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Innovations in a
Changing World

Edited by

Katrina Andrews PhD

Fiona Ann Papps PhD
Vincent Mancini PhD
Larissa Clarkson PhD
Kathryn Nicholson Perry PhD
Graeme Senior PhD
Eric Brymer PhD
Innovations in a
Changing World

Edited by

Katrina Andrews PhD

Fiona Ann Papps PhD

Vincent Mancini PhD

Larissa Clarkson PhD

Kathryn Nicholson Perry PhD

Graeme Senior PhD

Eric Brymer PhD

Published in Australia by Australian College of Applied Psychology (ACAP)

http://www.acap.edu.au

Innovations in a Changing World

ISBN: 978-0-9876309-0-2

Andrews, K., Papps, F.A., Mancini, V., Clarkson, L., Nicholson Perry, K., Senior, G., &
Brymer, E. (Eds.). (2020). Innovations in a changing world. Australian College of Applied
Psychology.

© 2020
Copyright in each of the papers printed herein is retained by the respective authors.
This work is copyright. Apart from any use permitted under the Copyright Act 1968, no
part may be reproduced by any process without written permission from the copyright
holders.

Disclaimer
The papers published in this document have been carefully peer reviewed.
The Editors wish to make it clear that whilst the strict peer review process has been
applied to all published papers, due to the multi-disciplinary nature of the submitted
manuscripts the editors have accepted a variety of International styles such as reference
structure and spellings.

Layout and Design: Eric Brymer

Front Cover photo: Eric Brymer

Innovations in a Changing World

LE OF CONTENTS
CONTRIBUTORS
DISTINGUISHED INVITATIONS

Professor Jacquelyn Cranney

Jacky’s engagement with broader educational issues began with a
leadership role in an institutional revamp of HDR student supervision
policy and practice, followed by an inaugural UNSW ITET Fellowship.
Through subsequent Fellowship and grant programs, Jacky has led
institutional and national innovation in undergraduate psychology
education and in evidence-based self-management for all students.
She also contributed as a team member to the Australian Indigenous
Psychology Education Project.

Her awards include two UNSW VCATEs and two national (Carrick,
OLT) citations (with colleagues), the APS Award for Distinguished Contribution to
Psychology Education, and an APA Society for Teaching Psychology Citation. Jacky has
made significant contributions to quality education at UNSW (eg through relevant
committees of the Academic Board) and nationally (eg as a founding member and vice-
president of the Australian Learning and Teaching Fellows), and to quality psychology
education (eg through the Australian Psychology Accreditation Council Working
Committee, and APS Education Committees).

She currently holds leadership positions in national and international psychology

associations. She is an ALT Fellow and an HEA Senior Fellow.

Professor Lindsay Oades

Professor Lindsay G. Oades (MBA, PhD) currently is the Director of
the Centre for Positive Psychology at the University of Melbourne.
Lindsay’s work as an applied psychologist began as a clinical
psychologist and has expanded across health, business and
educational contexts including a contribution to coaching psychology
- including the first text on research methods for coaching
psychology.

Lindsay was previously foundational Director of Australian Institute

for Business Wellbeing and received a Vice-Chancellors Award for his
work on Collaborative Recovery (in mental health services). Lindsay’s current research
examines wellbeing literacy, personalised wellbeing planning and his new
comprehensive theory of wellbeing; Thriveability Theory.

With five books and over 100 refereed journal articles in applied psychology Lindsay has
significant experience in developing fruitful collaborations with practitioners and
organisations for applied research.
AUTHOR BIOS
Dr Katrina Andrews is a Senior Lecturer with a PhD in Clinical Psychology from Griffith
University, Gold Coast. Her career includes working as a psychologist in government and
non-government institutions as well as in private practice, providing individual and
group psychological treatment to adults. Since being awarded her PhD (Clinical
Psychology), Dr Andrews has worked within academic institutions, providing academic
leadership in both psychology and counselling departments. Presently, Dr Andrews is a
Senior Lecturer at ACAP, and has been now for 3.5 years. During this time, Dr Andrews
has developed, coordinated, and taught research related units in the Master of
Counselling and Psychotherapy, and represented the Discipline of Counselling at the
ACAP HREC board. Alongside this role, Dr Andrews has also successfully course
coordinated the Master of Counselling and Psychotherapy and more recently the Assoc.
Degree and Bachelor of Applied Social Sciences. During her academic career, Dr
Andrews has research supervised both Psychology Honours students, and Master of
Counselling and Psychotherapy students to completion in both quantitative and
qualitative methodologies.
Dr Cathy Bettman is the Sydney Campus Counselling Discipline Lead, the Coordinator of
the Bachelor of Counselling and a Senior Lecturer. For some time, Cathy has been a
teacher in the Master of Counselling and Psychotherapy (MCP), she serves on the
Navitas HREC and supervises MCP research students undertaking qualitative
research. From 2015 to date, Cathy has supervised to completion almost 40 student
projects. For her own PhD, Cathy conducted a qualitative research study in the area of
domestic violence. Her thesis was entitled: Patriarchy: The Predominant Discourse and
Font of Domestic Violence. This resulted in a number of publications including a novel
based upon her thesis. Cathy's other qualifications include: Master of Couple and Family
Therapy, Master of Counselling, MSc (Psychotherapy), Post Graduate Diploma in Conflict
Resolution and BA.
Eric Brymer has extensive research experience and has been successful in attracting
funding grants for various research projects.
Ms Belinda Cabanes, School of Psychology, Charles Sturt University, Wagga Wagga,
NSW. Belinda Cabanes graduated from Charles Sturt University (B. Soc Sci (psych) (hons))
in 2017 and is currently living in Singapore.
Dr Tim Chambers is a Lecturer in the School of Psychology at Deakin University and
coordinates the delivery of a faculty-wide first-year unit on health behaviour. Tim’s
research program broadly focuses on investigating solutions to enhance individual
mental health and wellbeing. Specific research areas include exploring the diversity of
support services, and related organisational factors, that are designed to improved
athlete mental health and wellbeing and investigating the effectiveness of exercise in
natural environments as a vehicle to improve mental health for the broader population.
Prior to joining Deakin University, Tim was a Senior Lecturer in the Discipline of
Psychological Sciences at the Australian College of Applied Psychology.
Trina Charnock completed a Bachelor of Pharmacy at Otago University, New Zealand, in
1993 and a Masters in Literature at Roehampton University, London, in 2001. She is
currently completing an Honours Degree in Psychology at the Australian College of
Applied Psychology, Sydney. Trina has worked as a hospital pharmacist, medical
editor/writer, and medical information advisor. She has also received classical training
in fine arts and exhibited paintings in several group exhibitions. Trina's key research
interest is creativity and the motivations that drive creativity across different
contexts. She is currently living in Australia with her husband, three children, and two
miniature schnauzers.
Charini Gunaratne commenced as a lecturer in the Discipline of Psychological Sciences
at ACAP in 2018, and is currently the Course Coordinator for the Bachelor of
Psychological Sciences/Criminology degree. Teaching in to the undergraduate program,
Charini also supervises a number of Honours, Masters’, and PhD candidates. Previously
she was a lecturer in the School of Psychology at Charles Sturt University, Wagga Wagga,
where she was also the First Year Subject Convenor for two years. Charini completed her
Bachelor of Arts (Psychology, Astrophysics) at Ohio Wesleyan University, Delaware,
Ohio, USA, and completed her PhD at Deakin University, Geelong, Victoria. While at
Deakin, Charini held sessional teaching roles in the School of Psychology, School of
Exercise and Nutrition Sciences, and Institute of Koorie Education. Charini was also a
part of the Australian Unity Wellbeing Index research team at Deakin for a number of
years.
Dr Vicki Hutton is Associate Professor of Counselling Discipline Lead on the Melbourne
campus, and Coordinator of the Graduate Diploma of Counselling at ACAP. After working
in the community mental health sector for many years, Vicki now focuses on her
academic and research roles at ACAP. Her key research interests include health stigma,
HIV, the human-animal relationship, subjective wellbeing, cultural diversity and social
justice.
Professor Mike Innes, previously Head of School of Psychological Sciences, ACAP, is a
social psychologist with interests in the areas of social influence, group performance,
stereotyping and in the politics of science, technology and psychology. He has been head
of three schools of psychology and a Dean of Arts at the University of Adelaide. He is a
Fellow of the Academy of Social Sciences in Australia and of the Australian and British
Psychological Societies. He is currently investigating the threat of developments in
artificial intelligence to replace professionals in the health and helping professions,
especially psychologists and counsellors. He was a contributor to the Prime Minister’s
Horizon Scanning Report on the developments of artificial intelligence in Australia.
Ms. Amanda Kassis is a provisionally registered psychologist, who is currently
completing a Master of Clinical Psychology degree at the Australian College of Applied
Psychology. Amanda also graduated from ACAP with a BPsychSci(Hons). She has a long
interest in complementary and alternative therapies.
Mr. Scott Kelly is currently completing a BPsychSci(Hons) at the Australian College of
Applied Psychology under the supervision of Dr. Fiona Ann Papps. Scott has completed
the foundations training in Hakomi Therapy and is about to commence advanced
training. His interest in embodied therapies stems from his long career as a professional
musician and his personal mindfulness practice, which have shown him the importance
of being present in the moment in order to achieve full potential.
Dr Ben Morrison is a registered Organisational Psychologist and Senior Lecturer in the
School of Psychology at Charles Sturt University, Bathurst. Ben’s research and practice
focuses on organisational psychology issues, including human factors, cognitive
engineering, cyber-security, and the impacts of automation in the workplace. Ben is
currently working on research projects relating to users’ expertise in detecting phishing
threats, the impact of artificial intelligence on the health professions, and the causes of
algorithm aversion when deciding whether to accept algorithmic advice.
Dr Denis O’Hara is Professor of Counselling and Psychotherapy and previously Head of
School of Counselling at the Australian College of Applied Psychology, Director of the
Hope Research and Practice Institute and Adjunct Professor at Griffith University and the
University of the Sunshine Coast. Dr O’Hara is a chartered psychologist with the British
Psychological Society and register member of the Psychotherapist and Counsellors
Federation of Australia. Dr O’Hara has taught in several universities and colleges both in
Australia and overseas across faculties of education, psychology, and counselling. He
continues his passion for teaching via the provision of professional development. Dr
O’Hara enjoys research and writing and is a published author with an extensive list of
publications. His most recent book is entitled “Hope in Counselling and Psychotherapy”.
Some of his research interests include hope studies, psychotherapy integration, self-
differentiation, chronic problems of the self, and wellbeing.
Fiona O’Hara is an experienced counsellor, lecturer, and researcher. She has taught in
universities and colleges in Australia and overseas as well as working in a number of
NGO’s offering counselling and mental health support. Fiona has a passion for counsellor
education and for the professional recognition of counselling within Australia. She has
particular interest in research on therapeutic change, hope studies, relational
attunement, and personal growth. Fiona is a register member of the Psychotherapist
and Counsellors Federation of Australia.
Dr Kieran O'Loughlin is Senior Lecturer in the discipline of Counselling at ACAP
(Melbourne campus). He also works in private practice. Kieran was previously
employed as senior clinician and clinical supervisor at Thorne Harbour Health
(previously the Victorian AIDS Council) in Melbourne. He is passionately committed to
the provision of high-quality individual and relationship counselling, and group therapy
to people living with HIV.
Dr Pol McCann is a sociologist with a research background in gender, sexuality, sexual
behaviour and risk, and illicit drug use. He has managed large-scale mixed-methods
research projects, including the design qualitative and quantitative survey instruments,
at the University of New South Wales. He has been employed as Senior Lecturer at the
Australian College of Applied Psychology (ACAP) since 2012 and lectures in cultural
diversity and applied social research methods in the Bachelor of Counselling. He
currently supervises research students in the Master of Counselling and
Psychotherapy. His qualifications include a PhD (graduated 2007 from the University of
New England) and a BA (Hons) (graduated 2002 from the University of Sydney). His
research project in his PhD was ‘The Pressures of Modern Manhood: The Role of
Homophobia in Shaping the Gender and Sexual Identities of Australian Men’.
Dr. Fiona Ann Papps is a senior lecturer in Psychological Sciences at the Australian
College of Applied Psychology. She joined ACAP in 2011 after nine years at the University
of Prince Edward Island, Canada, where she served in a variety of roles, including
Assistant Professor of Psychology, Head of the Department of Psychology Research
Ethics Committee, and Head of the Department of Psychology. Fiona’s research interests
include body image and embodiment, sexuality, media representations of sex, gender
and sexuality, literature, madness, death and dying.
Ms Fatmata Parkinson is currently a student in the Master of Counselling and
Psychotherapy at ACAP. Her career includes working with migrants and refugees at
Metro Assist previously known as Metro Migrant Resource Centre, Sydney, working as a
contract interpreter with the Translation and Interpreting Service (TIS). Fatmata was
inspired to do counselling to assist the most vulnerable people in her community, in
particular, refugees. As a refugee from Sierra Leone, she experienced first hand the
struggles of resettling in a new country and the challenges faced by people from non-
English-speaking backgrounds. She was awarded Marrickville’s Young Australian of the
Year for her commitment in supporting refugee families to resettle in the community.
Presently, Ms Parkinson works with migrant families at The Multicultural Network. She is
looking forward to developing her career in counselling migrants and refugees.
Dr Shahin Rahimi is a lecturer in the Discipline of Psychological Sciences at ACAP. Shahin
completed his PhD in psychology at Australian Catholic University. His doctoral research
examined cognitive control and response inhibition in children with motor coordination
problems. He then worked as a post-doctoral researcher in the Human Neuroscience
Institute at Cornell University. As a part of his post-doctoral training, Shahin examined
the predictors of the ability to delay immediate gratification and risky decision-making in
young adults. Some of Shahin’s current research interests include examining the
development of cognitive control in adolescents and adults with and without
developmental disorders, understanding how different mental representations of
choices affect the propensity for risky choices, and understanding the relationship
between job burnout and psychological well-being.
Dr Despina Sfakinos is a Registered Psychologist and she works as a Lecturer at the
Australian College of Applied Psychology (ACAP). She has been working with ACAP in the
School of Counselling for the past 5.5 years and as part of her role she supervises
Masters students. Despina has experience in both qualitative and quantitative research
methods. Her qualifications include PhD (graduated 2013 from the University of Sydney,
School of Psychology), Graduate Diploma of Psychological Practice (graduated 2009 from
the College of Psychological Practice) and a BA (Hons) (graduated 2002 from the
University of Adelaide). Her research project in her PhD was “The Development of the
Multifactorial Self-Awareness Scale: A Theoretical Model of Self-Awareness and Its
Relationship to Leadership Development”.
Rebecca Sibthorpe is a psychology student at the Australian College of Applied
Psychology (ACAP) who is completing her Honours Thesis on the lived experience of
people who feel disconnected from nature. Before beginning her honours, Rebecca
completed a Bachelor of Psychological Science at the University of Newcastle and a
Graduate Diploma at ACAP. Throughout her student career she has worked as
administration at one of the biggest private psychology practices in Newcastle.
When she is not studying, Rebecca loves to be outdoors, camping, boating (she likes to
think she is a good wakeboarder), walking her dog or enjoying a game of netball.
Rebecca is particularly interested in psychopathology and wishes to eventually become a
Forensic Psychologist.
Gabriel Tillman is a Lecturer at the Australian College of Applied Psychology. He was
awarded a Bachelor of Psychology (Honours I) and a Ph.D. in cognitive psychology from
the University of Newcastle. Following his Ph.D. Gabriel worked at Vanderbilt University
as a postdoctoral research fellow. At ACAP, Gabriel is investigating the relationship
between decision processes and negative emotional states such as depression, anxiety,
and stress.
Deanne Tyrrell is currently a Master of Clinical Psychology student at Australian Catholic
University. She completed her Bachelor of Social Science (Psychology) (Honours 1) at
Charles Sturt University, and also holds a Bachelor of Architecture (Honours 1) from the
University of New South Wales (UNSW). Deanne has also worked as a sessional tutor in
psychology at the Australian College of Applied Psychology, and in architecture at
UNSW.
Dr Staci Vicary completed a PhD in Psychology in 2014 at the MARCS Institute for Brain,
Behaviour and Development at Western Sydney University, studying human short-term
memory and body perception. Staci then pursued a Post-Doctoral research position at
Goldsmiths University working with prominent cognitive psychologists and
neuroscientists to study group behaviour and emotional engagement with performing
arts. Currently, Staci is a Lecturer in Psychology at Australian College of Applied
Psychology where she works predominantly with undergraduate psychology students
and honours degree candidates. Staci’s research falls under the broad umbrella of
cognitive psychology, with focuses on dance cognition, social behaviour and executive
function. You will find Staci chatting with students about pop-culture, or proudly
showing off photos of her son.
Sharon Walker is a lecturer at the Australian College of Applied Psychology (ACAP).
Sharon has been working with ACAP for 5.5 years and has been responsible for
developing curriculum and lecturing in the Masters of Counselling and Psychotherapy
course. Sharon has Masters degree’s in Counselling (University of Western Sydney) and
Education (Adult Ed) (University of Technology Sydney). A significant part of Sharon’s
work has been in Papua New Guinea (PNG) in the field of HIV counselling. Sharon was a
researcher in a mixed method study conducted across four provinces of PNG aimed at
privileging the voice of women in regards to their experience of gender based violence
and HIV. The article related to the study is titled “Violence against women on Papua
New Guinea”.
Matthew Whelan is a student studying at the Australian College of Applied Psychology.
Professor Wilson is Co-Director of the Centre for Disability and Development Research
(CeDDR) and Professor of Developmental Psychology at Australian Catholic University.
Before that he was Deputy Head (R&I) in the School of Health Sciences at RMIT
University where he worked from 2000-2011. He leads internationally-recognised
programs of research in (1) motor and cognitive development in children, both typically
developing and in disorders of movement such as DCD, and (2) innovations in
neurorehabilitation, including the use of virtual reality.
James Woodhouse completed his undergraduate degree at Macquarie University.
Graduating with a Bachelor of Science (Psychology). He is now completing his Bachelor
of Psychological Sciences – Honours at the Australia College of Applied Psychology
(ACAP). He has worked in retail for the last 9 years, allowing him to hone his skills of
communication and understanding of other people. He hopes to complete a master’s
degree in Sports Psychology or Clinical Psychology, although he has not made a final
decision yet. He is passionate about health and wellness, including exercise and different
forms of movement. His other hobbies include fishing, bush walking, reading and
socializing with friends and family.
Acknowledgements
This manuscript evolved from the 2019 ACAP conference and would not have been
possible without the help and support of those who arranged and managed the
conference. As Conference Scientific Chair, it is my duty and privilege to acknowledge
and formally thank the many people who assisted in the planning, staging and
finalisation of the 2019 ACAP conference.
Many of those people have been acknowledged in these edited proceedings or
elsewhere. To those individuals, particularly the Conference Executive Team, led by
Meagan Johnson, the conference scientific team and the Keynote speakers, again I
express my appreciation of their many donations including their generosity with their
time and energies. Conferences such as the one that led to this manuscript rely on such
people.
I must also thank the students who participated and received an exciting initiation into
the various professions supported by the conference.
The administration support provided by the ACAP Melbourne campus and the campus
manager, Andrew O’Brien, was both professional and enthusiastically provided. A very
special vote of thanks is offered to the team.
Finally, thank you to all those who travelled intrastate, interstate and internationally for
their offerings which contributed to the outstanding success of the Conference and to
George Garrop who generously organised funding for the travel.

Eric Brymer, PhD.

Conference Chair
Editorial
Innovations in a changing world
Katrina Andrews PhD, Fiona Ann Papps PhD, Vincent Mancini PhD, Larissa Clarkson PhD,
Kathryn Nicholson Perry PhD, Graeme Senior PhD, Eric Brymer PhD

Society is undergoing rapid change and the higher education sector is not immune to the
impact of these changes. The last few decades has also been witness to considerable
increases in mental health issues across the globe. For an organisation that delivers
higher education opportunities for students interested in supporting the enhancement
of mental health in others, this brings considerable challenges. Innovation is needed to
support inclusivity, engagement and reflective practice. This manuscript begins the
evidence base for how to effectively support and deliver innovation in the human
services sector and in a sustainable manner. Authors in this manuscript have considered
innovation for optimising curriculum environments and learning and teaching activities,
for clinical and therapeutic outcomes, and to faciltate good health, wellbeing and
lifestyle behaviours. Ideas, strategies and interventions presented in this publication will
be of interest to practitioners, researchers and policy makers alike.

i
ii
Table of Contents
ACKNOWLEDGEMENTS I
EDITORIAL I
Innovations in a changing world i
Katrina Andrews PhD, Fiona Ann Papps PhD, Vincent Mancini PhD, Larissa Clarkson PhD, Kathryn Nicholson Perry
PhD, Graeme Senior PhD, Eric Brymer PhD i

INVITED PERSPECTIVES 1
1
Why should psychological literacy and self-management capability be key outcomes for undergraduate students?3
Jacquelyn Cranney 3
Towards a wellbeing literate society 14
Lindsay G. Oades 14

OPTIMISING CURRICULUM ENVIRONMENTS 19

Editorial: Optimising curriculum environments 21
Katrina Andrews 21
The relationship of perfectionism to mindfulness-based self-efficacy, distress, and procrastination: testing a model
in an undergraduate student sample 23
Ester Senderey and Fiona Ann Papps 23
What counts in managing diversity in the classroom: from the perspective of academic teachers and students at
ACAP 41
Despina Sfakinos, Pòl McCann, Sharon Walker and Cathy Bettman 41

PHYSICAL ACTIVITY AND WELLBEING 53

Editorial: Physical activity and wellbeing 54
Vincent Mancini PhD 54
Disconnected from nature: the lived experience of those disconnected from the natural world 59
Rebecca L Sibthorpe and Eric Brymer 59
Examining the lived experience of wellbeing through regular qigong practice 75
James Woodhouse and Eric Brymer 75
Supporting athlete mental health and wellbeing: A rapid review 100
Timothy P Chambers 100
The relationship between climate change issue engagement, connection to nature and mental well-being 113
Matthew Whelan and Eric Brymer 113

CLINICAL INTERVENTIONS 137

Editorial: Clinical interventions 138
Katrina Andrews 138
Deficits of (hot) executive function in developmental coordination disorder: implications for the contemporary
models of the disorder 140
Shahin Rahimi-Golkhandan and Peter H. Wilson 140
Can we predict the outcomes of deep learning algorithms that simulate and replace professional skills?
Understanding the threat of artificial intelligence. 155
J Michael Innes and Ben Morrison 155

LIFESTYLE ENHANCEMENT 169

Editorial: Lifestyle enhancement 170
Larissa Clarkson 170
The impact of brief, digital mindfulness meditation training on executive function. 171
Jacqueline Ward and Staci Vicary 171
Solving insight problems influences positive and negative affect 182
Deanne L. Tyrrell and Charini D. Gunaratne 182
Exploring the link between Leisure-Time Creativity and Motives for Workplace Creativity: A Literature Review 192
Trina Charnock and Staci Vicary 192
Cultural differences in measuring resilience across Australia and Singapore 205
Belinda L. Cabanes and Charini D. Gunaratne 205

iii
LEARNING AND TEACHING 218
Editorial: Learning and teaching 219
John Reece 219
“A good sketch is better than a long speech”: a pilot study on the use of sketchnoting to teach undergraduate
psychology 221
Tim Chambers PhD 221
Getting it right: Why personal pronouns matter 231
Vicki Hutton 231

THERAPEUTIC INTERVENTIONS 244

Editorial: Therapeutic interventions 245
Katrina Andrews 245
A metatheoretical framework for the integration of the common factors of psychotherapy 247
Denis O’Hara and Fiona O’Hara 247
An innovative approach to counselling newly diagnosed HIV positive clients: Applying the single session therapy
model. 259
Kieran O’Loughlin 259
Counselling African refugees: How is the process observed and experienced by practitioners? 269
Fatmata Parkinson and Katrina Andrews 269

INTEGRATIVE PSYCHOLOGICAL THERAPIES 280

Editorial: Integrative psychological therapies 281
Fiona Ann Papps 281
‘The Wisdom Lies Within’: Investigating therapeutic presence from a hakomi therapy perspective 284
Scott Kelly and Fiona Ann Papps 284
‘It is not a closed door but it is a locked room safe:’ Integrative psychology practice from the perspective of
practitioners with training in psychology and complementary and alternative therapies (CATs) 299
Amanda Kassis and Fiona Ann Papps 299

iv
 Invited
Perspectives

1
2
 Why should psychological literacy and self-management capability be key outcomes for
undergraduate students?
Jacquelyn Cranney

Abstract
Psychological literacy is the capacity to intentionally use psychology to achieve personal,
professional and societal goals. The domains to which psychological principles can be
applied include (1) the self – particularly in terms of self-management; (2) local contexts
(including employment); and (3) global contexts (demonstrating global literacy/citizenship).
Challenges and opportunities are discussed, and I argue that (a) a moderate level of
psychological literacy should be the outcome for all undergraduate psychology major
students, and (b) self-management should be an explicit and formally developed graduate
capability for all undergraduate students. For the first outcome, I provide examples of
curriculum innovation at the unit and program level. In terms of the second outcome, self-
management is the capacity to effectively pursue meaningful goals, and to be flexible in the
face of setbacks. Within the academic context, self-management includes time-
management, effective study skills, and emotional regulation. I argue that self-management
is a key enabler of effective learning and thus, academic success; thus, self-management
should be explicitly considered in curriculum design and delivery. Approaches to self-
management and success at the unit, program, and institutional levels are considered. I
suggest that these approaches are aligned with George Miller’s (1969) call to “give
psychology away”.

