Ngā mea kōaro o ngā wā tamarikitanga, te taumahatanga o aua mea me ētahi mahi whakaora hinegaro mō ngā wāhine Māori = Adverse childhood experiences, HPA axis functioning and culturally enhanced mindfulness therapy among Māori women in Aotearoa New Zealand : a dissertation presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Palmerston North, New Zealand

Abstract

Listed in 2019 Dean's List of Exceptional ThesesFigures 2.1 (p. 33), 2.2 (p. 38), 2.3 (p. 43), 3.1 (p. 58), 3.2 (p. 58) & 3.3 (p. 60) have been removed for copyright reasons but may be accessed via their sources listed in the References.Chronic health conditions such as obesity, type II diabetes, cardiovascular disease, depression and anxiety are prevalent among Māori women in New Zealand, as are adverse experiences in childhood and chronic stress. Recent studies have shown a link between adverse childhood experiences (ACEs) and chronic health problems later in life. Many of those studies propose that dysregulation in the stress response system - specifically the hypothalamic-pituitary-adrenal (HPA) axis - mediates that link. Cortisol is the primary corticosteroid released by the HPA axis and is commonly used as a biomarker for assessing HPA axis functioning. Mindfulness-Based Stress Reduction (MBSR) is a therapy that uses a range of breathing techniques, stretches, formal meditations and awareness exercises designed to help regulate the stress response by changing the way the brain manages and relates to stress. Due to its Eastern roots, MBSR therapy assumes an holistic view of health that mirrors some of the key concepts promoted in Te Ao Māori. This research tested the HPA axis functioning of eight adult Māori women who had experienced high ACEs, and explored associations between cortisol dysregulation, visceral obesity (a risk factor for many chronic health conditions) and psychological distress. This research also tested the clinical effectiveness and cultural responsiveness of an MBSR course that had been enhanced to suit a Māori audience. Participants provided pre, mid and post-treatment salivary cortisol samples that measured changes to their acute stress cortisol response, as well as changes to their daily cortisol slope, their cortisol awakening response and their overall cortisol levels. They also provided pre and post-treatment waist circumference measurements. Self-report data assessing depression and anxiety levels, PTSD levels, stress eating habits, perceived stress levels and mindful awareness levels, was collected, as was qualitative data in the form of pre and post-treatment interviews. The results indicated that culturally enhanced MBSR therapy was well received with this sample of Māori women and that the participants reported a wide range of benefits as a result of practicing mindfulness meditation