• Continuing professional development and journaling

      Bryson, David; University of Derby (Informa UK Limited, 2021-09-13)
      This professional development paper looks at CPD and journaling which will help you discover how journaling can support your professional practice, mental health and continuing professional development.
    • The role of perceived descriptive and injunctive norms on the self-reported frequency of meat and plant-based meal intake in UK-based adults

      Sharps, Maxine; Fallon, Vicky; Ryan, Sean; Helen, Coulthard; De Montfort University; University of Liverpool; University of Derby (Elsevier, 2021-07-28)
      Perceived social norms refer to beliefs that people hold about what other people do (descriptive norms) and approve of (injunctive norms), and are associated with food intake. However, less is known about whether perceived social norms are associated with meat and plant-based meal intake. Using a cross-sectional survey design 136 participants (aged 19-66 years, mean age=39.63, SD=12.85 years, mean BMI=25.77, SD=5.30, 80.9% female, 77.9% omnivores, 22.1% flexitarians) answered questions about how frequently they consumed meat and plant-based meals, and how frequently they perceived people in their social environment to consume (perceived descriptive norms), and approve of consuming (perceived injunctive norms) meat and plant-based meals. Perceived descriptive and injunctive norms were positively associated with participants’ frequency of meat intake: participants ate meat more frequently when they perceived their significant other to frequently eat meat (descriptive norm), and when they perceived their significant other and friends to approve of (injunctive norm) frequently eating meat. Perceived descriptive norms were positively associated, but injunctive norms were negatively associated with participants’ frequency of plant-based meal intake: participants ate plant-based meals more frequently when they perceived their extended family, friends, and significant other to frequently eat plant-based meals. However, participants ate plant-based meals more frequently when they perceived their extended family to approve of less frequent plant-based meal intake. These results suggest that different social groups may be important for meat and plant-based meal intake, with significant others and friends appearing to be important reference points for both food types. Further research examining the contexts in which the different social groups influence eating behaviour would be of value.
    • The flows of compassion in adolescents as measured by the compassionate engagement and action scales

      Cunha, Marina; Galhardo, Ana; Gilbert, Paul; Rodrigues, Cátia; Matos, Marcela; University of Coimbra, Coimbra, Portugal; University of Derby (Springer Science and Business Media LLC, 2021-07-23)
      The development of self-report instruments assessing the different facets of compassion adapted for different age groups is crucial for research and clinical practice. This study examined the factor structure and psychometric properties of the adaptation to adolescents of the Compassionate Engagement and Action Scales (CEAS-A) in a sample of 674 Portuguese adolescents. Confirmatory factor analyses showed that the factor structure of the CEAS-A was similar to the one found in the adults’ version, with higher-order factor models encompassing two first/s-order factors in each scale (Engagement and Actions). The CEAS-A revealed good construct validity, reliability, and temporal stability. Gender differences were found in Self-compassion and Compassion for Other scales. Path analysis results indicated that self-criticism had a direct negative impact on adolescents’ life satisfaction, whereas the impact of self-reassurance on life satisfaction was partially mediated by self-compassion and compassion from others. The CEAS-A is the first self-report instrument that allows for the assessment of the three different flows of compassion in adolescents and may be an important and useful tool for research and clinical practice.
    • Assisting you to advance with ethics in research: an introduction to ethical governance and application procedures

