Content removed due to copyright restrictions: Paper titled, "Practitioner characteristics with comparison of counselling and psychotherapy practices between New Zealand and Singapore mental health practitioners" was presented and published in the proceedings of The Inaugural International Asian Health Conference, at the University of Auckland, 4-5 November 2004. 2. Workshop cum paper titled, " A modified cognitive behavioural therapy model for working with Chinese people" was also presented and published in the above Conference. 3. Abstract on paper titled, "Integrating homework assignments based on culture: Working with Chinese patients" was accepted in April 2006 for publication in the Cognitive and Behavioral Practice. 4. Paper titled, "Cultural considerations in using cognitive behaviour therapy with Chinese people: A case study of an elderly Chinese woman with generalised anxiety disorder", was published in November 2006 in the New Zealand Journal oj Counselling, Volume 35(3), 1 53- 1 62, and presented at the 29th National Conference of the Australian Association for Cognitive Behaviour Therapy, 1 8- 20 October 2006, under the title "Cultural considerations for Chinese people: Implications for CBT". 5. Abstract on paper titled, "Cognitive behaviour therapy in New Zealand and S ingapore : From a doctoral study and personal experience" was presented and published (in a book of abstracts) at the 1 st Asian Cognitive Behaviour Therapy (CBT) Conference: Evidence-based Assessment, Theory and Treatment, at The Chinese University of Hong Kong, 28-30 May 2006. 6. Paper titled, "CounsellinglPsychotherapy with Chinese Singaporean clients" was published in 2006 in the Asian Journal oj Counselling, Volume 1 3(2), 27 1 -293 . / This study compared the characteristics, self-reported practices and experiential skills of mental health practitioners (MHPs) in New Zealand and Singapore with the aim of benefiting both nations in managing the mentally ill. A mixed-research design was used consisting of a mail questionnaire survey and a structured interview. For each country, mail questionnaires were sent to 300 MHPs, namely, counsellors, psychiatrists, psychologists, psychotherapists, and social workers, while structured interviews were held with 12 MHPs. Potential participants were drawn from available electronic or printed publications on counselling and psychotherapy services in both countries. Those drawn from individual listings of MHPs were systematically sampled, whereas those drawn from organisational listings of MHPs were sampled by way of estimation. Despite the relatively low response rates of 20% to 27% from the participants of the mail questionnaire, the major findings were supported and augmented by those from the structured interviews in the combined analysis of results. Results were categorised into personal, professional and practice characteristics of MHPs. Personal characteristics included demographic characteristics. Professional characteristics included training characteristics, primary job affiliation and use of Western therapy models and interventions. Practice characteristics were sub-divided into five categories: practice setting; diagnostic system and assessment procedures; client and caseload; gender/ethnic match; and experiential skills. Similarities in personal and demographic characteristics between MHPs of both New Zealand and Singapore were found with respect to gender, ethnicity, and language ability. Differences in these characteristics were found with respect to age range and religious affiliation. Similarities in professional characteristics between MHPs of both countries were found with respect to country of therapy training, qualification in therapy, number of years of supervised training received, and use of Western therapy models and interventions. Differences in these characteristics were found with respect to primary job affiliation, availability of clinical psychology programmes, years of experience in therapy, and registration of practice. Similarities in practice characteristics between MHPs of both countries were found with respect to relevance of therapy models, focus of practice, diagnostic system and use of assessment procedures, clients seen, clients' presenting problems, and gender/ethnic match. Differences in these characteristics were found with respect to preferences of therapy models, and average number of sessions per client. Similarities in experiential skills between MHPs of both countries were found with respect to handling of self-disclosure, religious or spiritual issues, and traditional healers. Implications for Chinese clients and cognitive behaviour therapy were discussed, as well as limitations of the study.

