Recent Submissions

  • Individual differences and medication-mediation in chronic illness conditions: a mixed methods approach to the development of a novel, conceptual framework

    Sheffied, David; Owen, Deborah J (University of DerbyCollege of Health and Social Care, 2021-04)
    Chronic illness is prevalent; adherence to pharmaceutical therapy facilitates an optimal outcome and is the single most influential affect in the individual’s illness trajectory. Hence, a prerequisite of efficacy is that medication is taken as prescribed. Adherence levels are, however, sub-optimal, with rates to pharmacological interventions as low as 17%; this represents a significant challenge to the effectiveness of therapy, undermining the benefits of clinical care. The reasons for nonadherence are various and complex, incorporating demographic factors, such as age and gender, cognitive variables including forgetfulness, as well as illness and treatment concerns, such as disagreeable symptoms and side effects. An underexplored factor, however, is the influence of personality factors on health behaviour, even though individual differences have been noted as central in health psychology. The ambit of this thesis is to explore the determinants of, and barriers to, pharmacological adherence in chronic illness, with a particular emphasis on personality affects; the overarching aims of the research are to develop a taxonomical framework of adherence factors and, further, a conceptual model demonstrating various influences of medication-taking. Two literature reviews were undertaken to establish what is currently known in extant literature; the first review, an expansive historical timeline, encompassed an appraisal of published literature in order to secure an overall understanding of topics that have been considered in relation to the phenomenon of medication adherence, and revealed the foci of adherence studies over the past few decades. This historical timeline evidenced that the biomedical stance is habitually used by researchers at the exclusion of patient’s perspectives, and highlighted a gaping lacuna in terms of individual differences; furthermore, the review formed a novel basis on which to contextualise the second systematic literature review and meta-analysis, which honed in on personality and its causal affects on medication adherence in chronic illness conditions. To substantiate quantitative data attained from the reviews and to expound the core dimensions underlying medication adherence, phenomenological investigation was performed. Emergent themes of experiential notions of adherence, informed by interviews with thirty-one participants, were thematically analysed; motifs included challenges with self-management in chronic illness, coping with an alteration in the self and notions of ‘normality’, together with psychosocial negotiation of the illness itself. Prior to interviews participants also completed psychometric assessments in order to ascertain adherence rates (the Medication Adherence Rating scale) and identify influential personality traits (the Five Factor Model). Data were synthesised to construct a comprehensive taxonomical framework of the diverse determinants of adherence, which deepens our understanding, facilitates an entry-point into adherence research and has significant utility as a research-informed theoretical structure. Additionally, the novel IndEx-MediC conceptual model of adherence was developed, predicated on findings that medication-taking is a mediational process influenced temporally, experientially, and contextually, determined by individual and external factors. The model presents a novel description of patients’ experiences of adherence to pharmaceutical therapy in chronic illness and serves as a foundation to develop a predictive measure to identify individuals potentially at risk of nonadherence, from which tailored interventional strategies may be devised.
  • Exploration of contributing factors to mental health in workers and students

    Van Gordon, William; Sheffield, David; Kotera, Yasuhiro (University of Derby, 2021-04-08)
    Having worked in the field of human resources, my publications focused on mental health and neuro-linguistic programming (NLP). Poor mental health has been reported among workers and university students in the United Kingdom (UK). The costs of poor work mental health are estimated to be £87 billion annually in the UK. In particular, hospitality workers, who comprise 7% of the country’s workforce, are known to suffer from poor mental health. Likewise, more than a quarter of UK university students suffer from a mental health problem. Through a series of cross-sectional studies using correlation, regression, moderation and path analyses, I found that mental health shame was positively related with mental health problems, and self-compassion and intrinsic motivation were negatively related to both mental health shame and mental health problems in a variety of population groups that had not been explored before, including UK workers, UK students and Japanese workers. In my NLP research, I investigated the application of NLP-derived skills for career guidance and critically reviewed psychological outcomes of applying those skills in organisational settings, through a pre-post study, thematic analysis, and systematic review. Two skills, the Disney Strategy and Sponsorship, were regarded particularly useful by the small sample of registered career consultants in Japan investigated in Publication 1. My systematic review (Publication 8) concluded that while NLP may be effective for diverse psychological outcomes, there is a need for rigorous future research. Taken together, my findings suggest the wide applicability of the effects of self-compassion and intrinsic motivation on mental health, and the similarity of Sponsorship to the soothing system in the three emotion regulatory systems. The critical appraisal of my published works identified four areas that are caveats for understanding the findings and could benefit from further work: (a) Lack of consideration for established predictors, (b) Mental health variables being treated as a unitary construct, (c) Balanced discussion of positive and negative aspects of mental health, and (d) Lack of critical appraisal 6 of NLP. Future research should consider these critical insights to improve our understanding of mental health and NLP.
  • Creating a student and patient focused research led environment in diagnostic radiography education

    Forman, Dawn; Hyde, Emma (University of DerbyHead of Diagnostic Imaging, College of Health, Psychology & Social Care, 2021-05-06)
    This critical appraisal explores my published works; how they have informed my development as researcher, diagnostic radiographer and teacher in Higher Education; and how they have changed practice at other institutions both nationally and internationally. Through my practice as a radiography educator and by undertaking research into diagnostic radiography practice, I have used a range of research methods to make a unique contribution to the knowledge base within the radiography profession. This new knowledge focuses on student radiographer’s experiences during their clinical placements and informed measures of patient centred care in diagnostic radiography. Through the research projects, I have influenced discussions about student placements at a national level and developed innovative new clinical placement opportunities. This has led to a secondment opportunity with Health Education England to lead a project on growing the Imaging Workforce in the Midlands. I have contributed to national and international debate about patient centred care in diagnostic radiography and developed theoretical models and audit tools to support patient centred approaches. In August 2020, I was awarded a prestigious National Teaching Fellowship by Advance HE, in recognition of the impact of my work and my research on radiography education within the UK. My research output now totals eight peer reviewed journal articles, one article in an industry magazine, one book chapter and one handbook to support Values Based Radiography education. These publications are helping to grow my research profile on ResearchGate, Scopus and Google Scholar. In addition, I have disseminated the findings of my research via 24 conference papers or posters. Contributions towards a new textbook about patient centred care, further journal articles and a Massive Open Online Course (MOOC) are currently in progress based on the findings of my largest research project, which sought to define informed measures of patient centred care in diagnostic radiography.
  • The Dark Side of Humanity Scale: A Reconstruction of the Dark Tetrad Constructs

