‘Not like rose-tinted glasses… like taking a pair of dirty glasses off’: A pilot intervention using positive emotions in expressive writing.

Studies conducted in various contexts and with varied populations have found expressive writing enhances physical and psychological wellbeing. This pilot intervention study countered the predominantly quantitative evidence by adopting a qualitative methodology, exploring the experience of using positive emotions in expressive writing. Participants (n = 10), who all had previous experience in expressive writing, were asked to select one of ten positive emotion cards (PECs) each day for three days. Participants were then asked to write expressively through the ‘lens’ of their chosen emotion. Semi-structured interviews were conducted and experiences were evaluated using Thematic Analysis. The results identified two main themes that compared the experience of expressive writing both with and without the PECs. The first theme, Processing (without the PECs) contained three sub-themes: sense of relief, habitual perspective and reactive to experience. The second main theme, Progressing (with the PECs) contained three different sub-themes: sense of direction, changed perspective and interactive with experience. This study found that, for expressive writers, positive emotions may function in three ways: to relate to others or self-expand, to move past challenges cognitively or change unconstructive perspectives, and finally as a way to interactively link or ‘bridge’ from the written subject matter to constructive action, thus breaking cycles of reactive writing and rumination. Implications of the study on the practice of expressive writing and its potential as a positive psychology intervention (PPI) are discussed

University Students' Constructions of 'Flourishing' in British Higher Education: An Inductive Content Analysis

The potential to flourish as a student has emerged as a topic of debate amid the current period of economic transition in British Higher Education (HE). The present study sought to explore the concept of ‘flourishing’ as it is constructed by students in British HE. An open-ended questionnaire was distributed to N=222 students across two post-1992 British HE institutions to elicit written qualitative data on their understandings of ‘flourishing’ and ‘flourishing at university’, and of their characterisations of ‘flourishing’ and ‘non-flourishing’ students. Data was content analysed using an inductive approach. Prominent categories emerging from the data sets constructed ‘flourishing’ primarily as self-actualisation (personal growth, potential realisation) and success. However, engagement (both academic and social) emerged as a significant facet of ‘flourishing at university’. The ‘flourishing student’ was characterised as academically and socially engaged, committed to learning, and oriented towards personal growth. Conversely, the ‘non-flourishing’ student emerged as having a general sense of lacking, a disengaged attitude towards academic work, and a lazy/withdrawn outlook. Results provide inductively derived support for Wellbeing Theory (Seligman, 2011) and allow generic understandings of ‘flourishing’ to be contextualised within a HE setting. Further implications of the study and suggestions for future research are discussed with regard to the findings

Five-year follow-up of participants in a randomised controlled trial showing benefits from exercise for breast cancer survivors during adjuvant treatment. Are there lasting effects?

In an earlier randomised controlled trial, we showed that early stage breast cancer patients who received a supervised exercise programme, with discussion of behaviour change techniques, had psychological and functional benefits 6 months after the intervention. The purpose of this study was to determine if benefits observed at 6 months persisted 18 and 60 months later

Modelling Everyday Understandings of Mortality: A Qualitative Enquiry

With few exceptions, much of the literature on mortality awareness (MA; the realization of one’s own and other’s mortality), though based on quantitative research, is focused on its negative effects and processes associated with fearing its occurrence. However, recent studies have demonstrated that MA is multifaceted and can be associated with positive processes and outcomes. Here, everyday understandings of MA were investigated using grounded theory. Ten participants engaged in one-off semistructured interviews about their everyday experiences of MA. Grounded theory analysis revealed four main themes: (a) Moments of MA, (b) Functionality of MA, (c) Coping strategies for MA, and (d) Inability to cope with MA. Each of these themes is composed of two to five subthemes. The results supported the notion that MA is experienced in a multidimensional manner, which appears to align with elements of the Multidimensional Mortality Awareness Measure and Model. Furthermore, positive and/or negative outcomes appeared to depend on the function attributed to MA by the individual. Therefore, the ability to attribute such function to MA appears to be important in our understanding of this key existential issue

Preliminary evaluation of a school-based resilience-promoting intervention in a high-risk population: Application of an exploratory two-cohort treatment/control design

Applying innovative methodology, we explored the efficacy of SPARK Resilience Programme––a new universal school-based resilience-promoting programme––regarding effects on depression symptoms and resilience in a high risk population in England. Quantitative and qualitative methods were combined in an exploratory two cohort treatment/control design with one cohort serving as the control group (single assessment) and a subsequent cohort as the treatment group (assessed before and immediately after treatment as well as 6 and 12 months after treatment ended), involving a total of 438 11–13 year old girls, According to analyses, depression symptoms were significantly lower directly after treatment and at 6 months but no longer at 12 months. Resilience scores, on the other hand, were significantly higher in the treatment cohort compared to the year-ahead control cohort at post-treatment and both follow-up assessments. Qualitative results demonstrated beneficial teacher experience overall. The current study provides first evidence for the efficacy of SPARK Resilience Programme. Furthermore, the applied two cohort treatment/control mixed methods design proved helpful for the preliminary testing of a school-based universal intervention programme efficacy in an authentic setting

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

Understanding the experience of posttraumatic growth following life threatening physical illness

Diverging from the pathological focus of 1950's psychology, positive psychologists have concentrated on the potential for people to grow and enhance their quality of life following adversity, a phenomenon coined as "posttraumatic growth" (PTG) (Tedeschi & Calhoun, 1996). Although there has been significant advancement in PTG research, there are limitations in the current models, theories and methods of assessment. Therefore, the aim of this thesis was to attain an in-depth insight into the nature of PTG following breast cancer diagnosis using interpretative phenomenological analysis. The participants were ten female breast cancer survivors who were self selected as having experienced posttraumatic growth, as well as participated in an exercise programme during their cancer treatment (Mutrie et al., 2007). They participated in one open-ended interview at their one year follow-up, the primary focus being to understand their experience of PTG. The analyses yielded seven main themes: the body, exercise class, existential re-evaluation, self-identity, philosophy change, society and narrative from growth-to-growth. Four of these have been extensively reported within the literature, thereby justifying the decision to further analyse the themes of 'narrative from growth-to-growth', 'exercise class' and 'the body' as they contributed the most to the expansion of PTG theory. The results suggest a reconfiguration of the Transformational Model of growth (Tedeschi & Calhoun, 2006) in terms of its proposed temporal sequences of initiation of growth and exclusivity upon rumination. Additionally, two other themes suggest that the facilitation of growth, and certain PTG outcomes, were the result of both the women's participation in an exercise class and a reconnection to their own body; previously these two elements have not been linked. Overall, the thesis provides in-depth and novel additions to the PTG research within illness related trauma. Future research could extend the findings to develop more definitive links between thought processes, physical activity interventions and the body in the experience of PTG.EThOS - Electronic Theses Online ServiceGBUnited Kingdo