Content removed due to copyright restrictions: Paper titled, "Practitioner characteristics with comparison of counselling and psychotherapy practices between New Zealand and Singapore mental health practitioners" was presented and published in the proceedings of The Inaugural International Asian Health Conference, at the University of Auckland, 4-5 November 2004. 2. Workshop cum paper titled, " A modified cognitive behavioural therapy model for working with Chinese people" was also presented and published in the above Conference. 3. Abstract on paper titled, "Integrating homework assignments based on culture: Working with Chinese patients" was accepted in April 2006 for publication in the Cognitive and Behavioral Practice. 4. Paper titled, "Cultural considerations in using cognitive behaviour therapy with Chinese people: A case study of an elderly Chinese woman with generalised anxiety disorder", was published in November 2006 in the New Zealand Journal oj Counselling, Volume 35(3), 1 53- 1 62, and presented at the 29th National Conference of the Australian Association for Cognitive Behaviour Therapy, 1 8- 20 October 2006, under the title "Cultural considerations for Chinese people: Implications for CBT". 5. Abstract on paper titled, "Cognitive behaviour therapy in New Zealand and S ingapore : From a doctoral study and personal experience" was presented and published (in a book of abstracts) at the 1 st Asian Cognitive Behaviour Therapy (CBT) Conference: Evidence-based Assessment, Theory and Treatment, at The Chinese University of Hong Kong, 28-30 May 2006. 6. Paper titled, "CounsellinglPsychotherapy with Chinese Singaporean clients" was published in 2006 in the Asian Journal oj Counselling, Volume 1 3(2), 27 1 -293 . / This study compared the characteristics, self-reported practices and experiential skills of mental health practitioners (MHPs) in New Zealand and Singapore with the aim of benefiting both nations in managing the mentally ill. A mixed-research design was used consisting of a mail questionnaire survey and a structured interview. For each country, mail questionnaires were sent to 300 MHPs, namely, counsellors, psychiatrists, psychologists, psychotherapists, and social workers, while structured interviews were held with 12 MHPs. Potential participants were drawn from available electronic or printed publications on counselling and psychotherapy services in both countries. Those drawn from individual listings of MHPs were systematically sampled, whereas those drawn from organisational listings of MHPs were sampled by way of estimation. Despite the relatively low response rates of 20% to 27% from the participants of the mail questionnaire, the major findings were supported and augmented by those from the structured interviews in the combined analysis of results. Results were categorised into personal, professional and practice characteristics of MHPs. Personal characteristics included demographic characteristics. Professional characteristics included training characteristics, primary job affiliation and use of Western therapy models and interventions. Practice characteristics were sub-divided into five categories: practice setting; diagnostic system and assessment procedures; client and caseload; gender/ethnic match; and experiential skills. Similarities in personal and demographic characteristics between MHPs of both New Zealand and Singapore were found with respect to gender, ethnicity, and language ability. Differences in these characteristics were found with respect to age range and religious affiliation. Similarities in professional characteristics between MHPs of both countries were found with respect to country of therapy training, qualification in therapy, number of years of supervised training received, and use of Western therapy models and interventions. Differences in these characteristics were found with respect to primary job affiliation, availability of clinical psychology programmes, years of experience in therapy, and registration of practice. Similarities in practice characteristics between MHPs of both countries were found with respect to relevance of therapy models, focus of practice, diagnostic system and use of assessment procedures, clients seen, clients' presenting problems, and gender/ethnic match. Differences in these characteristics were found with respect to preferences of therapy models, and average number of sessions per client. Similarities in experiential skills between MHPs of both countries were found with respect to handling of self-disclosure, religious or spiritual issues, and traditional healers. Implications for Chinese clients and cognitive behaviour therapy were discussed, as well as limitations of the study.

This research investigates type 2 diabetes using a psychological approach grounded in self-regulatory theory. Diabetes mellitus is usually described as a long-term illness with serious physical consequences, and biomedical perspectives predominate in published diabetes research. Findings from the present study add to accumulating knowledge about diabetes by addressing an identifiable gap in the literature, namely, an understanding of the psychological processes involved in managing type 2 diabetes. The common sense model (CSM) of illness self-regulation was used as the conceptual framework for this study. The research sample (N = 1145) was identified from a medical database. A mailed questionnaire survey was used to obtain psychological and self-report data, and this was subsequently merged with clinical data from a review of the medical database. A response rate of 55% provided a total of 629 completed questionnaires. The age, gender, and cultural composition of the sample were a close match with those reported for the New Zealand type 2 diabetes population. Research findings contribute to self-regulatory theory by testing key relationships specified in the CSM. The identification of a relationship cluster connecting emotional illness responses with cyclical symptoms, serious consequences, strong illness identity, and low coherence, highlights an emotional pathway in diabetes self-regulation. Observed relationships support the interaction between cognition and affect proposed in the CSM. Results show significant relationships between treatment perceptions and diabetes self-management, and draw attention to the importance of family relationships in explaining diet and exercise patterns. Perceived consequences of diabetes play a pertinent role in explaining variance in quality of life, and diabetes-related distress. The CSM postulates coping responses mediate between representations and illness outcomes; current findings, showing that medication use mediates the relationship between treatment representations and HbA1c, support the predicted mediating relationship. It is concluded the common sense model provides a useful theoretical framework for research investigating self-care and wellbeing among people with type 2 diabetes. Potential implications for psychological theory and clinical practice are discussed, and three areas - examining the roles of appraisal, emotion, and culture in illness management - are identified as priority targets for further research and conceptual development.

