To ‘be’ or not to ‘be’: the paradox of engagement in mindfulness-based interventions

Mindfulness-based interventions (MBIs) are evidenced to be effective for a range of physical and psychological health problems for the clinical and non-clinical population. However little is known about engagement in MBIs. In order to address this research gap, this thesis begins with a meta-analysis exploring the relative odds of engaging in an MBI intervention in comparison to other active interventions (Paper 1). Although the findings were inconclusive, as most papers included in the meta-analysis reported study dropout data only, a key issue identified in this paper was the lack of a consensual definition on engagement in MBIs. Papers 2 to 4 aim to develop a coherent definition of engagement in MBIs and identify the factors associated with it. Due to the paucity of research in engagement in MBIs this thesis starts with a bottom-up approach exploring qualitatively the experience of engaging in a self-help 8-week MBI (Paper 2). This paper identifies several key hindrances of engagement in MBIs. The most striking of these hindrances is habitual perseveration. This reflects a key contradiction as MBIs are theorised to reduce perseverative habits such as rumination and worry. Paper 3 explores this empirically and supports the paradox of engagement in MBIs that rumination and worry are barriers of engagement in MBIs. In addition, two facets of engagement in MBIs, physical and psychological, are identified. In order to understand if rumination and worry are hindrances to engagement in any interventions, Paper 4 explores the model of engagement identified in Paper 3 in comparison to an active control condition. In conclusion, this thesis defines engagement in MBIs and identifies some factors associated with engagement. Implications for treatment and future research directions are discussed

A qualitative study with healthcare staff exploring the facilitators and barriers to engaging in a self-help mindfulness-based intervention

In order to increase the cost-efficiency, availability and ease of accessing and delivering mindfulness-based interventions (MBIs), clinical and research interest in mindfulness-based self-help (MBSH) interventions has increased in recent years. Several studies have shown promising results of effectiveness of MBSH. However, like all self-help interventions, drop-out rates and disengagement from MBSH is high. The current study explored the facilitators and barriers of engaging in a MBSH intervention. Semi-structured interviews with members of healthcare staff who took part in an MBSH intervention (n = 16) were conducted. A thematic analysis approach was used to derive central themes around engagement from the interviews. Analyses resulted in four overarching themes characterising facilitation and hindrance to engagement in MBSH. These are: “Attitude towards Engagement”, “Intervention Characteristics”, “Process of Change” and “Perceived Consequences”. Long practices, emerging negative thoughts and becoming self-critical were identified as the key hindrances, while need for stress reduction techniques, shorter practices and increased sense of agency over thoughts were identified as the key facilitators. Clinical and research implications are discussed

Cognitive Arousal Mediates the Relationship between Perceived Ostracism and Sleep Quality but it is not Moderated by Experiential Avoidance

Previous research suggests that longer‐term perceived ostracism is related to poor sleep quality. In this study, we investigated the mediating effect of cognitive arousal on the perceived ostracism‐sleep quality relationship. We also investigated whether experiential avoidance was a moderator of the cognitive arousal‐sleep quality relationship. Participants (N = 251) were recruited through online research portals to take part in an online survey. A path analysis was used to test a moderated mediation effect between variables. It was found that cognitive arousal mediated the perceived ostracism‐sleep quality relationship, however, experiential avoidance was not a significant moderator. These findings suggest that further research needs to be conducted to elucidate the mechanism of experiential avoidance to account for when it may impact sleep quality. Moreover, treatment interventions targeted at reducing cognitive arousal (e.g., cognitive behavioral therapy) prior to sleep are likely to bear some fruit

Creating a hierarchy of mental health stigma: testing the effect of psychiatric diagnosis on stigma

Levels of mental health stigma experienced can vary as a function of the presenting mental health problem (e.g. diagnosis and symptoms). However, these studies are limited because they exclusively use pairwise comparisons. A more comprehensive examination of diagnosis-specific stigma is needed. The aim of our study was to determine how levels of mental health stigma vary in relation to a number of psychiatric diagnoses, and identify what attributions predict levels of diagnosis-specific stigma. We conducted an online survey with members of the public. Participants were assessed in terms of how much stigma they had, and their attributions toward, nine different case vignettes, each describing a different mental health diagnosis. We recruited 665 participants. After controlling for social desirability bias and key demographic variables, we found that mental health stigma varied in relation to psychiatric diagnosis. Schizophrenia and antisocial personality disorder were the most stigmatised diagnoses, and depression, generalised anxiety disorder and obsessive-compulsive disorder were the least stigmatised diagnoses. No single attribution predicted stigma across diagnoses, but fear was the most consistent predictor. Assessing mental health stigma as a single concept masks significant between-diagnosis variability. Anti-stigma campaigns are likely to be most successful if they target fearful attributions

