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(2010)Journal ArticlePapua New Guinea (PNG) is in a phase of scaling up access to antiretroviral therapy (ART), and adherence to the newly available drug therapy is becoming an important issue. This paper examines adherence to ART in a sample of 374 HIV-positive people in six provinces in PNG. Participants were recruited to the study using non-probability sampling. Sixty-two % of participants reported complete adherence (no missed or late doses in the past week) and 79% reported not missing any doses in the last week. Revival church members were significantly more likely to report having missing a treatment dose(s) (66%). Those living in the Highlands and those attending Catholic health clinics were significantly more likely to be adherent to their treatment. Age, gender, marital status, education level and employment type did not show significant association with treatment adherence. Adherence rates in PNG are not alarming, indicating that people with HIV can adhere to treatment despite the challenges of living in PNG.
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(2005)Journal ArticleObjective: Authors investigated the effects of current age, age at onset, and gender on the phenomenology of depression. Methods: A mixed-age sample of 810 Mood Disorders Unit attendees with a diagnosis of unipolar major depressive episode at or near its nadir were interviewed by clinician-rated and self-report instruments assessing symptoms and severity of depression. Results: Differences were found in depressive phenomenology according to current age but not age at onset, confirming previous findings. Age differences on several variables were found in women only. Subjective ratings of depression severity decreased with age, whereas objective, clinician-rated severity increased. Conclusions: The pattern and severity of depression change with increasing age. Longitudinal prospective studies would further elucidate this age-gender relationship. Clinicians should be aware of the decreased likelihood of older patients' reporting of depressive symptoms themselves.
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(2022)ThesisRodents learn to fear a stimulus (e.g., a light) that signals the imminent arrival of an innate source of danger (typically an aversive foot shock). They also learn to fear a stimulus (e.g., a noise) that signals a learned source of danger (e.g., the already conditioned fear-eliciting light). Following Pavlov (1927), the former type of fear is termed first-order conditioned fear, because the stimulus is paired with an aversive unconditioned stimulus (US). The latter is termed second-order conditioned fear, because the stimulus is paired, not with a US, but with an already conditioned stimulus. There are both commonalities and differences in the neural substrates underlying these two forms of fear. Both require neuronal activity in the basolateral amygdala complex (BLA), including activation of NMDA receptors, for their encoding, and both require CaMK signalling, gene expression and DNA methylation for their consolidation. However, de novo protein synthesis is required for consolidation of first-order fear but not for consolidation of second-order fear.
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(2023)ThesisBurnout is hot topic in public discourse, with members of the general public quick to self-diagnose as suffering from the syndrome. However, there is a lack of consensus among scientists and practitioners as to how burnout should best be conceptualised and whether/how it should be diagnosed. This thesis reports five studies examining self-diagnosed burnout and how it should best be defined, measured and distinguished from clinical depression. The literature review presented in Part I critiques the currently promulgated three-factor conceptualisation of burnout and highlights the inconclusive research findings regarding burnout’s overlap with depression. Part II contains three studies designed to re-define the burnout syndrome. In Study 1, qualitative and quantitative analyses were used to identify key syndromal features of self-diagnosed burnout. In Study 2, a series of bifactor analyses was undertaken to derive a new definitional model and preliminary measure of the syndrome. In Study 3, mixture modelling was used to examine whether the new burnout definition was best modelled dimensionally or categorically. The results of Part II indicated that burnout as experienced by the general population is characterised by several symptoms beyond the traditional triadic symptom model, and that categorical differences in burnout may exist between those with and without a history of mental illness. Part III contains two studies undertaken to evaluate the degree of overlap between burnout and depression. Study 4 assessed for qualitative differences between burnout and depression experienced by participants who reported having experienced both states. Study 5 compared participants with self-diagnosed burnout to participants with clinically-diagnosed depression across several symptom and causal variables. The results of Part III indicated that the new definitional burnout model derived in Part II showed poor differentiation overall between burnout and depression, but that several other phenomenological, symptom and causal differences are likely to exist between the two states. The results of Study 5 also suggested that burnout overlaps more with non-melancholic than melancholic depression. When taken together, as discussed in Part IV, the studies in this thesis extend knowledge of how self-diagnosed burnout should be defined and illuminate how burnout both converges with and diverges from clinical depression.