Medical textbooks have previously represented women’s bodies and menopause life transitions by using notions of ‘machine productivity’ and ‘machine breakdown’ (Martin, 1987). This study aimed to explore whether these representations have changed, especially given recent HRT clinical trial results. Eight relevant compulsory medical textbooks for first and second year medical students at two New Zealand Universities were identified. A Foucauldian discourse analysis (Parker, 1990) was undertaken on relevant content to identify representations of menopause, HRT, women’s bodies, and ageing. Five major discourses were employed in the textbooks in descriptions of menopause and HRT: failure, estrogen deficiency as disease; HRT as saviour; obscurity and the new discovery discourse. Menopause continues to be represented as resulting from a ‘failure’ of a machine-like body. Although the recent HRT clinical trials were reported as a serious risk factor in half of the textbooks, HRT was also represented as a saviour particularly against postmenopausal osteoporosis. The discovery of ‘new’ drugs to ‘treat’ HRT and the ‘postmenopausal’ patient were heralded with much excitement. Medical textbooks continue to use failure discourses to describe women’s bodies at menopause. New risk-based HRT assessments for ‘patients’ with menopause ‘symptoms’ are promoted. These portrayals reinforce linear and reductionist ways of thinking about menopause and women at midlife and provide few spaces for resistance or alternative constructions to more accurately reflect women’s embodied worlds.

Medical textbooks have previously represented women’s bodies and menopause life transitions by using notions of ‘machine productivity’ and ‘machine breakdown’ (Martin, 1987). This study aimed to explore whether these representations have changed, especially given recent HRT clinical trial results. Eight relevant compulsory medical textbooks for first and second year medical students at two New Zealand Universities were identified. A Foucauldian discourse analysis (Parker, 1990) was undertaken on relevant content to identify representations of menopause, HRT, women’s bodies, and ageing. Five major discourses were employed in the textbooks in descriptions of menopause and HRT: failure, estrogen deficiency as disease; HRT as saviour; obscurity and the new discovery discourse. Menopause continues to be represented as resulting from a ‘failure’ of a machine-like body. Although the recent HRT clinical trials were reported as a serious risk factor in half of the textbooks, HRT was also represented as a saviour particularly against postmenopausal osteoporosis. The discovery of ‘new’ drugs to ‘treat’ HRT and the ‘postmenopausal’ patient were heralded with much excitement. Medical textbooks continue to use failure discourses to describe women’s bodies at menopause. New risk-based HRT assessments for ‘patients’ with menopause ‘symptoms’ are promoted. These portrayals reinforce linear and reductionist ways of thinking about menopause and women at midlife and provide few spaces for resistance or alternative constructions to more accurately reflect women’s embodied worlds.