      Sivasubramaniam, Shivadas; Dlabolová, Henek Dlabolova; Kralikova, Veronika; Reza Khan, Zeenath; University of Derby; Mendel University in Brno, Zemědělská, 1665, Brno, Czechia; University of Wollongong in Dubai, Dubai, UAE (Springer Nature, 2021-07-13)
      Ethics and ethical behaviour are the fundamental pillars of a civilised society. The focus on ethical behaviour is indispensable in certain fields such as medicine, finance, or law. In fact, ethics gets precedence with anything that would include, affect, transform, or influence upon individuals, communities or any living creatures. Many institutions within Europe have set up their own committees to focus on or approve activities that have ethical impact. In contrast, lesser-developed countries (worldwide) are trying to set up these committees to govern their academia and research. As the first European consortium established to assist academic integrity, European Network for Academic Integrity (ENAI), we felt the importance of guiding those institutions and communities that are trying to conduct research with ethical principles. We have established an ethical advisory working group within ENAI with the aim to promote ethics within curriculum, research and institutional policies. We are constantly researching available data on this subject and committed to help the academia to convey and conduct ethical behaviour. Upon preliminary review and discussion, the group found a disparity in understanding, practice and teaching approaches to ethical applications of research projects among peers. Therefore, this short paper preliminarily aims to critically review the available information on ethics, the history behind establishing ethical principles and its international guidelines to govern research. The paper is based on the workshop conducted in the 5th International conference Plagiarism across Europe and Beyond, in Mykolas Romeris University, Lithuania in 2019. During the workshop, we have detailed a) basic needs of an ethical committee within an institution; b) a typical ethical approval process (with examples from three different universities); and c) the ways to obtain informed consent with some examples. These are summarised in this paper with some example comparisons of ethical approval processes from different universities. We believe this paper will provide guidelines on preparing and training both researchers and research students in appropriately upholding ethical practices through ethical approval processes.
    • An exploration of primary school teachers’ maths anxiety using interpretative phenomenological analysis

      Dove, Jane; Montague, Jane; Hunt, Thomas, E; University of Derby (Final International University, 2021-06-30)
      Primary school teachers are important in children’s learning of mathematics, and maths anxiety development has been partly attributed to children’s classroom experiences (Das & Das, 2013). Maths anxiety was explored in UK primary school teachers, with a view to understanding its development and impact. Data from four semi-structured individual interviews were analysed using Interpretative Phenomenological Analysis (IPA), which facilitates a deeper knowledge of individuals’ personal experience. Three key themes emerged: “experiencing the psychological consequences of maths anxiety”, “social influences” and “the consequences of experiencing maths anxiety as a teaching professional”. The findings contribute to our understanding of the influence of maths anxiety on teachers and teaching practices.
    • Nature Engagement for Human and Nature’s Wellbeing during the Corona Pandemic

      Richardson, Miles; Hamlin, Iain; University of Derby (Emerald, 2021-05-28)
      To explore the associations between noticing nature, nature connectedness, time in nature and human and nature’s wellbeing during the Corona pandemic restrictions. Natural England’s People and Nature Survey (PANS) data (n=4206) from the UK was used to assess a number of wellbeing outcomes (loneliness, life satisfaction, worthwhile life and happiness) and pro-nature behaviours as a function of longer-term physical time in nature and psychological connectedness to nature and shorter-term visits and noticing of nature. Longer-term factors of nature connectedness and time in nature were both consistent significant predictors of wellbeing measures (apart from loneliness) and pro-nature conservation behaviours. Considered alone short-term visits and noticing were again consistent and significant predictors of three wellbeing measures, but recent visits to nature were not associated with pro-nature conservation behaviours. A combined regression highlighted the importance of a longer-term relationship with nature in all outcomes apart from loneliness, but also revealed that, even when considered in concert with longer-term factors, currently noticing nature had a role in feeling one’s life was worthwhile, pro-nature behaviours and loneliness. The closeness of the human-nature relationship and noticing nature have rarely been examined in concert with nature visits. Further, the reciprocal benefits of pro-nature behaviours are often overlooked.
    • A systematic review of self-report measures of negative self-referential emotions developed for non-clinical child and adolescent samples

