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Optimistic explanatory style refers to the way in which individual’s routinely attribute cause to the events in their lives (Ambramson et al., 1978) and can be successfully enhanced through the use of cognitive behavioural therapy (CBT) group-based workshops (Buchanan et al., 1999; Seligman et al., 2007). It has been successfully measured via the self-report Attributional Style Questionnaire (ASQ: Peterson et al., 1982) and has been associated with better performance and lower levels of state anxiety following negative feedback (Martin-Krumm et al., 2003), a lower incidence of stress-related physical illness (Jackson et al., 2002; Buchanan et al., 1999), and lower levels of job-related emotional distress (Hershberger et al., 2000). In 2005, teaching was identified as the second most stressful job undertaken within the UK (Johnson et al., 2005) and two independent reviews of the teacher-stress literature both concluded that further research is required to develop effective stress-management interventions (Kyriacou, 2000; Jarvis, 2002). Furthermore, Jarvis (2002) specifically highlights CBT-based interventions as an avenue which requires research within the teacher-stress domain. In 2005, Bryant (unpublished MSc thesis) highlighted a link between optimistic explanatory style and lower levels of stress in student Physical Education (PE) teachers who were undergoing the practicum element of their one-year postgraduate diploma of education. The current thesis explored the effectiveness of a CBT-based optimism training programme in developing optimism and reducing stress in student and neophyte PE teachers. A longitudinal, repeated-measures, mixed methods design was employed in a naturalistic setting. Using a pre-test, intervention, post-test design, the effects of CBT-based training were shown to enhance optimism and positive affectivity, and reduce cognitive stress in student teachers during the practicum element of their professional training. To strengthen causal links, a dose-response design was used to provide enhanced training to a sub-group of student teachers. Although differences in optimism and perceived cognitive stress were present in the results, they were not significant. Finally, a qualitative interview based follow-up study identified that participants who had received the prolonged CBT-based optimism training exhibited higher levels of optimistic explanatory style, lower levels of stress and more dispositional optimism than participants who received either the initial or no optimism training. Theoretical and practical implications of the current findings and directions for future research are discussed.

ABSTRACT Indoor air pollution has been associated with acute lower respiratory infections amongst children less than five years old in developing countries. Very little is known about the potential role of behavioural change in reducing child indoor air pollution exposure. This thesis explores three questions: did people change their behaviours following exposure to an intervention that promoted the health benefits of behavioural change? Were changes in behaviour attributable to the intervention? What were the motivations and barriers to behavioural change? The evaluation included a quantitative and a qualitative study. The quantitative study utilised a quasiexperimental before-after design amongst an intervention village (n=98 households). Results were compared to a similar control village (n=121) that did not receive the intervention. Baseline data were collected during winter 2003 and follow-up data were collected during winter 2004 (12 months later). A qualitative evaluation, using two rounds of 4 focus group interviews each, was used to answer questions that emerged from the quantitative study. Indoor air quality - PM10, CO and CO (measured on the youngest child) - were measured over a 24 hour period in randomly selected households before and after the intervention in the intervention (n=36) and control (n=38) groups. After adjusting for confounding factors, there was no statistical association between having the received the intervention and the likelihood of burning outdoors at follow-up (OR=1.16; 95% CI 0.6-1.8). Indoor air quality data showed significant median reductions in PM10 (94-96%), CO (85-97%) and CO (child) (83- 95%) amongst households that burned outdoors compared to those that burned indoors. Results from the qualitative study suggest that motivations for outdoor burning included: health considerations, reaction to participating in the study, reduced drudgery and prestige. Barriers to outdoor burning included the need for space heating during winter, perceptions of low indoor air pollution risk and gender relations. This study highlights the potential for exposure reduction through behavioural change and is original for three reasons. It is the first behavioural intervention study designed to reduce indoor air pollution in a rural African setting. Secondly, it is the first intervention study in the indoor air pollution field to identify the factors that influenced behavioural change. Thirdly, it is one of the first studies to align debates about behavioural change in the field of indoor air pollution with those in the broader environmental health promotion literature.