Mindfulness-Based Interventions for Professionals Working in End-of-Life Care: A Systematic Review of the Literature

Objectives: The potential usefulness of mindfulness-based interventions (MBIs) is being investigated for healthcare staff burnout and associated problems, but empirical research on MBI’s for end-of-life (EOL) professionals is still in its infancy. The aim of this review is to describe and evaluate the body of evidence-based research on the use of MBIs to support the psychological wellbeing of professional staff in EOL care settings. Methods: A systematic review of the literature was conducted. Database records were extracted from ERIC, PsycInfo, EBSCO, PubMed Central (PMC) and Web of Science, using search terms to locate peer-reviewed studies on professional (not volunteer) staff in dedicated end-of-life settings, administering MBIs not embedded in more general therapeutic modalities (such as ACT or DBT). After removing duplicates, 8701 potential studies were identified: eliminating those that did not fit the eligibility criteria reduced the number of eligible studies to six. Results: A total of six empirical studies were identified and further evaluated. Interventions primarily focussed on reducing burnout symptoms, increasing self-care and selfcompassion, and fostering mindfulness. Studies demonstrated very little overlap in treatment, methodology and measures. Only one study was a randomised control trial, which on application of the 3-item Jadad quality scoring, (evidence of randomisation, blinding of researcher to participants’ identity and accounts provided of all participants), achieved 1 out of 5 possible points. Furthermore, other concerns were identified as to the study’s methodology. Conclusions: Results of this review point to significant gaps in the research on the potential of MBIs to improve the wellbeing of EOL professionals

Investigating success in the transition to university: a systematic review of personal risk and protective factors influencing academic achievement

The transition to university is a time of great change and adjustment. The challenges of university life can lead to numerous negative consequences for the students. Despite the importance of successful transition for both the student and the university, the current body of literature comprises methodological inconsistencies and disparate analytical goals that make it difficult to identify the most salient and effective factors that help predict transition success. This paper presents a systematic review of research linking personal level risk and protective factors to the outcome of academic achievement among students making the transition to university. This is part of a larger review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Synthesis Without Meta-analysis (SWiM) guidelines, preregistered on the International Prospective Register of Systematic Reviews (PROSPERO, CRD42022330515), searching PsychInfo, Web of Science, and ERIC databases. Records were included if they studied ‘traditional’ first year students transitioning to university and were longitudinal in design and excluded if they looked at specific subgroups of students (e.g., international students). The search yielded 27 articles that were eligible, highlighting a broad range of salient factors ranging from personality traits to procrastination and perfectionism. The findings are discussed in relation to moving the research forward towards an intervention to enhance the probability of successful student transition to university

Feeling Socially Anxious at University: An Interpretative Phenomenological Analysis

For those with feelings of social anxiety, university can present unique challenges. Socially anxious students can face functional impairments such as interpersonal and academic deficits, as well as social maladjustment due to a shift in their social networks. Despite this, there is surprisingly little research exploring their experiences at university using qualitative designs. The present study set out to explore how a small sample of undergraduate students experienced feeling socially anxious at university. Semi-structured interviews were conducted with eight psychology undergraduates and interpretative phenomenological analysis (IPA) was used to explore their experiences and interpret deeper meaning. Five main themes emerged, two of which are presented in the present study: “persistent self-consciousness” and “avoiding reality.” Findings are discussed in relation to Clark and Wells’ (1995) cognitive model of social anxiety as well as existing literature. Areas requiring further exploration are discussed, as well as how universities may support socially anxious students

Feeling Socially Anxious at University: An Interpretative Phenomenological Analysis

For those with feelings of social anxiety, university can present unique challenges. Socially anxious students can face functional impairments such as interpersonal and academic deficits, as well as social maladjustment due to a shift in their social networks. Despite this, there is surprisingly little research exploring their experiences at university using qualitative designs. The present study set out to explore how a small sample of undergraduate students experienced feeling socially anxious at university. Semi-structured interviews were conducted with eight psychology undergraduates and interpretative phenomenological analysis (IPA) was used to explore their experiences and interpret deeper meaning. Five main themes emerged, two of which are presented in the present study: ‘persistent self-consciousness and ‘avoiding reality’. Findings are discussed in relation to Clark and Wells’ (1995) cognitive model of social anxiety as well as existing literature. Areas requiring further exploration are discussed, as well as how universities may support socially anxious students