    Harvey, Caroline; Baker, Ian; Howard, Chris; Katz, Louise F. (University of DerbyCollege of Health, Psychology and Social Care, 2021-05-07)
    A myriad of criticisms have been directed at the widely available scales which measure the Dark Tetrad (DT), constructs of Machiavellianism, psychopathy, narcissism and everyday sadism. These have included construct incongruence, unstable factor structures, sex and age variance. Sex and age are salient variables in research studies and as such, their reported variance was considered to be a weakness of the measures, which contributed to their instability. To ascertain whether this was indeed the case, an investigation of the widely available DT measures was conducted in study one (n=605). Through the use of Classical Test Theories, Exploratory Graph Analysis and Item Response Theory, the criticisms of past research were supported, including variance across age and sex. Mediated by the evidenced issues and in order to address them, the Dark Side of Humanity Scale (DSHS), was developed, which was the main aim of this thesis. The focus of the measure was to assesses the DT personality constructs as they manifest in the general population, whilst also being sex and age invariant. Using a diverse range of statistical methods and guided by theory, expert ratings and past research, where available, the development of the DSHS began in the second study (n=667). During analyses, a divergence from the widely available DT measures emerged, whereby primary psychopathy and Machiavellianism were unified. However, this corroborated past research which has discussed the two constructs as being parallel. It further afforded the DSHS with a shift away from the traditional DT conceptualisation. The resulting scale encompasses four factors. The first represents the successful psychopath, factor two addresses the grandiose form of entitlement, factor three taps into everyday sadism and includes sadistic fantasies, direct and vicarious psychological malevolence, whilst factor four pertains to narcissistic entitlement rage. Each factor is specific to the traits and behaviours of the construct they address. Study three reports on the convergent and discriminant validity of the DSHS (n=712), and test-retest validity (n = 413), for which temporal reliability as well as nomological validity was achieved. The unique contributions of this thesis are discussed in the final chapter. The DSHS provides an alternative approach to investigating the dark side of human nature in general population samples, whilst also being sex and age invariant.
  • The design and feasibility of a work-focused relational group-CBT treatment programme to enhance job retention in employed service-users with moderate-severe recurrent depression.

    Townend, Michael; Strickland-Hodge, Barry; Walker, Nicola (University of DerbyHealth and Social Care, 2020-10-15)
    Background: Employees with moderate-severe recurrent depression are at risk of losing their jobs. A search of the literature revealed that most psychotherapeutic interventions are not work-focused, and there are none that have been specifically designed to enhance job retention in employed service-users of UK Community Mental Health Teams. A subsequent update of the research evidence using the same literature search strategy plus another search with more stringent inclusion criteria found several studies of work-focused psychotherapeutic interventions. However, but there is still a gap in terms of work-focused psychotherapeutic interventions specifically designed for employees with more severe mental health problems. Methods: The Medical Research Council guidance for the development and evaluation of complex interventions was used throughout this study. Firstly, an effectiveness review of relevant psychotherapeutic interventions revealed several over-arching principles which appeared to underpin their effects such as using a care pathway incorporating multi-disciplinary teamwork, guideline concordance, informed clinical decision-making, tracking of progress, and the use of outreach to encourage clients to complete treatment. Secondly, a stakeholder consultation was undertaken during the planning period, and realist analysis of the focus group data identified six plausible mechanisms of change which allowed for modification of the new intervention design and refinement of the programme theory. Thirdly, piloting involved a small feasibility study using a quasi-experimental pre-post design with eight participants which generated both quantitative and qualitative data regarding clinical and work outcomes. Fourthly, a further stakeholder consultation was undertaken during the reviewing period to consider re-design of the new intervention in terms of improving acceptability and accessibility. Finally, a process of mixed methods data integration was used to make recommendations for further implementation and evaluation in a definitive trial. Results: Six provisional Context-Intervention-Mechanism-Outcome (CIMO) configurations were developed into a programme theory. Overall, implementation and evaluation of the new intervention were feasible although problems were encountered in recruiting sufficient numbers for randomisation, and with collecting follow up data. It was also expensive to provide compared to CBT programmes in primary and secondary mental healthcare services. Outcomes suggest the new intervention is a promising treatment for moderate-severe recurrent depression for some women and may help them in maintaining their employment. Acceptability could be improved by making the new intervention more interesting and stimulating, with a focus on coping over the long-term. Accessibility could be improved by making the new intervention more understandable, delivering it at the worksite, and making it peer-led. Conclusions: Job retention for employed service-users may be enhanced if the tertiary individual level Treatment Programme is re-designed as a primary organisational level Training (and staff support) Programme informed by group-CBT.
  • An investigation into the role of acceptance and related factors in quality of life among renal dialysis patients.