      Ashra, Hajra; Barnes, Christopher; Stupple, Edward; Maratos, Frances A.; University of Derby (Springer Science and Business Media LLC, 2021-02-05)
      The crisis in child and adolescent mental health and wellbeing has prompted the development of school and community-based interventions to tackle negative emotions towards the self. Providing an evidence-base for such interventions is therefore a priority for policy makers and practitioners. This paper presents the first systematic review of self-referential and self-report measures of negative emotions for use with non-clinical child/adolescent populations, and evaluation of their psychometric properties. A systematic search of electronic databases and grey literature was conducted. Peer reviewed articles that introduced a new measure or included psychometric evaluation of a negative self-referential emotion for children and/or adolescents were identified. Study characteristics were extracted, and psychometric properties rated using internationally recognised quality criteria. Initially, 98 measures designed for evaluating children and adolescents’ negative self-referential emotions were found. Measures were primarily excluded if they were intended for clinical diagnosis or did not focus on self-referential emotions. The remaining eight measures (Brief Shame and Guilt Questionnaire; Self-Consciousness Scale-Children; Shame and Guilt Scale for Adolescents; Test of Self-Conscious Affect- Adolescents; The Child-Adolescent Perfectionism Scale [CAPS]; Child and Adolescent Dysfunctional Attitudes Scale Revised; Children Automatic Thoughts Scale [CATS]; Negative Affect Self-Statement Questionnaire) were organised into domains consisting of self-conscious emotions, self-oriented perfectionism and negative self-cognitions. Psychometric quality ratings identified the CAPS (Flett et al. in J Psychoeduc Assess 34:634–652, 2016) and the CATS (Schniering and Rapee in Behav Res Ther 40:1091–1109, 2002) as having the strongest psychometric qualities. However, all reviewed measures lacked full evaluation of essential psychometric properties. Our review revealed a paucity of self-referential emotional measures suitable for assessing adverse negative self-referential emotions in general child and adolescent populations. Measures suitable for use in non-clinical samples were identified, but these require further evaluation and/or new scale developments are needed. The psychometric findings and methodological issues identified will guide researchers and practitioners to make evidence-based decisions in order to select optimal measures.
    • Moments, not minutes: The nature-wellbeing relationship

      Richardson, Miles; Passmore, Holli-Anne; Lumber, Ryan; Thomas, Rory; Hunt, Alex; University of Derby; National Trust (University of Waikato, 2021-01-31)
      A wealth of literature has evidenced the important role that the greater-than-human natural environment plays in our mental health and wellbeing (reviews by Bratman et al., 2019; Capaldi et al., 2014, 2015; Pritchard et al., 2019). Spending time in nature, engaging with nature directly and indirectly, and a strong sense of nature connectedness (a psychological/emotional connection with nature) have each been shown to positively impact wellbeing. Few studies, however, have examined the importance that various nature-related factors have on our wellbeing when examined in concert with each other, with none including factors of nature connection and engagement. In the current study, using a national United Kingdom sample of 2,096 adults, we provide new insights into this gap in the literature. Our primary focus was on examining, when considered simultaneously, the patterns and relative predictive importance to hedonic wellbeing (i.e., happiness), eudaimonic wellbeing (i.e., worthwhile life), illbeing (i.e., depression and anxiety), and general physical health of five nature-related factors: (1) nature connectedness, (2) time in nature, (3) engagement with nature through simple everyday activities, (4) indirect engagement with nature, and (5) knowledge and study of nature. A consistent pattern of results emerged across multiple analytical approaches (i.e., correlations, linear regression, dominance analyses, commonality analysis), wherein time in nature was not the main (or significant) predictive nature-related factor for wellbeing. Rather, nature connectedness and engaging with nature through simple activities (e.g., smelling flowers) consistently emerged as being the significant and prominent factors in predicting and explaining variance in mental health and wellbeing. Implications for practical application and policy/programme planning are discussed.
    • The culture of culture plate photography

      Bryson, David; University of Derby (Taylor and Francis, 2021-01-04)
      In medical illustration we all know the role of specimen photography and as part of that the photography of culture plates for records, research and publication. However, there has been a trend towards a wider use of cultures in an artistic context whether part of public understanding of science or as a means of personal expression of identity. The sequence of culture plate photographs in this gallery are really of the ordinary rather than the extraordinary or artistic. The photography of cultures of different colours has even become an art form in its own right.
    • Using webinars to support your continuing professional development

      Bryson, David; University of Derby (Taylor & Francis, 2020-10-08)
      The transition from face to face to online learning in response to COVD-19 has massively increased the availability of webinars and other online learning experiences whether virtual meetings with colleagues or even the conversion of conferences into a webinar series. This transformation is especially advantageous for organisations whose members are so widespread geographically that regional meetings can be difficult to attend.
    • The gravitational pull of identity: Professional growth in sport, exercise, and performance psychologists

      Tod, David; McEwan, Hayley; Chandler, Charlotte; Eubank, Martin; Lafferty, Moira; Liverpool John Moores University; University of the West of Scotland; University of Derby; University of Chester (Informa UK Limited, 2020-10-07)
      Theories based in symbolic interactionism and narrative psychology can help us understand practitioner identity. Drawing on theories from these approaches, our purpose in this article is to distill research on sport psychologist growth, argue professional identity is a central goal in practitioner development, and offer applied implications. Professional growth includes movement from the self as an expert, who solves clients’ problems, to the self as a facilitator, who works alongside clients. Practitioners strive toward being authentic and along the way, develop self-awareness, learn to manage anxiety, and choose their preferred ways of working. A key feature of being authentic is an articulated professional identity. Practitioners can shape their professional identities by interacting with helpful people, consuming various genres of literature, and engaging in different types of writing.
    • Brief compassion-focused imagery dampens physiological pain responses