The first part of this paper will focus on psychological literacy, which gives the theoretical
background for the second part, which focuses on self-management – a concept relevant for
everybody. For each, I consider: What is it; why is it worth considering; and how do we ‘do’
it?
By way of introduction, I am not a psychologist; I am a psychology educator with a
background in neuroscience. I have become increasingly interested in the student
experience, within psychology but more broadly across the higher education sector.
Moreover, I take a broad perspective on psychology as a whole - both the science and the
profession. I acknowledge that my passion is undergraduate psychology and the potential of
such education. Nevertheless, much of what I present here has implications for education in
most disciplines and professions.
What is the promise and the paradox of psychology? The promise is that psychology is a
unique combination of: (1) knowledge created primarily through the scientific method, (2)
subject matter which is about us – the human mind and behaviour, and (3) evidence-based
practice. These three components uniquely create the imperative to share what we know
with other human beings. Fifty years ago, George Miller (1969) implored us to “give
psychology away” to everyone, by means of education, not only in the classroom but also
through public education (see also Banyard & Hulme, 2015). Here we will focus on the
higher education classroom.

3
The paradox is that we're not doing this as well as we could. My argument is that we should
be re-examining the outcomes of undergraduate psychology education, but also we should
be giving away what we know about evidence-based strategies that help people –
particularly our students - to reach their goals and to be successful in their lives. Of course,
many disciplines and professions already borrow from psychology in the sense of providing
students with opportunities to increase their self-management capability. Psychology could
facilitate this process by explicitly contributing evidence-based self-management strategies.

Psychological Literacy
The modern take on psychological literacy was offered by McGovern and colleagues (2010;
see Cranney, Morris, & Baldwin, n.d.), who conceptualised psychological literacy in terms of
the common graduate capabilities that students should acquire while undertaking a major in
psychology; these were derived from an analysis of programs in mostly Western English-
speaking countries. McGovern and colleagues also offered the value-laden concept of
psychologically literate citizens, who use their psychological literacy to problem-solve in an
ethical and socially responsible manner in a way that directly benefits their communities.
The intended graduate capabilities for undergraduate psychology are reproduced in Figure
1. Apart from the foundational statement about knowledge, most of these learning
outcomes are quite high-level competencies. Although some outcomes (e.g.,
communicating effectively) reflect generic outcomes that we would expect all tertiary-
educated students to acquire, Murdoch (2016) argues that in psychology, we should be
focusing on the evidence-based aspects of such outcomes.
More generally, Cranney and colleagues (e.g., Cranney, Botwood, & Morris, 2012; Cranney
& Dunn, 2011) defined psychological literacy as the capacity to intentionally use psychology
to achieve personal, professional societal goals. This definition includes an emphasis on
values and application (Murdoch, 2016). Cranney and Morris (2010) stated that psychology
can be applied in three broad domains: personal (to oneself, and to one’s relationships with
partner, best friends and closest family members; here evidence-based self-management
strategies are relevant), local communities (e.g., employment contexts), and global (i.e.,
application of psychological principles in local, national or global contexts, in a way that
reflects an awareness of global issues – this aspect reflects global citizenship). As George
Miller (1969) stated 50 years ago, most of our current societal problems have been created
by human behaviour, and so the more we know about human behaviour, the greater chance
we have of solving these problems. This should be seen by the psychology higher education
providers as an opportunity for our undergraduate psychology graduates to contribute to
solving those problems in the context of diverse career destinations.
So how well are we, as psychology educators, contributing to this potential? Are our
students healthier? Are they pursuing meaningful careers? Are they contributing to society
beyond their career boundaries? In Australia, the USA and Britain, most psychology major
students do not go on to study graduate professional psychology, partly because of the
imbalance between undergraduate and graduate training places (Cranney, Hulme,
Suleeman, Job, & Dunn, in press). Indeed, many end up in the public service, with the
potential to advise Ministers of Education, Health and Science. Thus, there are benefits to
having all undergraduate psychology major students appreciate the value of their
undergraduate psychology education in both their personal and (diverse) professional lives.
Cranney, Botwood, and Mellish ((2019) reported that although graduates from

4
undergraduate, honours, and graduate psychology education programs across Australia all
agreed strongly with the statement that “My undergraduate psychology program prepared
me well for a research career [if that is what I had chosen to do]”, their agreement ratings
regarding the statements “My undergraduate psychology program prepared me well for
working in a variety of work settings” and “My undergraduate psychology program prepared
me well for working in a multicultural global economy” were neutral at best. It appears
there is room for improvement in undergraduate psychology education.

Psychological Literacy

1. Having a well-defined vocabulary and basic knowledge of the critical subject

matter of psychology

2. Valuing the intellectual challenges required to use scientific thinking and the
disciplined analysis of information to evaluate alternative courses of action

3. Taking a creative and amiable skeptic approach to problem solving

4. Applying psychological principles to personal, social, and organizational issues in

work, relationships, and the broader community

5. Acting ethically

6. Being competent in using and evaluating information and technology

7. Communicating effectively in different modes and with many different audiences

8. Recognizing, understanding, and fostering respect for diversity

9. Being insightful and reflective about one’s own and others’ behavior and mental
processes

Figure 1: The components of psychological literacy as conceptualised by McGovern

and colleagues (2010, p11).

In terms of quality assurance and accreditation of undergraduate psychology programs,

the Quality Assurance Agency (2016) of the United Kingdom has explicitly specified
psychological literacy as an expected outcome. Moreover, the American Psychological
Association’s (2013) Guidelines for the Undergraduate Psychology Major includes the
usual learning outcomes such as discipline knowledge, but also “Professional
Development” and “Ethical and Social Responsibility in a Diverse World” – overlapping
substantially with Cranney and Morris’s (2011) psychological literacy domains, and
Cranney, Morris, Krochmalik, & Botwood’s (2013) pragmatic taxonomy of psychological
literacy.
What about Australia? The new Australian Psychology Accreditation Council (APAC)
Standards have a number of “Standard” Domains, which include D.3.8 Cultural
responsiveness and D.4.5 …skills to adequately maintain their own well being (2019, p.9).

5
What is specifically important for undergraduate psychology are the Level 1 Foundational
Competencies, listed in Figure 2, along with a rough equivalence comparison with
McGovern and colleagues’ graduate competencies (two of which do not feature - 3,6).
Disappointingly, compared to the 2010 APAC standards, the 2019 APAC Standards do not
include (a) knowledge and practical skills in undertaking research, (b) critical thinking as a
general evidence-based capability (beyond the essential but narrow research domain), (c)
communication as a general evidence-based capability (beyond the narrow research
domain), and (d) application to personal, professional and global goals. The fact that
these Foundational Competencies do not include Professional Development and Career
Development Learning highlights the lack of appreciation by the APAC Board of the
potential value of undergraduate psychology education for all graduates, not just those
who progress to further postgraduate professional psychology training.

Competency PL
GC

1.1 Comprehend and apply a broad and coherent body of knowledge of 1,4
psychology, with depth of understanding of underlying principles, theories and
concepts in the discipline, using a scientific approach, including the following
topics…

1.2 Apply knowledge and skills of psychology in a manner that is reflexive, 4,8,9
culturally appropriate and sensitive to the diversity of individuals.

1.3 Analyse and critique theory and research in the discipline of psychology and 2,7
communicate these in written and oral formats.

1.4 Demonstrate an understanding of appropriate values and ethics in psychology. 5

1.5 Demonstrate interpersonal skills and teamwork. 4,7

1.6 Demonstrate self-directed pursuit of scholarly inquiry in psychology.

Figure 2: APAC Level 1 Foundational Competencies (APAC, 2019, p.11), and the
approximate equivalent to McGovern and colleagues’ (2010) Graduate Capabilities
(GC) constituting Psychology Literacy (PL).

So how do we develop psychological literacy? How do we operationalise psychological

literacy in terms of program and unit outcomes? At the very least, we need to meet the
APAC minimum standards, but we can choose to extend the program learning outcomes to
include essential missing aspects of psychological literacy, such as training in the application
of psychology to professional and societal goals.
In a recent discussion of developing psychological literacy within the undergraduate
curriculum, Hulme and Cranney (under review) set out a number of individual

6
unit/educator approaches, which begins with Developing a Psychologist [Psychological
scientist] Mindset. The example given for this approach is first-year psychology students
designing, conducting, and presenting the results of a research study. Next were
categories of application of psychology to particular goal types. Under Personal Goals,
one example is having students determine a particular goal that they would like to
achieve in the next month; they search for and implement evidence-based strategies to
achieve that goal; they measure their progress; and in their report they reflect on that
progress. This gives students a taste of utilizing evidence-based strategies in an attempt
to change their own behaviour to achieve a particular goal. Goals chosen usually relate to
physical exercise or study goals, or changing habits such as what they are eating (Hulme
& Cranney, under review).
Under Professional Goals, examples were given of: creating a Career Development
Learning portfolio that includes evidence-based strategies such as informational
interviews; and, in-house and external work-integrated learning experiences. Under
Societal Goals, examples were given of the application of psychology to issues
determined by stakeholders/citizens, such as reading programs in poor socio-economic
areas, and grant-writing for Indigenous Community Projects (Hulme & Cranney, under
review).
In contrast to individual unit/educator approaches, for the (preferred) program level, the
idea is to systematically develop psychological literacy as a meta-competency, that is,
undergo a process of curriculum renewal with constructive alignment of intended
competencies, assessments, and teaching activities (Biggs, 1996; Dunn, Cautin, & Gurung
2011; Halpern et al., 2010). For example, at Keele University: first-year students learn the
same core knowledge; at second year there is an increased emphasis on developing skills
in applying psychology; at third year there is choice to specialize and develop
psychological literacy in particular areas. At the University of Stirling, in the final two
years of the 4-year program, there is increased emphasis on application in authentic
contexts, and on student independent leadership within the classroom (Hulme &
Cranney, under review).
Another perspective on the ‘how’ to develop psychological literacy as the primary outcome
of undergraduate psychology education is in terms of the educators: in particular, educators
adopting psychological literacy as their ‘pedagogical philosophy’ (see Cranney & Morris, in
press). This pedagogical philosophy includes: (a) being critically reflective practitioners (e.g.,
knowledge of strengths and weaknesses as educators), striving for continuous
improvement, indeed, striving to be scientist-educators (Bernstein, 2011) by, for example,
(b) using evidence based practice (e.g., Worrell et al., 2010) in supporting student learning,
and recognizing both the influence of the curriculum environment and the importance of
student self-management skills (Cranney, 2018); and (c) explicitly emphasizing psychological
literacy as the integrative meta-literacy for undergraduate psychology educational (which
requires curriculum renewal and alignment). Note that factors (a) and (b) should be
common characteristics for all educators. For examples of how Goodyear’s (2005) notion of
pedagogical philosophy translates to practice, see Cranney and Morris (in press). In
summary, as psychology educators, I argue that we adopt psychological literacy as our
pedagogical philosophy, in the sense that we strive to be psychologically literate in our
approach to curriculum design and delivery, with the intended outcome of undergraduate
psychology education being a moderate level of psychological literacy.

7
Self-management
Self-management is the capacity to work effectively toward meaningful goals and to be
flexible in the face of setbacks (Cranney, Cejnar, & Nithy 2016). Student self-management
(SM) within the academic context includes: (a) meaningful goal selection and effective
goal pursuit, including (b) time- and task-management; (c) general study skills; (d) specific
academic skills; (e) emotional regulation skills (including dealing with challenges to
achievement such as procrastination, exam anxiety, and stressors in general); (e)
metacognitive and reflective skills for life-long learning, and (f) ‘life balance’ skills, such as
managing finances, relationships, physical health, and having fun. I argue that this should
be a university-wide graduate capability (e.g., Deakin University, n.d.), and that, like any
graduate capability, should be explicitly developed – and thus ‘normalized’ – within the
curriculum.
Why should we be concerned that students develop their self-management capability? If
one takes a negative framing to answering this question, then there are reports of high
levels of distress in tertiary education students (e.g., Orygen, 2017). Whether this level of
distress is higher than that for the age-matched non-university population, and higher than
historical levels, is a matter of controversy, given the methodological limitations of applied
non-experimental research. Regardless, it cannot be denied that students – like most of us
– experience numerous stressors which, if not adequately managed, can lead to significant
distress, which is associated with poor academic outcomes (Andrews, 2016).
Alternatively, one could take a positive framing, and in particular acknowledge that there
are evidence-based self-management strategies – derived from psychological science (e.g.,
Morris, Cranney, Baldwin, Mellish, & Krochmalik, 2018) -- available to be shared with
students. Relatedly, educators can take a population approach to psychological health and
wellbeing, by shaping their curriculum environment (e.g., Enhancing Student Wellbeing,
2016; Hulme & Cranney, under review) and by providing opportunities within the curriculum
to develop SM capability. By doing so, educators can contribute to (a) early intervention,
prevention, and the promotion of wellbeing, and thus (b) shifting the student wellbeing
distribution from languishing to flourishing (Huppert, 2009; Keyes, 2002). From a theoretical
perspective, these kinds of approaches contribute to student engagement and motivation,
which contribute to effective effort, which leads to the achievement of meaningful and
realistic academic goals (the equivalent of academic success), which leads to the satisfaction
of psychological needs, which leads to increased wellbeing, which then supports further
goal-striving behavior in a cyclical ‘upward-spiral’ fashion (Cranney, 2018; Sheldon & Elliot,
1999). As Richard James intimated (see Enhancing Student Wellbeing, 2016), embracing
these approaches is a fabulous opportunity for progressive higher education institutions.
Indeed, there is a global movement toward ‘healthy universities’ (e.g., Okanagan Charter,
2015), whereby a whole-of-institution approach is taken. At the same time as we work
collaboratively with stakeholders toward such an institution-wide approach, we may also be
able to influence Faculty and School/Department initiatives, program-level curriculum
renewal, and single-unit initiatives.
In this paper, I focus on SM skills. If students are supported in their development of SM
skills, they are more likely to be successful as both students and in graduate employment
(e.g., Choi & Chung, 2012). Although total curriculum renewal to integrate development of
SM as a graduate capability is the desired approach, I describe here a number of different
examples that any single educator could adopt, right now: (1) integrating time-management
8
and reflection skills into a biochemistry unit; (2) integrating resources contained in a
learning management system section into classroom activities; (3) integrating tools from
published resources such as The Rubber Brain (Morris et al., 2018). Other approaches
include encouraging students to enroll in credit-bearing units focused on the psychological
science of wellbeing (e.g., Morris, Cranney, & Olschewski, 2018), but I will not focus on that
here.
The first example is from Rebecca LeBard at UNSW, in the second-year biochemistry course
that she coordinated. Her aims were to support students to better manage their time so as
to submit assignments on time, and to have them reflect on their self-management
strategies directly after submitting an assignment. We worked together to create activities
and resources (e.g., group and individual goal selection activities based on worksheets,
Assessment Time Management worksheet; Cranney, 2015; Cranney & Nithy, 2015), and
train instructors to deliver the activities in lectures, labs and tutorials, thus normalising self-
management learning. Rebecca also organised optional consultations with tutors to help
individual students who needed assistance in planning and executing assessments. As a
result of these initiatives, there was an unprecedented turnout to assignment help sessions
as student prepared ahead of time to complete their assignments. Compared to the
previous year, average grades for this unit were higher, and the educators involved were
rewarded with institutional and national awards.
The second example is my creation of a section for a learning management system – in this
case, Moodle – that could be imported into any unit Moodle platform by the unit
coordinator. This section, “Self-management for Effective Learning”, consisted of 9 topics:
goal setting, scheduling time, study strategies, procrastination and motivation management,
assessment feedback and reflection, stressors vs. distress, balancing life, mindfulness
meditation and learning effectiveness, emotional management for a balanced life, and quiz
and exam preparation. There are a number of different ways in which a unit coordinator
could use this section: (1) allow students to use it freely as they need, with no specific
instruction from the coordinator; (2) refer to relevant resources (e.g., quiz and exam
preparation) at relevant points in the semester/term, perhaps in a weekly announcement;
and (3) integrated some of the activities into lectures, labs and tutorials. In a pilot study,
Jenny Richmond (Cranney et al., 2019) found that when she ‘pointed’ to specific SM
resources form the Moodle Section as optional activities in her weekly Moodle post, hit
rates were significantly above those for resources not so signaled. This is not rocket science,
and we currently do not know the implications of those higher hit rates, but it is a start, and
suggests that ‘nudging’ students could be a good way to start. Nevertheless, actual
integration into formal curriculum activities is likely to have a much greater impact. This
Moodle section is currently being revised, and activities will be integrated into the
curriculum of key first-term Science Faculty introductory units at UNSW, in order to support
student transition. The third example is using “The Rubber Brain” book exercises in a similar
was to the Self-Management for Effective Learning” example. Each chapter presents theory,
research and practical exercises on topics such as stress management, motivation and time-
management, procrastination and perfectionism, study strategies, and communication.

9
Conclusions
As educators, we have the opportunity to support students to increase their capacity to be
successful in their studies and their careers, and to make positive contributions to our global
society. We can start this process by:
• integrating self-management capacity building opportunities into the curriculum
• supporting development of psychological literacy for our psychology students.
Finally, by way of underlining the connection between the two concepts discussed in this
paper, I note the similarities between these quotes from a student and from a scholar:
Psychological literacy means being aware of the psychological knowledge one
possesses and what one still needs to acquire, being able to apply this knowledge
appropriately and adaptively to all areas of life and acknowledging that one is and
should be continually learning and integrating this into one’s current aggregation of
knowledge. Psychological literacy also involves thinking beyond oneself through global
awareness and future-thinking (UNSW PSYC3011 student, Final Reflection, 2012)
The aim of education is not only to prepare students for productive careers, but also
to enable them to live lives of dignity and purpose; not only to generate new
knowledge, but to channel that knowledge to humane ends; not merely to study
government, but to help shape a citizenry that can promote the public good. Thus,
higher education’s vision must be widened if the nation is to be rescued from
problems that threaten to diminish permanently the quality of life (Boyer, 1990, pp.
77-78).

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13
 Towards a wellbeing literate society
Lindsay G. Oades

Abstract
The growth of wellbeing science in general, and positive psychology, in particular have
major relevance to applied psychological practice. Contemporary views of wellbeing
emphasise the presence of positive attributes (e.g. positive emotions, meaning, positive
relationships) which is more than the absence of illness or deficit. Wellbeing as a higher-
level concept affords an opportunity to conceptually unify applied psychology and link it
further to population health. The wellbeing of the population cannot and should not be the
sole responsibility of trained practitioners, applied psychology or otherwise. Wellbeing is
everyone’s business, and it is argued that language is a key lever in such a population health
endeavour. Practitioners however have the responsibility of contributing to this broader
wellbeing literate society- a society that communicate about and for wellbeing in a manner
consistent with contemporary views of wellbeing. After defining wellbeing literacy, its five
necessary conditions are summarised to provide applied psychology practitioners with a
contemporary literacy model to situate their practice and examine their role in wellbeing
communication.

What is Wellbeing?
The question of the definition of wellbeing has been dominant in religion and philosophy for
centuries, and more recently the province of economics and psychology. A comprehensive
answer to defining wellbeing is beyond the scope of this chapter. Key issues in arriving at an
answer includes key considerations as to whether (a) one views wellbeing as an experience
(eg happiness) or as an evaluation (eg life satisfaction) (b) one views wellbeing as
subjectively defined (eg subjective wellbeing) or objectively defined (eg quality of life)
(Huppert & So, 2013). A key debate in the philosophy of wellbeing is whether one takes a
view of wellbeing as hedonic (ie more pleasure than pain) and often referred to as
happiness or eudaimonic (ie based on Aristotelean philosophy meaning flourishing, living a
virtuous life). Influences by a negativity bias, many may view wellbeing as wellness or the
absence of illness- or use it interchangeably with health. For wellbeing scientists, these are
inadequate or simplistic approaches. Contemporary views of wellbeing emphasise the
presence of positive attributes (e.g. positive emotions, meaning, positive relationships)
which is more than the absence of illness or deficit (Mental Health Commission of NSW,
2017). Language and concepts are closely related, hence the focus on wellbeing literacy.

What is Wellbeing Literacy?

Wellbeing literacy is the capability of mindful language use about and for wellbeing (Oades,
2017; Oades & Johnston, 2017). This means that one can communicate intentionally about
wellbeing with the intent of improving their own wellbeing or the wellbeing of those
receiving the communication. It is important to note that communication is multimodal;
that is may involve speaking and listening, or reading and writing, or creating and viewing.
When people have high wellbeing literacy, they have high language capability for wellbeing

14
(Nussbaum, 2011, Sen, 1993,). In short, this means that wellbeing literacy helps people have
increased choices (what one can be and do) for their own wellbeing or that of others.

The study of wellbeing literacy is concerned with how and why people use language in their
everyday lives and how this awareness can be leveraged to empower wellbeing for the self
and others. Language is a key lever for influencing wellbeing because language is natural,
ubiquitous and constant – communication takes place in face-to-face conversations, books,
social media, emails and a range of other possible media. From this perspective, experiences
and mindsets are often created and co-created in language (Burr, 2003; Raskin, 2012).
Brothers (2025) asserts that language is a tool we cannot put down and a tool that is
required for all other tools. Related to wellbeing literacy, this tool has a user, with
intentions, in a context. Wellbeing literacy is a tool we need for other tools gained in applied
psychological interventions. Importantly, literacy is conceptualised here as multimodal, that
is, broader than just reading and writing. Moreover, it involves language use, by users, in
context. It is not a static view of language that is assumed to be autonomous. Language is
viewed here as an instrument with a user with intentions within a context. Wellbeing
literacy contains five necessary conditions (See Table 1).

First, wellbeing literacy requires vocabulary and knowledge. People need some proficiency
in wellbeing vocabulary (e.g. being able to articulate the things that they value) and
wellbeing knowledge (declarative knowledge about wellbeing that is relevant to what they
value). People may confuse the broader term wellbeing literacy with emotional literacy
(Steiner, 2003). However, emotional literacy is conceptually more specific than wellbeing
literacy, as emotions are one of several domains of wellbeing. Wellbeing literacy is also
conceptually different from health literacy and mental health literacy.

