Despite the prediction that religion would wane in the 21st century, evidence suggests otherwise. It is important therefore for mental health professionals to understand the role of religion in the lives of their clients and to appreciate its impact on mental health. Research suggests a moderate inverse relationship between religion and depression and anxiety with some cross-cultural support. The relationship is however complex and context needs to be taken into account. The effect of culture and the importance of intrinsic religiosity are discussed. Much research is conducted in the US in the field of psychiatry, suggesting a gap in the British psychological literature. Some implications for clinical practice are discussed. The interplay between religion, culture and wellbeing is discussed

The physical and psychological health enhancing benefits of physical activity have been well established (US Department of Health & Human Services, 1996; Warburton, Nicol & Bredin, 2006) and reviews support the anxiolytic, antidepressant and stress reducing effects of physical activity, but it is unclear if group or solo physical activity is more effective in the reduction of these forms of psychological distress. A recent survey found that approximately a third of adults in Scotland do not engage in sufficient levels of physical activity recommended to achieve these benefits. The aim of this thesis was to investigate the effectiveness of group versus solo physical activity in the reduction of psychological distress (including stress, depression and anxiety) and factors involved in participation to promote greater engagement in physical activity. The first study issued questionnaires to members of the general population and university students. Inverse correlations were found between group physical activity and psychological distress in both samples. However a single positive correlation was found between anxiety and solo physical activity in the student sample, which suggests that group physical activity may be more effective in the reduction of psychological distress than solo physical activity. Low active individuals appeared to prefer solo physical activity to group, which may be due to lower perceived barriers. More active participants either preferred group activity or had no preferences between group or solo activity, despite also perceiving greater barriers to group than solo activity. The second study allocated university students to a group versus solo jogging condition intervention and found that psychological distress increased for those allocated to solo jogging, but did not increase amongst those allocated to group jogging, suggesting that group physical activity may protect against university related distress. Those allocated to group jogging engaged in (non-significantly) more jogging and engaged in significantly more moderately intensive physical activity throughout the intervention than those allocated to solo jogging. The final study compared group and solo physical activity using the Theory of Planned Behaviour and structural equation modelling. The model explained more variance in group physical activity than variance in solo physical activity. When the model was expanded, self-efficacy made a significantly greater contribution to intention in the solo physical activity model than it did in the group activity model, therefore promotion of group physical activity may not be as dependent on self-efficacy as solo physical activity. Perceived autonomy support (PAS) was included in the model, as guided by modification indexes, but only the group physical activity model was significantly improved by the addition of PAS; this may be useful for the development of group physical activity promotion. This thesis finds some support that group physical activity may be associated with reduced psychological distress and be more beneficial in protecting against psychological distress than solo physical activity. Promotion of group physical activity may benefit from reducing perceived barriers, developing PAS, and having less reliance on self-efficacy than required for the promotion of solo physical activity.

The primary aim of this thesis was to increase healthcare professionals’ understanding surrounding the emotional distress of paediatric oncology patients prior to reaching five-year survivorship status, to inform resource allocation and evidence-based clinical interventions. Paper 1 systematically reviewed the extant literature that has assessed the emotional distress severity of paediatric oncology patients who had not yet reached five-year survivorship status. Contradictory findings were evident from the 21 studies reviewed. These inconsistencies in findings were discussed in relation to methodological limitations present within the studies and the heterogeneous oncology and control groups studied. The review concluded that further multiple-centre studies, using appropriate self-report and parent-proxy standardised measures, and larger, representative samples comprising patients with CNS and non-CNS malignancies at differing points in their treatment journeys, are needed to identify demographic, illness and treatment variables that leave paediatric oncology patients vulnerable to emotional distress. The empirical paper presented in Paper 2 utilised a rigorous methodology to address this need, and additionally explored modifiable psychological risk factors for emotional distress in this population. 74 paediatric oncology patients (aged 12-18 years), who were within five years of treatment completion, completed self-report measures of emotional distress, self-concept and health related quality of life (HRQOL), whilst their parents provided background information regarding patients’ demographics, diagnoses and treatment protocols. 72 parents also provided ratings surrounding patients’ self-concepts and HRQOL. The mean emotional distress rating indicated that the sample was clinically distressed. Demographic, illness and treatment factors explained little variance in emotional distress, whilst global self-concept, global-generic and cancer-specific HRQOL were significant predictors. Provisional analyses indicated that experiencing pain, illness-related worries, communication difficulties and negative self-views in relation to maths abilities, parent relations and opposite-sex peer relations were specific risk factors in the sample studied. Patient- and parent-reports of patients’ self-concepts and HRQOL were highly consistent. These findings suggest that paediatric oncology patients would benefit from frequent routine screening for emotional distress to allow early identification and intervention. Furthermore, prevention-oriented interventions surrounding emotional distress, and indirect interventions targeting global self-concept and HRQOL could be beneficial. Paper 3 critically appraises the systematic review and empirical paper in terms of their methodologies and clinical contexts. It is acknowledged that some of the results are preliminary in nature and need replicating in larger samples. Nevertheless, this research was successful in exploring demographic, illness, treatment and psychological risk factors for emotional distress for paediatric oncology patients prior to reaching five-year survivorship status, providing guidance for future clinical interventions, and making suggestions for future studies, in terms of their aims and methodologies.