    Mitchell, Kathryn; Elander, James; Stewart, Paul; Stalker, Carol (University of DerbyCollege of Health, Psychology and Social Care, University of Derby, 2020-11-13)
    For patients with end stage renal disease, renal replacement therapy (RRT) is essential to a patient’s survival. Haemodialysis is one RRT, and a growing body of evidence has suggested that how patients relate to this treatment is associated with both clinical and psychological outcomes. Adjusting to illness is a complex process (Dennison, Moss-Morris, & Chalder, 2009; Moss-Morris, 2013; Walker, Jackson, & Littlejohn, 2004) and one factor identified as important in other chronic conditions is acceptance. Evidence supports that acceptance can be important in helping patients manage conditions that cannot be improved through medication or therapies (McCracken, 1998; Veehof, Oskam, Schreurs, & Bohlmeijer, 2011). Findings from studies across a range of chronic conditions (Brassington et al., 2016; Poppe, Crombez, Hanoulle, Vogelaers, & Petrovic, 2013; Van Damme, De Waegeneer, & Debruyne, 2016) suggest that more positive acceptance of illness facilitates improvements in patients overall quality of life (QoL). However, there is limited research addressing the role of acceptance of illness and the impact on dialysis patients. This thesis has evaluated the role of acceptance and associated psychological variables in haemodialysis patients to develop an understanding of the influence of acceptance and to enable the development of targeted acceptance-based interventions. This thesis aims to; gain an understanding of what acceptance means for dialysis patients; compare the influence of acceptance and associated psychological factors on patient outcomes, and examine the longitudinal relationships between acceptance and quality of life for dialysis patients. A mixed-methods approach was utilised and four methodologies were adopted; a systematic review evaluated the impact of acceptance on outcomes for patients with end-stage renal disease and how patients viewed acceptance in relation to these outcomes; cross-sectional studies compared the influence of acceptance, psychological and clinical variables on quality of life outcomes; a qualitative study explored patients experiences of accepting dialysis treatment, and a longitudinal study tested the impact of acceptance and psychological variables at 6 and 12 months post baseline. All participants were dialysis patients recruited from a single hospital site; a total of 102 participants were recruited. 98 were retained for analyses at baseline and 50 retained at 12 months. Ethical approval was obtained prior to the commencement of recruitment. The research generated several important findings. Firstly, it highlighted that acceptance in dialysis was complex, with qualitative findings indicating that acceptance of illness in dialysis patients related to themes of ‘accepting the necessity’, ‘accepting the functional aspects’, ‘acceptance from experience’ and ‘acceptance from support’. This resulted in the proposal of a conceptual model utilising acceptance mindset to address how patients reach acceptance and how they interpret their illness and treatment. Secondly, relationships between acceptance, psychological variables and QoL were identified; acceptance is a significant predictor of kidney disease QoL and physical QoL, with depression found to be a significant predictor for kidney disease QoL and mental QoL and was a significant mediator between acceptance and QoL. These findings demonstrate that acceptance is an important component of QoL in dialysis patients but also highlights the associations to other psychological variables. Theses associations in the cross-sectional study were confirmed longitudinally. Thirdly, tests of longitudinal associations demonstrated that although there were no significant changes in overall acceptance levels over time, group changes masked individual differences. The individual changes in acceptance were associated with changes in mental QoL and kidney disease QoL. Changes in acceptance rather than depression were predictive of mental QoL and kidney disease QoL at 6 months. At 12 months changes in acceptance and depression were important predictors of mental QoL and kidney disease QoL. The overall findings identified that acceptance of illness is an important aspect related to QoL for dialysis patients. Acceptance is a complex construct and relates to psychological factors, particularly depression. The qualitative analyses highlighted important areas related to acceptance and these were supported in the more complex analyses of QoL, these are areas that need considering in any future intervention developments. Although group acceptance did not change over time evidence at the individual level suggests that there may be benefit in targeting of interventions. Developing specific acceptance interventions targeted at dialysis patients may improve patients QoL and reduce the overall burden.
  • The needs of clients coming to counselling following an experience of second harm: A Q Methodology study

    Whiffin, Charlotte; Townend, Michael; Kenward, Linda (University of DerbyUniversity of Cumbria, 2021-02)
    Introduction Successive reports identified that psychological harm (second harm) can be caused to patients by poor responses of healthcare providers to initial errors or neglect. Aim To explore the needs of clients coming to counselling following experience of second harm. Method A Q methodology study involving ten participants UK wide was undertaken. Participants sorted 42 statements online constructed from a concourse comprising sources on experiences of second harm. Concourse sources focused on the deficits of interpersonal relationships, therefore statements focused on what participants needed from interpersonal relationships with counsellors moving towards recovery. Data analysis Factor Analysis via PQMethod was undertaken on the Q sort data. The interview data was used to elucidate the nuances of the Factors as viewpoints. Findings Two Factors were extracted from the Q sort data that demonstrated the viewpoints of participants: Viewpoint 1 – Needs that are both past and present focused: being understood. Viewpoint 2 – Needs that are both present and recovery focused: making me well. From these two viewpoints 11 perceived needs were identified. Nine were identified as generic needs within the counselling relationship; however, two were identified as specific to those attending counselling for second harm. Counselling needs specific to second harm were; the need for participants to not be blamed for what happened and, the need to have the counsellor understand the impact of the harm and the complaints and litigation system including issues of control, power, and autonomy. Conclusion Findings of this study revealed people who seek counselling following experiences of second harm have specific needs beyond those expected from a general counselling relationship. Furthermore this study was able to define second harm for the first time and offers this to the research and practice community in the hope it will advance the field by helping counsellors to understand the concept, nature, and impact of second harm in addition to the expected skill set for any counsellor supporting those who have experienced second harm. Further research is required to evaluate the impact of educating counsellors in second harm and further testing of the definition of second harm.
  • A Qualitative Exploration of Drug and Alcohol Using Parents’ Experiences in Drug/Alcohol Treatment when Social Services are Involved.

    Montague, Jane; Elander, James; Goddard, Kashmir (University of DerbyCollege of Health, Psychology and Social Care, 2021-02-05)
    This thesis is concerned with the lives of drug and alcohol using parents, who access treatment for their addiction. Parents who are drug and alcohol users may experience stigma, fear, shame, and denial around their misuse, which means that many fail or feel fearful to access any treatment for fear of official intervention. This thesis aims to explore the narratives of Class A drug users and alcohol users who access drug and alcohol treatment and who have been referred to Children’s Social Services when a Child Protection issue has been raised. Qualitative data was generated during the three studies. Semi-structured interviews took place during each study (1, 2 and 3). Study 2 allowed the use of photographs taken by participants to be examined. Study 3 allowed the use of a journal to capture the experience of the participants. Interpretative Phenomenological Analysis was applied to the verbatim transcripts. Key findings are presented as four superordinate themes in chapters 5, 6, 7 and 8. Each chapter focused on one of the four superordinate themes that were identified in the data analysis, which combined data from all three studies. ‘Risk and vulnerabilities’ in Chapter Five suggested that when these parents were teenagers’ drugs and alcohol were easily accessible, and there was trauma in their lives, which meant exposure to drug and alcohol use was a way of escape. Parents described addiction as a cycle they were continually on, and regardless of what they did the power of this cycle made it difficult to break free. This, for some, developed into committing a crime to fund their addiction. The theme of drug and alcohol use and parenting is discussed in Chapter Six. This chapter suggested that parents’ mental health was severely impacted as a result of their drug and alcohol use. This left the parents feeling stigmatised and experiencing a tainted identity. Parents expressed grief and trauma about their experience and how this impacted on family attachments and affected partner relationships. Parent’s emotional reaction to Social Services and Child Protection in Chapter Seven suggested a loss of control and negative emotions such as anxiety, anger feeling embarrassed, scared, guilt, and frustration when professionals became involved. Parents wanted professionals to understand addiction, and they hoped the professionals supporting them would be supportive to help them change. Recovery and change in Chapter Eight suggested coming to the point of realisation that they had no choice but to change their behaviour. There was also an understanding that their behaviour had impacted their children. Parents expressed the difficulty of treatment without proper effective interventions and, at times, relapse and how this was frowned upon. The subordinate themes linked to one another and some similar themes appeared in several chapters. Chapter Nine, the final chapter summaries the thesis as it provides a glimpse into the complex nature of being a drug/alcohol addicted parent. Key findings suggest a change in professional practice to meet the needs of the user and the wider family.
  • Mapping Stress and healthy balance with the workable ranges model in mindfulness-based stress reduction: First-person embodied reflections