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(2022)ThesisThere are studios all over the world where neurodiverse artists work together in a supportive way. This thesis is an inquiry into how art works in two of these organisations—Studio A in Sydney, Australia, and Project Art Works in Hastings, UK. It draws from traditions of narrative inquiry and ethnography to understand the lived experiences of the people at the heart of these studios, and the role that art has played in their storied lives. As such, the thesis contributes to knowledge in three ways: 1) It documents the important practices of makers and organisations whose work has not yet received significant critical or academic attention. It explores the dimensions of these practices that hold potential for reshaping normative understandings of both art and disability; 2) It conceptualises the role of art as a point of connection between neurodiverse people, and as a way of coming to express and understand lived experience. It maps the resonances across different fields that help articulate empathic encounters with and through art; 3) It demonstrates, through its written form, an ecological mode of creative inquiry that resists reductionism—an inquiry that is, like the practices it studies, embodied and relational. It interrogates the value, and ethical implications, of this mode of research. To contribute to knowledge in this way, the thesis assembles many forms of pre-existing knowledge, including the lived experience of its subjects, and the academic literature preceding it. It is grounded in an ecological understanding of cognition, informed by theories that help situate thought in the world, as a dynamic system of relationships between self, others, and the environment. It draws links between disability aesthetics, care ethics, and an ecological approach to empathy, through detailed insights into the social and aesthetic dynamics operating in the work of the two studios. These insights were built up over three years of fieldwork, including over one hundred interviews, and hundreds of hours spent looking, listening, and making alongside artists in the studio. This thesis is an invitation to enter the world of the studios, and of some of the people who work there. It offers a way of paying attention to art, and to other people, that is attuned to the senses, and that allows us to be comfortable with not knowing—or, knowing differently. It argues that this is a practice of ethical importance, in a world where both disability and art are still poorly understood.
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(2022)ThesisTargeting and reducing the processes underlying the development and maintenance of depression and anxiety disorders, such as repetitive negative thinking (RNT), is a promising approach suggested to improve the efficacy and durability of psychological treatment. Delivering treatment online overcomes many of the barriers to accessing mental health treatment and improves treatment coverage. This thesis therefore involved the development and evaluation of a novel internet-delivered treatment targeting RNT. Study 1 involved an online qualitative survey to gain insight into how individuals define, experience, and understand rumination and worry. The findings from Study 1 were used to inform the development of the online intervention evaluated in subsequent chapters. Study 2 outlines the pilot evaluation of the online intervention. The results of Study 2 demonstrated the preliminary efficacy and acceptability of the intervention in adults, with significant reductions in participants self-reported levels of RNT, rumination, and worry, as well as symptoms of depression and generalised anxiety. Treatment effects were maintained at 1-month follow-up. Study 3 aimed to extend these preliminary findings using a randomised controlled trial design and compared the intervention when it was delivered with and without clinician guidance to a treatment-as-usual (TAU) control group. Participants in both the clinician guided and self-help groups had significantly lower levels of RNT, rumination, and worry, as well as symptoms of depression and anxiety compared to TAU at both post-treatment and 3-month follow-up. Treatment effects were significantly larger in the clinician guided group compared to self-help. This thesis provided the first evidence that targeting rumination and worry, both types of RNT, using an online intervention is efficacious, feasible, and acceptable in adults. This thesis also provided the first direct comparison of treatment outcomes and adherence between guided and self-help intervention formats and, in doing so, is the first to demonstrate the superiority of the clinician guided format. These findings add to the growing body of literature suggesting that internet-delivered interventions can successfully simultaneously target rumination and worry and that doing so is associated with significant improvements in depression and anxiety symptoms.