      Maratos, Frances A.; Sheffield, David; University of Derby (Springer Science and Business Media LLC, 2020-09-03)
      Affiliative processes are postulated to improve pain coping. Comparatively, compassion-focused imagery (CFI) also stimulates affiliate affect systems with a burgeoning behavioural, cognitive and physiological evidence base. Thus, the purpose of the present research was to investigate if engaging in brief CFI could improve pain coping. Utilising a randomised repeated measures crossover design, 37 participants were subjected to experimental pain (cold pressor) following counter-balanced engagement with CFI or control imagery, 1 week apart. Salivary alpha-amylase (sAA) and questionnaire measures of emotional responding were taken: at baseline, following introduction to the imagery condition (anticipation), and immediately after the cold pressor pain task (actual). Participants exhibited increases in sAA levels in response to pain following control imagery but, no such changes were observed following CFI (i.e. there was a significant time-by-condition interaction). Pain tolerance (the length of time participants immersed their hands in the cold pressor) did not differ by imagery condition. However, sAA responses to actual pain predicted decreased pain tolerance in the CFI condition. Additionally, anticipatory sAA response predicted increased pain tolerance across both conditions. None of the emotional measures of well-being differed by imagery condition, nor by condition over time. These data demonstrate that using CFI can curtail a physiological stress response to pain, as indicated by increases in sAA in the control imagery condition only, following pain; pain tolerance was not influenced by CFI. Compassion-based approaches may therefore help people cope with the stress associated with pain.
    • Embedding compassionate micro skills of communication in higher education: implementation with psychology undergraduates

      Harvey, Caroline; Maratos, Frances; Montague, Jane; Gale, Maggie; Gilbert, Theo; Clark, Karen; University of Derby; University of Hertfordshire (British Psychological Society, 2020-09-01)
      Many students struggle with group-based assessments. The pedagogic approach of the ‘compassionate micro skills of communication’ (CMSC) aims to equip students with the skills necessary to work effectively in group settings. To this end, students studying on a core psychology module involving group-work, received structured CMSC learning in seminars. Following its implementation, analysis of data from four student and one staff focus groups, using thematic analysis, indicated support for the pedagogic approach. Four themes emerged: the use of CMSC for addressing unhelpful group behaviours; employing helpful group behaviours; enhancing inclusivity; and areas for CMSC improvement and roll out. Quantitative data collection is still on-going and will be reported elsewhere. However, our preliminary analysis of the qualitative data provides good support for utilising a CMSC pedagogic approach in Higher Education regarding both its efficacy and potential positive impact.
    • Exploring the international utility of progressing compassionate mind training in school settings: a comparison of implementation effectiveness of the same curricula in the UK and Portugal

      Maratos, Frances A.; Matos, Marcela; Alberquerque, Isabel; Wood, Wendy; Palmeira, Lara; Cuna, Marina; Lima, Margarida; Gilbert, Paul; University of Derby; University of Coimbra (British Psychological Society, 2020-09-01)
      Given current retention and well-being crises within the teaching profession worldwide, this research sought to explore implementation efficacy of a Compassion Mind Training (CMT) programme in cross-cultural school-settings. A 6-module CMT curriculum was implemented in teaching staff of two primary schools in the UK (N=76) and one primary school in Portugal (N=41). Results revealed that high-quality implementation was achieved across the UK and Portuguese cohorts, with the majority of staff providing extremely positive ratings regarding all aspects of module content, delivery, and interest/relevance. Moreover, recommendation of the CMT to others was the modal response across cohorts. These findings indicate that CMT in school settings has international appeal and utility in helping educators manage educational-based stresses.
    • Pellino-1 regulates the responses of the airway to viral infection