Second, people need to be able to comprehend wellbeing communication through reading,

listening, and viewing (ACARA, 2017). This is a real-world view of literacy, not solely school-
based. Human language happens between people, a socio-cultural phenomenon, rather
than a cognition inside the body boundary. Language, by definition, is central to our
relationships, which are in turn central to our wellbeing. Wellbeing literacy is
communicating about and for wellbeing. In this case, comprehending about and for
wellbeing. Reading about and/or for wellbeing may include reading about optimism so you
can review how you attribute positive events. Listening about and for wellbeing may include
intentionally listening to dance music to boost one’s mood. Viewing about and for wellbeing
might entail viewing a piece of street art, which then engenders positive feelings and a
sense of social justice.

Third, people need to be able to compose texts relevant to wellbeing in multiple modalities,
including writing, creating, and speaking (ACARA, 2017). Similar to comprehension, people
might compose their wellbeing experiences via multiple modalities in a way that is
consistent with their values and social context. Writing about and for wellbeing might be
writing a note to your friend to say “Thankyou for being you”. Creating about and for
wellbeing might include creating a piece of pottery that communicates health. The
relationship between creativity and wellbeing is of major relevance to wellbeing literacy.
Speaking about and for wellbeing may be as simple as saying “How are you today?”, or as
complex as speaking technically about a friends medical condition.

15
Fourth, wellbeing literacy necessarily involves both the conception of context and literally
paying attention to the situation one is actually in. That is, the meaning of language changes
with context. Hence, a wellbeing literate person is able to adapt language use to context.
Therefore, a wellbeing literate person is also able to adapt to context and compose and
comprehend language accordingly. More broadly, what is considered wellbeing is also
conceptually bound (Alexandrova, 2017).

Finally, wellbeing literacy requires intentionality (Malle, & Knobe, 1997). The definition of
intentionality used here is based on Malle and Knobe (1997) and involves belief, desire,
intention and awareness. This relates to the “for” component of wellbeing literacy: about
and for wellbeing. Does the sender or receiver of communication aim for wellbeing
outcomes? In common language, the terms ‘skillful’ or ‘mindful' language use are relevant
to the awareness dimension and intentionality. Table 1 illustrates the necessary features of
wellbeing literacy. That is, they are conceptually necessary conditions to meet the definition
of wellbeing literacy.

Table 1 Necessary Features of Wellbeing Literacy

Feature Explanation
(1) Vocabulary and Knowledge Words and basic facts about wellbeing (ie
about wellbeing content that is signified).
(2) Capability to Comprehend Reading, listening, viewing about and for
Multimodal Text Related to wellbeing
Wellbeing
(3) Capability to Compose Writing, speaking, creating about and for
Multimodal Text Related to wellbeing
Wellbeing
(4) Context Awareness and Awareness of differences across contexts
Adaptability and adapt use of language to fit the
relevant context.
(5) Intentionality for wellbeing Habit of intentionally using language to
maintain or improve wellbeing of self or
others.

Practitioners assisting us to move towards a wellbeing literate society.

To achieve sustainable improvements in wellbeing, it is important to go beyond thinking
solely at the level of the individual to how wellbeing literacy can be addressed on a
population level. Population health aims to improve the health of populations that
“considers the distribution of health outcomes within a population, the health determinants
that influence distribution of care, and the policies and interventions that impact and are
impacted by the determinants” (Kindig & Stoddart, 2003, p. 380). These initiatives target a
range of health-related issues including management of common physical diseases,
reduction of habits deemed to be unhealthy, and mental health promotion (DeVries, 2014;
Nash, Reifsnyder, Fabius, & Pracilio, 2011; Tudor, 1996).
Practitioners are encouraged here to think about what it will take to created wellbeing
enhancing actions across the population. This is similar to standard health promotion
endeavours but at a more fundamental level. That is, thinking at the level of language use ie

16
wellbeing literacy. Many health practitioners are illness literate- with elaborate vocabularies
of illness, deficit and disease. Whilst this is not wrong, and certainly assists with cure,
treatment, rehabilitation and prevention of illness, it is not however the broader, systemic
and more positive view of wellbeing. For this a different set of communication is required.
With the rise of wellbeing science, there is the opportunity for interplay between lay views
of wellbeing and a scientific view of wellbeing.

Conclusion
Wellbeing literacy has been described as a language capability about and for wellbeing. The
multimodal capability is relevant across the many contexts in which applied psychologists
operate. Moreover, if the general population is encouraged to take a greater role and
responsibility for their wellbeing enhancing actions, greater attention to language and
language use of wellbeing will be required- as opposed to illness language and discourse.

References
ACARA. (2017). Literacy. Retrieved from https://www.australiancurriculum.edu.au/f-10-
curriculum/general-capabilities/literacy/
Alexandrova, A. (2017). A philosophy for the science of well-being. New York; Oxford
University Press.
Brothers, C. (2005). Language and the pursuit of happiness. Naples, FL: New Possibilities
Press.
Burr, V. (2003). Social constructionism (2nd ed.). London, UK: Routledge.
DeVries, M. W. (2014). Retooling for wellbeing: Media and the public's mental health. In F.
A. Huppert & C. L. Cooper (Eds.) Interventions and policies to enhance wellbeing:
Wellbeing, a complete Reference Guide, Volume VI (pp. 511-540). Chichester, West
Sussex: John Wiley & Sons.
Huppert, F. A., & So, T. T. C. (2013). Flourishing across Europe: Applications of a new
conceptual framework for defining wellbeing. Social Indicators Research, 110(3),
837-861.
Kindig, D., & Stoddart, G. (2003). What is population health? American Journal of Public
Health, 93(3), 380-383.
Mental Health Commission of NSW (2017). Wellbeing language and definitions guide 2017.
Sydney, Mental Health Commission of NSW
Malle, B.F. & Knobe, J. (1997). The folk concept of intentionality. Journal of Experimental
and Social Psychology, 33, 101-121.
Nash, D. B., Reifsnyder, J., Fabius, R. J., & Pracilio, V. P. (2011) (Eds.) Population health:
Creating a culture of wellness. Sudbury, MA: Jones & Bartlett Learning.
Nussbaum, M. C. (2011). Creating capabilites: The human development approach.
Cambridge, MA: Harvard University Press.
Oades, L. G. (2017). Wellbeing Literacy: The Missing Link in Positive Education. In Future
Directions in Well-Being (pp. 169-173): Springer.

17
Oades, L. G., & Johnston, A.L. (2017). Wellbeing literacy: The necessary ingredient in positive
education. Psychology Behavioural Science International Journal; 3(5), 1-3.
Raskin, J. D. (2012). Evolutionary constructivism and humanistic psychology. Journal of
Theoretical and Philosophical Psychology, 32(2), 119.
Sen, A. K. (1993). Capability and wellbeing. In M. C. Nussbaum and A. K. Sen (Eds.), The
quality of life (pp. 30-53). Oxford, England: Clarendon Press.
Steiner, C. (2003) Emotional Literacy; Intelligence With a Heart. Personhood Press.
Fawnskin, California.
Tudor, K. (1996). Mental health promotion: Paradigms and practices. London, UK:
Routledge.

18
 Optimising
Curriculum
Environments

19
20
 Editorial: Optimising curriculum environments
Katrina Andrews

The 21st century has seen a paradigm shift in higher education (Blessinger, Reshef, &
Sengupta, 2018). Learning is no longer confined to lecture rooms filled with paying students,
limited by local libraries, and delivered to the elite few. With the technological boom and
consequent abundance of knowledge, learning is now global, everywhere, and available to
everyone (Blessinger et al., 2018). This paradigm shift means higher education providers,
globally, need to adapt. Scholarship in the area of 21st century learning theories such as
self-directed learning (Manning, 2007), lifelong learning (Nesbit, Dunlop, & Gibson, 2007),
and connectivism (Conradie, 2014) is thriving. Similarly, demand for disciplines to teach
global 21st century employability skills (known as soft-skills) is unprecedented (Krskova,
Wood, Bryer, & Baumann, 2020; Taylor, 2016). This session, optimising curriculum
environments, explores recent research aimed at embedding industry-valued soft skills
within the higher education curriculum, to meet 21st century industry needs. The soft skills
being explored include well-being strategies (emotional regulation and distress tolerance) to
target perfectionism traits impinging on procrastination whilst higher education students
(Senderey & Papps) and tolerance of diversity in the lecture room (Sfakinos, McCann,
Walker, & Bettman).
The first presentation by Senderey and Papps, explores the predictive relationship between
perfectionistic traits and procrastination, and whether this relationship is mediated by
emotion regulation and distress tolerance with the aim of increasing awareness of
maintaining student wellbeing, academic success, and retention. Using Structural Equation
Modelling procedures to examine responses to the above variables in 851 undergraduate
students, results indicated that perfectionistic cognitions significantly predicted
procrastination, and this relationship was mediated by distress tolerance and emotional
regulation skills. These outcomes can be used as evidence of the need to embed emotional
regulation and distress tolerance skills within the curriculum in order to combat
psychological distress and procrastination behaviours as a result of perfectionistic cognitions
within the student body cohort.
Using qualitative research techniques, the second presentation by Sfakinos, McCann,
Walker, and Bettman explored how diversity can be managed in the classroom in order to
improve pedagogic practice, increase equality, opportunity, and wellbeing, and reduce
cultural gaps and friction in the classroom. In so doing, student outcomes are improved, as
are institutional retention rates. Main techniques identified speak to the 21 st century
learning theories identified above by embracing authenticity, collaboration, diversity,
empathy, etc, all of which are essential skills for success in today’s global world. Thus, it can

21
be argued that the modelling of these skills in the classroom environment may be replicated
in the workplace.
References
Conradie, P.W. (2014). Supporting Self-Directed Learning by Connectivism and Personal
Learning Environments. International Journal of Information and Education
Technology, 4, 254-259. Retrieved from
https://pdfs.semanticscholar.org/29cc/4bf0c9c007c8d0d298f012a82062c41e8c74.p
df
Krskova H., Wood L.N., Breyer Y.A., Baumann C. (2020) F.I.R.S.T: Principles of Discipline
for 21st Century Skills. In: Wood L., Tan L., Breyer Y., Hawse S. (eds) Industry and
Higher Education. Springer, Singapore
Manning, G. (2007). Self-Directed Learning: A Key Component of Adult Learning Theory.
Institute of China Studies, 2. Retrieved from
https://www.bpastudies.org/bpastudies/article/view/38/78
Nesbit, T., Dunlop, C., & Gibson, L. (2007). Lifelong Learning in Institutions of Higher
Education. Canadian Journal of University Continuing Education, 33, 35-60. Retrieved
from https://journals.library.ualberta.ca/cjuce-rcepu/index.php/cjuce-
rcepu/article/view/19944
Taylor, E. (2016). Investigating the perception of Stakeholders on Soft Skills Development of
Students: Evidence from South Africa. Interdisciplinary Journal of e-skills and Lifelong
Learning, 12, 1-18. Retrieved from http://www.ijello.org/Volume12/IJELLv12p001-
018Taylor2494.pdf

22
 The relationship of perfectionism to mindfulness-based self-efficacy, distress, and
procrastination: testing a model in an undergraduate student sample
Ester Senderey and Fiona Ann Papps

Abstract
A recent study of perfectionism and psychological distress in 1,506 Australian university
students recommended focused interventions targeting students at risk of developing
psychopathology as a result of perfectionistic personality traits. Certain aspects of
perfectionism have been associated with the onset and maintenance of psychological
disorders, such as depression, and with negative behavioural responses, such as
procrastination. Therefore, identification of mechanisms through which perfectionism
affects distress and procrastination in students can improve targeted interventions that
increase both students’ welfare and academic success and retention. The present study
aimed to gain understanding of the ways in which perfectionistic cognitions contribute to
student procrastination through emotional responses related to mindfulness-based self-
efficacy (emotion regulation and distress tolerance) and distress in a sample of first year
students in Australia. Specifically, we predicted that perfectionistic cognitions would directly
predict procrastination, and that the relationship between perfectionistic cognitions and
procrastination would be mediated by emotion regulation, distress tolerance, and distress.
We collected data from 851 first year students in an undergraduate psychological science
program in Australia at their entry into the program. Results partially supported predictions.
Although perfectionistic cognitions directly and significantly predicted procrastination, both
emotional regulation and distress tolerance mediated the relationship between
perfectionistic cognitions and procrastination, and distress mediated the relationship
between perfectionistic cognitions and procrastination, perfectionistic cognitions directly
predicted distress through both emotion regulation and distress tolerance. The resultant
theoretical model will be used to facilitate the development and implementation of
measures to increase students’ well-being and retention rates in undergraduate programs
of study.
Keywords: perfectionism, mindfulness-based self-efficacy, distress, procrastination,
undergraduate students

Perfectionism is regarded as a trans-diagnostic, contributing, and maintaining factor of the

most common clinical disorders, such as mood, eating, and anxiety disorders (Brustein,
2014; Egan, Wade, & Shafran, 2011; Flett & Hewitt, 2002; Flett, Hewitt, Wheelan, & Martin,
2007; Harvey, Watkins, Mansell, & Shafran, 2009, Iarovici, 2014; Rice, Richarson, & Clark,
2012; Shafran, Egan, & Wade, 2010). It is a multidimensional personality trait that can lead
to excellence and to negative outcomes as well, particularly in academic settings, where
research has shown it to be associated with poor student outcomes including
procrastination, unsatisfactory performance, and student retention (Scielzo & Mccloskey,
2015). One in four of Australia’s university young population (aged 15-24) will experience
mental ill-health in any one year. Students with poor mental health are more likely to drop
out from their studies (Orygen, 2017). Mental health issues not only affect young students,
they affect mature aged students as well. Fifty nine percent of older students described

23
their mental health as ‘fair’ or ‘poor’ and 53% reported high or very high psychological
distress (Headspace, 2016).
One promising area of research has been the use of mindfulness to redress perfectionistic
cognitions (Wimberley, Mintz, & Suh, 2015). The practice of mindfulness involves the
process of being purposely attentive of moment-to-moment awareness without passing
judgment (Kabat-Zinn, 1994), and mindfulness-based interventions have been especially
effective for reducing anxiety, depression, and stress (Khoury et al., 2012). However,
research has yet to examine the ways in which emotional responses associated with
mindfulness-based self-efficacy, such as emotion regulation and distress tolerance, may be
related to perfectionistic cognitions and procrastination, particularly in student samples.
Understanding how mindfulness-based self-efficacy might affect the relationship between
perfectionistic cognitions and procrastination may be a useful starting place in the
development of intervention programs for undergraduate students, building student
resilience, psychological literacy, and supporting student success and retention. The present
research, therefore, aims to contribute to this gap in knowledge by testing a conceptual
model exploring the relationships among perfectionistic cognitions, mindfulness-based self-
efficacy, distress tolerance, distress, and procrastination in a sample of first year students at
their point of entry into an undergraduate psychological sciences program.

Perfectionism and Distress

Perfectionism is a multifaceted personality tendency in a continuum ranging from non-
perfectionism, healthy perfectionism, and in the extreme, problematic perfectionism (PP). In
PP, self-worth is based exclusively on performance and achievement. Not surprisingly, self-
criticism, self-destructive behaviours, negative mood, low self-esteem, insecure
relationships and doubts about academic success co-exist with PP (Aldea & Rice, 2006;
Shafran et al., 2010). Stoeber and Otto (2006) identified a difference between people with
perfectionistic strivings and people who have perfectionistic concerns. Those with
perfectionistic strivings pursue ambitious goals and are achievement oriented. Those people
with perfectionistic concerns engage in constant self-criticism and procrastination, and they
have an all-or-nothing cognitive style which results in low productivity and chronic
frustration (Ellis, 2002). The combination of excessive preoccupation with unrelenting
standards and punitive self-derogation triggers rumination. Subsequently, rumination
perpetuates distress, anxiety, depression and in some extreme cases, suicide (Iarovici,
2014).
Perfectionism can be particularly problematic for tertiary students. For example, Talebi et al.
(2014) examined the relationship between personality type and happiness with
perfectionism in university students. They concluded that regardless of personal abilities,
the more perfectionism university students displayed, the more anxious and unhappy they
became. Similar findings were reported by Chang et al. (2011), who examined the
relationship between perfectionism and psychosocial adjustment in a sample of college
students. They found that the cognitive tendency of maximising (an exaggerated cognitive
appraisal)—central to perfectionism—was associated with low life satisfaction, emotional
exhaustion, and poor academic accomplishment. Furthermore, a recent study on
perfectionism, cognitive perseveration, and distress in students found that perfectionistic
cognitions affected distress through the mediating effect of rumination and worry
(Senderey, 2018). Cognitive perseveration, a cognitive style combining rumination and

24
worry, accounted for 62% of the variance of distress. The findings supported the Flett et al.’s
(2015) cognitive model of perfectionism which proposed that perfectionism is related to
ruminative thinking styles which lead to and maintain distress and other negative health
outcomes. Overall, these empirical findings highlight the importance of perfectionistic
cognitions in eliciting significant levels of distress.

Perfectionism and Procrastination

Not only are perfectionistic cognitions related to distress, they have also been found to be
associated with procrastination. Procrastination is a behaviour pattern of deliberate action
postponement, where an individual makes a decision for no valid reason to delay or not
complete a task to which they have committed, despite there being negative consequences
attached to following the original plan (Saulsman & Nathan, 2008, p. 2). Procrastination
exists on a continuum of behaviour ranging from normal to problematic. Flett, Hewitt, Davis
and Sherry (2004) indicated that the ‘perfectionistic procrastinator’ has frequent negative
automatic thoughts in connection to achieving perfection to gain approval. Additionally,
they typically experience negative self-concept, decreased sense of self-efficacy, extreme
fear of failure, and high dysphoria (Flett et. al., 2004; Mallinger, 2009).
Procrastination is a common occurrence in academic settings (Grund & Fries, 2018). The
‘relaxed procrastinator’ simply avoids responsibilities and redirects energies into more
pleasant tasks. In contrast, the ‘anxious procrastinator’ (Kaur & Kaur, 2011) engages in a
cycle of avoidance, delay and failure, which inevitably triggers negative emotions, social
withdrawal and in certain cases, serious disorders. Encouraging students who exhibit both
forms of procrastination in building skills both to encourage task focus and manage negative
affect could support them in the management of procrastination. Two such skills are
mindfulness-based self-efficacy and distress tolerance.

Mindfulness-Based Self-Efficacy
The practice of mindfulness involves the process of being purposely attentive of moment-to-
moment awareness without passing judgment (Kabat-Zinn, 1994). Baer et al. (2006) argue
that mindfulness is comprised of multiple components, including non-reactivity to inner
experience, observing, describing, non-judging of inner experience, and acting with
awareness. In psychology, mindfulness is used as a purposeful, and non-judgemental
sustained attention to an experience. Mindfulness-based interventions have been shown to
be particularly efficacious in reducing anxiety, depression, and stress (Khoury et al., 2012),
preventing relapses of depression, improving the individual’s sense of self-management
(Alexander, Tatum, Takos, Whittemore, &Fidaleo, 2012).
Mindfulness-based self-efficacy is a concept that blends Bandura’s (1977) notion of self-
efficacy, a self-belief system of competency to complete a task, with that of mindfulness.
Mindfulness-based self-efficacy has been defined as ‘ability to maintain non-judgmental
awareness during different situations’ (Chang et al., 2004, cited in Alexander et al., 2012, p.
116), and it is comprised of six factors: emotion regulation (an emotional response that is
well modulated and falls within the expected normal range of responses); distress tolerance
(an emotional response which inhibits avoidance of experiential intolerance or discomfort);
equanimity (the ability to normalise difficulties and prevent reactivity); taking responsibility
(clarity of interpersonal boundaries and locus of control); social skills (social abilities in the

25
broader sphere of interaction); and interpersonal effectiveness (the ability to connect with
others within the intimate sphere of relationships) (Cayoun, 2012).
The relationships among perfectionism, mindfulness, and distress are complex. A study of
university students tested the hypothesis that emotional dysregulation is a mediator
between perfectionism and distress (Aldea & Rice, 2006). The researchers found that
perfectionistic students had poor strategies for coping with their emotions. They concluded
that maladaptive perfectionism leads to an inability to regulate emotions effectively, which
then results in heightened distress. Distress tolerance has similarly been shown to relate to
distress. Huang, Szabo, and Han (2009) reported that in a sample of college students, lower
distress tolerance was associated with more worrying, even when levels of negative affect
were statistically controlled for. Distress tolerance refers to the voluntary inhibition of
avoidance of unpleasant stimulus. Distress tolerance and emotional regulation are
interconnected. The more distress tolerance and emotional regulation a person exhibits, the
less prone to engage in avoidant behaviour. A typical example of avoidant behaviour is
procrastination. Admittedly, focus on building capacity for emotional regulation and distress
tolerance can mitigate the effect of perfectionistic cognitions. This may result in a student
population with decreased levels of distress and therefore less engagement with avoidant
behaviours such as procrastination.
To date, there is no research of which we are aware that investigates the role of
mindfulness-based self-efficacy in minimising distress and procrastination, particularly in
undergraduate students. It seems likely, however, that given research demonstrating the
positive effects of self-efficacy on procrastination (e.g., Batool, Khersheed, & Jahangir, 2017)
emotional responses associated with mindfulness-based self-efficacy might be related to
both distress and procrastination. Indeed, because of the inter-relatedness of emotion
regulation and distress tolerance (Cayoun, 2012), and the relationship of both of these
emotional responses to avoidant behaviour (Boulanger, Hayes, & Pistorello, 2010), it is likely
that they would be related to distress and procrastination, which, by definition, is an
avoidant behaviour.

The Current Study

To further understand the relationships among perfectionistic cognitions, mindfulness-
based self-efficacy, distress tolerance, distress, and procrastination in a sample of
undergraduate students, we tested a conceptual model in which perfectionistic cognitions
directly predicted procrastination, mediated by the mindfulness-based self-efficacy variables
of emotion regulation and distress tolerance, and distress (see Figure 1). In this conceptual
model, we posited that in undergraduate students, engagement in perfectionistic cognitions
is associated with a lesser ability to regulate emotions and tolerate distress, in turn
predicting higher levels of distress, and a greater tendency to procrastinate. Specifically, we
hypothesized that in undergraduate students: first, we would find a positive direct
relationship between engagement in perfectionistic cognitions and procrastination; and
second, that the relationship between engagement in perfectionistic cognitions and
procrastination would be mediated by mindfulness-based self-efficacy (emotion regulation
and distress tolerance) and distress.

Method

26
Participants
We collected data from 851 first year students in an undergraduate psychological science
program in Australia at their entry into the program. Of these students, 188 (22.1%)
indicated their gender as male and 663 (77.9%) indicated their gender as female; 462
(54.3%) studied full-time, 257 (30.2%) studied part-time, and 132 (15.5%) did not indicate
their mode of study; and 134 (15.5%) studied in on-campus mode, 427 (50.2%) studied in
online mode; 63 (7.4%) studied in blended mode; and 227 (26.7%) did not provide a
response. Participants were aged between 17 years and 73 years (M = 31.71, SD = 9.90),
and 639 (75.1%) indicated their country of birth as Australia.