    Sheffield, David; Hogan, Susan; Rose, Sally (University of Derby, 2021-12-14)
    During Mindfulness-Based Stress Reduction (MBSR) courses, participants are taught to be more present with stressful experience in order to respond to it more effectively. The meditation-based experiential pedagogy is supported by didactic teaching about stress to increase awareness of patterns of reaction and to support the application of mindfulness to self-regulation. The content of teaching about stress, and how it is best taught within the pedagogy, is an important practical and theoretical consideration. This thesis addresses a gap in knowledge by focussing on this little-regarded area of practice. The aim of this research was to develop practical and theoretical knowledge about the inclusion in the MBSR curriculum of the Workable Ranges Model of stress and emotional regulation, developed by the author. This visual model lays out regulated states and both mobilised and immobilised threat-based reactions in relation to each other. The main research question was: how does the Workable Ranges Model complement MBSR? Three key themes were identified in the literature and began to address the research questions. They were: the role of didactic teaching about stress; the notion that how difficult experiences are negotiated is a paradoxical mechanism; and that the Workable Ranges Model provides a novel perspective on participants’ progression through mindfulness-based programmes. Qualitative research was conducted as an illuminative evaluation of the practice innovation. An enactivist, embodied-mind epistemology was used to consider both embodied and verbal forms of knowledge. The application of mindfulness-based, first-person phenomenological methodology, within the frame of the conceptual encounter method, functioned as both learning and data-collection processes. The first phase focussed on the inclusion of the model in three MBSR courses. Data were gathered from participants in classes using diagrams and a question schedule. A template analysis elucidated engagement and resonance, awareness of the features of regulated and dysregulated states and patterns of reactivity, ways of responding to dysregulated states and applications linked with MBSR. In the second phase, seven course graduates engaged in a diary exercise, post-meditation reflective inquiry and a group discussion. Thematic analysis identified an overarching theme that the Workable Ranges Model provides a dynamic map for the mindful exploration of stability and stress. Three interrelated processes were evident: charting regulated and dysregulated states, embodied application in mindfulness practice, and orienting to and resourcing regulation and self-care. The themes from phase two shaped a broader meaning to both data sets. Three functions of the model as a map were identified and discussed. It worked: (i) as a method for teaching about healthy balance and stress; (ii) as a heuristic for self-exploration and developing insight; and (iii) as a guide for mindfulness-based self-regulation and self-care. Together, these aspects acted as aids to teaching and learning about mindfulness-based self-regulation. Theoretical and practical implications are discussed.
  • "I don't want to be touched all the time" - Street Harassment and the Indian Woman

    Holland, Fiona, Dr.; Williams, Sophie, Dr; Montague, Jane, Dr.; Khan, Sumana (University of DerbyCollege of Life & Natural Sciences, UoD, 2020-12-10)
    Street harassment is the gender-based sexual harassment of individuals in public spaces by strangers. Studies have shown that the majority of victims of street harassment are women and the perpetrators are men. Despite its serious implications on women’s quality of life and psychological well-being, street harassment remains an understudied area and has not been included in the wider ‘violence against women and girls’(VAWG) research and discourse. This research aimed to position street harassment as a distinct form of VAWG by exploring Indian women’s sense-making of their lived experiences of street harassment. The research was structured into two parts: Part 1 – The ‘Sociocultural Study’ implemented dispositive analysis of three recent Bollywood films of romantic genre to explore the construction of sociocultural discourses on Indian womanhood. Part 2 – The ‘Experiential Study’ explored the lived experiences of street harassment of adult Indian women by using Interpretative Phenomenological Analysis (IPA). The participants included four single women (aged 25-35) and four mothers (aged 35-50) to teenage daughters. The Sociocultural Study provided the cultural context for the Experiential Study. The findings of the Sociocultural Study indicated that the concept of womanhood is constructed by the Indian male gaze—the virginal sanskari (traditional) Indian woman is considered the symbol of Indian womanhood, whereas the “westernised” vamp is the morally corrupt temptress of men. These patriarchal constructions were rooted in deeply ingrained sexism, sexual objectification, and rape myth acceptance, proposed as the ‘triad’ of core mediators of street harassment by this research. The ‘triad’ featured significantly in the meaning-making of the participants in the Experiential study. The participants interpreted their experiences in themes of disempowerment, emotional isolation, loss of sense of agency, identity conflicts, and stress in family relationships. The findings aligned with UN’s definition of ‘violence against women’. Recommendations for future research include better theoretical developments to explain street harassment; investigation of potential long-term effects of street harassment in women such as post-traumatic stress disorder (PTSD); designing studies with more male participants to explore an ‘insider’ view into harassment; and finally, development of new standardised quantitative instruments to measure various aspects of street harassment.
  • An exploration of the role of visual arts projects for refugee well-being

    Hogan, Susan; Sheffield, David; Phillips, Katherine (University of Derby, 2020-03-14)
    Art therapy and other art-for-health initiatives are part of UK health and social care policy, as well as international humanitarian services for people fleeing persecution. There are currently unprecedented numbers of refugees and high levels of mental distress have been identified in this population. The non-verbal and symbolic potential for expression within art-making may provide a unique form of beneficial initiative. Through a critical realist perspective this thesis adds to the body of knowledge about art-based projects for refugee well-being. A mixed-methods systematic review was conducted in 2018. The quantitative data (k=2) showed that group art therapy is an effective intervention for reducing symptoms of mental distress in refugee children. The qualitative synthesis (k=24) presents a way to conceptualise the kinds of outcomes people experience from different modes of art-based engagement. Themes were developed through the qualitative data synthesis, including Beautifully handmade, Seeing with fresh eyes, Honour the past: forget the past, Telling the story and Being part of the world and Learning and working together. Accordingly, an interplay of creative, personal and social elements is proposed to occur is such activities. While different art-based approaches are identified: art therapy, facilitated art-making and independent art practice, these are shown to engender similar human experiences. This thesis builds on previous research on the use of colouring books for well-being. A mixed-methods randomised controlled study demonstrates their efficacy as a selfsustained well-being activity over one week. This study compared the effect of colouring pre-drawn mandala patterns with free-form drawing and a control group. The study included 69 university students and staff. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and the Depression Anxiety and Stress Scale (DASS) were used. A large and significant effect size was found for WEMWBS and a dose response was demonstrated in the colouring condition. A feasibility project was then run at a refugee drop-in centre, where colouring books and colouring pages were provided on a weekly basis for seven weeks. While colouring books have been provided to refugees previously, this thesis demonstrates the potential well-being value of such provision, and the likely uptake of colouring books by this population. Data are presented from four refugees and four staff members. Accordingly, this thesis shows that colouring books are acceptable to refugees. Thematic analysis and qualitative content analysis were used to explore the qualitative data from both primary research studies. Colouring was found to be a relaxing activity by participants in both studies. Participants valued both the process of colouring and the final product. Both reflection and distraction are presented as potential mechanisms involved in improving well-being through colouring. Some participants found the colouring evoked memories, some used the process to express emotions and others found the colouring gave them a welcome diversion from other thoughts. Colouring at the refugee centres also provided an impetus for inter-personal relationships, such as colouring with friends. Art-based approaches are explored as a range of useful and acceptable interventions to improve the well-being of refugees. Consideration is given to the variety of contextual factors that influence the creative and relational elements that are considered central to these interventions. Art-based projects operate within complex social and political systems. Identifying cultural norms and exploring power dynamics can contribute to the understanding and development of initiatives seeking to improve individual well-being, and effect wider collective social and political change.
  • Exploring Observational Pain Assessment Tools for Individuals with Moderate-to-Severe Dementia