      Marsh, Elizabeth K; Prestwich, Elizabeth C; Marriott, Helen M; Williams, Lynne; Hart, Amber R; Muir, Claire F; Parker, Lisa C; Jonker, Marnix R; Heijink, Irene H; Timens, Wim; et al. (Frontiers, 2020-08-31)
      Exposure to respiratory pathogens is a leading cause of exacerbations of airway diseases such as asthma and chronic obstructive pulmonary disease (COPD). Pellino-1 is an E3 ubiquitin ligase known to regulate virally-induced inflammation. We wished to determine the role of Pellino-1 in the host response to respiratory viruses in health and disease. Pellino-1 expression was examined in bronchial sections from patients with GOLD stage 2 COPD and healthy controls. Primary bronchial epithelial cells (PBECs), in which Pellino-1 expression had been knocked down, were extracellularly challenged with the TLR3 agonist poly(I:C). C57BL/6 Peli1-/- mice and wild type littermates were subjected to intranasal infection with clinically-relevant respiratory viruses; rhinovirus (RV1B) and influenza A. We find that Pellino-1 is expressed in the airways of normal subjects and those with COPD, and that Pellino-1 regulates TLR3 signalling and responses to airways viruses. In particular we observed that knockout of Pellino‐1 in the murine lung resulted in increased production of proinflammatory cytokines IL‐6 and TNFα upon viral infection, accompanied by enhanced recruitment of immune cells to the airways, without any change in viral replication. Pellino-1 therefore regulates inflammatory airway responses without altering replication of respiratory viruses.
    • ‘Trying to bring attention to your body when you’re not sure where it is’: An interpretative phenomenological analysis of drivers and barriers to mindfulness for people with spinal cord injury

      Hearn, Jasmine Heath; Finlay, Katherine Anne; Sheffield, David; University of Derby; Manchester Metropolitan University; The University of Buckingham (Wiley, 2020-08-04)
      Work is beginning to explore the impact of mindfulness in managing the physical and psychological health of people with spinal cord injury (SCI). However, no previous work has sought to understand what drives people with such conditions to try mindfulness, and what barriers are experienced in accessing mindfulness. An exploratory, qualitative, interview design, utilizing interpretative phe- nomenological analysis. Semi-structured interviews were conducted with 11 people with SCI who had experience of mindfulness since sustaining their injury. Verbatim transcripts were analysed using IPA to understand the lived experience of mindfulness post-SCI. Analysis suggested that managing physical and mental health, and viewing mindfulness as proactive and protective were key drivers for exploring mindfulness. However, multiple barriers to accessing opportunities and developing capability impeded engagement. These included the focus on areas of the body that participants had reduced sensation in, physical environments that could not be navigated in a wheelchair, social stigma surrounding the use of mindfulness, and a sense of obligation and risk of failure implied by perceived requirements for engagement. The results demonstrate the need for specific interventions to accom- modate the reduced sensory and physical function experienced by people with neurological conditions and to enhance sense of control and autonomy. In addition, recommendations include minimizing the stigma surrounding mindfulness, and the potentially demotivating impact of the perception of ‘failing’ to engage.
    • Melting temperature measurement and mesoscopic evaluation of single, double and triple DNA mismatches

      Olivieira, Luciana; Long, Adam; Brown, Tom; Fox, Keith; Webber, Gerald; Universidade Federal de Minas Gerais, Brazil; University of Southampton; University of Oxford (Royal Society of Chemistry, 2020-07-23)
      Unlike the canonical base pairs AT and GC, the molecular properties of mismatches such as hydrogen bonding and stacking interactions are strongly dependent on the identity of the neighbouring base pairs. As a result, due to the sheer number of possible combinations of mismatches and flanking base pairs, only a fraction of these have been studied in varying experiments or theoretical models. Here, we report on the melting temperature measurement and mesoscopic analysis of contiguous DNA mismatches in nearest-neighbours and next-nearest neighbour contexts. A total of 4032 different mismatch combinations, including single, double and triple mismatches were covered. These were compared with 64 sequences containing all combinations of canonical base pairs in the same location under the same conditions. For a substantial number of single mismatch configurations, 15%, the measured melting temperatures were higher than the least stable AT base pair. The mesoscopic calculation, using the Peyrard–Bishop model, was performed on the set of 4096 sequences, and resulted in estimates of on-site and nearest-neighbour interactions that can be correlated to hydrogen bonding and base stacking. Our results confirm many of the known properties of mismatches, including the peculiar sheared stacking of tandem GA mismatches. More intriguingly, it also reveals that a number of mismatches present strong hydrogen bonding when flanked on both sites by other mismatches. To highlight the applicability of our results, we discuss a number of practical situations such as enzyme binding affinities, thymine DNA glycosylase repair activity, and trinucleotide repeat expansions.
    • “Suddenly you are King Solomon”: Multiplicity, transformation and integration in compassion focused therapy chairwork