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(2022)ThesisThe agency of women with disability is undermined by long-held ideas of what women with disability can or should be. These narrow, reductive views of their identity are limiting and harmful, and lead to exclusionary practices. My research used a feminist framework to challenge these views. My research addressed the social inclusion of women with physical disability in two stages. First, it investigated identity and inclusion through photographic self-portraits by women with physical disability. Second, my research examined the role of arts-based research in shifting negative community attitudes about disability. In the first stage, six women with physical disability photographed aspects of themselves using the photovoice method to focus on their strengths and issues affecting them. Photos, stories, interviews and discussions were analysed thematically. Findings from the first stage indicate that these six women engage in the ‘work of disability’. They articulated identity through their depictions of gender and disability. They challenged expectations through portraits of strength, sexuality and connection. They illustrated the gendered realities of daily life with disability that explain disability to non-disabled others. This research emphasised the personal capacity of the women to critically challenge how women with disability are portrayed. In the second stage, I explored the extent to which a public exhibition of disability self-portraits could be an effective platform to provoke social change. Audiences responded to open-ended questions about their thoughts and feelings after viewing the exhibition. I employed interpretive thematic analysis through a generic social processes framework to analyse responses. My findings indicate that audiences acknowledged underlying conscious or unconscious biases that contribute to their negative attitudes about disability. Audiences connected with the exhibition in ways that not only explored the women’s stories, but also led to better understandings of their own value sets. Audiences reassessed their assumptions about disability as a direct result of viewing the exhibition. My research findings demonstrate the valuable role of arts-based research. The agency expressed through self-portraits and stories helped shift negative attitudes and perceptions of disability to counter prejudice and promote equality. My research reveals a new pathway for the public to see women as they see themselves through art.
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(2023)ThesisHoarding disorder (HD) is associated with social impairment, including isolation, loneliness, and reduced social support. Social factors also play a role in the maintenance of hoarding symptoms. However, current treatments for HD do not include an interpersonal component. One potential treatment target for hoarding is empathy. Empathy is fundamental to the development of successful social bonds, and disrupted empathy has been implicated in the social difficulties in other disorders. As such, the aim of this current thesis is to explore the relationship between hoarding and empathy and examine whether empathy could be an interpersonal target in hoarding treatment. In Study 1, I investigated the relationship between hoarding and empathy in an unselected sample. Hoarding was positively associated with emotional contagion, a core component of emotional empathy, and negatively related to cognitive empathy. Self-reported emotional empathy and a behavioural measure of cognitive empathy predicted hoarding beyond depression, and a clinical subgroup of participants showed mild-to-moderate impairments in the behavioural cognitive empathy task. Studies 2-4 expanded upon these findings to investigate empathy-related concepts in relation to hoarding. In Study 2, I examined the relationship between hoarding with social motivation and social support, two variables that represent a predecessor and consequence of normal empathy development, respectively. Hoarding was associated with greater social anhedonia, enjoyment of both positive and negative social rewards, and reduced social support. In Study 3, I aimed to investigate if those with high and low hoarding symptoms differ in prosocial behaviour, a common behavioural component of empathy. No significant differences were found between groups. In Study 4, I aimed to clarify if hoarding was associated with experiences and expressions of anger. Dysregulations in emotional and cognitive empathy may reflect in unhelpful emotional and cognitive experiences of anger. Moreover, aggression is a common behavioural consequence of dysregulated empathy, so was potentially relevant to hoarding. Hoarding was positively associated with angry feelings, hostility, and direct aggression, as well as related concepts of angry rumination and displaced aggression. Lastly, Study 5 was a pilot intervention investigating a social cognition intervention for individuals diagnosed with HD. Participants showed improvements in primary outcomes of cognitive empathy and hostility bias and secondary outcomes of hoarding symptoms and loneliness from pre- to post-treatment. This dissertation provides preliminary evidence that empathy may represent a promising construct to improve the understanding and treatment of psychosocial difficulties in hoarding.