    Ainslea, Cross; Dawn, Forman; Kreshnik, Hoti; Babicova, Ivana (University of DerbyCollege of Health, Psychology and Social Care (University of Derby), 2020-11-26)
    The global increase in the prevalence of dementia has provoked a multidisciplinary response from researchers, policymakers, educators and clinical sectors. There are many important aspects of care, which need to be considered when looking after an individual with dementia. One such aspect of care, and a fundamental human right, is appropriate pain treatment and management. Due to the progressive neurodegenerative nature of dementia, individuals in the moderate to severe stages of the condition are often unable to self-report their pain, therefore health professionals rely on the use of observational pain assessments. Unfortunately, pain continues to be under-recognised, underestimated and under-treated in people living with moderate-to-severe dementia. There is, therefore, a need to enhance observational pain assessment, to ensure that appropriate pain treatment and management is implemented. This thesis set out the following aim and objectives: Aim: To examine the psychometric properties, in terms of validity and reliability, of observational pain assessment tools for people living with moderate-to-severe dementia. Objective (a) to conduct a systematic review to further investigate the current state of observational pain assessment tools. Objective (b) to explore feasibility and use of observational pain assessment tools, specifically the Abbey Pain Scale and the PainChek®, in a UK care home setting. Objective (c) to validate and evaluate the psychometric properties of PainChek® in a UK care home. Objective (d) to investigate three case studies of individuals living with dementia who demonstrated atypical pain behaviours. The aim and objectives were accomplished by conducting four studies. The first study was a systematic review which examined the psychometric properties of observational pain assessment tools. The results from the seventeen studies which met criteria for inclusion indicated a highly heterogeneous, indicating that validity and reliability measures, such as inter-rater reliability or concurrent validity, were highly diverse across observational tools which were tested for psychometric qualities. The second study utilised exploratory qualitative methods to explore perceived feasibility of two observational pain assessment tools; Abbey Pain Scale and PainChek®. Transcripts from the semi-structured interviews were analysed using a thematic analysis. Four main themes were identified; strengths of the Abbey Pain Scale, limitations of the Abbey Pain Scale, strengths of PainChek®, limitations of PainChek® and critical factors of pain assessment. The third study focused on validating PainChek®; a semi-automated observational pain assessment tool in a UK care home. Twenty-two participants diagnosed with dementia and a painful condition were recruited. Over a period of sixteen weeks, psychometric properties in terms of validity and reliability of PainChek® were evaluated by direct comparison to the Abbey Pain Scale. Three hundred and two paired pain assessments were completed. The analysis of the data revealed excellent validity and reliability results, demonstrating that PainChek® would be a suitable tool to asses’ pain in people with dementia in UK care homes. The fourth and final study explored three case studies in depth. During the data collection in the previous study, three participants were consistently expressing atypical and unexpected pain behaviours. The investigation into the three individual case studies has highlighted the importance and growing need for increasing interprofessional education and learning, and a consideration of how uncommon expressions of pain could hinder the accuracy of pain assessment. The research conducted for this PhD thesis reiterated the on-going issue with under-recognition, underestimation and under-treatment of pain in people with dementia. The overall results collectively investigated and contributed findings towards the current knowledge of pain assessment in people with moderate to advanced dementia, by presenting an in-depth mixed-methods approach. In addition, the results from this thesis demonstrated excellent psychometric properties of PainChek® in a UK care home and explored the current limitations of pain assessment and offered possible solutions. To prevent poor treatment and management of pain in individuals with dementia, regular and accurate use of observational pain assessment tools is recommended. Finally, while feasibility and appropriateness of the use of the PainChek® were explored, further research focusing on implementation is needed to investigate the pragmatic and practical aspects of using an electronic device in care homes.
  • Exploring the Conceptual Constructions of the Mobile Phone Within the Neoliberal Digital Age: A Thematic Analysis