Measures
Participants in the study completed an online survey comprising demographic questions and
a series of questionnaires assessing perfectionistic cognitions, mindfulness-based self-
efficacy (emotion regulation and distress tolerance), distress, and procrastination. They
received partial course credit for participation.
Perfectionistic cognitions. We used the 25-item Perfectionistic Cognitions Inventory
scale (PCI; Hewitt & Flett, 2007; Cronbach’s α = .95) to assess the frequency with which
the participant used perfectionistic cognitions (e.g., ‘Why can’t I be perfect?’). Items were
rated using a 5-point Likert-type scale (0 = not at all to 4 = all of the time). Higher scores
indicated a greater tendency to engage in perfectionistic tendencies. The PCI has been
shown to have excellent convergent validity with measures of anxiety and depression in a
clinical sample of 77 psychiatric patients (see Shafran & Mansell, 2001; Cowie et al.,
2018). Cronbach’s internal consistency reliability coefficient for the current study’s
sample was excellent, α = .96.
Mindfulness-based Self-efficacy. We used the 22-item Mindfulness-based Self-efficacy
Scale - Revised (MSES-R; Cayoun, 2012) to assess the extent to which participants
reported being able to regulate their emotions and tolerate distress. The scale comprises
six subscales: Emotion Regulation, Distress Tolerance, Equanimity, Taking Responsibility,
Social Skill, and Interpersonal Effectiveness. The scale is a valid measure, with good
inverse relationships with the Depression Anxiety and Stress-Short Form (DASS21), and
able to discriminate scorers who report having a mental illness from those who do not
with a 6-factor structure (Kasselis et al., 2011). Francis and Cayoun (2011) also reported
validity of the MSES with respect to the Freiburg Mindfulness Inventory (r = .62) (FMI,
Buchheld, Grossman and Walach (2001), Kentucky Inventory of Mindfulness Skills (r =
.67) (KIMS; Baer, Smith, & Allen, 2004), the Mindfulness Awareness Scale, (r = .57) MAAS;
Brown and Ryan, 2003). We used only the Emotion Regulation and Distress Tolerance
sub-scales of this scale in our study.
Emotion regulation. We used the six-item Emotion Regulation subscale of the
Mindfulness-based Self-efficacy Scale - Revised (MSES-R,; Cayoun, 2012) to measure the
degree to which participants reported being able to regulate their emotions (ER;
Cronbach’s α = .86; Kasselis, et al., 2011). A sample item is ‘I get easily overwhelmed by
my emotions.’ Items were rated on a 5-point Likert-type (0 = not at all to 4 = completely).
Scores were reversed so that higher scores indicated a greater ability to regulate the
emotions. Cronbach’s internal consistency reliability coefficient for the Emotion
Regulation subscale for the current study was excellent, α = .90, and validation of the

27
scale demonstrated it to be correlated with body esteem, and it had negative
correlations with measures of distress like the Depression, Anxiety and Stress Scales
(Francis & Cayoun, 2011).
Distress tolerance. We used the three-item Distress Tolerance subscale of the
Mindfulness-based Self-efficacy Scale- Revised (MSES-R; Cayoun, 2012) to measure the
degree to which participants reported being able to inhibit avoidance of experiential
intolerance or discomfort (DT; Cronbach’s α = .86; Kasselis, et al., 2011). A sample item is
‘When I have unpleasant feelings in my body, I prefer to push them away.’ Items were
rated on a 5-point Likert-type (0 = not at all to 4 = completely). Scores were reversed so
that higher scores indicated a greater ability to tolerate distress. Cronbach’s internal
consistency reliability coefficient for the Distress Tolerance subscale for the current study
was moderate, α = .59, and validation of the scale demonstrated it to be with measures
of distress like the Depression, Anxiety and Stress Scales (Francis & Cayoun, 2011).
Distress. We used the 21-item Depression, Anxiety, and Stress Scales (DASS-21;
Cronbach’s α = .75; Lovibond & Lovibond, 1995) to measure distress. The DASS-21
comprises three subscales : anxiety (DASS‐A – autonomic arousal, physiological
hyperarousal, and situational anxiety; e.g., ‘I was aware of dryness of my mouth’),
depression (DASS‐D – anhedonia, hopelessness, and dysphoria; e.g., ‘I couldn’t seem to
experience any positive feeling at all’), and stress (DASS‐S – non-discriminating anxiety
and depression items that pre-dominantly consist of tension, nervous arousal, and
irritability; e.g., ‘I found it hard to wind down’) and provides a global measure of
psychological distress. Items were rated on a 4-point Likert-type scale (0 = did not apply
to me at all to 3 = applied to me very much or most of the time). Scores for items on the
DASS-A, DASS-D, and DASS-S were summed to yield a total score on distress. Higher
scores indicate higher levels of distress. The DASS-21 has outstanding psychometric
properties (Johnson et al., 2017) and Cronbach’s internal consistency reliability
coefficient for the current study’s sample was excellent, α = .95.
Procrastination. We used the 20-item Procrastination Scale (PS; Lay, 1986; Cronbach’s α
= .79). A sample item is ‘I usually buy an essential item at the last minute.’ Items were
rated on a 5-point Likert-type scale (1= extremely uncharacteristic to 5 = extremely
characteristic). Higher scores represent higher engagement in behaviours indicating
procrastination. Hasanagic and Özsağır (2018) reported a high reliability of this scale (α =
0.88) to measure behaviours indicating procrastination. Cronbach’s internal consistency
reliability coefficient for the current study’s sample was exceptional, α = .88.

Procedure
After gaining approval from the Human Research Ethics Committee of our institution,
participant recruitment began. Data were collected from first year undergraduate students
entering a psychological sciences degree at their point of entry to the degree between 2015
and 2018. Participants accessed the online survey through a link posted through an
institutional research site advertising all research which could be accessed for partial course
credit by undergraduate students. Participants were informed that submitting the
completed survey was an indication that they had consented to participate in the study, that
they would receive partial course credit in compensation for their participation, and that
they could withdraw from the study at any time by closing their browser window, but that
once their responses had been submitted, they could not be withdrawn as no names were

28
attached to the data. The debriefing page contained further information about the study
and the contact details of the corresponding researchers.
Results
Preliminary analyses
Questionnaires completed in less than five minutes were excluded from the data set.
Missing data were fewer than 1%. We handled the missing data with the Expectation
Maximisation (EM) procedure to replace missing values in the data, and all further analyses
were conducted on the new data file generated. The skewness and kurtosis values of the
scale scores indicated distributions of scores on the variables of emotion regulation (skew =
-.27, c.r. = -3.17), distress tolerance (skew = -.45, c.r. = -5.35), and distress (skew = .95, c.r. =
-11.33) had significant skew, and distributions of scores on the variables of perfectionistic
cognitions (kurtosis = -.80, c.r. = -4.73), emotion regulation (kurtosis = -.84, c.r. = -4.98), and
distress (kurtosis = .46, c.r. = 2.73) showed significant kurtosis. We therefore used a bias-
accelerated boot strapping procedure for all analyses conducted in both SPSS v. 25 and
AMOS v. 23 to deal with issues attached to non-normally distributed samples. This
procedure entailed creating 5,000 bootstrap (pseudo) samples of randomly selected
observations from the data set that were drawn with replacement (Edwards & Lambert,
2007). The model paths were estimated for each bootstrap sample (Shrout & Bolger, 2002).
Results from the bootstrap samples were then used to construct an estimate and
confidence interval for each model path. A confidence interval that did not contain 0,
indicated a significant model path (Preacher & Hayes, 2004). Strength of all correlational
relationships was assessed using Cohen’s conventions of r = .1 (weak), r = .3 (moderate), and
r = .05 (strong).
Means, standard deviations, and the range of scores for perfectionistic cognitions, emotion
regulation, distress tolerance, distress, and procrastination are shown in Table 1, and
means, standard deviations, and the range of scores for perfectionistic cognitions, emotion
regulation, distress tolerance, distress, and procrastination for men and women are shown
in Table 2. Independent t-tests indicated that women reported significantly higher levels of
distress (M = 5.99, SD = 4.61) than men (M = 5.20, SD = 4.07), t(336.03) = -2.30, p = .022,
95% BCa CI [-1.48, -1.10]; significantly lower levels of distress tolerance (M = 7.87, SD = 2.54)
than men (M = 8.33, SD = 2.38), t(849) = 2.20, p = .028, 95% BCa CI [.05, .86]; and
significantly lower levels of emotion regulation (M = 13.42, SD = 6.05) than men (M = 15.45,
SD = 6.09), t(849) = 4.06, p < .001, 95% BCa CI [1.05, 3.01]. There were no significant
differences on any of the other predictor or criterion variables according to modes of study
(full or part-time and on-campus, online, or blended). Age of participants was significantly,
weakly, and positively correlated with both emotion regulation and distress tolerance, r =
.29, p < .001 and r = .24, p < .001, respectively, and significantly, weakly, and negatively with
perfectionistic tendencies, r = -.21, p < .001; distress, r = -.27, p < .001; and procrastination, r
= -.23, p < .001.
Relations with Procrastination
The zero-order correlations among perfectionistic cognitions, emotion regulation, distress
tolerance, distress, and procrastination are displayed in Table 3. We found a weak
significant positive correlation between procrastination and perfectionistic cognitions; a
moderate significant positive significant correlation between procrastination and distress; a
moderate significant negative correlation between procrastination and emotion regulation

29
and procrastination and distress tolerance, and between perfectionistic cognitions and
distress tolerance; a strong significant negative correlation between perfectionistic
cognitions and emotion regulation, between emotion regulation and distress and between
distress tolerance and distress; and a strong significant positive correlation between
perfectionistic cognitions and distress and between emotion regulation and distress
tolerance. These results indicate support for the existence of a direct relationship between
perfectionistic cognitions and procrastinations, directly supporting our first hypothesis.
We used structural equation modelling (SEM) to test the hypothesized model in Figure 1.
Maximum likelihood estimation was undertaken using AMOS v. 23.0. All variables were
treated as observable variables. A variety of indicators was used to assess the adequacy of
the model following recommendations made by Kline (2005): the Tucker-Lewis index (TLI),
the comparative fit index (CFI), the root mean square error of approximation (RMSEA), and
the normed chi-square (χ2/df), since the chi-square test is sensitive to sample size (Teng et
al. 2017). Hu and Bentler (1999) suggested a good fitting model is indicated by values of .95
and higher for the TLI and CFI, values between .05 and .08 for the RMSEA, and a normed χ2
value of 3 or less.
The fit indices of the hypothesized model suggested that it was less than acceptable: χ2(4) =
249.36, p < .001, χ2/df = 62.34, TLI = .64, CFI = .86, and RMSEA = .27 (see Figure 2).
Examination of the standardized residual co-efficients, regression weights, and modification
indices indicated direct relations between emotion regulation and distress tolerance, and
between both emotion regulation and distress tolerance and procrastination. We therefore
added these three pathways to the model. By doing so, the fit of the revised model was
improved and provided satisfactory fit to the data: χ2(1) = 5.17, p < .001, χ2/df = 5.17, TLI =
.98, CFI = .99, and RMSEA = .07. The final model summarising these relationships is
displayed in Figure 3. A summary of the fit indices of both models against recommendations
is presented in Table 4.
As Figure 3 illustrates, perfectionistic tendencies directly predicted both emotion regulation
and distress tolerance, and both emotion regulation and distress tolerance directly
predicted distress and procrastination. Emotion regulation also directly predicted distress
tolerance and distress directly predicted procrastination. However, because SEM only
estimates the total indirect effect from predictor to criterion variables, we next adopted a
multiple mediator procedure (Preacher & Hayes, 2008) to further test the significance of
each mediation effect proposed in Hypothesis Two. We used bootstrapping analyses with
5,000 bootstrap samples to calculate 95% bias-corrected confidence intervals. The
mediation effect was evaluated as significant when the 95% confidence intervals of the
indirect effect did not contain 0. The results of tests of indirect effects are presented in
Table 5.
Contrary to our second hypothesis, which focused on emotion regulation, distress tolerance,
and distress as mediators of the relationship between perfectionistic cognitions and
procrastination, both the direct effect of perfectionistic cognitions on distress (b = .04, 95%
BCa CI [.03, .06]) and the indirect effect of perfectionistic cognitions on distress through
emotion regulation (b = .07, 95% BCa CI [.06, .08]) were significant, suggesting partial
mediation. Similarly, both the direct effect of perfectionistic cognitions on distress (b = .08,
95% BCa CI [.07, 09]) and the indirect effect of perfectionistic cognitions on distress through
distress tolerance (b = .04, 95% BCa CI [.03, .05]) were significant, suggesting partial
mediation. However, only the indirect effect of perfectionistic cognitions on procrastination
30
through distress was significant (b = .12, 95% BCa CI [.10, .16]), suggesting full mediation.
Furthermore, the indirect effect of perfectionistic cognitions on procrastination through
emotion regulation (b = .15, 95% BCa CI [.12, .19]) and through distress tolerance were
significant (b = .09, 95% BCa CI [.07, .11]), suggesting full mediation.
Discussion
In the current study, we examined the extent to which engaging in perfectionistic cognitions
predicted compromised the ability to engage in mindfulness-based self-efficacy, as assessed
by challenges with emotion regulation and distress tolerance, affecting general levels of
distress, and procrastination in a sample of undergraduate students entering a psychological
sciences program of study. As hypothesized, engaging in perfectionistic cognitions
significantly and directly predicted procrastination. However, contrary to prediction, this
relationship was not mediated by mindfulness-based self-efficacy and distress. Rather,
engaging in perfectionistic cognitions directly predicted lower levels of mindfulness-based
self-efficacy, both emotion regulation and distress tolerance, and lower levels of
mindfulness-based self-efficacy, both emotion regulation and distress tolerance,
significantly and directly predicted higher levels of distress. However, engaging in
perfectionistic cognitions indirectly predicted procrastination through mindfulness-based
self-efficacy, both emotion regulation and distress tolerance. Higher levels of distress
significantly and directly predicted greater procrastination and engaging in perfectionistic
cognitions also indirectly predicted procrastination through distress. Overall, our findings
suggest that greater engagement in perfectionistic thoughts in a sample of undergraduate
students inhibits mindfulness-based self-efficacy, which in turn encourages greater general
distress, and a greater engagement in procrastination.
Although not predicted, we also found that compared with the men in the sample, women
reported higher levels of distress, and lower levels of mindfulness-based self-efficacy, both
emotion regulation and distress tolerance. This gender difference is consistent with findings
from the National Tertiary Education Survey for females in the general population and in a
student sample (Headspace, 2016). Finally, younger students reported higher levels of
perfectionistic cognitions, distress, and procrastination, and lower levels of mindfulness-
based self-efficacy, both emotion regulation and distress tolerance. Overall, our results
suggest that the students who are most vulnerable to procrastination at the entry point to
their degree are women, younger, and those who engage in higher levels of perfectionistic
cognitions, are less able to regulate their emotions and tolerate distress, and thus
experience more global distress. This finding is consistent with a national survey which
found that 67 % of young tertiary education students in Australia (age 15-24) reported high
levels of distress (Headspace, 2016). Students not only experience distress but substance
abuse, eating disorders and other psychiatric disorders (Iarovici, 2014).
Overall, the results of this exploratory study contribute to an already significant body of
literature that demonstrates a relationship between perfectionistic cognitions, distress, and
procrastination (e.g., Chang et al., 2011; Talebi et al., 2014). It also demonstrated the
hypothesised relationships between perfectionism and mindfulness-based self-efficacy
(Flett et. al., 2004; Mallinger, 2009); between mindfulness-based self-efficacy and distress
(Batool et al., 2017; Cayoun, 2012); and between mindfulness-based self-efficacy and
procrastination as an example of avoidant behaviour (Boulanger et al., 2012) that we
inferred from the inter-relatedness of these constructs in other research.

31
Our study had limitations which require consideration. First, the sample used in the present
research was White and we collected no data on the sexuality and spiritual affiliations of our
participants. Second, data on several variables demonstrated significant skew and kurtosis,
most notably, the distress variable. The significant positive skew of the scores on distress
suggest a low overall level of distress in the sample. Although we used bias accelerated
bootstrapping to calculate robust estimates, future research may want to investigate which
group of students is most vulnerable and has highest distress scores. Third, although the fit
of the model that we devised was adequate for the data, it was not excellent. It is possible
that a better fit for the data could be obtained by including the cognitive variable of
rumination in the model. Given previous research that posits rumination as a mediator
between perfectionistic cognitions and distress (Flett et al., 2015; Senderey, 2018), it is likely
that rumination might prompt poor emotion regulation and distress tolerance, encouraging
distress and procrastination. Future research should include the variable of rumination in
the model. Fourth and finally, our study used self-reported questionnaires and a general
questionnaire of procrastination instead of a specific academic procrastination scale such as
the Procrastination Assessment Scale–Students (PASS; Solomon & Rothblum, 1984) or the
Tuckman Procrastination Scale (Tuckman, 1991) which may have provided more relevant
information about the student population. Future studies may compare different
populations (students and non-students, or clinical populations) and the same population
over a period of time.
Practice Implications
The present study extends the current literature and has important practice implications.
The resultant theoretical model could be used to facilitate the development and
implementation of measures to increase students’ well-being and retention rates in
undergraduate programs of study. Psychological interventions to foster mindfulness,
emotion regulation, flexibility, resilience, effective problem-solving and realistic goal setting
have been suggested as necessary for perfectionistic procrastination in an academic setting.
Targeting cognitive perseveration (worry and rumination) and enhancing emotion
regulation and distress tolerance skills, would seem particularly suitable in this sphere
(Macedo et al, 2017; Morris, Cranney, Baldwin, Mellish, & Krochmalik, 2018; Senderey,
2018).
Early intervention targeting perfectionism, emotional regulation, and distress tolerance are
likely to have a beneficial impact on both levels of distress and procrastination. Universities
are ideal settings for early intervention and prevention efforts directed at building a culture
of health and well-being, encouraging the development of psychological literacy in student
populations:
Health promoting universities and colleges transform the health and sustainability of our
current and future societies, strengthen communities and contribute to the well-being of
people, places and the planet. They enhance the success of the institutions, and create
campus cultures of compassion, well-being, equity and social justice (Okanagan Charter,
2015, p.2).
Conclusions
Our study is the first to our knowledge to investigate the role of mindfulness-based self-
efficacy in minimising distress and procrastination in an undergraduate student population.
In the present study, we examined the extent to which engaging in perfectionistic cognitions

32
compromised the ability to engage in mindfulness-based self-efficacy, as assessed by
challenges with emotion regulation and distress tolerance, affecting general levels of
distress, and procrastination in a sample of undergraduate students entering a psychological
sciences program of study. We found that engaging in perfectionistic cognitions significantly
and directly predicted procrastination. However, the relationship was not mediated by
mindfulness-based self-efficacy and distress. Moreover, we found that women reported
higher levels of distress, and lower levels of mindfulness-based self-efficacy, both emotion
regulation and distress tolerance, and that younger students reported higher levels of
perfectionistic cognitions, distress, and procrastination, and lower levels of mindfulness-
based self-efficacy, both emotion regulation and distress tolerance. Overall, our results
suggest that the students who are most vulnerable to procrastination at the entry point to
their degree are those who are female, younger, and those who engage in higher levels of
perfectionistic cognitions, are less able to regulate their emotions and tolerate distress, and
thus experience more global distress. This knowledge will enable us to target interventions
for students negatively affected by perfectionistic cognitions, encouraging them to build
skills grounded in mindfulness-based self-efficacy, decreasing their distress and consequent
procrastination, building on an already promising body of literature showing the
effectiveness of mindfulness in redressing perfectionistic cognitions (Wimberley et al.,
2015). Such interventions could be significant in helping to build a future cohort of
psychology graduates and potential practitioners who are engaged and resilient, with strong
psychological literacy skills, and who therefore are well-placed to contribute strongly to the
continued growth of the profession.

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Figure 1. Proposed conceptual model of procrastination in first-year undergraduate

students at point of program entry. Unbroken lines represent direct pathways
between variables.

37
 Figure 2. Initial model of procrastination in first-year undergraduate students at point
of program entry. n = 851. Unbroken lines represent direct pathways between
variables. Standardized effects are shown and represented by b values.

Figure 3. Final model of procrastination in fist year undergraduate students at point of

program entry. n = 851. Unbroken lines represent direct pathways between variables.
Standardized effects are shown and represented by b values.
Notes. a Distress = Global distress score = Sum of scores on anxiety (DASS-A), depression
(DASS-D), and stress (DASS-S) subscales of the Depression, Anxiety, and Stress Scale-21, and
averaged (DASS-21; Lovibond & Lovibond, 1995).
Perfectionistic Cognitions = Scores on the Perfectionistic Cognitions Inventory (Hewitt &
Flett, 2007); Emotion Regulation = Scores on the Emotion regulation subscale of the
Mindfulness-based Self-efficacy Scale – Revised (MSES-R; Cayoun, 2012); Distress Tolerance
= Scores on the Distress Tolerance subscale of the Mindfulness-based Self-efficacy Scale –
Revised (MSES-R; Cayoun, 2012); and Procrastination = Scores on the Procrastination Scale
(PS; Lay, 1986). *p < .05. **p = .01. ***p < .001.

38
Table 1 Means and Standard Deviations for Measures.

Measure M (SD) Minimum Maximum

Procrastination 59.03 (13.77) 22.00 95.45

Perfectionistic cognitions 45.79 (22.31) 2.00 100.00

Emotion regulation 13.87 (6.11) 0 24.00

Distress tolerance 7.98 (2.51) 0 12.00

Distressa 5.81 (4.50) 0 21.00

Notes. n = 851. All values represent raw, unstandardized scores.

Notes. a Distress = Global distress score = Sum of scores on anxiety (DASS-A), depression
(DASS-D), and stress (DASS-S) subscales of the Depression, Anxiety, and Stress Scale-21, and
averaged (DASS-21; Lovibond & Lovibond, 1995).
Perfectionistic Cognitions = Scores on the Perfectionistic Cognitions Inventory (Hewitt &
Flett, 2007); Emotion Regulation = Scores on the Emotion regulation subscale of the
Mindfulness-based Self-efficacy Scale – Revised (MSES-R; Cayoun, 2012); Distress Tolerance
= Scores on the Distress Tolerance subscale of the Mindfulness-based Self-efficacy Scale –
Revised (MSES-R; Cayoun, 2012); and Procrastination = Scores on the Procrastination Scale
(PS; Lay, 1986).

Table 2 Means and Standard Deviations for Measures for Men and Women.

Measure M (SD) t

Men Women

Procrastination 59.15 (13.78) 58.99 (13.78) .14

Perfectionistic cognitions 44.45 (20.31) 46.17 (22.85) -.93

Emotion regulation 15.45 (6.09) 13.42 (6.05) 4.06***

Distress tolerance 8.33 (2.38) 7.87 (2.54) 2.20*

Distress 5.20 (4.07) 5.99 (4.61) -2.30*

Notes. n = 851.
All values represent raw, unstandardized scores; *p < .05. **p = .01. ***p < .001.

39
Table 3 Correlations of Measures.
Measure 1 2 3 4
PS (1) -
PCI (2) .21*** -
ER (3) -.40*** -.59*** -
DT (4) -.32*** -.49*** .61*** -
DASS-21 (5) .36*** .58*** -.73*** -.57***
Notes. n = 851.
*p < .05. **p = .01. ***p < .001.
aDASS-21 = Global distress score = Sum of scores on anxiety (DASS-A), depression (DASS-D),
and stress (DASS-S) subscales of the Depression, Anxiety, and Stress Scale-21, and averaged
(DASS-21; Lovibond & Lovibond, 1995).
PCI = Scores on the Perfectionistic Cognitions Inventory (Hewitt & Flett, 2007); ER = Scores
on the Emotion regulation subscale of the Mindfulness-based Self-efficacy Scale – Revised
(MSES-R; Cayoun, 2011); DT = Scores on the Distress Tolerance subscale of the Mindfulness-
based Self-efficacy Scale – Revised (MSES-R; Cayoun, 2011); and PS = Scores on the
Procrastination Scale (PS; Lay, 1986).
Strength of all correlations are assessed using Cohen’s conventions, r = .01 (weak); r = .30
(moderate); and r = .50 (strong) (Cohen, 1992). All correlations are significant at p < .001.
*p < .05. **p = .01. ***p < .001.

Table 4 Summary of Indices of Fit for Models 1 and 2.

Index Recommended Model 1 Model 2
TLI >.95 .64 .98
CFI >.95 .86 .99
RMSEA .05 - .08 .27 .07
Normed χ2 <3 62.34*** 5.17***
Notes. n = 851.

Table 5 Tests of Indirect Effects.

Effect b [95% BCa CI] Mediation effect type
PCI → ER → Distress .07 [.06, .08] Partial
PCI → DT → Distress .04 [.03, .05] Partial
PCI → Distress → PS .12 [.10, .16] Full
PCI → ER → PS .15 [.12, .19]
PC → DT → PS .09 [.07, .11] Full

Full
Notes. n = 851.
Standardized effects are shown and represented by b values.

