Perceived professional development among mental health practitioners in New Zealand : a thesis presented in partial fulfillment of the requirements for the degree of Masters in Arts in Psychology at Massey University

Study of psychotherapy processes and outcomes has far outweighed study of its practitioners. New methodological advances in psychotherapy research have led to an increased emphasis on the role of therapist factors in ensuring successful psychotherapy outcome. Implicit in these methodological advances is the suggestion that the treatment procedures, and not the therapists delivering them, are ultimately the main determinants of successful treatment outcome. Although researchers have incorporated therapist years of practice or extent of training when evaluating psychotherapy, this is often misleading as it fails to consider what is actually done during those training and practice years of professional development. Unfortunately, only a few studies have examined mental health professionals' professional development, and little is currently known about the process of development over the course of a practitioner's career. This thesis is an extension of the Collaborative Research Network's study of mental health professionals' professional development to New Zealand. This thesis starts with a description of some recent advances in psychotherapy research, and how they have refocused the field's attention towards the role of the practitioner in influencing treatment outcomes. This is followed by a description of the existing theoretical and empirical work on practitioners' professional development, and an overview of existing methods of assessment. An outline of the CRN study aims and methods are then overviewed, before presenting and discussing the results of the New Zealand practitioner survey

Mental Health Smartphone Apps: Review and Evidence-Based Recommendations for Future Developments

BACKGROUND: The number of mental health apps (MHapps) developed and now available to smartphone users has increased in recent years. MHapps and other technology-based solutions have the potential to play an important part in the future of mental health care; however, there is no single guide for the development of evidence-based MHapps. Many currently available MHapps lack features that would greatly improve their functionality, or include features that are not optimized. Furthermore, MHapp developers rarely conduct or publish trial-based experimental validation of their apps. Indeed, a previous systematic review revealed a complete lack of trial-based evidence for many of the hundreds of MHapps available. OBJECTIVE: To guide future MHapp development, a set of clear, practical, evidence-based recommendations is presented for MHapp developers to create better, more rigorous apps. METHODS: A literature review was conducted, scrutinizing research across diverse fields, including mental health interventions, preventative health, mobile health, and mobile app design. RESULTS: Sixteen recommendations were formulated. Evidence for each recommendation is discussed, and guidance on how these recommendations might be integrated into the overall design of an MHapp is offered. Each recommendation is rated on the basis of the strength of associated evidence. It is important to design an MHapp using a behavioral plan and interactive framework that encourages the user to engage with the app; thus, it may not be possible to incorporate all 16 recommendations into a single MHapp. CONCLUSIONS: Randomized controlled trials are required to validate future MHapps and the principles upon which they are designed, and to further investigate the recommendations presented in this review. Effective MHapps are required to help prevent mental health problems and to ease the burden on health systems

The OnTrack Diabetes Group Therapy Project: Feasibility Trial of a Web-based CBT Program with Conjunctive Group Therapy

Context. Type 2 diabetes is a global public health concern due to its wide-spread impacts on mortality, morbidity and quality of life, which are largely preventable through adequate self-management. However, emotional and psychological barriers to effective self-management remain a challenge for health systems to address. Interventions targeting diabetes self-management, emotional and psychological issues can lead to improvements in patients’ physical and mental health outcomes. Furthermore, there is a significant, positive relationship between social support and psychological wellbeing in people with diabetes and cognitive behavioural therapy (CBT) has demonstrated efficacy in reducing symptoms of depression and anxiety in this population. Intervention. This paper presents on the feasibility trial of an intervention that includes social support in the form of CBT-based group therapy delivered in conjunction with a web-based CBT type 2 diabetes self-management and mood intervention. Methods. Aims of this study include: (i) to evaluate user uptake, engagement, perceived usefulness and acceptability of the intervention; and (ii) to evaluate the implementation fidelity of both intervention components, as well as group cohesion and group-facilitator alliance, and their relationship to participant engagement in the group therapy program. A sample of 30 adults with type 2 diabetes is recruited to take part in the trial at three locations, including metropolitan Victoria and regional areas of Victoria and Queensland. Results. Results will indicate the feasibility of delivering a face-to-face group therapy program with web-based support and will inform the future roll-out of the program as a complete web-based intervention. Conclusions. Implications for the future implementation of the program based on feasibility trial findings will be discussed

Cognitive behavioral therapy for older adults: Practical guidelines for the use of homework assignments

There is emerging evidence to support the effectiveness of cognitive behavior therapy (CBT) for older adults. However, there are a number of clinical difficulties that practitioners often encounter when using homework assignments with the older adult population. In this article, we provide a brief summary of the research findings on homework in CBT, review common obstacles to the use of homework, and provide concrete suggestions for the adaptation of homework assignments to increase their potential effectiveness with older adults. We also describe several types of homework assignments that may be most helpful, augmenting these suggestions with clinical examples

The Options Value of Blue Hydrogen in a Low Carbon Energy System

A developer considering the construction of a Steam Methane Reforming facility for the production of hydrogen from natural gas faces the decision as to whether to incorporate and operate a Carbon Capture and Storage (CCS) unit, as part of the facility, in an environment where the costs of inputs and the price of hydrogen are uncertain. Conventional valuation methodologies such as Discounted Cash Flow (DCF) cannot systematically integrate uncertainty from changing market and regulatory conditions. Such methods are also unable to account for the ability of management to make use of flexibility to respond as the uncertainties are progressively resolved proactively. Consequently, an Engineering Flexibility / Real Options approach has been developed to allow the calculation of the additional value that the developer might obtain if a CCS unit is not fitted at the time of construction of the SMR plant. Instead, the plant is constructed so that the CCS unit can be retrofitted during the plant’s lifetime if the economic conditions are such that it appears that this will increase the value of the SMR plant. Application of this approach has shown that, for this example, the Net Present Values are increased in a range of energy price and cost of CO2 release scenarios, i.e. the Real Option has a positive value. These findings hold for a range of discount rates. Similarly, the approach improves the Value at Risk and the Value at Gain. Whilst in this work, the approach has been applied to the example of the decision of whether to fit a CSS unit to an SMR plant for the production of blue hydrogen, it is believed that a similar approach can be applied to other situations

The role of homework assignments in cognitive and behavioral therapies : a thesis presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University

Full text removed at author's request 26/04/2012Homework assignments have long been considered crucial within cognitive and behavioral treatment formulations. A large number of commentary articles have suggested that when homework is administered systematically, client homework adherence and successful therapy outcome can be enhanced over and beyond the effects in cognitive and behavioral therapies. However, despite the apparent importance of homework, the relationship between homework assignments and outcome is a relatively uninvestigated aspect of therapy. Only a few studies have examined homework's effect on outcome in therapy, and little is currently known about its use in everyday clinical practice. This dissertation is an attempt to evaluate the findings of prior research, determine methodological limitations, and examine the role of homework assignments in promoting positive change in cognitive behavioral therapies. This dissertation starts with a description of the theoretical and practical rationale for the use of homework assignments in therapy. The results of a practitioner survey designed to investigate the use of homework assignments in clinical practice are next presented (Study 1). This is followed by a power survey of the statistical sensitivity among prior empirical research designed to examine the relationship between homework assignments and outcome (Study 2), and a meta-analytic aggregation designed to quantify the magnitude of homework's effect in cognitive and behavioral therapies (Study 3). Finally, the dissertation describes the results of an empirical study designed to examine the role of systematic homework administration and homework performance in predicting therapeutic change (Study 4)