    Howard, Chris; Hallam, Jenny; Montague, Jane; Smyth, Michael (University of DerbyPsychology, College of Life and Natural Sciences, University of Derby, 2020-10-27)
    This thesis is an investigation into the ways in which mobile phone users’ contextualised understanding of the mobile phone may have shaped their mobile phone practices and subjectivity within the cultural narratives of the neoliberal digital age in the UK. The proliferation of research literature focused on mobile phone practices has been dominated by mainstream psychology’s pathologised rationales for differences between mobile phone users’ practices. However, the distinction between normal and problematic practices are not clearly defined across studies. This thesis adopts a critical perspective to consider the socially integrated relationship between meaning, subjectivity and behaviour in order to inform the current rationales for differences between mobile phone users’ practices from an underrepresented perspective on the topic. The thesis is collection of four discrete but interconnected studies which progress from exploring the culturally accessible conceptualisation of the mobile phone presented by the mass media to the culturally contextualised understanding of the mobile phone by mobile phone users. Mass media data were collected from UK national newspaper articles about the mobile phone published between 1985 (first consumer handheld mobile phones in the UK) and 2019, to provide a wide historical context, and website-based advertising of mobile phones accessible to the UK population during 2019. Data was collected from mobile phone users through participant-generated reviews of their mobile phone by 164 self-selected mobile phone users and in-depth interviews with 20 mobile phone users positioned as at-risk problem users by the psychology literature. The data collected was analysed using an inductive thematic analysis informed by social constructionism. The analysis of the news media revealed that the conceptualisation of the mobile phone shifted from a business tool accessible by a wealthy few to a normal need of modern living for the masses which is integral to the user’s identity. It was argued that current cultural conceptualisations of the mobile phone were shaped by societal powers related to neoliberalism and regulation. The conceptualisations related to the advertisements promoted a normal, essential, desirable and continually developing contemporary tool of self-improvement, empowerment, independence, control, social connection and identity development. Mobile phone users’ conceptualisations related to the deep meaning that essential lifestyle enhancing activities had for them and positioned themselves as attached to their lifestyle and identity development that was accessible through their mobile phone practices which they positioned as culturally normal and essential to a modern lifestyle. For the users positioned as at-risk problem users, the mobile phone was an emotionally complex object which was related to emotional support and emotional tensions, in conflict at times. The relationship between the mass media’s conceptualisations of the mobile phone and mobile phone users’ contextualised understanding showed that cultural narratives, fashioned by societal powers, shaped users’ understanding and practices. It was concluded that mobile phone users were attached to the continual development of their lifestyle, identity and knowing that they experience through their mobile phone practices rather than attached to the device. Mobile phone practices are a symptom of neoliberal digital culture rather than a problematic symptom of the user. Future research must sustain the critical perspective to build upon the findings of this thesis and explore the identities of those who actively resist using mobile phones with consideration to their contextualised personal interests in order to further inform the distinction between normal and problematic mobile phone practices.
  • Developing a Cognitive-Behavioural Therapy Treatment Programme Designed to Promote Hopefulness and Self-Esteem in Mental Health Service Users Recently Diagnosed with a Psychotic Illness: A Pilot Study to Explore Service-Users’ Experiences of Accessibility, Engagement and Efficacy

    Townend, Michael; Strickland-Hodge, Barry; Pearson, Daniel James (University of DerbyLeicestershire Partnership NHS Trust, 2020-11)
    This study sits within a wider research agenda, the aim of which is to develop a novel psychological therapy programme designed to target hopelessness and compromised self-esteem in young people recently diagnosed with a psychotic illness. The aspiration is to develop a programme that is experienced as accessible and engaging and perceived to be of value. It is anticipated that that process will progress through several stages and a number of iterations. The primary objectives of this specific piece of research were to undertake a first piloting of the Therapy Programme, gather evaluative feedback from participant-service users, and fine-tune the approach. The secondary objective was to explore the perceived value of the programme with regard to ‘proof of concept’. The research design combined the methodological rigour of Interpretative Phenomenological Analysis with a mixed-methods focus on data, underpinned by the philosophical paradigm of critical realism. Quantitative data was collected through the completion of outcome measures pre, during and post-therapy. Qualitative data was gathered through the facilitation of semi-structured feedback interviews with participant-service-users shortly after the completion of each of their Therapy Programmes. Participants were followed-up at 2 years from the commencement of their therapy to ascertain the subsequent trajectory of their lives and to explore reflections on their experiences of the programme from a perspective of temporal distance. Eight Early Psychosis Service clients were recruited to receive the Therapy Programme. Three withdrew from the therapy. Another completed the Programme, but failed to complete all of the research requirements. One completer-participant experienced a psychotic relapse shortly before the end of therapy. The principal purposes of the research were the elicitation of critical reflections on the Therapy Programme and meaningful recommendations for its improvement. There was some evidence of reticence amongst participants regarding the expression of critical statements. Where more critical observations were expressed, they focussed primarily on the relative balance and chronological ordering of different elements. The consensus recommendation was for the ‘pure’ elements of the approach, including direct attention to the cognitive-constructs of hope and self-esteem, to proceed the consideration of more applied goals. There was a strong collective recommendation to allocate more attention to addressing unhelpful illness narratives. A Participant Handbook, written as a resource for those involved in the therapy, was positively received with regard to design. Participants, however, recommended significant change to the complexity of its content. Of the four completer-participants, three showed substantial improvements in reported hope, self-esteem and wellbeing over the period in which the therapy was delivered. Those gains were sustained at follow-up. The participant who experienced a psychotic relapse showed limited improvements on all measures at the end of the treatment period, but had progressed significantly at follow-up. In each case, reported scores on the outcome measures were supported by substantial success in negotiated life-goals. Participant feedback regarding the programme, post-therapy and at follow-up, was generally very positive, with all participants identifying causal connections between the therapy, achievement of therapy and life goals, and subsequent improved outcome scores. To accommodate a priority focus of qualitative data, participant numbers were small and there was no access to normative or comparative data for the service user population. The limitations of the sample size were compounded by a high rate of attrition. The delay to follow-up introduced additional confounding variables. As a consequence of the study-design, therefore, quantitative data can only be regarded as providing indicative evidence of reported improvements across the measures of wellbeing. It cannot be said to evidence a causal connection between therapy and identified improvements or to support statements regarding the efficacy of the approach. Finally, although participants were recruited explicitly to be collaborators in the evaluation and betterment of the Therapy Programme, reflections appeared to be somewhat biased towards a validation of the approach and critical evaluations, although present, were limited. The credibility of these observations is, further, undermined by the design-decision to have the therapist conduct the post-therapy feedback interviews. The primary objective of the research was to generate meaningful recommendations for the improvement of the Therapy Programme. That purpose was achieved. The secondary objective was to consider the programme with regard to ‘proof of concept’. Subject to the limitations detailed above, the level of improvement reported over the period in which the therapy was offered, together with the fact that those gains had not been lost at follow-up, tentatively supports an argument for further development of the programme.
  • The Enosis Method: An Alternative Mixed Method to Analyse Qualitative Information

    Fakis, Apostolos (University of DerbyUniversity Hospitals of Derby and Burton NHS Foundation TrustDerby Clinical Trials Support Unit, 2020-06-24)
  • Creative ageing: participation, connection & flourishing. A mixed-methods research study exploring experiences of participatory arts engagement in later life through a systematic review of literature and focus groups with older people