40
 What counts in managing diversity in the classroom: from the perspective of academic
teachers and students at ACAP
Despina Sfakinos, Pòl McCann, Sharon Walker and Cathy Bettman

Abstract
Globalisation and specifically increased mobility have resulted in many major cities of
Australia having some of the most culturally and linguistically diverse classrooms in the
world (Diallo & Miazonniauz, 2016). This creates both challenges and opportunities for
ACAP. A research project was undertaken to gain a better understanding of the dynamics
between academic teachers and students in the culturally diverse classroom to assist the
College to optimally manage its increasingly diverse student cohort. The study was
qualitative and semi structured interviews were held with both teachers and students. The
data collected through recordings were transcribed, coded and thematically analysed with
the help of NVivo software. The aim was to uncover rich and in-depth data that would
result in improved pedagogic practice, increased equality, opportunity and wellbeing and
the reduction of cultural gaps and friction that ultimately would improve student outcomes
and retention rates.
Key words: Diversity, diverse classrooms, culturally and linguistically diverse

Introduction
Australia has some of the most diverse classrooms in the world due to globalisation and
mobilisation (Diallo & Miazonniauz, 2016). International enrolments have skyrocketed along
with increasing participation rates across the Australian community (Grattan Institute,
2018). The most common student now is a young person speaking an Asian language at
home (Grattan Institute, 2018). This creates challenges and opportunities for the delivery of
higher education generally and at the Australian College of Applied Psychology (ACAP).
Much has been written about the benefits for students studying in a diverse classroom.
Students learn about their own and others’ cultural backgrounds, are more open to diversity
generally, to different ways of thinking and to challenging their beliefs, are more engaged
with problem solving, critical thinking and writing (Valentine, Prentice, Torres & Arellano,
2012). Murray (2018) suggests that international students benefit from studying at a
university or institution that has a diverse student body as well. Some of the benefits
include greater social and academic integration, the development of intercultural
competence and increased proficiency in English which is important for international
students and new migrants.
However, academic teachers at ACAP, like many higher education faculties, do not
represent the same degree of diversity as does the student population. For instance, the
National Center for Education Statistics (2003, as cited in Covarrubias, 2008) in the USA
indicated that 80% of full time faculty at postsecondary institutions is ‘white’ and represents
the dominant cultural group. More recent statistics indicate that the Australian higher
education sector has become highly diversified in the past few decades (Oishi, 2017). It was
reported that in 2015, 45% of academic staff with full-time contracts were born overseas
(DET, 2016, as cited in Oishi, 2017) but it seems evident that this may not be reflected in all

41
disciplines. Although at ACAP statistical information is not currently available, it appears
that the greater majority of teaching staff fall into the category of 'white', which for the
purposes of this paper is understood to mean European of Anglo-Saxon descent. There are
questions therefore about the impact that the lack of diversity in academics has upon the
dominant discourse of the college and whether social structures that enforce the values of
‘whiteness’ and dominant culture are perpetuated.
A number of studies were reviewed from the existing literature on the topic of diversity in
the classroom. The phenomenon of White privilege was highlighted by McIntosh when she
wrote “White privilege: unpacking the invisible knapsack” (1992). McIntosh questioned the
largely invisible areas of everyday life in which the dominant group benefited and
perpetuated inequality both consciously and unconsciously. Another study conducted by
Covarrubias (2008) in a US University involved asking American Indian students to describe
experiences of discrimination in the classroom. What became evident in the study was that
students recalled incidents as recent as the day before when White teachers had not spoken
up when peers/students or guest speakers had spoken in a derogatory way about American
Indians. The study found that there was a pattern of dismissive silence after a discriminatory
statement. Covarrubias suggested that these silences may be “invisible” to Whites but speak
loudly to people of colour and “to those to whom the discriminatory silences are aimed”
(p.229).
An international study conducted by Australian academics sought to investigate conceptions
of diversity by university educators (Gordon, Reid & Petocz, 2010). A key question asked in
the study was “how does student diversity influence learning and teaching in your classes?
(Gordon, Reid & Petocz, 2010, p.964)”. The study found that teacher responses fell into
three hierarchical conceptions which the authors labelled ignore, compensate and utilise.
The ‘ignore’ category contained responses from teachers who believed it was important to
get on with teaching the standard curriculum regardless of who was in their class. The
teachers identified as ‘compensating’ made accommodations for students such as giving
extra time, attention, support and resources. Teachers who ‘utilised’ students’ diversity in
the classroom believed it benefited students to be exposed to and to develop greater
understanding of, others diversity as a resource in learning and also in preparation for the
workforce.
Daddow’s (2017) action research study raised questions about academic teachers who are
experts in their field but may not be experts in pedagogy nor resourced to manage teaching
diverse students. He found that not all cultural literacy practices attract equal value and that
students from diverse backgrounds may face disadvantages due to being unfamiliar with
many of the transitions into tertiary study compared to students who are more culturally
privileged. When students’ own literacies were given explicit attention and they were
allowed to ask questions, relate their personal experience to a topic and to consider their
own potential contribution to the field, there was a significant shift and reduction in the
student’s anxiety. The reduction in the power differential between teacher and student
allowed students to reveal aspects of their world which otherwise would not have
eventuated resulting in a richer pedagogical opportunity. Brantmeier (2013), likewise,
challenged the inherent power dynamics of teacher/student by stating that the vulnerability
of the teacher can be beneficial for student learning. He suggested that they take risks, self
disclose and are courageous. Cayanus (2004) and others agreed that teacher self-disclosure
is a powerful tool in the classroom (Cayanus & Martin, 2008; Hosek & Presley, 2018).

42
Although the literature was rich with strategies to deliver diverse or culturally competent
classes, studies addressing cultural competence from the teachers’ and students’
perspectives were limited. With this in mind, the main focus of this study was to explore
the management of diversity in the ACAP classroom to prevent cultural misunderstandings
being a negative factor in a student’s academic performance or experience at ACAP. In this
study, it needs to be noted that diversity relates to a broader focus than is often addressed
in relation to classroom dynamics. A great deal of research has focussed on racial and
ethnic diversity but for the purposes of this undertaking, the term diversity is viewed more
broadly and includes ethnicity, sexual orientation, religion, gender, age and social class.
Method
Research design
As the study was exploratory in nature, a qualitative design based upon social constructivist
philosophies was utilized. It was interpretative, ideographic and phenomenological. This
approach was considered appropriate in order that the experiences of participants could be
communicated and the meaning that participants associated with their experiences could
be studied (Lapan, Quartaroli, & Reimer, 2011). Though not strictly grounded theory, this
research was inductive and used open, axial and selective coding methods once the data
had been transcribed and de-identified. Thematic analysis was conducted by following the
approach proposed by Braun and Clarke (2006) which involves generating initial codes from
the data, sorting and collating the codes to develop themes, and reviewing the main themes
to find subthemes.
Participants
34 participants participated in this study – 20 students and 14 teachers. 25 participants
were female and 9 were male. Data was collected through both individual semi structured
interviews and focus groups of either teachers and students and either face to face or via
Zoom.
Purposive sampling was adopted to allow for the inclusion of those participants with
relevant experiences to share (Polkinghorne, 2005). Educators were to be currently
employed and teaching either on campus or in blended classes at ACAP in any discipline and
on any of the campuses. They needed to be prepared to talk about how they manage
diversity in the classroom and their attitude towards cultural competence as an academic
teacher. Students were to be currently studying on any of the campuses and in any of the
disciplines. They needed to be prepared to talk about their experiences or perspectives of
how diversity is handled in ACAP classrooms.
Procedure
Ethics approved was applied for and granted. The study was advertised by making
information flyers about the study available in ACAP student lounges (both online and on
campus), educator rooms, staff kitchens and on a dedicated Facebook website and via a
group email to all academic educators. Care was taken to ensure the researchers did
not interview either students or educators with whom they have had, or have, a
professional, social or familial relationship.
Interested individuals who met the inclusion criteria were requested to email the Chief
Investigator using an ACAP email address. The Chief Investigator provided the potential

43
participants with an information package which included a Research Participant
Information Statement as well as Consent and Withdrawal of Consent Forms. If the
potential participant indicated their agreement to take part in the study after having
read these documents, an individual interview time was arranged. The semi-structured
interviews were audio recorded and lasted from 50-60 minutes. The recordings were
transcribed verbatim, following which the transcripts were sent to participants for
verification. In order to protect the identity of participants, participant names and other
identifying information were not used at any stage of the study.

Data analysis
Once the recordings were transcribed and the process of member checking had been
completed, the data was coded. Codes were both emergent and pre-set and the software
program, NVivo was used to assist in the organisation of the data. Working as a group of
four both assisted and challenged the process. All the researchers were lecturers in the
counselling discipline but with differing levels of counselling experience and specialisation.
This resulted in the initial stages of open coding bringing forth a rich, varied and expansive
number of codes which then had to be considerably refined and collapsed into reliable,
logical and representative categories, sub-themes and themes. This was the demanding
part as four individuals wrestled to define and determine the relevance of these themes and
then to select those that adequately spoke to the project at hand. However, following much
discussion and iterative reviewing of codes and categories, it became very clear that the two
main themes that emerged were the “self” or person of the teacher and what that teacher
actually does; that these are the essential ingredients or “what counts” in establishing the
dynamics and resulting potential for learning in the diverse classroom. The main themes,
sub-themes and categories are represented in the table below and are followed by a
description of each.
Table 1: What counts:
Main themes Sub-themes Categories
The “self” or Who they are Open and vulnerable
person of the Authentic
teacher Principled
Prepared to learn from students
Empathic and resilient

What they bring Life experience

Cultural differences
Knowledge of diversity
What the teacher Is inclusive Encourages
does Acknowledges diversity
Leads by example
Shows skill managing the Challenges
classroom Supports students
Sets the tone
Creates a safe space
Is flexible
Considers self-disclosure For (but with care)
Against

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Theme 1: The “self” or person of the teacher
This first theme identifies aspects of the teacher that appear to be significant when working
successfully in the diverse classroom. Teachers and students alike recognise an inherent
essence, “self” or personhood that effective teachers epitomise. In addition, they define
meaningful aspects that teachers have acquired through life that they bring with them, both
consciously and unconsciously, into the classroom.
1.1 Who they are
It appears that effective teachers in the diverse classroom are open and vulnerable,
authentic, principled, prepared to learn from students as well as being empathic and
resilient.
1.1.1 Open and vulnerable
Teachers spoke of at times being a little nervous before starting a new class, of seeing the
students face-to-face and coming to grips with what they would have to manage. Indeed, a
student stated that they could imagine that teachers might feel a little intimidated
particularly by some of the older students. One teacher admitted blushing, said she would
not choose this to happen but that students, who are adults, could then understand that
even someone on whom they had projected power had the potential to be vulnerable as
well. Another teacher commented that teachers are not born knowing everything but that
possibly vulnerability was experienced as being supportive and that perhaps a sense of
openness helped. Indeed, said a student, it does help that the educator is open.
1.1.2 Authentic
One of the teachers said that trust was necessary to deal with challenging moments and
that she achieves this by being authentic and by “being able to demonstrate that what I am
doing is from the bottom of my heart”. One student said that it was their experience that
some people “just seem to understand and others don’t”. Another said that he had not
openly talked about his bisexuality but that there was just something about the teacher’s
identity that “just made it comfortable for me to talk about it”. Some teachers, “just keep
missing the mark”, observed still another, “because sometimes it’s an attitude that needs to
be adjusted”.
1.1.3 Principled
One teacher was very determined about what constituted acceptable behaviour for a
teacher at ACAP. “It’s unacceptable for a teacher or a student to be behaving in ways that
are derogatory”, she said. “I work really hard”, said another, “in making the students feel as
equals … it’s about giving them your time and attention and treating them as individuals in
the class”. This teacher felt strongly that every student was unique and that others could
use whatever was brought into the classroom as a lesson.
1.1.4 Prepared to learn from students
A teacher commented that it was the cross-cultural elements of the class that she found
fascinating; that she never knew enough and that “she was constantly learning from each of
the students”, “contradictory things” from their “quite extraordinary” experiences. Another

45
commented that there was a real maturity around her students that she really enjoyed and
which left her “a bit humbled at the end of a session”. Another said:
If you get it wrong and the student calls you on it, and you accept it with some
humility … I think that builds respect too … it is modelling a learning space too, so
they’re not the only ones who have to … look within.
1.1.5 Empathic and resilient
Two quotes capture the essence of this category. In a diverse classroom, explained one
teacher, “You need those strengths and those gifts to hold people as they go through it and
make sense of it and adjust themselves”. Another pointed out that
There are lots of students who’ve been traumatised and are narcissistic, and they’re
acting out. So that’s basically how I deal with it. It’s empathy, empathy, empathy and
giving them the gallery that they require within reason.
1.2 What they bring
Teachers and students alike identified that life experience, cultural differences and a
knowledge of diversity were valuable attributes that teachers brought into the classroom.
1.2.1 Life experience
A student claimed that life experience goes a really long way; that teachers having
anecdotes up their sleeves relating to the learning were invaluable. “If you talk about your
own experience”, agreed another student, “it comes out more relevant. You are not just
picking information out of a book and saying ‘Well, Freud said such and such’”. One student
shared that they specifically came to ACAP to learn from practitioners who had practical
skills and not necessarily from the academic staff.
1.2.2 Cultural differences
A teacher shared that “being an ethnic and having a mother who still doesn’t speak English”
allowed her to understand that if you are trying to speak broken English, you kind of have to
make do and think on your feet. Another felt that being a migrant herself allowed her to
sort out the good things that she had learned here. Students believed that “when teachers
relate to you it makes it a lot easier” and that teachers from abroad are more easily able to
“share this thing of living in a different country”.
1.2.3 Knowledge of diversity
References were made to the usefulness of training and professional development for
educators. A visually disadvantaged student praised a teacher for doing some training so
“they knew the drill and there were no issues in me feeling included in the class or accepted
with other students”. Teachers revealed different professional development opportunities
and one vividly described how working in a hospital with diverse patients allowed her to
understand what is culturally important and even necessary for them. A student was
adamant that it is damaging when teachers have no awareness of multiculturalism. The
general mood was that it just “helps if there’s more awareness” and that sometimes there
are no issues at all “because [the teacher] had some previous experience”.

Theme 2: What the teacher does

46
The very “self’ or person of the teacher has been shown to be crucial but in addition, the
data has indicated that what also counts is what the teacher does. Within this theme, 4
sub-themes were identified. It was apparent that what really makes a difference is if the
teacher is inclusive, leads by example, shows skill managing the classroom and considers
very carefully the use of self-disclosure.

2.1 Inclusive
The data in this sub-theme pertained to the teacher being both encouraging and
acknowledging of diversity.

2.1.1 Encourages
Students identified that it was valuable when teachers recognised laggards and encouraged
them to become involved; that it was good when the teacher actively offered students from
all “different, diverse backgrounds … room to have a say … to speak up giving their opinion”.
One student with a disability appreciated having prior contact with an educator so that they
“could explain and work things out” before class because it was humiliating to have to
constantly ask questions in front of a group. It was also good to be given verbal prompts to
keep going. This allowed the student to feel comfortable and to gradually become more
competent.
2.1.2 Acknowledges diversity
Students enjoyed it when teachers acknowledged Aboriginal and Torres Strait Islanders.
They also appreciated recognition by teachers that “people are different” and they valued
evidence of a real desire to be interested in and value those differences. It was apparent
that asking people who look different if it was “okay” to talk about it or whether it was a
“no-go zone” was also valued. One student said that they preferred that someone asks
rather than form their own incorrect or negative view. Another opined that “if you really
respect and want to hear someone, if you don’t understand them, you ask them again”.
Another commented that the lecturers who have most inspired her and whom she wishes to
emulate, were those that loved, drew out and made beautiful the differences in people.

2.2 Leads by example

A teacher spoke of the need to embody values, to “walk our talk”. “You can’t be an
umpire”, she said, “and try and call something there and then turn around, and yourself
kind of come out with stuff that’s hurtful or mean”. Another said that “modelling
acceptance tends to make students who are racially prejudiced … much more accepting”.
Teachers modelled acceptance in a variety of ways. For example one teacher acknowledged
that theorists are sometimes “particularly blind to their own arrogance and their own
privilege” and so to counteract that, she would give students cross cultural examples and in
her PowerPoint slides always presents images of diverse groups. Another teacher spoke of
immediately shutting down any signs of disrespecting other cultures. “I would come back to
the ground rules”, she said, “and wouldn’t allow this kind of behaviour to continue”.
Students indicated that things like criticising a co-worker or not attempting to pronounce a
name correctly indicated that an educator did not handle diversity well and was not very
self-aware. A student said that she wanted to be with someone that she could be
comfortable with and trust. That person would need to be empathetic and lead by example.

47
2.3 Shows skill managing the classroom
Five categories were identified in this sub-theme. Data indicated that teachers were
considered to be helpful if they are challenging, support students, set the tone, create a safe
space and are flexible.

2.3.1 Challenges
One of the teachers identified that diversity in itself “helps people to open up … We have
gays, lesbians, we’ve got people from other countries, we’ve got people with disabilities,
people who are just people ... so, when all of these get together, it can be fiery”. A student
agreed, “that’s where the rich growing happens”. Teachers indicated that they challenged
students in a number of ways. One teacher said that they challenged “the narratives that
they were writing down”, another that “when people are very black and white about it, I’ll
poke it a little bit and say, No, you need to think outside the square”. Still another stated
that she encourages tension between students in a supervision class by making them do the
work of giving feedback to other students who might have a different perspective. One of
the teachers admitted that she has to work quite hard to be gentle around the way that she
challenges students “because of cultural differences around conflict”. She spoke of
simplifying her language and being conscious of her tone of voice when delivering what
needed to be delivered. Another teacher said that one day she proceeded with great
success to mimic a student in “a way that she wouldn’t feel that I was making a joke of her”.
The teacher recognised that she had to be sincere, build trust and that the relationship was
fundamental.

2.3.2 Supports students

“Teachers give you lots of support,” said one of the students. “I must say that any time that
I’ve emailed or asked for help … they’ve been brilliant. They have been really supportive
and I mean gone out of their way”. Another comment was that a teacher even continued to
explain things in the break. “She didn’t have to”, said the student, “and she’s incredibly
supportive”.

2.3.3 Sets the tone

One of the teachers stated, “Unless we are the people teaching and holding the space, it
really starts to impact how some of those who aren’t positioned at the centre see
themselves”. This was confirmed by a student who said that “the lecturer, whether they
mean to or not, can set the tone. And, if the student is sort of excluded even accidentally,
the other students kind of do that a bit too”. A teacher used a metaphor in saying: “It’s sort
of like you’re a conductor and this becomes organic …you’re kind of on stage”.

2.3.4 Creates a safe space

A teacher shared that her aim is to make sure that there is space for all. “I think that’s
something that I’ve worked hard at because it doesn’t feel nice when you are not included”.
Another said that she wanted to provide a safe, comfortable space where everyone could
“embrace education as an equal in the room”. The challenges indicated included for
example Middle Eastern students who had undergone terrible trauma in war torn countries
from which they had escaped and who felt marginalised and unable to talk of their
experiences. Teachers faced students who came up with discriminating comments and

48
those who were clearly different like one who “was dressed in a very unusual way …
wearing a lot of nail polish, for instance, and lots of jewellery, and earrings, yet they were
dressed in a masculine way at the same time”. Some comments were made about how
difficult situations like these are to overcome. A student spoke of a teacher who asked the
class to introduce themselves by their preferred pronoun, “which was quite clever”. A
teacher explained that arrogance and rudeness would be used as a teaching moment to
keep the place safe; that it is not about censoring or wronging the person for coming out
with a “clanger” “but supporting a movement from unawareness to awareness, from not
knowing to knowing”.

2.3.5 is flexible
Comments made by a student sum up the essence of this category. When “we are dealing
with people”, they said, “It is very dangerous to expect the same thing of everybody and
expect it all to look the same” …
I understand we all have to meet the same kind of standards or hurdles, or whatever it
may be but to think that we’re all going to do it in the exact same way I think is really
dangerous and limiting to the beautiful, diverse people we’ve got in the classroom. To
make them all want to be the same and all act the same … you’ve lost so much
richness … If you are going to deal with people and not computers or something, you
need to be creative. You need to be flexible.

2.4 Considers self-disclosure

All the comments made about self-disclosure indicated that there was a need for caution.
Whilst some remarks pointed towards the value of carefully considered disclosure at
appropriate times, other comments indicated strong feelings about it never being a
worthwhile practice. A teacher said that she sometimes made the choice to out herself in a
classroom right at the beginning. “I might just say my partner and then use her pronoun,
and that’s enough for some people to maybe relax and feel that they’re safe in the space”.
She recognised though that there are people who are really uncomfortable “with other
dynamics around them in terms of gender and sexuality”. Another teacher, said that she
was very open about having a male partner but that she had never told students that she is
transgender. Partly, she said, it was because “it’s academia which is close to my heart” but
also because there could be people around who were homophobic” and “people are still
murdered for being transgender” … I don’t want to make it about me … I don’t want to be
giving them all of my life history and then having them have to manage that. A new-
Australian teacher thought that disclosing where she was from lowered barriers and allowed
students to be themselves but another stated categorically that as a result of suffering a lot
of prejudice at school, she knew that “if they know anything about you, they’re going to get
you … I would never, never open up”.

Reflexive statement and Limitations

It is true that the participants that took part in this study were all students or teachers at
one college and therefore it might be argued that the outcome cannot be generalised to a
wider context. However, by virtue of the qualitative research methodology that was
specifically employed, and the rich textual descriptions that have resulted, this study can
only augment the current literature that is available on this topic. Again, it is true that the

49
researchers were all employees of the College from which the participants were recruited,
but very strict procedures were incorporated so that no dual relationships or bias could
result in the data collection process. In addition, the aim of the researchers was not to
provide a generalizable correlation of quantitative data but an outcome that considered and
represented the “human” side of the subject.
Discussion
In analysing the data from students and teachers the authors were reminded of a
previous study that found that teachers either ignored, compensated or utilised
diversity in the classroom (Gordon, Reid, & Petocz, 2010). What became evident in this
study about ACAP was the utilisation of the diversity of students and teachers
themselves as a tool. It was reported that classes often began with the teacher
recognising the traditional owners of the land and then both teacher and students
disclosed something about themselves including their diverse backgrounds. Students
reported that these gestures were useful in helping them settle in to the learning space.
They also reported drawing strength from hearing both teachers and students share
their diversity. A student who was gay himself and worked with older gay men was
even asked by the teacher to prepare a presentation on his work to share with the
class.
Brantmeier (2013) discussed the pedagogy of vulnerability. This study, likewise, provided
evidence of careful consideration by teachers and students alike of when their self-
disclosure and teachers’ use of self assisted in breaking down barriers in the classroom. The
small classes at ACAP were also mentioned as contributing to an intimacy that can be
created between students and teachers. Some students also noted with such small classes
students cannot get away with views that were derogatory.
In terms of the initial concerns about White privilege and dominant discourse impacting the
student experience this was not explicitly evidenced in the current study. However, as
suggested by Covarrubias (2008) it may not be possible to look for overt discrimination but
rather more detailed analyses are required to reveal deeper and more subtle layers of
discrimination. Given that the majority of educators in academia are still predominantly of
Anglo-Saxon heritage this may be worth exploring further in future studies.
The analysis of the data from the diverse ACAP study is ongoing and it is anticipated that
principles of management of diversity will be drawn from the study to inform staff practices.
This will evolve through discussions with academic and non academic staff.
Implications and Conclusion
The implication of this and previous studies in this area suggest that a student’s
diversity has an impact on their learning and personal development. This echoes what
other studies have identified, that there are a multitude of benefits for students, and
indeed educators, in learning in a diverse environment. This is a particularly pertinent
point for ACAP given that students will be working in the helping professions and with
diverse populations.
The study did not find evidence of dominant discourses disadvantaging students from
diverse backgrounds. In future a discourse analysis may find more subtle forms of bias
or privilege which may have an impact on student experience in the classroom.

50
In sum, the diverse classroom is a reality at ACAP and it is anticipated that it will
remain, and even become more diverse in the future. As a result of this study, there is
now an opportunity to further develop a “holistic” framework for pedagogical practice
in the diverse classroom at ACAP and beyond.

