Implications for Counsellors Who Have Worked in The English Improving Access to Psychological Therapies (IAPT) Programme

      Reeves, Andrew; Gubi, Peter; Mason, Richard (University of Chester, 2020-12)
      Background: Prior to the implementation of the IAPT programme by NHS England in 2008, counsellors were commonly employed to deliver psychological therapy in English NHS Primary Care Mental Health (PCMH) services. Pre-IAPT, professional development for PCMH practitioners, like the therapeutic approaches they offered, was non-standardised. Post-IAPT, PCMH provision became standardised, utilising manualised therapies alongside a commitment to outcome data completion. IAPT operates a highly structured approach to PCMH provision, arguably a treatment paradigm, in which ontological and epistemological entities are controlled. The model allows minimal flexibility in relation to what should, and how it should be treated; what data should, and how it should be gathered, and how outcomes should be interpreted. Clinical Commissioning Groups, contract to deliver IAPT services to any qualified providers, using IAPT data to determine performance. Arguably, IAPT has franchised PCMH in England. Professional development of IAPT practitioners is confined to training that supports the delivery of its aims. Consequently, service investment in training is focussed towards NICE approved approaches that are considered to be evidence-based. These approaches are epistemologically nomothetic, creating ideological challenges to counsellors who are epistemologically idiographic. This incommensurability between the IAPT treatment paradigm and counsellors, can affect professional development. Objectives: This research focusses on implications for professional development of counsellors who have worked in IAPT. Conducted amongst ex-IAPT counsellors, to explore: the degree to which counsellors engage in IAPT professional development opportunities; how facilitative IAPT service is to professional development; how counsellors conceptualise and respond to those professional development opportunities. Method: Semi-structured interviews of eight participants who had worked in different IAPT services across England were completed and analysed utilising an Applied Thematic Analysis. Findings: Three themes were identified, exposing many implications for counsellor professional development, influenced by: the IAPT Business and Clinical Models, and Participants Responses to those influences, reflecting both external and internal ideological challenges towards professional development. Conclusions: Ideological incommensurability, can result in both positive and negative professional development outcomes. Business and clinical models contributed to the struggle to identify, secure, or adapt to formal opportunities that are ideologically incompatible. However, participants capitalised on informal professional development opportunities. Exposure to the IAPT program, and the working environment of primary care mental health, enhanced knowledge and experience, administrative competence, and provided valuable exposure to wide-ranging variety of type and complexity in clinical presentation. This was identified as contributing to the development of a notable level of pluralistic practices. Participants did not disclose planned professional development strategies (appearing to respond intuitively to opportunity), suggesting that professional development was lacking intent. Therefore, counsellors are encouraged to reflect upon the type of psychological therapist they wish to become; contemplate the benefit of a structured professional development plan to achieve that aim; recognise the rich potential IAPT offers, and consider how IAPT might contribute to their professional development.