    Bradfield, E. (University of Derby, 2020)
    Background: A rapidly increasing ageing population has significant consequences for the demography, health and wellbeing of our society. Participatory arts programmes and activities can contribute to health promotion in later life, by providing community-based, non-clinical opportunities for meaningful engagement and interaction. To date, academic research studies have mainly focused on people living with dementia and have investigated the benefits of therapeutic and / or musical interventions. However, little research has been conducted with healthy older people participating in other arts’ domains such as the visual arts or been approached through a creative ageing lens. Creative ageing is an inherently interdisciplinary field of enquiry, which sits at the intersection of arts and health and social gerontology and places emphasis on the role of creative engagement in enhancing personal growth, creativity and building social connections in later life. Aims: This thesis uses a mixed-methods approach to explore experiences of participatory arts engagement in later life through a study of literature and focus-group conversations. The study considers existing theory within social gerontology, arts and health and the creative ageing movement in a conceptual review, providing the context that underpins the thesis. A mixed-methods systematic review is conducted to examine the published evidence on the effect of participatory arts on wellbeing, quality of life and cognitive function and to explore distinctions between engagement in different arts domains and levels of participation. A two stage focus group study aims to investigate whether themes developed from the review resonate with older people’s own subjective experiences of participatory arts engagement and to explore barriers to participation in the arts in later life. Methods: The study employs a multi-stance approach to data collection and analysis, through a mixed-methods methodology which draws on the traditions of pragmatism and phenomenography. First, a conceptual review explores key concepts in social gerontology, definitions of arts and health and approaches to ageing, including the burgeoning field of creative ageing, providing the theoretical context for the thesis. Next, a mixed-methods systematic review is conducted to identify relevant qualitative, quantitative and mixed-methods studies of the effect of participatory arts engagement in later life and older people’s subjective experiences of engagement. Quantitative results from studies in the review are analysed through an exploratory meta-analysis of the topic of subjective wellbeing and through narrative analysis, categorised by wellbeing and cognitive function domains for clarity. To employ creative methods in the analysis, as this is a study about arts engagement, qualitative findings are analysed using thematic and I-poem analysis, which places emphasis on the older people’s voice. The qualitative and quantitative analyses are then integrated to provide a combined evidence synthesis of experiences and effects of participatory arts engagement in later life. A two-stage focus group study is then carried out to explore whether the themes developed from the review resonated with participants’ own subjective experiences of participatory arts engagement and to explore barriers to participation. The first stage of the study involves three focus group sessions with groups of older people, which took place at three locations in Cambridge. Themes from the review were used as the stimulus for conversation and provide the structure for analysis. The findings are further scrutinised using Seligman’s (2011) PERMA model of wellbeing (Positive emotion, Engagement, Relationships, Meaning and Achievement) as a framework, focusing on the elements of wellbeing which contribute to a meaningful life. Stage two of the study examines barriers to participation with a more socioeconomically diverse sample of older people. This stage involves two additional focus groups which were held in Peterborough and Wisbech. Findings are re-analysed in light of the second study and identifies both barriers and facilitators to participation in the arts. Systematic reviews play an integral role in the production of research knowledge. However, review reports often remain in academia, without the findings being shared with relevant stakeholders. By further examining the systematic review findings through focus group interviews with older people, this thesis may help to close the gap between research and practice. Additionally, enabling groups of older people to discuss the findings meant that the study could be contextualised in contemporary group settings, increasing the quality and relevance of the review and reflecting participants’ voice. Concepts developed during the analysis are discussed in the final chapter and presented in a conceptual framework of creative ageing. Findings: The mixed-methods systematic review identified 33 relevant studies which investigated the effects of participation in dance, visual arts, creative writing and theatre on wellbeing, quality of life and / or cognitive function for healthy older people. Quantitative analysis produced as part of the systematic review process showed statistically significant improvements to some aspects of wellbeing following engagement in dance and visual arts activities, and enhanced cognitive function in the domains of general intellectual ability and attention after participation in different art forms. The exploratory meta-analysis showed an overall combined effect size of g=0.18 indicating the effect of dance on enhanced subjective wellbeing. Qualitative findings were developed into five themes: making and creating; connections and communities; identity; the ‘feel good’ factor; and body, mind & soul. Additionally, I-poem analysis revealed an association between positive emotion and participation in dance and a poem titled ‘I feel happy when I’m dancing’ was produced as a creative output. Findings from the review were shared in a two-stage focus group study. In the first stage of the focus group study, three supplementary themes were developed to those identified above: engagement as ritual; emotion and engagement; and ikigai. In stage two, an iteration of the theme of engagement as ritual was developed into spiritual resonance: engagement as ritual, along with a further theme around transitions of ageing. These themes elucidate the role of the arts and cultural engagement in supporting people to remain active and involved in their communities in later life and which may provide a ‘reason for being’. The study also allowed a connection to be made between the ritual of engagement in the arts and the sense of belonging felt by bringing people together creatively, in addition to the potentially detrimental effect of non-participation on subjective wellbeing. Transitions of ageing provides evidence for the role of creative engagement in challenging perceptions of ageing and enabling opportunities to explore a new sense of self in later life. In the second stage of the focus study, barriers to participation were categorised as: infrastructure, situational and dispositional barriers, as well as factors which might facilitate participation, classified as: intra-personal, inter-personal and external factors. Infrastructure barriers emphasised the need for accessible transport links which enable older people to access arts and cultural activities, particularly in more rural areas. Personal circumstances including finance and relationship status were highlighted as situational barriers preventing participation, while dispositional factors including low levels of selfefficacy and literacy may inhibit engagement. Findings also explicated factors which may provide solutions that improve access and inclusivity for older people wishing to participate in the arts, including offering taster sessions, befriending schemes and reducing financial and access restrictions. Finally, a conceptual model was developed which highlighted three key interwoven concepts of creative ageing: participation, connection and flourishing. Conclusions: This thesis substantiates existing evidence on the potential role of creative engagement in enhancing quality of life, promoting social connectedness and thus reducing loneliness in later life. It also contributes to the mixed-methods’ paradigm discourse through its innovative use of a creative method within the systematic review and the multiple-stance approach to the thesis. The study contributes new knowledge by establishing a meaningful association between creative ageing and human flourishing and provides evidence for the need for more accessible community-based arts activities which encourage older people to participate and develop positive connections. Factors which might inhibit or encourage participation should be considered in the design of creative programmes to ensure that they are accessible and inclusive to a diverse range of older people. In conclusion, creative engagement may contribute to developing more resilient, creative and healthier communities within which our ageing population are enabled to flourish. With an established evidence base on the benefits of participating in the performing arts, including dance for promoting subjective wellbeing, there is now an opportunity for us to expand our perceptions and understanding of creativity in later life through further research which embraces a broader definition of creative ageing.
  • An evaluation of a specialist service model for treating Body Dysmorphic Disorder (BDD): application of the National Institute for Health and Clinical Excellence Guidelines for BDD (NICE, 2006).