References
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applications. In Lin, J., Oxford, R., Brantmeier, E.J., Re-Envisioning Higher Education:
Embodied Pathways to Wisdom and Transformation (pp. 95-106). Information Age
Publishing.
Cayanus, J. (2004). Effective Instructional Practice: Using teacher self-disclosure as an
instructional tool, Communication Teacher, 18:1, 6-9, DOI:
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 Physical
Activity and
Wellbeing

53
 Editorial: Physical activity and wellbeing
Vincent Mancini PhD

The four papers that comprised this session of the 2019 ACAP Conference presented several
findings unified under the broader topic of Physical Activity and association with Wellbeing.
Three of these papers were authored by current Bachelor of Psychology (Honours) students
and all concerned mankind’s relationship to the natural world. This research showcased the
valuable contributions to broader literature already being made by an emerging generation
of researchers. The fourth paper was presented by a senior researcher that offered expert
insight into the complex literature related to the Health and Wellbeing of Elite Athletes. The
diversities in research topics, methods of inquiry, and practical implications facilitated an
interesting and thought-provoking session.
The natural world enriches people’s lives beyond the provision of resources required to
meet basic needs (i.e., food and water. Interaction with the natural world is frequently
demonstrated to improve physical and mental wellbeing for most people (Capaldi,
Dopko, & Zelenski, 2014). One leading explanation for this phenomenon is the Biophilia
Hypothesis (Wilson, 1984). In brief, people are thought to derive life satisfaction and a
sense of meaning when they feel connected to the natural world and not as an entity
that exists outside of it (Wilson, 1984). Two of the student-led papers presented in this
session can be underpinned within the Biophilia Hypothesis perspective. The first paper
by Sibthorpe provided a qualitative exploration about those people self-reported to be
experiencing a disconnection from nature. The second paper by Whelan explored how a
connection to nature in the face of potentially catastrophic global climate change could
be detrimental to mental wellbeing.
Coinciding growth in urbanisation and technology have permitted a rift between people
and the natural world to occur more easily than in previous generations (Kesebir &
Kesebir, 2017). This rift is sometimes referred to as a disconnection from nature. A
disconnection from the natural world is typically associated with lower quality of life
satisfaction and a risk factor for innumerable adverse physical and psychological
consequences (Greenleaf, Bryant, & Pollock, 2014; Nisbet, Zelenski, & Murphy, 2011).
Whilst the majority of existing research in this area explores the perspectives of those
who experience a connection to the natural world (either existing or through
intervention), few studies had sought to explore the lived experiences of individuals who
admitted to experiencing a disconnection from the natural world. Therefore, Sibthorpe’s
paper, Disconnected from Nature: The Lived Experience of Those Disconnected from the
Natural World, investigated the lived experiences of individuals disconnected from
nature was a welcomed piece of research. Findings gained through qualitative interviews
with a small group of nature-disconnected individuals yielded interesting findings
concerning the perceived feelings of guilt and isolation occurring as a consequence of
feeling disconnected from nature; however the reported discomfort of actively engaging
with nature persists as a deterrent from achieving a connection to the natural world.
Though these findings remain preliminary, important directions for future research are
highlighted.
Whelan’s paper, titled The Relationship Between Climate Change Issue Engagement,
Connection to Nature and Mental Well-Being, explored one of the major challenges for

54
academics and the historical research establishing the positive associations between
nature-connectedness and both physical and mental wellbeing. Evidence of a warming
global climate at an unprecedented rate can represent an immediate threat to wellbeing
(e.g., displacement due to rising sea levels, drought-affected agricultural industry, and
even increases in heat-related violence). However, the consequences of climate change
can also induce a feeling of anxiousness among people who may be less-directly affected
by changes in the climate (Berry, Bowen, & Kjellstrom, 2010). In other words, people who
feel a strong connection to nature often have a greater awareness of the rapid damage
to the natural world and the monumental human-effort required to restrict the damage
induced by a changing climate, leading to distress and despair (Fritze, Blashki, Burke, &
Wiseman, 2008). Feelings of helplessness and uncertainty about the future compromise
physical and mental wellbeing, that may be reconciled by the degree to which individuals
are actively engaging in issues relating to climate change (Wiseman, 2010). Whelan’s
paper explored this topic in detail, first looking at the correlates between demographics,
mental wellbeing, and connection to nature before comparing different profiles of
climate change issue engagement. Findings demonstrated that climate change issue
engagement represents an important contribution to the wellbeing among those
individuals who were concerned with the threat of climate change, with diminishing
importance in the mental wellbeing of those who are dismissive about climate change.
The third paper presented in this session provided a shift away from the natural world,
and toward the role of physical activity and wellbeing. In this study by Woodhouse titled,
Examining the Lived Experience of Wellbeing Through Regular Qigong Practice,
practitioners of Qigong, a non-traditional form of physical activity characterised by
meditative movements, were involved in a qualitative exploration regarding the
perceived benefits of the practice to physical and mental wellbeing (Posadzki, Parekh, &
Glass, 2010). Growth in the popularity, and reported benefits, of alternative forms of
physical activity in the Western World (e.g., various forms of yoga, tai chi, or other
meditative practices) have led to growing need to empirical investigation (Ng, 1999).
Woodhouse’s study provides early insight into the reported benefits of Qigong from the
perspective of experts in this practice. These preliminary findings may help to direct
future investigation for those emerging or less-experienced practitioners.
The final paper in this session was presented by Chambers, titled: Supporting Athlete
Mental Health and Wellbeing: A Rapid Review. This research examined the quality and
resources available to support the wellbeing of Elite Athletes. Whilst the benefits of
physical activity on wellbeing are well-established empirically, the unique experiences of
Elite Athletes relative to the general population advocate a need for athlete-centric
research (Lam, Valier, Bay, & McLeod, 2013; Rice et al., 2016). The commitment to
becoming an Elite Athlete and pervasive pressure to be the best among the best
engenders vulnerability to poor wellbeing, particularly poor mental health (Drew et al.,
2018). Growing recognition of the mental health challenges among Elite Athletes has led
to growing accountability upon sporting institutions and demand for strategies that allow
these individuals to maintain their mental health (Moreland, Coxe, & Yang, 2018). The
research presented by Chambers provided a review of thirteen quantitative studies
meeting strict eligibility criteria that were provided a comprehensive overview of the
current state of knowledge regarding Elite Athlete mental health. Key findings
established the importance of informal (e.g., friends and family) sources of support.

55
Formal sources of support were also highlighted (e.g., specifically employed staff such as
Player Development Managers), though the overall effectiveness of these current policies
appears to be contingent on several other factors. A need for holistic support to Elite
Athletes was a key finding, with several new strategies to address the limitations of
current strategies were also identified.
The four papers in this session presented very different topics, all unified under the broader
topic of Physical Activity and Wellbeing. The diversity in these presentations is characteristic
of this broader topic; people can engage in any number of activities in a variety of contexts
that can shape their immediate and future trajectories of wellbeing.

References
Berry, H. L., Bowen, K., & Kjellstrom, T. (2010). Climate change and mental health: a causal
pathways framework. International journal of public health, 55, 123-132.
doi:10.1007/s00038-009-0112-0
Capaldi, C. A., Dopko, R. L., & Zelenski, J. M. (2014). The relationship between nature
connectedness and happiness: a meta-analysis. Frontiers in Psychology, 5, 976.
doi:10.3389/fpsyg.2014.00976
Drew, M., Vlahovich, N., Hughes, D., Appaneal, R., Burke, L. M., Lundy, B., . . . Lovell, G.
(2018). Prevalence of illness, poor mental health and sleep quality and low energy
availability prior to the 2016 Summer Olympic Games. British journal of sports
medicine, 52, 47-53. doi:10.1136/bjsports-2017-098208
Fritze, J. G., Blashki, G. A., Burke, S., & Wiseman, J. (2008). Hope, despair and
transformation: climate change and the promotion of mental health and wellbeing.
International journal of mental health systems, 2(1), 13. doi:10.1186/1752-4458-2-13
Greenleaf, A. T., Bryant, R. M., & Pollock, J. B. (2014). Nature-based counseling: Integrating
the healing benefits of nature into practice. International Journal for the
Advancement of Counselling, 36, 162-174. doi:10.1007/s10447-013-9198-4
Kesebir, S., & Kesebir, P. (2017). A growing disconnection from nature Is evident in cultural
products. Perspectives on Psychological Science, 12, 258-269.
doi:10.1177/1745691616662473
Lam, K. C., Valier, A. R. S., Bay, R. C., & McLeod, T. C. V. (2013). A unique patient population?
Health-related quality of life in adolescent athletes versus general, healthy
adolescent individuals. Journal of athletic training, 48, 233-241. doi:10.4085/1062-
6050-48.2.12
Moreland, J. J., Coxe, K. A., & Yang, J. (2018). Collegiate athletes' mental health services
utilization: A systematic review of conceptualizations, operationalizations,
facilitators, and barriers. Journal of sport and health science, 7, 58-69.
doi:10.1016/j.jshs.2017.04.009
Ng, B.-Y. (1999). Qigong-induced mental disorders: a review. Australian and New Zealand
Journal of Psychiatry, 33, 197-206. doi:10.1046/j.1440-1614.1999.00536.x
Nisbet, E. K., Zelenski, J. M., & Murphy, S. A. (2011). Happiness is in our nature: Exploring
nature relatedness as a contributor to subjective well-being. Journal of Happiness
Studies, 12, 303-322. doi:10.1007/s10902-010-9197-7

56
Posadzki, P., Parekh, S., & Glass, N. (2010). Yoga and Qigong in the psychological prevention
of mental health disorders: a conceptual synthesis. Chinese journal of integrative
medicine, 16, 80-86. doi:10.1007/s11655-009-9002-2
Rice, S. M., Purcell, R., De Silva, S., Mawren, D., McGorry, P. D., & Parker, A. G. (2016). The
mental health of elite athletes: a narrative systematic review. Sports medicine, 46,
1333-1353. doi:10.1007/s40279-016-0492-2
Wiseman, J. (2010). Community engagement and climate change: learning from recent
Australian experience. International Journal of Climate Change Strategies and
Management, 2, 134-147. doi:10.1108/17568691011040399
Wilson, E. O. (1984). Biophilia. Cambridge, MA: Harvard University Press.

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58
 Disconnected from nature: the lived experience of those disconnected from the natural
world
Rebecca L Sibthorpe and Eric Brymer

Abstract
Previous empirical research has reported nature-connectedness to be directly linked to
enhanced mental and physical well-being, but researchers have neglected to study those
who are disconnected from nature. With more than half of the world’s population now
living in urban areas scarce of natural presence, it is becoming important to understand the
impact being disconnected from nature has on well-being. This exploratory study
investigates the lived experience of three people who identify as being disconnected from
nature. By drawing on interpretive phenomenological principals, data collected from semi-
structured interviews was analysed to reveal how the participants make sense of their
experiences. Three emergent themes and one superordinate theme was explicated from
participant accounts: discomfort, isolation, attachment and an overarching sense of conflict.
The results of this study indicate that a connection is not required for an individual to
maintain environmental concern and an attachment to nature. Furthermore, participant
experiences were flooded with accounts of stress and anxiety, social isolation and great
internal struggles. This study extends the literature on the impacts modern lifestyles have
on mental and social well-being and acts as a spark to ignite future research on those
disconnected from nature.

With the rise of technology and urbanisation, it is becoming crucial to understand the
human-nature relationship and the ever-growing disconnection between modern lifestyle’s
and the natural world (Kellert, & Wilson, 1993; Shultz, 2000; Nisbet, & Zelenski, 2011).
Nature has long been associated with the physical, mental and social health of humans.
Previous research demonstrates that being in nature, viewing nature and even seeing
pictures or paintings of nature are sources of numerous emotional, psychological and
behavioural benefits (Kesebir, & Kesebir, 2017). Researchers noticed that the level of
immersion in nature determined the robustness of the effects and termed the occurrence,
nature-connectedness (Weinstein, Przybylski, & Ryan, 2009). Shultz (2002) defines nature
connectedness as a sense of affiliation with the natural environment to the point where it
plays a significant role in one’s identity. Evidence demonstrates feeling a deep sense of
connection with the natural world can enhance human well-being by fostering a number of
benefits including reduced stress, anxiety and aggression (Thompson et al., 2012; Ulrich,
1993; Barton, & Pretty, 2010). However, with the rise of technology and a shift away from
lifestyles dependent on the land, people’s connection with nature is rapidly eroding (Wilson,
1984). Consequently, researchers need to turn their attention to what disconnection means
for both humans and nature.
Benefits of Nature
Nature is commonly thought of as a space that provides food, water and in the past, shelter.
More recently experimental data has indicated that interactions with nature are not only
imperative for survival but also central to social and mental wellbeing (Mayer, Frantz,
Bruehlman, & Dolliver, 2009). Researchers have discovered numerous benefits to come

59
from interacting with or even viewing a natural scene (Park, & Mattson, 2008). Among these
benefits is a significant reduction in stress levels (Thompson et al., 2012; Ulrich, 1993),
improved mood (Barton, & Pretty, 2010) and restoration of attentional stores (Berman,
Jonides, & Kaplan, 2008). Research also demonstrates nature has a positive effect on social
behaviours with evidence for decreased levels of aggression (Kuo, & Sullivan, 2001; Poon,
Teng, Wong, & Chen, 2016; Young, 2004), reduced crime rates (Kuo, & Sullivan, 2001b) and
a significant increase in prosocial behaviours (Zhang, Piff, Iyer, Koleva, & Keltner, 2014;
Weinstein, Przybylski, & Ryan, 2009). Findings from these studies plainly exhibit the
significant therapeutic influence of nature and fortify the need for future research into the
impact urbanisation has on human well-being.

Nature-Connectedness
Wilson (1984) was one of the first to look at the reason why nature is beneficial to humans
and termed the now popularised theory; the Biophilia hypothesis. The hypothesis suggests
that humans have an innate desire to connect with nature and affiliate with other living
things (Wilson, 1984). Wilson asserted that humans are dependent on nature for more than
just food and water, but rather a connection with nature is integral for life satisfaction and
cognitive and spiritual meaning (Kellert, & Wilson, 1993). Research on nature-
connectedness found that all benefits provided by viewing nature are enhanced when the
individual feels a deep sense of connection with the natural world (Dean et al., 2018).
Among the countless benefits reported are: increased levels of happiness, reduced anxiety,
stress and symptoms of depression, increased mindfulness and restoration of attentional
stores. In addition to improved mental well-being, a sense of connectedness with nature is
also seen to promote pro-environmental behaviours (Kesebir, & Kesebir, 2017; Zelenski,
Dopko, & Capaldi, 2015; Mayer, & Frantz, 2004).

Disconnection from Nature

With the rise of technology and a shift away from lifestyles dependent on the land, people’s
connection with nature is rapidly eroding (Wilson, 1984). Previous researchers note that our
understanding of the numerous enrichments nature provides is shadowed by urbanisation
and the rise of the digital world (Hance, 2011; Schweitzer, Glab, & Brymer, 2018). Kesebir
and Kesebir (2017) conducted a study which effectively depicts society’s disconnect from
the natural world by investigating the use of nature-related words in song lyrics. They found
a decline in the use of nature-based words such as Autumn, cloud, lake and bird with
reduction of more than 50% from 1950 to 2010. Kesebir and Kesebir noted that this decline
coincided with the rapid rise of television, which quickly became the most popular source of
indoor recreation and entertainment. This deterioration of nature vocabulary is a reflection
of nature as a taken for granted notion which is overshadowed by busy lives ruled by
technology. Dean et al. (2018) similarly depicts the decline in nature’s role since the 1950s,
in their Australian study which surveyed 1538 people on their experience of nature-
connectedness. Findings indicated a significantly greater sense of connection with nature in
older people as compared to those born after the mid-1960s. They hypothesised this cohort
effect to be due to the older generation’s experiences being so different from the current
lifestyles which are dominated by the now common household items of televisions,
computers and cars. Dean et al. postulated that technology is responsible for the decline in
human’s intrinsic desire to connect with nature.

60
Kahn, a professor of psychology in an interview with Matei in 2017, corroborated previous
ideas and dubbed the term ‘environmental generational amnesia’, to explain why we
continue to destroy nature. Kahn conducted interviews with children across America and
noticed a trend where children knew of the world’s environmental worries but could not say
what they meant for the future. He concluded that we all construct an idea of what is
normal based on encounters we have throughout our childhood, with each generation our
environment is becoming more and more degraded, and the children of each generation see
this environmental condition as normal (Matei, 2017). In line with Wilson’s initial quote
“people can grow up with the outward appearance of normality in an environment largely
stripped of plants and animals, in the same way that passable looking monkeys can be
raised in laboratory cages” (Wilson, 1984, p.118). Kahn’s ideas are aligned with Wilson
where he notes that people believe they are happy and the environment is healthy, because
they don’t know what they are missing. He permits that we cannot be entirely happy when
our brain is missing out on such a wide array of experiences that it was built to receive
(Matei, 2017; Wilson, 1984).

Consequences of Disconnection
Our modern lifestyles are causing us to spend majority of our time indoors. This physical
disconnection from nature is shown to be fostering a psychological disconnection causing
humans to be removed from the benefits provided by nature and see themselves as a
separate entity to the larger ecosystem (Zelenski, Dopko, & Capaldi, 2015). The clear divide
between nature and urban lifestyles has been described using terms indicative of mental
disorders; Biophobia and Nature Deficit Disorder. Biophobia is defined as an aversion to
nature where one feels discomfort in natural places and maintains an urge to affiliate with
technology and man-made effects (Orr, 1993). Orr poses that Biophobia is becoming more
and more prevalent due to children growing up in urban environments where nature is
placed purposefully for decoration, and technology such as television and video games are
the main source of entertainment. Louv (2012), extended on Orr’s notion and coined the
term Nature Deficit Disorder which he describes as a metaphor for the cost humans are
paying for being disconnected from nature. Louv described these costs as diminished
senses, obesity, attention deficits and emotional ailments. In line with previous research,
Louv notes the reason for this deficit is due to our modern lifestyles, which he describes as a
“plugged-in culture” that lures people inside and reduces contact with the outdoors.
Theories on diminished senses are sparing, one suggests that our digital environment forces
us to block out majority of our human senses to focus solely on a screen (Suttie, 2016).
Another theory is that we no longer require to see long distances to scope out prey or
possible dangers (Louv, 2012). While Louv’s predictions are quite extreme, many
researchers do agree with the notion that it is no longer necessary to be connected to
nature, unlike as it was with our ancestors where feeling a sense of connection with nature
meant finding food, water and other resources necessary to survive (Capaldi, Dopko, &
Zelenski, 2014).
Other researchers revealed empirical data indicating that urbanisation is, in fact, associated
with mental illness (Bratman et al., 2015). Peen et al. (2010) conducted a meta-analysis on
population surveys collected from 1985 to 2010, with the aim to investigate links between
urbanisation and well-being. Their analysis revealed those living in urban areas experienced
significantly higher rates of both mood disorders (39%) and anxiety disorders (21%). Wang
(2004), further studied this phenomenon and similarly found that participants in urban
61
areas were more likely to have major depressive episodes. This research ignores the
influence of a psychological sense of connection or disconnection with nature and focuses
solely on the physical distance. While it provides a possible silhouette of the consequences
of physical removal from nature, the lived experience of individuals who are disconnected
remains unresearched.
With this dearth in research, many have made their predictions on what this growing
disconnect means for us and our world. Kareiva, of the world’s largest nongovernment
environmental organization, argues that people’s increasing disconnect from nature “may
well be the world’s greatest environmental threat” (Kareiva, 2008, p. 2757–2758). Orr
contributes to this idea quoting “technology now allows us to move much further toward
total domination of nature now than ever before” (Orr, 1993, p. 188). Kahn similarly uses
the term domination where he notes that connecting with nature teaches us to live
alongside nature rather than the trend in the world today of dominating over all other living
things (Matei, 2017). Kellert also posed that deprivation of contact from nature may
promote maladaptive functioning and inhibit people from effectively responding to changes
(Kellert, 1997). While many have theorised about those who are disconnected by basing
their hypotheses on nature-connectedness findings, they have all failed to provide empirical
data on this population.
As research on disconnection with nature is limited, research on social disconnection
potentially shed some light on the otherwise unrevealed topic. Social disconnection has
been identified as one of the most distressing experiences that human beings can face
(Eisenberger, 2012). Yet, as technology improves, human social connections are
deteriorating (McPherson, Smith-Lovin, & Brashears, 2006). Researchers have found
technology to limit the depth of social connections which result in reports of increased
depression and loneliness and reduced life satisfaction (Green et al., 2018; Huang, 2010; Lin,
et al., 2016).

The Present Research

With the world’s trend towards urbanisation and the rapid growth of technology, research
on the human-nature relationship is becoming exceedingly important in order to aid the
struggle against the destruction of our earth and enhance mental well-being. The necessity
of this study is bound in research where some propose that modern lifestyles are potentially
eroding the connection people feel with nature and shielding them from nature’s numerous
benefits (Kellert, & Wilson, 1993; Shultz, 2001; Nisbet, & Zelenski, 2011). With anxiety and
depression related issues currently acting as one of the world’s most prevalent mental
health concerns (World Health Organisation, 2011), research on strategies to improve
mental-wellbeing is crucial. To lend to the fight against future destruction and poor mental
health, we aim to better understand the relationship between humans and nature. In this
study, the lived experiences of three people who report being disconnected from nature will
be explored to gain insight into their lives and the impact of being disconnected. The current
exploratory study aims to act as a spark to ignite future research and an appreciation of the
role of nature in everyday lives.

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Methodology

Interpretive Phenomenological Analysis

Phenomenology as a research method employs an acknowledged set of principles that
allow the researcher to explicate and portray a rich understanding of how a particular
phenomenon is experienced. The method depicts a vivid representation of lived
experiences by negating the constraints applied by scientific assumptions on empirical
research and represents the human experience as it was lived rather than attempting to
explain it. There are several variations of phenomenology, the one used within this
particular study is interpretive phenomenological analysis (IPA). IPA, like all
phenomenology, attempts to explore and understand the lived experiences of humans.
IPA pursues idiographic accounts from the individual and places focus on how individuals
make sense of their own experiences (Finlay, 2011). IPA acknowledges language as
the window into lived experiences and that it is only through language that we can begin
to understand the world. While phenomenology endeavours to represent experiences
explicitly, it also understands that language, and its true representation of our
experiences, can be a dilution of reality (Schweitzer, & Brymer, 2017). The method
acknowledges that the participant’s dialogue can result in many interpretations (Finlay,
2011). IPA accepts that the researcher’s own experiences will influence the obtained
results and has a set of clearly defined processes for IPA researchers to employ in the
attempt to reduce the impact of researcher bias. Phenomenological researchers employ
bracketing, a process in which all prior knowledge and predispositions of the interviewer
are set aside to focus wholly on the client’s unique lived experiences. IPA also prompts
reduction in researcher influence by adopting semi-structured or unstructured
interviews, open-ended questions and researcher reflexivity to provide the participant
the best opportunity to convey their experiences. IPA is guided by phenomenological
principals which allow lived experiences of a phenomenon to be holistically represented
and the core tenets of individual’s perspectives to be explicated. With this study being
one of the first on disconnection from nature, an interpretative phenomenological
approach is the most appropriate to explore the unknown phenomenon and set the
stage for future research.

Researcher Reflexivity
As someone who takes an active role in sustainability and feels a deep sense of connection
with nature, I had to take great caution and place particular importance on the bracketing
process. To minimise the influence of my personal views on nature, I maintained a reflexive
journal throughout the entire research process. The journal allowed me to address and
critically evaluate my own thoughts and interpretations during each stage and
systematically attend to possible biases.

Participants
Purposive sampling techniques were employed to recruit three participants of varied ages
and ethnicity (one male and two females) from Australia and America. All participants met
the inclusion criteria a) over the age of eighteen; b) self-identified as being disconnected
from the natural world. To protect the anonymity of participants, pseudonyms not relevant
to their identity were allocated. Any names that were mentioned throughout the interviews

63
were changed during transcription. This process was conveyed to the participants prior to
partaking in the research to aid the construction of rapport and thus, produce deep and
truthful representations of their lived experiences.