One of the goals of cognitive rehabilitation following traumatic brain injury is to help people perform everyday tasks. However, options for the rigorous assessment of everyday cognitive effectiveness after rehabilitation are limited. Performance on neuropsychological tests is only moderately correlated with everyday functioning, while previous measures of everyday functioning include only fairly general estimates of overall cognitive functioning. The aim of the current study was to develop an ecologically valid measure that captured a number of subdomains of executive functioning, using systematic behavioural observation of an everyday task. The initial phase of the research involved identifying an everyday task that was sufficiently complex to ensure that executive functioning was utilised in the completion of the task. Participants with traumatic brain injury were then asked to prepare chocolate brownies, using a recipe provided, and a hot drink. Participants were allowed to use any compensatory strategy to help complete the task. Participant performance was directly observed by an examiner and videotaped for subsequent inter-rater reliability. Two independent raters assessed nine components of executive functioning. During this phase, the examiner manuals were modified improving inter-rater reliability. The final version of the measure was then trialled with participants with and without traumatic brain injury. Final inter-rater reliability indicated the approach had merit. Significant and moderate correlations were found between traditional measures of executive functioning and the everyday task. This study employed systematic behavioural observation to obtain fine-grained information regarding a person’s cognitive functioning. With further development, this approach may prove useful for targeting and monitoring specific functional difficulties during cognitive rehabilitation.

Using interview data the present study applied a leading health care use explanatory model (the Anderson model) to a sample of 502 community-dwelling New Zealand Māori adults. To date the Andersen model has been applied extensively in overseas (principally U.S.) research, yet not specifically to an indigenous population such as the New Zealand Māori. The Andersen model proposes that health service use is a function of three components: predisposing, enabling and need characteristics. Using hierarchical multiple regression analyses three overarching research goals concerning the model were investigated: (1) To test the efficacy of the Andersen model in the prediction of Māori health care utilisation; (2) to extend the model by considering the role of life events as a predictor of Māori health service utilisation; and (3) to extend the model by considering the role of psychological distress as a predictor of Māori health service utilisation. As a further extension on previous work, the present study also sought to: (4) Extend the model by considering the role of traumatic experience in the prediction of Māori health service utilisation. The Andersen model was found to explain between 8.5% and 26% of variability in the sample's use of six types of health care, finding need characteristics to be the major determinants of health care use. Life events was not a significant contributor to explaining use, and psychological distress was effective only in predicting mental health service use. Findings suggest that using aggregate measures of traumatic experience is not a particularly helpful strategy for predicting subsequent health care use by Māori. On reflection of findings and implications the present study concludes with discussion concerning: (1) A need to advance conceptualisations of what constitutes health services for Māori; (2) suggestions for future examination of trauma and Māori health care use; (3) the role of culture in influencing health beliefs and behaviour; and (4) potential barriers to health care access by Māori.

Whole document restricted, see Access Instructions file below for details of how to access the print copy. / This exploratory study investigates Traumatic Brain Injury (TBI) rehabilitation processes and outcomes among culturally diverse outpatients in community-based rehabilitation who have sustained a Mild to Moderate TBI. The major aims of this study are twofold: firstly, to determine whether community-based rehabilitation outcomes following TBI differ across Mäori, Pacific and Pakeha cultures; and secondly, to determine and identify any service delivery needs for Mäori and Pacific people in TBI rehabilitation that may be distinct from Pakeha. A fixed comparative non-experimental design was utilised where participants were selected using direct control based on their self-identified ethnic group resulting in sub-samples of 11 Mäori, l1 Pacific and 11 Pakeha (n=33). A "Close Other" from their care-giving support network was selected by the participant to take part in the study (n=20). Each participant completed the Neurobehavioural Cognitive Status Examination (Cognistat), the Brain Injury Community Rehabilitation Outcome Scales (BICRO Scales), the Client Satisfaction Questionnaire (CSQ-31), the Beck Depression Inventory, 2nd Edition (BDI-II), the Impact of Events Scale Revised (IES-R) and a semi-structured qualitative interview, while a "Close Other" completed a BICRO "Carer" questionnaire. Results indicate that all participants were at a homogenous level of overall cognitive functioning but Pacific peoples scored significantly lower than both Mäori and Pakeha on two Language subtests and significantly lower than Pakeha on the Memory subtest. Statistical analysis suggests that both Years of Formal Education and English as a Second Language are important factors contributing to these differences. Individual handicap increased following TBI and decreased following rehabilitation, with no significant difference across cultures and suggesting efficacy of rehabilitation. Of the total sample, 42% scored in the clinically depressed range (half of whom were Pakeha) and 24% of the sample showed mild signs of post-traumatic stress (of whom almost 90% were Mäori or Pacific). Although 97% of participants were generally satisfied with their overall rehabilitation service, Mäori and Pacific people were significantly less satisfied with their Physical Surroundings and the Quantity of Services they received. In conclusion, there appears to be universalities in TBI experience and global rehabilitation outcomes that transcends individual cultures. However, there are micro-level cultural variations that have valuable implications when planning culturally appropriate rehabilitation services for the future. For Mäori and Pacific People, acculturation levels will determine the extent to which these implications apply.

