Modelling smoking motivation: mood, personality and appetitive behaviour

The overarching aim of this research was to investigate the role of affectivity in real-world smoking behaviour. The motivational relationship between affect and smoking was conceptualised within an interactive hierarchical framework: assessing associations with natural situational variability over time, and moderation by relevant individual differences (chiefly, BIS-BAS scores - as reflecting affective disposition/motivational sensitivity). An initial questionnaire study was undertaken towards the development of a diary design that would be useful in capturing experiences around everyday smoking behaviour (Chapter 4). This design was then applied in a series of diary studies that were set up to address questions pertaining to the central aim of the research. The main body of the thesis is structured around these areas of enquiry. Chapter 5 tested competing theoretical models of mood-smoking motivation in everyday contexts and Chapter 6 extended this Investigation hierarchically: to ascertain whether there are individual differences in identified motivational experiences. Chapter 7 compared smoking with natural appetitive behaviour (food consumption) to better demarcate parts of the motivational process that might be set awry in reinforcement of non-natural consumption. The influence of more general periodic shifts in motivational experiences and behaviour on consumption/desire to consume was examined in Chapter 8. The final investigative chapter (Chapter 9) compared processes identified for normal smoking behaviour with processes during deprivation/abstinence. Each chapter draws on data from the diary studies as appropriate. Findings were generally congruent with other naturalistic research in supporting positive mood enhancement (principally, anticipatory elevation of hedonic tone) as a motivation for normal smoking. BAS reward-sensitivity moderated hedonic incentive effects, but not in the expected direction. Comparisons with natural consumption behaviour suggested that motivations for natural appetitive rewards may differ from those for acquired substance use. Notably, smoking motivations changed somewhat during deprivation, when tense arousal and frustration emerged as operative factors. Chapter 10 considers the implications of the research for models of mood and personality. These include implications for conceptualising reinforcement sensitivity

Modelling smoking motivation: mood, personality and appetitive behaviour

The overarching aim of this research was to investigate the role of affectivity in real-world smoking behaviour. The motivational relationship between affect and smoking was conceptualised within an interactive hierarchical framework: assessing associations with natural situational variability over time, and moderation by relevant individual differences (chiefly, BIS-BAS scores - as reflecting affective disposition/motivational sensitivity). An initial questionnaire study was undertaken towards the development of a diary design that would be useful in capturing experiences around everyday smoking behaviour (Chapter 4). This design was then applied in a series of diary studies that were set up to address questions pertaining to the central aim of the research. The main body of the thesis is structured around these areas of enquiry. Chapter 5 tested competing theoretical models of mood-smoking motivation in everyday contexts and Chapter 6 extended this Investigation hierarchically: to ascertain whether there are individual differences in identified motivational experiences. Chapter 7 compared smoking with natural appetitive behaviour (food consumption) to better demarcate parts of the motivational process that might be set awry in reinforcement of non-natural consumption. The influence of more general periodic shifts in motivational experiences and behaviour on consumption/desire to consume was examined in Chapter 8. The final investigative chapter (Chapter 9) compared processes identified for normal smoking behaviour with processes during deprivation/abstinence. Each chapter draws on data from the diary studies as appropriate. Findings were generally congruent with other naturalistic research in supporting positive mood enhancement (principally, anticipatory elevation of hedonic tone) as a motivation for normal smoking. BAS reward-sensitivity moderated hedonic incentive effects, but not in the expected direction. Comparisons with natural consumption behaviour suggested that motivations for natural appetitive rewards may differ from those for acquired substance use. Notably, smoking motivations changed somewhat during deprivation, when tense arousal and frustration emerged as operative factors. Chapter 10 considers the implications of the research for models of mood and personality. These include implications for conceptualising reinforcement sensitivity

Evaluating a person-centred chronic pain service using indices of reliable and clinically significant change

Background: Psychological interventions for chronic pain often require substantial individualisation, which can undermine links with the research evidence on which treatment is based. To ensure patients receive effective therapy, evaluation is needed. This paper demonstrates the use of individual level change indices, which may be more appropriate for assessing effectiveness of person-centred treatment than traditional group-level statistics. Aims: To evaluate the efficacy of a psychological chronic pain service at individual level and to recommend improvements for future service evaluation. Method: Indices of reliable and clinically significant change were used to assess outcomes on the HADS, CORE-10 andPSEQ. Results: Fifty-six out of 83 patients had usable outcome data. On the most widely administered outcome measure, the CORE-10, n=15 met reliable change and n=22 met clinically significant change criteria. Eighteen showed no reliable change. Only one person deteriorated. Conclusions: The person-centred treatment provided by this service was effective and achieved outcomes similar to published data from a structured group programme. However, missing data reduced the reliability of these conclusions andled to reduced usefulness of the evaluation for service planning. Recommendations for future evaluation are made

Are acceptance and commitment therapy-based interventions effective for reducing burnout in direct-care staff? A systematic review and meta-analysis

Purpose: Work-related stress amongst staff working in direct care roles in mental health and intellectual disability settings is associated with a range of problematic outcomes. There has been a proliferation of research into the use of acceptance and commitment therapy (ACT)-based interventions in this staff population. The purpose of this paper is to review the extant literature. Design/methodology/approach: A systematic search of the literature was conducted, and seven studies identified which met the criteria for inclusion in the review, of which four were eligible for meta-analysis. Findings: Results of the meta-analysis were most convincing for the effectiveness of ACT-interventions to reduce psychological distress within a subgroup of those with higher distress at baseline. There was no statistically significant effect for the amelioration of burnout, nor for an increase in psychological flexibility (a key ACT construct). Research limitations/implications: Conceptual issues are considered including the purpose and treatment targets of ACT interventions, such as supporting valued living rather than diminishing stress per se. Methodological issues are discussed around the measurement of psychological flexibility. Originality/value: This review makes recommendations for future research and for the implementation of ACT-interventions for work-related stress in these settings

Mindfulness self-help interventions for symptoms of depression, anxiety and stress: review and meta-analysis

Background: Mindfulness-based therapy has been found to be an efficacious treatment for a range of mental and physical health conditions. There are increasing efforts to deliver benefits of mindfulness through less intensive/more accessible modalities but whether this efficacy holds in lower-intensity forms is unknown. This paper reviews the effectiveness of mindfulness delivered in a self-help manner for reducing symptoms of anxiety, depression and stress. Methods: We conducted a systematic search on a number of databases. Data were analysed with primary outcome measures of depression, anxiety and stress, and a secondary outcome of mindfulness. Sub-group analyses were completed for active control versus passive control. Findings: Analyses revealed statistically significant differences for primary and secondary outcomes, favouring the intervention group. Sub-group analyses were conducted for depression and anxiety (passive control) and depression (active control) and showed no significant differences. Discussion: There is support for the use of mindfulness in a self-help format, although there are relatively few studies and sample sizes are generally small. The high heterogeneity reduces the potential impact of these findings as well as mixed ratings for risk of bias within studies. Limitations of this review and implications for future research are discussed