Thesis (Ph.D.)--University of Tennessee Health Science Center, 2008. / Title from title page screen (viewed on July 30, 2008). Research advisor: Mona Newsome Wicks, Ph.D. Document formatted into pages (x, 157 p. : ill.). Vita. Abstract. Includes bibliographical references (p. 121-141).

This thesis investigated the longitudinal role of defeat and entrapment in populations where these factors were expected to be particularly relevant (a sample of individuals from areas of socioeconomic deprivation and a sample of formal caregivers). The thesis then considered whether defeat and entrapment influenced reward sensitivity on a gambling task and lastly, designed a short scale measuring defeat and entrapment suitable for use in clinical populations. The research incorporated a review of the literature, two longitudinal studies, a behavioural study and the development of a scale. The literature review presented in Chapter 1 provided evidence of a well-established link between defeat, entrapment and poor mental health, suggesting that defeat and entrapment may act as a transdiagnostic process; contributing to the development and maintenance of a range of mental disorders. However, the review also demonstrated that defeat and entrapment relate to the same experiences, suggesting that logically these constructs may equally co-occur, although the structure of the constructs is currently debated. The studies presented in Chapters 3 and 4 demonstrated that perceptions of defeat and entrapment predicted poor mental health (depression and anxiety, and depression and caregiver burden) at a second time point, 12 months later. These chapters presented the first longitudinal evidence for samples recruited from the general population and occupational settings. Furthermore, these chapters provided evidence that the relationship between defeat, entrapment and poor mental health operates in a bidirectional way within a sample recruited from community settings, but a linear way within a sample of formal caregivers, suggesting that further research is needed to confirm the direction of this relationship. The research presented in Chapter 5 found a non-significant relationship between defeat and entrapment and reward sensitivity among a sample of undergraduate students. This may have arisen due to the generally low levels of defeat and entrapment within the sample despite highly varied performance on the task. Replication of this research within a sample where a wider range of defeat and entrapment experiences would be expected might be beneficial. Additionally, this thesis aimed to confirm the factor structure of defeat and entrapment amongst various populations. Exploratory and confirmatory factor analysis demonstrated that defeat and entrapment are best conceptualised as a single psychological construct (Chapters 3 and 6), supporting one-factor theories of defeat and entrapment (e.g. Taylor et al., 2011a). During the course of conducting research for this thesis, it became apparent that the length of existing scales used to measure defeat and entrapment were not suitable for use with clinical populations. Despite evidence that defeat and entrapment may reduce symptoms of mental health problems, their measurement has not yet translated to clinical practice. Although several reasons underlie this, a lack of short measurement tool is a major factor. To address this, an eight-item scale was developed, which demonstrated good psychometric properties across four samples from clinical and non-clinical settings. The current research was supported by a discussion of the clinical implications of the work, specifically identifying how defeat and entrapment could be implemented within therapeutic interventions for mental health problems. The current thesis represents a significant contribution to original research considering defeat and entrapment as predictors of mental health problems. The thesis presents the first longitudinal evidence that defeat and entrapment impact on mental health problems for individuals recruited from community and occupational settings and first application of defeat and entrapment to a behavioural task. Through development of a short scale, the thesis also presents a potential avenue to increase the measurement of defeat and entrapment in clinical settings.

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Rumination is a well-established risk factor for the onset and maintenance of depression and anxiety and has been identified as a transdiagnostic factor due to its association with multiple forms of psychopathology. A renaissance of psychedelic research shows promise in treating psychopathology with potential for acting on ruminative processes. Despite the growing interest and developments in legality, very few research studies have investigated the psychological consequences of participating in an ayahuasca ceremony in North America. The current study included 30 participants (Mage = 41.03, SD = 7.35; range = 30-59 years; 50.0% women; 76.7% White/Caucasian) who participated in an ayahuasca ceremony at a North American ayahuasca church. Participants were asked to complete seven daily surveys prior to their ceremony (Phase I) and seven daily surveys following their ceremony (Phase II). Multi-level models tested changes in rumination and depression, anxiety, and stress scores across both phases of the study. Significant and large reduction were evidenced in levels of rumination and depression, anxiety, and stress immediately following the ayahuasca ceremony. This effect was maintained during Phase II, with scores remaining lower than Phase I and relatively stable. Furthermore, path models did not support the mediating role of rumination in the negative link between ayahuasca ceremony effects (as indexed via ego-dissolution) and depression, anxiety, and stress scores (though evidence for mediation was found without bootstrapping samples). Findings of this study contribute to the emerging literature on the role that ceremonial ayahuasca use may have on reducing psychological distress.