Data Collection
Following ethical approval from the Australian College of Applied Psychology ethics board
(Appendix B), a post was made to Reddit and a dedicated research Facebook page was
created and shared among the principal researcher’s contacts. Both tools included a post
with all relevant information about the study and instructions to contact the principal
researcher via email for further information. Through social media and the resulting
snowballing effect, three suitable participants were identified. Prior to data collection,
participants were provided with a participant information pack (Appendix C) via email. A
meeting time was decided upon where a total of four semi-structured interviews were
subsequently conducted by the principal researcher. The first interviewee was revisited
after the researchers interview techniques and knowledge of the topic improved. All
interviews were conducted via Skype due to location difficulties and ranged from 40 to 90
minutes in length. The interview schedule (Appendix A) consisted of five open-ended and
non-leading questions and prompts. Employing such questions allowed for rapport to be
built between researcher and participant and aid the bracketing process. Further questions
that arose from the participant’s responses were asked judiciously and without bias with the
aim to effectively explore the lived experience of being disconnected from nature. Each
interview was recorded using the Skype record function and later transcribed verbatim.
Transcripts were then provided to each participant via email where they were invited to
make any changes; no amendments were requested.
As required by the adopted phenomenological framework, the principal researcher treated
each step of the study with an open-mind, where all pre-existing ideals and knowledge were
bracketed with the use of reflexivity. A space of safety and encouragement was created by
adopting a casual, unprejudiced presence and by reminding participants throughout the
process of their rights. A sense of safety was also promoted by the use of Skype to conduct
the interviews as participants were able to speak freely within their own home.

Ethical Considerations
Ethical considerations of participant confidentiality, representation of participant accounts
and possible distress were identified. Concerns were addressed and steps to minimise the
risks were discussed prior to commencement of data collection. Throughout the project,
vigilance and care was taken to apply the steps in order to reduce and monitor the following
potential risks:
Participant Confidentiality. Rigorous steps were put into place to ensure participant identity
remained completely confidential. The first step was for the principal researcher to conduct
all interviews and transcriptions on their own before deleting the audio recording, so that
participant identity was only known by one person. All names were changed throughout
transcription, where each participant was given a pseudonym and any names announced
throughout interview were replaced with alternate names.
Explicit Representation of Participant Accounts. A major ethical consideration for all
qualitative data is appropriately and accurately representing the participant’s lived

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experience. The present study was no exception to this consideration, so the guidelines
defined by Pietkiewicz and Smith (2009) were closely followed to aid an authentic
explication of meaning. These steps included immersing myself into the participants
experiences, keeping a reflexive diary to minimise researcher influence and continually
checking themes and initial noting against transcripts. To further minimise the risk of
misinterpretation of participant’s experiences, member checking as defined by Braun and
Clarke (2013) was employed. This process took place in two stages of the study. During
transcription, the participants were provided with their final transcript and invited to make
any changes. Later, participants were provided with the final thematic map and again asked
to check if it is a true representation of their experience.
Distress to Interviewer and Participants. The following steps were taken to manage any
distress that may have arisen from the data collection process. Services sheets were
provided to participants prior to commencement of interview and the use of it was
encouraged throughout the interview process. Participants were also welcomed to cease
the interview at any point if they wish and advised to tell the interviewer if they would like a
question skipped. At the end of each interview, participants were again reminded of the
services sheet and welcomed to email the principal researcher at any point if they would
like to ask further questions. Participants were also welcomed to advise the researcher via
email if they wish to have their results removed from the manuscript at any point up until
two weeks prior to due date. Furthermore, a reflexive diary was kept, not only to minimise
researcher influence but also to recognise and manage any distress that may come to the
researcher during data collection and analysis.

Analytic Strategy
Drawing upon phenomenology and sources of IPA, common themes were explicated and an
attempt to make meaning of the transcripts completed. The phenomenological method
defined by Pietkiewicz and Smith (2009) was closely followed to aid the explication process.
Throughout analysis, an open-mind was upheld, and a reflexive diary kept aiding
subjectivity. The adopted analytic process is described:
Step One: Immersion into data. Analysis began by immersing myself in the collected data
via transcribing the audio recordings verbatim. I replayed the recordings multiple times to
ensure the transcripts were accurate. To further immerse myself into the data I continually
read the transcripts before deconstructing them and successfully fracturing the narrative
flow. I completed this by printing the transcripts, cutting them into sections, mixing them up
and focussing on one paragraph at a time. This helped to avoid reading the transcript as
what I think the participant is saying and helped get closer to the real meaning of their
words.
Step Two: Initial noting. I then began to examine the content of the transcripts by noting
any word, phrase or topic that could possibly be of interest. Deconstructing the transcripts
also helped in this stage by allowing me to analyse the data as one large lived experience
and immerse myself into the overall lived experiences of being disconnected from nature.
During this stage I also made reflexive notes when I found a quote which could possibly
bring out some personal bias.
Step Three: Developing emergent themes. To begin developing emergent themes I
analysed the notes taken in step 2 and identified interrelationships, connections and

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patterns between exploratory notes. I completed this by compiling written notes and
corresponding quotes into a document and colour coding those with similar ideas (Appendix
D). Themes reflected the participant’s original words and their perception of personal
experiences, as well as my own interpretation.
Step Four: Establishing connections and refining themes. I then further analysed the
emergent themes by re-reading through the quotes and producing multiple mind maps to
reveal eight initial themes. To further refine the initial themes, I collaborated with my
research supervisor and researched literature on each theme. After discussion, from the
eight initial themes, one was dropped due to insufficient evidential base behind the notion.
Then I was then able to identify similar characteristics between six of the remaining themes
which lead to combining them into three overall themes. After rigorous evaluation, the
transcripts revealed four shared themes which represent the participants’ lived experience
of being disconnected from nature. A process of member checking was included in this step
where a final thematic structure was emailed to participants, asking them to evaluate if the
themes represent their personal experiences. No suggestions were made.

Results
This process led to the explication of four key themes: (a) sense of discomfort; (b) sense of
isolation; (c) sense of attachment; (d) sense of conflict. While all themes play a significant
role in representing the lived experience of the participants, a sense of conflict filtered into
each part of their accounts, compelling conflict to be explicated as a superordinate theme.

Sense of Discomfort
The participants’ description of their lived experience of being disconnected from nature
was filled with notions of discomfort and unease. Each participant documented the
natural world as a place that brings them a sense of discomfort both physically and
psychologically. In the physical sense, it is seen as a place they have to be, not a place
they wish to experience. They describe the outdoors as an undesirable location polluted
with bad weather, bugs, allergies and people. HB clearly portrays this notion “I don’t have
any interest in sitting out there…it’s uncomfortable and it’s not like a nice climate”.
Throughout the portrayal of their lives, participants employed a number of negative
feelings to describe how they felt outdoors: bothered, allergies, irritable and miserable.
MS portrayed the outdoors as a “miserable” place which she would prefer to avoid. In
line with Orr’s (1993) definition of Biophobia, each participant describes this physical
discomfort as the main reason for spending such little time in nature.
Psychologically, the participants reported an overall sense of discomfort from the idea
that they are unable to control the natural world. The concerning sense of
unpredictability was undoubtedly conveyed by WS “I guess being at home to me means I
can be myself and I can choose my surroundings whereas being outside…I can’t control
anything”. HB similarly portrays this notion “there is always things to worry about like
sunscreen and if the UV index is going to be too high”. In the quotes above, both HB and
WS indicate that the demands of the environment dictate their participation in certain
behaviours, such as applying sunscreen. Furthermore, they also suggest that the
unpleasantness of the natural world forces behaviours that do not enable a state of
relaxation. Where nature is often seen as a place of calmness where you can be in touch
with your own thoughts and feelings (Howell, Dopko, Passmore, & Buro, 2011), for those

66
who are disconnected, nature poses as place of stress and unease. This is further
reflected by WS’s comments “I often find myself easily overwhelmed, anxious and
irritable while outdoors”. This notion of anxious symptoms being exacerbated in the
outdoors is contrary to previous research which states that going outdoors and viewing
natural scenes reduces anxiety and stress levels (Thompson et al., 2012; Ulrich, 1993).
While the finding in this study seems dissimilar from previous evidence that suggests
nature reduces anxiety and improves mood, it remains in line with research on nature-
connectedness. For example, Martyn and Brymer (2014), note that a deep sense of
connection with nature is required for the benefits it offers to be attained. Therefore,
those who do not feel connected will not experience the calming effects of nature. As the
current participants identify as disconnected from nature, their experiences of increased
anxiety and irritability when coming into contact with nature is supported by previous
findings of nature connectedness.
The overarching theme of discomfort was prevalent throughout all the participant’s
reflections of their lives. Each account was flooded with negative experiences with nature
and expressions of animosity towards the role it plays in causing them to feel such
discomfort. Almost no positive words were used throughout the interviews where their
discomfort overshadowed any happy experiences that may have been shared.

Sense of Isolation
A sense of isolation was conveyed by the lived experiences of those disconnected from
nature. The participant’s experience of isolation was two dimensional, where they
experienced it both socially and physically. Identifying as disconnected causes WS, MS and
HB to decline invitations to events, thus electing to isolate themselves from friends and
family. The reason for this isolation was varied but one major contributing phenomenon
was technology. In accordance with Orr (1993) and Matei (2017) technology was seen as
somewhat superior to nature, something that can be used to replace the experiences had in
the outdoors. HB often described outdoor experiences being replaced by Youtube or
television:
I can sit and drink soda at my desk and have this thing (footage of bears eating
salmon) on like a 4K TV, I can see better than the bear can! Why would I want to go to
Alaska?! That’s like dealing with 30 to 40 people from me to that stupid bear, you
know you got to buy a ticket and get in the car and you got to drive but why would I do
that when it’s on Youtube
The modern ‘plugged in culture’ (Louv, 2012) contributes to each participant’s sense of
disconnection and causes them to be isolated from the natural world and the benefits it
provides. Participants are removed both emotionally and through physical distance from
nature by viewing it often through an artificial lens like a window or camera. As described by
HB “It’s not that I hate nature, it’s just that I would like to view it through a window”. In this
quote, HB stopped short of describing the experience as strongly negative, he does not
‘hate’ nature, instead just preferring to be separated by something that still allows his visual
sense to appreciate the beauty of nature. The barrier of technology between person and
nature causes the participants to only partially immerse themselves in the natural world.
Similar to Orr’s notion of technology causing humans to only view nature for entertainment,
each participant has a one-dimensional view of nature as something to be watched from a
distance rather than experiencing it with all senses. Technology asks us to only use one or

67
two senses at a time where it has forced us to focus solely on a screen and tune out the rest
of the world (Suttie, 2016). These isolated views of nature have reduced the experience of it
to solely visual senses, but viewing nature, even if through a window, is seen to provide a
number of benefits, including reduced stress and anxiety (Ulrich, 1984; Park, & Mattson,
2008).
For some participants, the sense of isolation from the natural world was expressed as seeing
themselves as a separate entity from nature. This finding bolsters previous hypotheses of
the consequences of disconnection, for example Zelenski, Dopko and Capaldi (2015) posed
that a psychological disconnection from nature causes people to see themselves as separate
from the larger ecosystem. HB in particular described his isolation from nature: “there is a
delineation between nature and you and then there is this little grey part where you
shouldn’t be”. HB’s experiences portray nature as something we should view from a safe
distance, something that is not for us and something that is definitely not part of us. All
participants did not identify as part of nature and view themselves, as well as all humans, as
figures living outside of nature. Shultz (2002) defines nature-connectedness as nature
playing a significant role in one’s identity, so it comes as no surprise that the participants
who see themselves as disconnected from nature to feel as if it is a separate entity to them.
Isolation imposed by their disconnection from nature was also seen in participant accounts
of their relationships. MS fears that her disconnection with nature will cause her to lose the
relationship with her son as he grows older; “if that is what he is into (the outdoors) and I
am like err boring, then we would never spend any time together”. HB similarly notes that
his relationship with nature has had a negative effect on his relationship with his kids.
Today we were going to go to the local park, and there is lots of fun stuff to do
there and I guess when I was younger I would have been running around, you
know taking pictures of the kids and stuff…but now I am just like yep, there is
the playground children, go play! While I am sitting there like, I don’t
know…I don’t really care, I am just like are we leaving yet?
HB further describes moments where he misses out on time spent with his family when
they are “grilling out” as he declines the invitation in turn for watching television inside.
He notes that staying inside makes him “the un-fun uncle”. WS similarly depicts foregoing
time spent with friends and family due to her sense of discomfort in nature. Both WS and
HB describe replacing quality time with social networks with communication via the
internet. This finding remains in line with Green (2018) where they note that technology
and internet use is causing human connections to deteriorate. While the participants
relationships still flourish, they report missing out on important experiences with their
social circles. Studies on social disconnection and isolation indicate that social exclusion is
one of the most distressing experiences for humans and can be akin to physical pain
(Eisenberger, 2012).

Sense of Attachment
Surprisingly, throughout all recollections of their disconnection from nature, each
participant exhibited a strong sense of attachment to nature. Participants expressed a need
for our environments to be protected and displayed anger towards humans for destroying
what we had. HB’s anger towards humans and their impact was clear

68
 “I used to hike there all the time when I was growing up and now people have
spray painted it and it is just desecrated, so no I really don’t want to go and see what
humans have done to one of my most favourite places”.
The above quote poses the idea that nature itself is not the cause of the disconnection for
HB, instead human’s role in the destruction of nature makes the outdoors a place of
sadness. MS similarly expressed feelings of sadness towards human’s role in the erosion of
the natural world. In line with these findings and contrary to previous research, all
participants took part in environmentally sustainable behaviours and expressed
environmental concern. Both MS and WS depicted their want to protect nature by taking
part in recycling and reusable coffee cups. WS also noted she “feel(s) guilty about how us
being here and out modern lifestyles affect nature”. HB expressed taking part in additional
pro-environmental behaviours and thinking about his impact on nature during a lot of his
everyday decisions “lets get something a little nicer, to lessen our impact”. This finding is
conflicting with previous research which evidences that a sense of connection with nature
predicts pro-environmental behaviours (Mackay, & Schmitt, 2019; Zelenski et al., 2015;
Nisbet, & Zelenski, 2011). While participants portrayed a deep sense of concern for nature,
they reported taking part in minimal sustainable behaviours. Clearly depicted by WS “like I
don’t go out of my way advocating for sustainable housing and I am not vegan or anything
but I still think I do some things to minimise our impact”. The reduced actions towards
sustainability are in line with Howell et al. (2011) who notes that nature connectedness does
not directly cause the behaviours, instead it is seen to be positively correlated with
increased participation in environmentally sustainable behaviours. Consequently,
disconnection may not mean maintaining no environmental concern, instead it may result in
reduced participation in pro-environmental behaviours. Matei’s (2017) definition of
‘environmental generational amnesia’ could be one possible explanation for this finding.
Participants understand the world’s environmental worries and may see the current
condition of nature as normal, thus resulting in the minimal participation of sustainable
behaviours.
Throughout the interviews the sense of protection was obvious, but it wasn’t until the
explication process that the notion of attachment to nature surfaced. The theme of
attachment to nature was evoked by participant behaviour rather than their emotion. Each
participant explained nature as something negative in their life yet they all described actions
to save it and moments where they appreciate it. The intrinsic sense of attachment is
therefore deeper than thoughts, it is an unconscious and implicit experience for the
participants. On the surface they all identify as disconnected from nature, where they are
not a part of it and feel unwelcomed, but at the core there is a profound sense of
attachment and need to nurture the environment. This overarching theme speaks to the
Biophilia hypothesis where Wilson (1984) substantiated that nature is at our core as humans
and no matter how far technology or urbanisation physically distances us it will forever be a
part of humans.

Sense of Conflict
Throughout all of the participant recollections there was a prominent and overarching
theme of conflict. A sense of conflict is presented as a superordinate theme as it coloured
experiences for every participant and was present within each of the emergent themes. The
expression of conflict can be seen in two modes; socially, where the participants continually

69
battle with society’s expectations and their own individual feelings about nature.
Emotionally, where they struggle between an intrinsic sense of attachment to nature and an
overt sense of disconnection.
Social Conflict. Each participant expressed a conscious battle between social norms and
their personal feelings towards nature. Similar to all social norms, when individuals’
beliefs do not match those of the general population it causes a great sense of internal
conflict and shame. MS represented this theme expressly, when asked if she often thinks
about humans’ impact on nature, she responded reluctantly with “I am going to have to
say no. I know that sounds terrible…but no”. MS clearly felt a sense of guilt for responding
truthfully to this question and seemed to judge herself based on the pressures of society.
While a safe and judicious environment was preserved throughout the interview, the
pressure of social expectations on sustainable behaviours and thoughts seeped into the
interview. All participants similarly portrayed an ongoing conflict, where HB describes
himself as “broken” because what he feels about nature is abnormal and not what he
believes someone should feel. The negative judgment placed upon oneself is also evident
in WS’s account “I would love to tell you that I look after our world to the best of my
ability but I just don’t “. Social norms and the sense that what they feel is wrong, causes
them to spend more time avoiding the outdoors and the judgement from self and others
that comes alongside leaving their homes.
Emotional Conflict. Within each participant reflection of their lives, an internal battle was
evident between an intrinsic sense of attachment to nature and an extrinsic
disconnection. While the sense of disconnect was obvious in each interaction, the sense
of nurture was implicit and to some, it was so hidden by their identity of being
disconnected that they could not recognise it in themselves. Both WS and MS described a
very limited relationship with nature and admitted to not taking part in many, if any,
sustainable behaviours. Yet, both said they would hate to live in an urban environment
where nature plays no role and expressed concern about the impact humans are having
on the environment. A sense of almost surprise was elicited when speaking about
wanting to save nature, as if they had never thought about it before and their behaviours
to save it were unintentional. This surprise seemed to be born out of a conflict between
explicitly identifying with disconnection yet possessing an intrinsic sense of adoration for
nature. The core attachment to nature also conflicted with the participants distaste for
the discomfort and isolation is causes. This is seen in accounts of avoiding the outdoors
and identifying nature with irritability and anxiety but still noting that they “don’t hate
nature” (HB) and wish to protect it.
Discussion
This study set out to explore the lived experience of those who report being disconnected
from nature. The rich portrayals of participant lives illustrated that those who are
disconnected experience nature both in ways similar and distinctive from those who are
connected to nature. Participant accounts reflected the significant impact of technology on
their connection with nature and like so many phenomena, they experienced guilt and
internal conflict from the pressures of society. A great sense of isolation was suffered by
each participant causing them to move closer towards technology and the safety of their
homes. Lastly, and the most surprising of all is the participants attachment to nature. Each
maintained environmental concern which drove their participation in pro-environmental

70
behaviours. While they all identified as disconnected from nature they are unable to deny
the intrinsic sense of attachment to nature and the desire to protect it.

Transferability and Future Directions

The present study contributed to existing knowledge on the human-nature relationship. Our
findings defied previous theories about those who are disconnected from nature and should
highlight a critical need for future research. Whilst the study’s small participant pool may
limit the transferability of findings, the individuals were varied in gender, upbringing and
culture, making the sample representative of a diverse range of people. We also
acknowledge that the interpretation of participant’s dialogue can result in many
interpretations, but we remained true to phenomenological principals and maintained
researcher reflexivity to move towards a true representation of the lived experiences of the
present participants. The qualitative nature of the study provides a stable foundation for
further research on people who are disconnected from nature. While our findings were both
interesting and surprising, this study is new, so this phenomenon should be considered in
the future. Future research will expand the minimal knowledge we have on these
experiences and optimistically aid our battle with environmental erosion and increased
instances of mental illness.

Conclusion
In summary, the lived experience of being disconnected from nature is largely impacted by
technology and social norms. Identifying as disconnected caused participants to focus on
the discomfort of the outdoors and overlook the positive experiences to be had in nature. In
the present study, the participants declared discomfort and isolation due to their disconnect
but they also experienced environmental concern and an intrinsic attachment to nature.
The current findings both contradict and sustain previous theories on disconnection and
inspires discussion on the impact modern lifestyles have on the human-nature relationship.
Through further research, the present study will contribute to the fight against both
environmental degradation and the increase in mental illness.
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 Examining the lived experience of wellbeing through regular qigong practice
James Woodhouse and Eric Brymer

Wellbeing, often referred to as wellness, is generally defined as “optimal psychological

functioning and experience” (Ryan & Deci, 2001, p. 142), beyond the absence of illness
(WHO, 1967). Wellbeing is understood as a multidimensional concept informed by
interactions between various domains, contributing to optimal psychological functioning
(Rachele, Washington, Cockshaw & Brymer, 2013). The domains with the most empirical
support include: physical, emotional, social and spiritual wellness (Roscoe, 2009). Physical
wellness describes a state of physical health, facilitating self-care and awareness of bodily
feelings and sensations (Hettler, 1980). The emotional domain relates to being aware of and
accepting of one’s feelings, including the capacity to handle stress and act autonomously
(Roscoe, 2009). Social wellness relates to an individual’s ability to have meaningful
connection and interactions with other people (Roscoe, 2009). Spiritual wellness refers to a
subjective sense of meaning and purpose in life (Roscoe, 2009), including an appreciation of
the complexity of life and the universe (Hettler, 1980).
From a psychological perspective, empirical research and theoretical models on wellbeing
have, for the most part, approached the concept from two distinct philosophical
perspectives. Hedonic wellbeing focuses on subjective happiness and pleasurable
experiences (Ryan & Deci, 2001), whereas, eudaimonic wellbeing conversely focuses on self-
actualization or fulfilling one’s potential (Waterman, 1993).
Theoretical models have conceptualized this dichotomous interpretation of wellbeing in a
variety of ways. Models such as Diener and Lucas’ (1999) Subjective Wellbeing (SWB) model
conceptualize wellbeing from a hedonic perspective, with the focus on maximizing
happiness. SWB consists of 3 elements: predominance of positive affect, little or absence of
negative affect and high satisfaction with life (Deci & Ryan, 2008). In contrast, theorists of
eudaimonic wellbeing have critiqued the assumption that happiness is equivalent to
wellbeing. For example, Ryff and Keyes (1995) conceptualized psychological wellbeing as
distinct from SWB, arguing for six components facilitating actualization of human potential,
including: personal growth, self-acceptance, life purpose, positive relatedness, autonomy
and environmental mastery. Self-Determination Theory (SDT) (Ryan & Deci, 2000) was
another theory that also emphasized self-realization as a crucial element of wellbeing. In
order to achieve self-actualization, proponents of SDT believe three basic psychological
needs must be met: including: autonomy, competence and relatedness. Common factors
across different eudaimonic wellbeing theories highlight the importance of 1) feelings of
control over one’s life and behaviour (autonomy) and 2) positive relationships, including
connectedness to others (relatedness/positive relatedness; Ryan & Deci, 2000; Ryff & Keyes,
1995). Waterman (1993) posited that maximizing potential as a human being, would
facilitate feelings of authenticity and aliveness, operationalized as ‘Personal Expressiveness’
(PE). These theoretical perspectives have some overlap, as Waterman (1993) found hedonic
enjoyment, a component of hedonic wellbeing, was strongly correlated with PE, despite
representing distinct experiences. Given the strong correlation between both wellbeing
perspectives, wellbeing likely consists of elements from both hedonic and eudaimonic
paradigms.