    Stalmeisters, Dzintra; Townend, Michael; Govender, ANUSHA (University of Derby, 2020-02)
    Body dysmorphic disorder (BDD) is still poorly recognised with a dearth of research into treatment. This is the only known study to date to evaluate the implementation of the National Institute for Health and Clinical Excellence (NICE) guidelines recommended treatment for BDD in clinical practice as well as providing qualitative data of both patients and clinicians (NICE, 2006). The study aims to evaluate current recommended treatments for Body Dysmorphic Disorder utilised in a specialist service for BDD. In addition the study elicits the experiences of patients receiving treatment and the clinicians providing the treatment. This provides a basis to assess if refinements are to be made to treatment protocols for BDD in this specialist service. A mixed methods approach was employed with quantitative data from patients treated for BDD collated from the Trust’s database and examined with intention to treat analysis. Thematic Analysis (TA) was used to analyse data from semi-structured interviews conducted with clinical staff and patients to elicit their experiences of respectively providing and receiving treatment. The clinical data indicated impairment in patients’ functioning plus high risks and substance misuse. Treatment outcomes of NICE recommended CBT and medication (Selective Serotonergic Reuptake Inhibitors and augmentation) produced significant improvements in BDD symptoms in patients with severe symptoms at baseline. Patients also showed significant improvements in depression and overall functioning. However despite improvements symptoms were not completely eliminated and one group treated by the service (Level 6 outpatients) showed minimal to no improvement on all symptom measures. Both clinician and patient participants expressed dissatisfaction with the lack of sufficient knowledge and expertise for treating BDD. Both groups also placed high value on the therapeutic relationship. However clinicians interviewed indicated a higher dissatisfaction with current treatment options for BDD than patients. The experiences of patients provided a different perspective to the findings in the quantitative phase. Their view of improvements was based on their functioning and overall quality of life. Clinicians’ perspectives provided insight into other options for treatment which are lacking and could provide substantial support for current recommendations. Given the evidence base for recommended treatments is still limited, it is essential to include qualitative data in evaluating effectiveness of treatment and in developing services that respond to patient needs and choice.
  • A living inquiry: activating and integrating the multiple identities of dramatherapist, researcher, artist and teacher

    Forman, Dawn; Mitchell, Kathryn; Bird, Drew (University of Derby, 2019-05-31)
    The critical narrative explores published and creative works as a performer and how this has informed the author’s development as researcher, artist, dramatherapist and teacher in Higher Education. Through clinical work as a dramatherapist in different settings and practice as a dramatherapy educator the author explores the integrating of therapy and teaching approaches such as meaning making, deep learning and student-centred learning. The research is a living inquiry that is an unfolding of the researcher’s experience and deepening of understanding over a fourteen-year period as a clinician and teacher. The author examines the encounter and interrelationship dynamic between the performer and audience; therapist and client; teacher and student; and researcher and research participant as a means for co-construction and co-creation of meaning, knowledge and raising awareness. The author explores the importance of a research approach that is congruent with a dramatherapy and teacher identity emphasising non-verbal exploration, the senses, the imagination and play as a means for deepening understanding of dramatherapy and teaching practice. Through the creative works of a solo performer the author explores how engagement as an artist informs and strengthens their identity as a dramatherapist, researcher and teacher. Different research methodologies including heuristic inquiry, autoethnography and a/r/tography are considered for their suitability for a living inquiry that addresses the multiplicity of roles.
  • Morbidity and mortality in coeliac disease.

    Holmes, Geoffrey; University of Derby (2018-09)
    Celiac disease is a small intestinal immune-mediated enteropathy precipitated by exposure to gluten, a protein complex in the cereals wheat, barley and rye, in genetically susceptible people. Once considered an uncommon disorder restricted to children of European descent, it is now known to be one of the most common chronic diseases encountered in the Western world, with a serological prevalence of 1% that can be diagnosed at any age. Since it is so common much co-morbidity comprising malignant and non-malignant conditions will occur in association. Malignant complications particularly lymphoma were first described over 50 years ago but the natural history and how commonly these occurred were unknown until relatively recently. Similarly, many non-malignant conditions were known to occur but initially the risks were unclear. It was not until the frequency of coeliac disease could be determined accurately in the community and population-based studies of morbidity and mortality in coeliac disease patients carried out in defined cohorts that these questions could be answered. My research into these aspects of coeliac disease began in 1971 and a body of 35 of my publications spanning the years 1974 to 2018 on the morbidity and mortality of the disorder are presented in this thesis. I have introduced my research findings at many international and national meetings and these data have been influential in shaping the research agenda of other workers. One of my papers (Publication 9) published in Gut in 1989, was the most cited of all papers which appeared in the journal for that year. To date it has been cited 1122 times. Information exists for 24 papers presented here and for these the total number of citations stands at 3,887. This excludes references to book chapters. Anecdotal evidence indicates frequent mentions in lectures and clinical practice.
  • Me, myself, and I: Women’s perceptions of their body-image using clay making as a tool for exploration.

    Crocker, Trisha; University of Derby (2018-05-04)
    An expanse of research literature has confirmed that a significant percentage of women are concerned about their body size and appearance. Western cultures have emphasized that women must look good to be worthy. Media attention that alludes to the benefits of a thin, fit body exacerbates women's beliefs that they need to look a certain way to be acceptable and to fit in. How though, can the majority of women fit into a world of contrary ideals? Being strong and healthy does not absolutely mean a woman has to be model thin with conspicuous abdominal muscles and extreme body definition. In the field of art therapy, there has been no specific research to demonstrate the advantages of clay for the exploration of body-image, male or female. The research undertaken focuses on and evaluates the manner and methods in which clay can be employed as an enabling material for body-image issues with women within art therapy practice. With the help of small groups of female participants who were invited to attend sessions in my pottery to make their body-images from clay and join in discussion, I was able to explore within a safe and contained environment the ways in which clay can be utilised within an art therapy setting. None of the women who took part in the research had a diagnosis relating to body-image issues. By pursuing the methods of Participatory Action Research (PAR) for Study One I employed the fundamental features of Cycles of Reflection. The results of Study One assisted me in choosing Interpretative Phenomenological Analysis (IPA) to further the research. In this way, I would be able to identify the most robust of themes within the dialogues of the three women who attended the individual sessions that comprised Study Two. The final results of the research point to a positive and contained means of working with clients and patients in order to provide a significant resource to help women explore and be more accepting of their bodies.

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