In this thesis, Stroop task performance was investigated (using behavioural, electrophysiological and functional magnetic resonance imaging (fMRI) techniques) in late and proficient adult bilinguals currently living in the second language (L2) environment. Monolingual participants, matched for age and handedness, were recruited as controls. The Stroop colour-word task was considered an appropriate tool to test the general hypothesis that bilingualism might influence executive or cognitive control processes. In Study One, a dual-task paradigm was used for assessing the lateralisation of language functions (given the linguistic nature of the Stroop paradigm used here) in the bilinguals (Macedonian-English/M-E). Bilinguals showed a more bilateral hemispheric involvement, for both languages, compared to monolinguals. These findings also provided supporting evidence for the hypothesis of greater right-hemispheric involvement for language in bilinguals. In Study Two, two behavioural Stroop task paradigms (manual and verbal) were used in order to assess the magnitude of the Stroop effect between the groups. Bilinguals (M-E, German-English/G-E) showed a trend of smaller interference scores across both languages compared to monolinguals. In Study Three, manual Stroop task performance with concurrent electroencephalograph (EEG) recording revealed that bilinguals had temporal shifts in the N400 component (of about 30-40 ms) for the interference comparison for both languages compared to monolinguals. Also, relative to monolinguals, M-E bilinguals (for both L1 and L2) and G-E bilinguals (for L2) had fewer electrodes over frontal and central sites with a significant amplitude difference in the interference comparison (i.e., a reduced interference effect). In Study Four, the neural substrates engaged during Stroop task performance were investigated using fMRI. In general, monolinguals showed greater activation in regions such as the prefrontal cortex and anterior cingulate (regions associated with good executive control). This suggested that relative to bilinguals, monolinguals require more neural resources to accomplish conflict resolution. Taken together, Stroop task performance in late and proficient bilinguals currently living in the L2 environment differed from that of monolinguals across all methods of investigation. It appears that cognitive processing changes at the executive level can be observed as a result of bilingualism. The results also provide some evidence for changes in L1 processing following late L2 acquisition, as similar results across both languages and tasks were observed for the M-E bilinguals. It is also possible that slight modifications to cerebral laterality as a result of the late learning of (and continuous exposure to) a second language could contribute to these differences in executive functioning. The language environment might therefore be a major factor in the lateralisation of language processing and executive functioning in bilinguals. These conclusions, though tentative and require further investigation, have important implications for language and executive processing in general and for theories regarding cognitive flexibility in bilinguals. / Auckland University Doctoral Scholarship

Medical textbooks have previously represented women’s bodies and menopause life transitions by using notions of ‘machine productivity’ and ‘machine breakdown’ (Martin, 1987). This study aimed to explore whether these representations have changed, especially given recent HRT clinical trial results. Eight relevant compulsory medical textbooks for first and second year medical students at two New Zealand Universities were identified. A Foucauldian discourse analysis (Parker, 1990) was undertaken on relevant content to identify representations of menopause, HRT, women’s bodies, and ageing. Five major discourses were employed in the textbooks in descriptions of menopause and HRT: failure, estrogen deficiency as disease; HRT as saviour; obscurity and the new discovery discourse. Menopause continues to be represented as resulting from a ‘failure’ of a machine-like body. Although the recent HRT clinical trials were reported as a serious risk factor in half of the textbooks, HRT was also represented as a saviour particularly against postmenopausal osteoporosis. The discovery of ‘new’ drugs to ‘treat’ HRT and the ‘postmenopausal’ patient were heralded with much excitement. Medical textbooks continue to use failure discourses to describe women’s bodies at menopause. New risk-based HRT assessments for ‘patients’ with menopause ‘symptoms’ are promoted. These portrayals reinforce linear and reductionist ways of thinking about menopause and women at midlife and provide few spaces for resistance or alternative constructions to more accurately reflect women’s embodied worlds.