Well-being incorporates psychological, social and moral development, the capacity to enter into and sustain satisfying relationships and limit distress and maladaptive behaviour. The benefits of physical activity and dangers of a sedentary lifestyle to health outcomes, e.g. cardio-vascular disease, obesity, diabetes and psychological well-being are well documented children. Due to methodological and measurement problems, research addressing the relationship between psychological well-being and physical activity are inconsistent and weak. This series of studies aimed to overcome the problems of previous research and investigated the relationship between children’s psychological well-being and habitual physical activity. Previous research has highlighted an association between children’s physical activity and individual psychological well-being constructs. However, Masse et al. (1998) argued that psychological well-being should contain the measurement of both positive (e.g. self-esteem) and negative (e.g. depression) psychological states. Subsequently, Parfitt and Eston (2005) identified an association between children’s total physical activity and psychological well-being (anxiety, depression, self-esteem). Limitations of previous studies include the type of physical activity measures used and the measurement of only global self-esteem, which itself is multidimensional. The purpose of this research was to extend and expand on the limitations of the Parfitt and Eston’s (2005) study. Psychological measures included both global, domain and sub-domain measurements of self-esteem, with accelerometry providing estimates of total daily physical activity and time spent in sedentary through to vigorous intensity activity. Study One assessed relationships between psychological well-being and physical activity using the same psychological constructs as Parfitt and Eston (2005), but with physical activity intensity included. Results highlighted an association between self-esteem and time spent in very light activity. Study Two assessed the current data’s applicability with the proposed models and theories related to self-esteem. It was concluded that the current data provided an adequate fit with the proposed models and theories of self-esteem. Study Three introduced the domain and sub-domain constructs of self-esteem and a more valid measure of physical activity. Results highlighted associations at the global, domain and sub-domain levels with predominately time spent in very light and vigorous intensity activity. Very light intensity activity was associated with negative effects while vigorous intensity activity was associated with positive effects. It was hypothesised that if these cross-sectional relationships also existed longitudinally, then an intervention study changing the time children spend in very light and vigorous intensity activity may be beneficial to children’s psychological health. With the relationship between children’s psychological well-being and physical activity clearly highlighted, Study Four assessed the direction of this relationship and aimed to inform a potential intervention study. Longitudinal data were collected over a 12-month period and multi-level modelling was used to analyse the direction of the relationship. Results highlighted a potential indirect effect of time accumulated in very light and vigorous intensity activity on psychological well-being, which reinforced the previous cross-sectional studies. Furthermore, a reciprocal effect was identified between physical activity and the physical self-worth domain. It was concluded that interventions decreasing time spent in very light and increasing vigorous intensity activity may be beneficial to children’s psychological well-being. Study Five aimed to have an impact on children’s psychological well-being, by reducing the time children spent in very light intensity activity, through an increase in daily step counts. Although the intervention decreased the time children spent in sedentary behaviour, there was no influence on psychological well-being. However, there were several methodological limitations that affected the intervention, limiting the conclusions that can be drawn from this study, including a small sample size providing available data for analysis. The results of this thesis show a relationship between children’s psychological well-being and habitual physical activity intensity exists. Further research manipulating the time children accumulate in very light (reduction) and vigorous (increase) intensity activity, can potentially impact positively on the psychological well-being of a normal population of children.

Objective: Recent research has supported the construction of a model of depression and anxiety in older adults ( > 60years), in which the decline in working memory with age is implicated in increasing propensity to engage in repetitive negative thinking, thereby predisposing older adults to anxiety and depression. The study detailed here intended to extend these research findings by exploring the efficacy and acceptability of a working memory intervention in older adults. Methods: The study employed a randomised multiple-baseline single case research design, in which six older adults participated in baseline assessment of mood, repetitive negative thinking and working memory. Participants then tracked their repetitive negative thinking daily throughout a baseline phase, the length of which was defined by the randomisation procedure. Following phase change, participants continued to rate their repetitive thinking daily, as well as engaging in a daily working memory training intervention. On completion of the intervention phase, outcome measures of mood, repetitive negative thinking and working memory were repeated. Full visual and statistical analysis of all data was undertaken to support exploration of the findings. Results: Results of the study indicated that that the working memory training program was unlikely to have elicited a significant impact upon participants’ working memory. However, two participants demonstrated reliable improvement in both repetitive thinking and mood. Analysis of relevant variables to predict the selective impact of the intervention was not fruitful, but may indicate that improvements in working memory underscore the improvements in thinking and mood, lending support to the proposed model. There appeared to be a small, non-significant decrease in daily repetitive negative thinking across five of the six participants. Conclusion: Further research is needed to identify factors that may predict response to working memory training within older adult populations. The research supports the on-going investigation of innovative working memory interventions within an older adult population, although results are not sufficiently robust to indicate wider adoption of these models within health services or as routine treatments for this population.