      Bell, Tobyn; Montague, Jane; Elander, James; Gilbert, Paul; University of Derby (American Psychological Association (APA), 2020-07-16)
      Chairwork is a psychotherapeutic method that frequently focuses on self-multiplicity and internal relationships. Compassion-focused therapy (CFT) uses chairwork to generate and apply compassion towards threat-based aspects of the self. This study explores self-multiplicity in a CFT chairwork intervention for self-criticism. Twelve participants with depression were interviewed following the intervention and the resultant data were analyzed using Interpretative Phenomenological Analysis. Three super-ordinate themes were identified: differentiating selves; mental imagery of selves; and integrating and transforming selves with compassion. The results highlight how the intervention enabled clients to differentiate internal aspects of themselves in a way that was accessible and helpful, increasing self-complexity and introducing the potential to observe and change patterns of self-to-self relating. The process of bringing compassion to self-criticism was shown to integrate both aspects of the critical dialogue, transforming the ‘critic’ by understanding its fears and function. The use of mental imagery was also shown to facilitate clients’ experience of self-multiplicity and to symbolize the kind of changes generated by the exercise. Implications for clinical practice are discussed.
    • The green care code: How nature connectedness and simple activities help explain pro‐nature conservation behaviours

      Richardson, Miles; Passmore, Holli‐Anne; barbett, lea; Lumber, Ryan; Thomas, Rory; Hunt, Alex; University of Derby; Insight and Data, National Trust, Swindon, UK (Wiley, 2020-07-08)
      The biodiversity crisis demands greater engagement in pro‐nature conservation behaviours. Research has examined factors which account for general pro‐environmental behaviour; that is, behaviour geared to minimizing one's impact on the environment. Yet, a dearth of research exists examining factors that account for pro‐nature conservation behaviour specifically—behaviour that directly and actively supports conservation of biodiversity. This study is the first of its kind to use a validated scale of pro‐nature conservation behaviour. Using online data from a United Kingdom population survey of 1,298 adults (16+ years), we examined factors (composed of nine variable‐blocks of items) that accounted for pro‐nature conservation behaviour. These were: individual characteristics (demographics, nature connectedness), nature experiences (time spent in nature, engaging with nature through simple activities, indirect engagement with nature), knowledge and attitudes (knowledge/study of nature, valuing and concern for nature) and pro‐environmental behaviour. Together, these explained 70% of the variation in people's actions for nature. Importantly, in a linear regression examining the relative importance of these variables to the prediction of pro‐nature conservation behaviour, time in nature did not emerge as significant. Engaging in simple nature activities (which is related to nature connectedness) emerged as the largest significant contributor to pro‐nature conservation behaviour. Commonality analysis revealed that variables worked together, with nature connectedness and engagement in simple activities being involved in the largest portion of explained variance. Overall, findings from the current study reinforce the critical role that having a close relationship with nature through simple everyday engagement plays in pro‐nature conservation behaviour. Policy recommendations are made.
    • Using the theoretical domains framework to improve access to cervical screening for women with intellectual disabilities

      Whitelegg, Victoria; Elander, James; University of Derby (British Psychological Society, 2020-07-03)
      Regular attendance for screening can prevent most cervical cancers, but women with learning disabilities are potentially at greater risk of developing and dying from cervical cancer because current screening processes and practices create inequitable barriers, restricting their access to screening. In response, an objective of Public Health England’s 2018 ‘Screening Inequalities Strategy’ was to reduce inequalities through ‘evidence-based contributions’ to policy and best practice (Public Health England, 2018b). Health psychologists could contribute to this objective by facilitating collaborative work with cervical screening practitioners using the Theoretical Domains Framework. This enables health psychology evidence and theory, combined with the perceptions and experiences of screening practitioners, to identify relevant barriers and enablers to access, and this information can inform interventions and policy changes to make cervical screening programmes more open and effective for women with learning disabilities.