Systematic reviews have consistently found that moderate intensity physical activity levels at or above a threshold value of 150 minutes per week reliably deliver cardiovascular, metabolic and musculo-skeletal health benefits. As a result, this threshold value has been widely adopted as an aspirational, public health goal throughout the world. However, while epidemiological and laboratory studies have established clear links between physical activity and sleep outcomes, the evidence base does not yet provide guidelines on minimum levels of exercise likely to reduce insomnia symptoms and improve sleep quality. Such a guideline, if evidence based, could greatly clarify advice, and accelerate the use of physical activity goals to improve sleep outcomes in behavioural sleep medicine and public health. This thesis examined the current public-health recommendation of 150 minutes of moderate intensity activity per week in relation to sleep outcomes. To commence, it established a population-level pattern of the relationship between levels of physical activity and sleep quality by reviewing relevant epidemiological evidence. Exploratory analyses were then conducted using data from an ongoing longitudinal study of physical activity and health outcomes among older people (aged 65 years and above) in which respondents were classified as walking at or above, or below the recommended threshold of 150 minutes per week. In regression models controlling for health and demographic factors, these analyses showed that higher levels of walking were significantly and independently associated with a lower likelihood of either reporting insomnia symptoms (OR = 0.67 (95% CI = 0.45 0.91) p=0.04), or experiencing poor sleep efficiency (OR = 0.70 (95% CI = 0.52 0.94 p=0.02). Using the same data, the predictive validity of this activity threshold was then confirmed in a 27-year survival analysis which showed a significantly decreased all-cause mortality risk associated with the higher level of walking (HR = 0.75 (95% CI = 0.65 - 0.86) p<0.01). These findings offered proof of concept that physical activity-sleep relationships operated on a continuum, with sleep benefits possible even at relatively low levels of activity. Experimental evidence on the acute and sustained effects of physical activity on sleep quality was then analysed and discussed. Outcomes from this review, together with the preliminary analyses described above, were then used to inform the design of a randomised controlled trial to investigate the effects on sleep quality of increasing physical activity to currently recommended levels among sedentary people with insomnia. A total of 41 sedentary adults meeting DSM-IV criteria for insomnia (30 female; mean age 59.8??9.5) were randomised to a physical activity group (???150 minutes moderate intensity activity/week) or a waiting list control group. The principal outcome was Insomnia Severity Index (ISI) change 6 months post baseline; secondary outcomes were anxiety (using the State Trait Anxiety Inventory) and depression (Beck Depression Inventory II). Physical activity was assessed using Actigraph GTX3+ accelerometers. Outcomes were assessed in univariate general linear models, adjusted for baseline confounders. Activity and sleep assessments did not differ at baseline. At 6 months post baseline the intervention group engaged in 213 min/week of moderate intensity PA, compared to the control group (82 min/week). Compared to the control group, the intervention group showed significant improvement in the ISI score at 6 months F(1,28) = 5.16, p=0.03), adjusted means difference = 3.37, with an adjusted Cohen's d =.78 (95% CI 0.10 1.45). There was a significant improvement in trait anxiety, and depression outcomes post-intervention, F(6,28)=4.41, p=0.05, and F(6,28)=5.61, p=0.02, respectively. The results showed that increasing activity in line with current guidelines could deliver clinically significant improvements in sleep quality and mood outcomes among inactive adults with insomnia. While the effect sizes are modest, the pattern of results reported here allow for two conclusions with clear implications for public health: 1) measures to increase levels of physical activity above the currently recommended threshold of 150 minutes per week could usefully be added to other approaches to insomnia management; and 2) the likelihood of improved sleep quality should be routinely added to those evidence-based cardiovascular and metabolic benefits most frequently associated with increased physical activity in behaviour change initiatives.

This study investigated the effectiveness of the Triple P Programme to reduce non-compliant behaviour in three solo father families. Using behavioural monitoring, observational coding, and self-report questionnaires, outcome measures included non-compliant behaviour, the quality of the parent-child relationship, parenting efficacy, parental mental health, and parenting practices. A measure of change was also included to identify change points in the therapeutic process. Results suggest that parent training is effective in the reduction of non-compliant behaviour, as positive changes were found across all the measures employed. This early intervention has the potential to increase child compliance with solo fathers, and contributes to the knowledge base about this under-reported population. Limitations of the study and directions for future research are discussed.

Analgesic products can produce serious side effects. Because potent analgesics are not under medical surveillance but are available to the public without a medical prescription, any attempt to influence consumer behaviour in relation to these products must be via interventions at pharmacist level. The Australian government is now pressuring the pharmacy profession to monitor effectively the use of such non-prescription medication. The aim of this study was to train community pharmacists on brief intervention strategies for use in a pharmacy setting in relation to combination analgesic products. Focus groups showed that participants had concerns about adopting confrontational counselling styles, as they feared this would antagonise consumers leading to loss of patronage without having an impact on consumer behaviour. This concern was later reinforced by consumer interviews, which showed that a significant proportion of respondents thought that the use of non-prescription analgesics was their responsibility. A protocol for the sales of analgesic products was designed with these issues in mind. The transtheoretical model of change (TTM) and motivational interviewing were selected as theoretical frameworks, as they take into account differences among consumers in motivation and in intention to change behaviour and are congruent with pharmacists' concerns. Consumer-centred intervention strategies were tailored to the individual consumer according to his/her readiness to change. This approach was borrowed from the area of smoking secession in which it has been related to positive clinical outcomes. The assumption was made that TTM-based intervention would also be effective in a pharmacy setting in relation to analgesic products. In the initial pilot study, community pharmacists who simply attended a workshop in the cognitive-behavioural intervention strategies failed to incorporate the newly acquired skills to their practice and consequently lost their proficiency. In the subsequent pilot study, when the workshop was followed by ongoing on-site training with immediate feedback and coaching through the use of pseudo-patron visits, the investigator was able to shape community pharmacists' practice behaviour in relation to the monitoring of pharmacist only analgesic products. The methodology was then refined and in the final study trained pharmacists were significantly more likely than control pharmacists and baseline to engage in a number of behaviours related to the study intervention. These included handling the sales of pharmacist only analgesics themselves, identifying inappropriate use, assessing readiness to change, and delivering an intervention according to the consumer's readiness to change. The results suggested that in pharmacy practice post qualifying therapeutic skill transfer is not achieved by workshop presentation alone. Modelling of the desired behaviour involving reinforcement and feedback is necessary.

This study investigated the effectiveness of the Triple P Programme to reduce non-compliant behaviour in three solo father families. Using behavioural monitoring, observational coding, and self-report questionnaires, outcome measures included non-compliant behaviour, the quality of the parent-child relationship, parenting efficacy, parental mental health, and parenting practices. A measure of change was also included to identify change points in the therapeutic process. Results suggest that parent training is effective in the reduction of non-compliant behaviour, as positive changes were found across all the measures employed. This early intervention has the potential to increase child compliance with solo fathers, and contributes to the knowledge base about this under-reported population. Limitations of the study and directions for future research are discussed.

Analgesic products can produce serious side effects. Because potent analgesics are not under medical surveillance but are available to the public without a medical prescription, any attempt to influence consumer behaviour in relation to these products must be via interventions at pharmacist level. The Australian government is now pressuring the pharmacy profession to monitor effectively the use of such non-prescription medication. The aim of this study was to train community pharmacists on brief intervention strategies for use in a pharmacy setting in relation to combination analgesic products. Focus groups showed that participants had concerns about adopting confrontational counselling styles, as they feared this would antagonise consumers leading to loss of patronage without having an impact on consumer behaviour. This concern was later reinforced by consumer interviews, which showed that a significant proportion of respondents thought that the use of non-prescription analgesics was their responsibility. A protocol for the sales of analgesic products was designed with these issues in mind. The transtheoretical model of change (TTM) and motivational interviewing were selected as theoretical frameworks, as they take into account differences among consumers in motivation and in intention to change behaviour and are congruent with pharmacists' concerns. Consumer-centred intervention strategies were tailored to the individual consumer according to his/her readiness to change. This approach was borrowed from the area of smoking secession in which it has been related to positive clinical outcomes. The assumption was made that TTM-based intervention would also be effective in a pharmacy setting in relation to analgesic products. In the initial pilot study, community pharmacists who simply attended a workshop in the cognitive-behavioural intervention strategies failed to incorporate the newly acquired skills to their practice and consequently lost their proficiency. In the subsequent pilot study, when the workshop was followed by ongoing on-site training with immediate feedback and coaching through the use of pseudo-patron visits, the investigator was able to shape community pharmacists' practice behaviour in relation to the monitoring of pharmacist only analgesic products. The methodology was then refined and in the final study trained pharmacists were significantly more likely than control pharmacists and baseline to engage in a number of behaviours related to the study intervention. These included handling the sales of pharmacist only analgesics themselves, identifying inappropriate use, assessing readiness to change, and delivering an intervention according to the consumer's readiness to change. The results suggested that in pharmacy practice post qualifying therapeutic skill transfer is not achieved by workshop presentation alone. Modelling of the desired behaviour involving reinforcement and feedback is necessary.

Theory and research supports the implementation of cognitive and behavioural interventions (CBI’s) to address social, emotional and behavioural difficulties (SEBD) in children. The literature argues that schools are an ideal place in which to implement such interventions. As part of a county initiative, school staff were trained and offered follow up support by 2 Educational Psychologists (EPs) around the use of school-based CBI to support children who have SEBD. The 10 participants (from 5 schools) in this research were part of this initiative: they received 4 sessions of training followed by either monthly individual supervision, or group supervision, around their use of CBI. Training and supervision targeted implementation of key CB competences, selected from a competency framework recommended by ‘Improving Access to Psychological Therapies’ (IAPT, 2011). The research explored staff perceptions around the CB competences that they implemented, their methods of implementation and the barriers and facilitators to their implementation. The research used a mixed methodology design. Qualitative data was analysed using thematic analysis and quantitative data was analysed using descriptive statistics. Data was gathered through interviews, supervision sessions, intervention diaries and training evaluations. Exploration of facilitators and barriers to implementation was based on Durlak and DuPre’s (2008) model of intervention implementation. Facilitators/barriers discrete from this model were also identified. Identification and exploration of such factors can assist in ensuring quality implementation of school-based interventions in the future. This study demonstrates how school staff can implement a range of CB competences and through multi-levels of intervention in schools. The potential role of the EP in supporting school staff to implement CBI is also discussed.

Intensive Behavioural Intervention (IBI) is one of the most widely used treatments for children with an autism spectrum disorder (ASD). While IBI has been recognized as the treatment of choice for very young children with an ASD, its sensible use among school age children is a matter of dispute. The aim of this thesis was to determine the clinical effectiveness of IBI, as compared with no treatment or treatment-as-usual, for the management of cognitive functioning and adaptive skills in preschool and school age children with an ASD, as well as to examine predictors of treatment response. Peer-reviewed, English language publications were identified using MEDLINE, EMBASE, PsychINFO, CINAHL, and ERIC from 1995 to September 1, 2014. Grey literature and reference lists of published papers were also searched for relevant records. Retrieved citations were screened by two independent reviewers, and data extraction was performed by a single reviewer with verification by a second reviewer. The methodological quality and procedural fidelity of included studies was assessed by one reviewer, and a subset of included studies were pooled in a random-effects meta-analysis using the standardized mean difference (SMD) effect size. A total of 24 unique studies were selected for inclusion in this review, comprising a total of 1,816 participants. Findings revealed that IBI improves full-scale IQ (SMD ES = 0.66, 95% CI 0.46 to 0.85, p<0.00001; 13 studies) and adaptive skills (SMD ES = 0.57, 95% CI 0.33 to 0.82, p<0.00001; 12 studies) in preschool and school age children with an ASD, with seemingly higher clinical benefits in children aged under 4 years at intake. Better outcomes with IBI are predicted by children’s relatively younger age, increased cognitive and adaptive ability, as well as a milder severity of symptoms at treatment entry. Results warrant careful interpretation in light of several methodological limitations and inadequate monitoring of procedural fidelity.