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There is a substantial body of evidence indicating physical activity can promote physical and
psychological improved wellbeing. Boehm et al. (2017) found both psychological and
physical wellbeing were enhanced through high levels of cardiovascular fitness. Increased
frequency of physical exercise has also been linked to greater feelings of positive affect
(Hyde, Conroy, Pincus & Ram, 2011). Bumen et al. (2010) reported any intensity of exercise
conferred physical health and wellbeing benefits. These findings appear to be robust, as
Arbinaga, Fernández-Ozcrorta, Sáenz-López and Carmona (2018) found no evidence of a
placebo effect, demonstrating wellbeing and life satisfaction increases in multiple exercise
groups, regardless of the participant’s psychological expectations.
In recent years, research has found that non-traditional forms of physical activity, such as
extreme sports or yoga, have profound impacts on psychological and physical wellbeing
beyond those recorded for traditional physical activity. For example, activities that fostered
a deep connection with nature and a harmony with the natural world, such as extreme
sports, have been shown to profoundly increase wellbeing (Brymer, Cuddihy & Sharma-
Brymer, 2010; Brymer & Gray, 2010). This connection with nature was described as
experiencing a primal force (Brymer & Schweitzer, 2017), challenging the participant’s
concept of ‘self’ and ‘other’, facilitating a shift from egocentrism to ecocentrism (Brymer &
Gray, 2010). Extreme sports participants have reported wellbeing experiences including: an
intense awareness of being in the present, embodiment and a deep sense of meaning
(Morse, 2015). Brymer and Schweitzer (2017) described being completely present resulted
in experiences of mental silence, dissolving mundane thoughts and responsibilities.
Experiences of embodiment have also been recorded in yoga practitioners (Morley, 2001).
Through breath control, participants were able to connect the mind and body (Morley,
2001). Brymer and Schweitzer (2017) described how sports undertaken in the natural world
were able to transform participants’ capabilities and their relationship to other people and
the outer world. Participants reported experiencing radical personal transformation and
freedom from constraints (Brymer & Schweitzer, 2017), describing how the experience
impacted various other aspects of their lives (Brymer & Oades, 2009). Through participation
in extreme sports, participants have described feeling much more alive than other
moments. Therefore, alternative forms of physical activity may provide an interesting way
to examine wellbeing.
Meditative movements (MM), another of a non-traditional form of physical activity,
demonstrate an ability to improve various dimensions of wellbeing. Meditative movements
are characterised by four dimensions: movement, a meditative state of mind, deep
relaxation and attention to the breath (Larkey, Jahnke, Etnier & Gonzalez, 2009). The unique
combination of these elements appears to offer synergistic holistic wellbeing benefits. This
meditative state of mind shares conceptual similarities with mindfulness, defined as
awareness and acceptance of the present moment (Keng, Smoski & Robins, 2011).
Mindfulness interventions have shown the ability to improve wellbeing and stress after an
eight-week intervention (Carmody & Baer, 2008) and improve quality of life (Carlson, Speca,
Patel & Goodey, 2004). Psychological wellbeing appears to be improved through increased
mindfulness (Keng et al., 2011), enhancing attenuation of cognitive and emotional reaction
to stimuli (Gu, Strauss, Bond & Cavanagh, 2015). MM’s element of breath control,
specifically “diaphragmatic breathing” or “deep breathing”, has demonstrated an ability to
reduce mood disturbances and psychological stress (Perciavalle et al., 2017) in addition to
decreasing negative affect (Ma et al., 2017). A review by Payne and Crane-Godreau (2013)

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found MMs reduced levels of anxiety and depression when compared with exercise
controls. Similar results were also found in a meta-analysis by Wang et al. (2013)
demonstrating relief of depressive symptoms, conferring greater benefits than conventional
exercise. Therefore, meditative movements may offer unique wellbeing benefits, distinct
from regular exercise.
The Ancient Chinese art of Qigong is an example of a meditative movement linked to a
variety of multidimensional health and wellbeing outcomes. Qigong is philosophically
described as acquiring and working with a notion of life energy (Cohen, 2005). Common
elements of all Qigong practices include movement postures, deep breathing and focused
attention (Horowitz, 2009). Although several branches of Qigong exist, health Qigong is the
primary focus of this study as it is aimed at improving holistic wellbeing, physical health, and
treating illness.
Qigong has shown an ability to reduce the presence of negative affect, improving
psychological factors such as anxiety, depression and stress. Chan et al. (2013) found ratings
of depression, anxiety and stress in a sample of nursing and midwifery students were
significantly lower than a control group after a ten-week Qigong intervention. In participants
with depression, eight weeks of Qigong practice improved wellbeing, mood and self-efficacy
when compared to a newspaper reading group (Tsang, Fung, Chan, Lee & Chan, 2006).
Qigong has also demonstrated the ability to improve wellbeing and quality of life. Zou and
colleagues’ (2017) meta-analysis reported Qigong significantly improved quality of life.
Cheng, Wang, Chou and Yeh (2018) found similar improvements in quality of life, with
participants also reporting improved psychological health and spiritual wellbeing. Oh et al.
(2010) and Oh et al. (2012) reported improvements in four domains of wellbeing after a
Qigong intervention, including: physical, emotional, social and functional wellbeing.
Whilst Qigong has demonstrated the ability to improve multi-dimensional health and
wellbeing, quantitative research on meditative movements possesses inherent limitations.
Zou et al. (2018) highlight the difficulty of blinding in MM interventions, positing inadequate
concealment may lead to expectation bias in the participants. Yeung, Chan, Cheung and Zou
(2018) noted significant heterogeneity of participants, differing controls and a wide range of
outcomes and measures in the Qigong literature. Another criticism of existing Qigong
literature is the large focus on health compromised participants (Jahnke, Larkey, Rogers,
Ethnier & Lin, 2010). Many experimental intervention protocols consist of eight to twelve
weeks of Qigong practice, rarely investigating the effect of prolonged Qigong practice
(Jahnke et., 2010). Leung and Singhal (2004) demonstrate years of Qigong practice is
negatively correlated with neuroticism, therefore, regular Qigong practice over an extended
period of time may be associated with differential wellbeing outcomes and warrants some
investigation.
This study examines this question using a phenomenological approach to investigate the
impact of regular Qigong practice on wellbeing and how wellbeing comes about.
Furthermore, there is limited research examining the subjective lived experience of
wellbeing through regular Qigong practice. Therefore, this study aimed to explore
participants’ lived experience of wellbeing through regular Qigong practice.
Study Overview & Reflexive Statement

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Data in this study was gathered and analysed using a hermeneutic phenomenology
methodology. The aim of hermeneutic phenomenology is for the researcher to act as an
“interpreter of interpreters” (Brymer & Schweitzer, 2017, p. 20), whilst concurrently
providing a rich and rigorous description of the phenomenon in question (Brymer &
Schweitzer, 2017). Phenomenology adopts the epistemological position that immediate
experience occurs on a pre-reflective level, and may not be captured adequately by
language (Ajjawi & Higgs, 2007). However, it is only through language participants can
express their direct experience (Willis, 2001). Therefore, the language selected by
participants is examined very carefully to ascertain what the words reveal about the
phenomenon in question (Brymer & Schweitzer, 2017). Phenomenological analysis aims to
explore beyond language to articulate the phenomenon’s characteristics at a profound
depth (Brymer & Schweiter, 2017).
The researcher is required to “bracket” preconceived ideas and subjective understandings of
the experience, allowing the essence of the experience to emerge from the data (Brymer &
Gray, 2010). However, the researcher is intrinsically connected with the interpretation
process and must engage in a deep analysis of not only the participant’s lived experience,
but also their role in interpreting these experiences (Smith, Flowers & Larkin, 2009).
Practically, this takes the form of an iterative cycling between understanding the lived
experience, and considering the researcher’s role in making sense of this experience (Smith
et al. 2009). This is referred to as the hermeneutic circle (Langdridge, 2007). In this study the
researcher reflected upon their role in interpretation through considering whether the
themes were grounded in the data by reflexively asking themselves “am I interpreting this
text from a position of interference from theory or bias?” (Brymer & Schweitzer, 2017, p.
50). The researcher must also acknowledge that the analytic process is indeed creative, and
accept that many interpretations of the data are possible (Klein & Westcott, 1994)

Method

Participants
Following ethics approval from the Australian College of Applied Psychology (HREC approval
number - 510280519). Four regular Qigong practitioners (one man and three women, aged
40-56 years) were recruited across three continents: Europe, Australia and Oceania. To
meet inclusion criteria, the participants were required to have practiced Qigong regularly,
operationalized as practicing for at least two months, and have experienced wellbeing
through their practice. Initially, participants were recruited via email correspondence with a
Qigong instructor (Appendix I). Participants were then recruited through an invitation to a
Qigong event, for script see (Appendix K). Participants were subsequently recruited through
social media (Appendix L),

Interview
During the interview process pre-conceived ideas and understandings regarding Qigong
were ‘bracketed’ as much as possible. In practice, this was achieved by asking follow-up
questions such as ‘when you say Qigong makes you feel alive, what exactly does it feel
like to feel alive?’. In this way, meaning and understandings emerged from the data,
rather than the researcher’s pre-conceptions. Interviews were conducted face-to-face (n
=2) or by Skype video-conference (n =2), with the place and time arranged through

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mutual agreement. Face-to-face interviews were conducted in a private meeting room in
a local library. The room was quiet and free of distraction to allow for optimal participant
engagement.
A semi-structured interview process was used to encourage an in-depth discussion, allowing
the researcher the ability to ask follow up questions. Before the interview commenced the
participant was presented with a participant information statement (Appendix B), list of
interview questions (Appendix H), consent form (Appendix C), interviewer agreement form
(Appendix E) and withdrawal of consent form (Appendix D). Four pre-set questions were
used to guide the interview process, based on the overall phenomenological question of:
“What is your lived experience of wellbeing through regular Qigong practice?”. Initial
questions were designed to facilitate rapport building and explore the participant’s
understanding of wellbeing. Sub-questions and follow-up prompts were used to further
explore aspects of their experiences. Open ended questions were used to allow themes to
emerge from participants’ accounts, rather than being imposed by the interviewer.

Analytic Strategy
Data was analysed using a hermeneutic phenomenological methodology. Each interview
was audio-recorded and listened to thoroughly, then transcribed into text for analysis. The
recording was then erased to ensure no identifiable record exists. Each transcript was then
read as a whole, to gain a sense of the themes and meanings arising from the text. After a
summary was prepared of the transcripts, each transcript was closely analysed for relevant
phrases and meanings related to the phenomenological question of ‘what is the experience
of wellbeing through regular Qigong practice?’ Data addressing the research question from
the range of interviews were collated, with the context and non-verbal considerations
relevant to these quotes also noted. Each transcript was examined numerous times to
ensure important nuances of the experience were respected and acknowledged.
The data was first analysed by grouping similar ideas and meanings into first order themes.
First order themes were subsequently analysed to examine whether they were able to be
amalgamated. In order to group first order themes, interpretations were considered in light
of the question “what am I missing?” (Brymer & Schweitzer, 2017, p. 50) Second order
themes emerged from several iterations of re-reading, conceptualisation and interpretation
of the data, whilst remaining aware of the context in the original transcript. In practice, this
was achieved through free imaginative variation, described by Brymer & Schweitzer (2017)
as a process in which themes are imaginatively altered or deleted to test whether they were
valid. Subsequently, themes and respective data were closely analysed to ensure
appropriate fit, ensuring distinct ideas were not grouped together.

Trustworthiness and Transferability

Trustworthiness and credibility of the data is reflected by how faithful and vivid the text is to
the experience itself (Beck, 1993). To ensure themes accurately represented the
participant’s experience, the researcher utilized the process of member-checking. A
description and summary of emergent themes was emailed to participants involved in this
study for feedback. Transferability has been ensured by clearly documenting the steps taken
in the research process, allowing for replication. The epistemological stance taken by
hermeneutic phenomenology is knowledge is subjective and constructed by the mind,
therefore, multiple realities are equally possible (Smith, 2018). Therefore, hermeneutic

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methodology aims to describe and explore an experience, rather than attempt to generalize
or explain (Brymer & Gray, 2010).

Results and Discussion

This study set out to investigate the lived experience of wellbeing through regular Qigong
practice using hermeneutic phenomenology. The findings reveal relationships and nuances
of experiences of wellbeing not previously explored in the traditional empirical positivist
framework, aiding a deeper understanding of the phenomenon of Qigong and enhancing
our understanding of how best to design wellbeing interventions. Two distinct elements of
experience emerged from the research. The first was the moment-to-moment experience of
practicing Qigong, i.e. the thoughts, sensations and percepts involved during the act of
practicing Qigong. The moment-to-moment experience can be conceived in three themes:
being present, being alive and being connected. As these themes concerned moment-to-
moment experience, they were labelled as ‘being’ themes. The second element was related
to the effects of regular Qigong practice over an extended period of time. This element
focused on the personal impact on the practitioners’ lifeworld by repeatedly engaging in this
practice over time. Regular practice of Qigong can be conceived by three themes: becoming
well, becoming transformed, becoming embodied. Given these themes reflected a process
of change and transition over time, these themes were labelled as ‘becoming’. In the
following sections these themes will be explored. To protect co-researcher confidentiality
this study refers to participants as Participant 1, 2, 3 and 4.
Being Present
This theme describes a dramatic temporal shift in perception, allowing participants to
become intensely aware of only the present moment. Through a combination of deliberate
focused attention, movement and breathing techniques the participant experienced acute
present moment awareness. Through concentration and focus, participants described
merging with the present moment, creating separation from thoughts of past and future.
Participants also reported changes in their relationship to thought. The act of merging with
the present moment facilitated deep feelings of relaxation and letting go, providing freedom
from constraining circumstances.
A key element of being present was focused attention and a deep sense of concentration.
This single pointed concentration was frequently directed toward a physical point of
reference, as a facilitator to the present moment. Present moment awareness had a
sensorial component, with participants reporting acute awareness of physical sensations.
Participant 3 described how acute kinaesthetic awareness triggered this state: “When
you’re thinking about where you move your weight on your one foot and you have to think
about that, you absolute forget everything”. According to Participant 3, the action of
adjusting the foot forced them to become acutely aware of their bodies’ orientation in
space, taking them deeply into the present moment, free of thoughts and considerations of
past and future. Morse (2015) described similar experience of present moment awareness
in a study of kayakers. The experience of being lost in the moment was an all-encompassing
phenomenon, merging the perceiver and the perceived (Morse, 2015).
Absolute forget it, which is really sad. For example, if my son stayed home sick but I
have to go to teach, I absolutely forget the problem. Because I am in the present to do
that one. And when I turn on my phone, ohh my son! Absolute forget. (Participant 2)

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Here Participant 2 describes the depth of engagement in the present moment was so
overpowering the participant was removed from experiences of ordinary consciousness, to
a state where worries and problems ceased to exist, even if they involved elements clearly
of concern. Morse’ (2015) similarly described the experience of present moment awareness
withdrew participants’ attention from everyday distractions. As a result, participants were
able to experience the present moment without any boundaries, unimpinged by societal or
other considerations (Morse, 2015).
Not worried about what’s happened in the past, you don’t worry about what’s
coming. You’re enjoying. When you drink the water which you like, and is going
through in your mouth, and you enjoy what is going down in your body, that is the
present. (Participant 3)
Here the participant’s sense of time was radically altered, removing themselves from the
unceasing narrative of past and future. As a result, the participant was no longer concerned
about what had happened or what was to come, allowing them to fully enjoy the sensations
experienced in the present moment.
Present moment awareness in Qigong was achieved through keeping the ‘monkey mind’
occupied, referring to the thinking mind’s tendency to tangentially jump from one thought
to another, leading to a barrage of thoughts, or “monkeys chasing different thoughts”
(Participant 4). The silence described as characteristic of being in the present moment was
achieved by keeping the thinking mind occupied through focused attention.
What we do in Qigong is when we do an exercise, a movement, we focus our minds on
the smiling intention, the breathing, the way the movement is done. We concentrate
on adjusting all the time… Those are the things you can observe and that’s the way
you keep the monkey mind occupy, to create the silence, to create this being in the
now. (Participant 4)
The focus required to complete the movements in Qigong can be likened to experiences of
mental quietness reported by extreme sports participants (Brymer & Schweitzer, 2017).
Extreme sports required such an intense level of focus, participants had no space for
intrusive or undesired thoughts. The dissolution of everyday thoughts and responsibilities
facilitated a sense of freedom and full relaxation (Brymer & Schweitzer, 2017).
When the ‘monkey mind’ was occupied through the practice, participants reported a
disidentification from their thoughts and an enhanced ability to watch these thoughts as
they arose, with the ability to simply observe these thoughts. In this regard, stressful or
anxious thoughts no longer effected the participants in the same way: ”then you do not
identify yourself with the thoughts, with the monkeys, but you identify ourselves with the
one observing these thoughts” (Participant 4). This shift in perspective shares conceptual
similarities to the construct of mindfulness, in which one is aware of and accepting of the
present moment (Keng et al., 2011). Mindfulness has shown an ability to enhance
participants’ ability to attenuate cognitive and emotional reactivity to negative stimuli (Gu
et al., 2015). A similar ability to attenuate emotional reactivity to stimuli through awareness
and acceptance of the present moment is described above by Participant 4, enabling them
the ability to observe their thoughts, rather than react.
Being present allowed the Qigong practitioner to completely relax, with each movement
releasing stress and allowing a sense of joy and freedom from notions of time, including

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thoughts of past and future: “When people do Qigong, Tai Chi, doesn’t matter which one,
the mind is relaxed, releases the stress and that time is in the present, enjoying each
movement which is coming” (Participant 3). This temporal release dissolved subjective
feelings of stress, as the participant focused on the one thing they could control, the present
moment. This allowed the individual to experience complete relaxation, letting go of
distressing emotions. The implications of this experience of relaxation allowed the
participant to let go and experience a cathartic sense of release.
Yeah, at first I got the sensation of no pain. No worries. Just being able to relax
completely. That sensation of relaxation, it was letting go, letting go of that
frustration, letting go of worrying, letting go of being depressed, just letting go, just
being. (Participant 4)
Being Alive
When participants were asked what it feels like to practice Qigong, the feeling of being alive
was a recurring theme. Being alive had a sensorial component, with participants describing
an enhanced awareness of physical sensations. Another component of feeling alive related
to a notion of energy, or the idea of a life force animating the body, appraised as vital for a
healthy life. Feeling alive was related to improvements in the perceived level and flow of
this life-giving energy. Brymer and Schweitzer (2017) describe how some of the most
significant wellbeing facilitating experiences are beyond the capacity of words to adequately
capture. The notion of energy described in this study had ineffable components.
A key element of feeling alive was the physical sensations that arose from the practice of
Qigong. These often related to enhanced perceptual capabilities and awareness, additionally
improving participants’ ability to interact and respond to the external world. Participant 2
described during practice: ‘Everything feels more alive, more responsive, more sensitive to
what’s around you”. Movement of the body led to enhanced freedom of movement and
flow of bodily energy, allowing the participant to feel alive: “during practice you start to feel
alive, is a good description actually. As things start to move, you got to feel freedom of
movement. And you start to feel the energy flow” (Participant 2). In the above quote
Participant 2 describes the feeling of aliveness as if energy was flowing through their body
when they started to move. Extreme sports participants describe similar experiences,
reporting intense feelings of aliveness when engaged in their activity compared to other
moments (Brymer & Schweitzer, 2017).
the best way to describe what does Qi feels like is, it feels like to feel alive... It’s the
feeling from the nerves, from the cells being active, there’s feelings like electrical
feelings and magnetism and warmth and vibration the movement. But all those things
come together, into feeling alive. You know, you put all those things together that you
feel bright, active, able to move, all of those things. (Participant 2)
Feeling alive was associated with tangible physical sensations relating to heightened sensory
perception, resulting in an enhanced capability to move and a clarity of mind. This enhanced
their ability to respond to the external world. Aliveness was understood as an experience
beyond their capacity to pinpoint specifically, rather, it was combination of both physical
and psychological elements.
So again a lot of it is just that feeling of aliveness, because that is the sum total of it.
Everything feels more alive, more responsive, more sensitive to what’s around you.

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 You know. But there are also specific sensations that relate to, a heightened or a
greater than normal flow of energy. So, some of those commonly are electrical type
feelings, tingling or magnetics type sensations of movement at that time. Physical
vibrations, or changes in tension and pressure through the body and often heat as
well. Vibration, again part of that physical thing. So, sometimes those sort of
heightened aspects you feel quite clearly flowing and moving in different ways, but
the overall result of it is just that of general aliveness. (Participant 2)
Aliveness is described as an experiential feeling, rather than a concept to be intellectually
understood. Through Qigong, participant 2 developed an experiential understanding and
the ability to work with a notion of energy. The ability to palpably feel this energy allowed
the participant to go beyond mere theoretical conceptual knowledge, to reach a sense of
intimacy and personal connection with the energy.
Again through Qigong practice you get not just a theoretical understanding but
experiential, you actually have an experiential knowledge or experience of actually
being able to identify, feel, sense what’s happening with the energy and that
something quite interesting, quite fascinating. (Participant 2)
Energy was seen as integral for life, as Participant 3 remarked energy was important: “not
just for Qigong, but for life. If you have not energy, you died”. Before practicing Qigong, they
confided they felt “wrong and dying in my body, so it was not with any energy in”
(Participant 3). Whilst theoretical notions of energy may differ between participants,
participants appeared to connect the idea of energy in the body to subsequent feeling of
aliveness. A lack of this energy, led to decreased aliveness or in extreme instances, death. In
this way, participants attributed the benefits of Qigong to this enhanced flow of energy.
If the people tired or have not enough energy, discolour the skin, the eyes is different.
Greater energy, the oxygen, the blood, the hormones everything, the face and eyes
wide, is absolute change. You can see. (Participant 3)
Here Participant 3 highlights the perceived connection between energy in the body and
overall health and wellbeing. A lack of energy is interpreted as leading to decreased health.
Energy was perceived as inseparable from life itself and a crucial part of being alive.
Whilst the feeling of being alive manifested physically, this energy and corresponding
aliveness also improved psychological aspects of wellbeing, leading to increased positive
affect: “more happiness, giggling, chatting little bit” (Participant 3). This idea of energy was
appraised as a vital component of wellbeing by one participant. For example, Participant 2,
defined wellbeing as “to feel full of energy, to feel able to do what you want to do”
(Participant 2).
Brymer and Schweitzer (2017) described participants’ feelings of aliveness during
participating in extreme sports and Morse (2015) described participants being alive to the
present moment, however, these findings differed conceptually from the notion of being
alive in this study. In contrast to previous studies, the notion of an energy or life force was
integral to feeling alive, Participants insisted cultivation of this energy was the mechanism
for the benefits manifested through Qigong practice. Therefore, this experience of energy is
intricately linked to experienced wellbeing benefits, both physically and psychologically.

Being Connected

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Participants reported a sense of connection through the practice of Qigong. This feeling of
connection enabled them to perceive themselves as part of a larger whole, larger and more
powerful than themselves. The experience of connection altered participants’ relationship
to their environment. This was a profoundly powerful theme as it blurred the distinction
between object and subject. A felt sense of connection helped guide the participant’s
actions, providing a sense of meaning and purpose: “Yeah, it gives me a connection where I
feel that I am, it’s almost, it is of a spiritual or religious character or sensation. For me, it’s
been like connected to source, some sort of meaning, purpose” (Participant 3).
This connection to source has been described by extreme sports participants as
experiencing a primal force, connecting the individual to their environment (Brymer &
Schweitzer, 2017). For Participant 3, as long as this connection was maintained, the
participant was optimistic and empowered about the future: “as long as I stay connected,
this feeling of things always working out for me, it stays with me (Participant 3).”
Connection to source imbued the participant with a sense of meaning and purpose, which
are inextricably linked to notions of wellbeing. Ryff & Keyes (1995) describe purpose as one
of the key components facilitating self-actualization and psychological wellbeing. The
participant’s feeling of being connected allowed them to feel life was meaningful and
purposeful. Sense of meaning and purpose in life is also implicated in spiritual wellbeing
(Roscoe, 2009). Considering the common elements between various representations and
domains of wellbeing, feelings of meaning and purpose are evidently crucial in promoting
feelings of wellbeing. Here the culmination of these elements provided the participant a
sense of fulfillment and optimism about life. This connection was crucial in how the
participant interacted with the world around them, as they utilized this connection to cope
with challenges faced in life.
I know when life happens, because life happens also to me, shit happens, that’s just
part of the deal when we are in this world. I just have this, this toolbox I can use when
life happens, so I start breathing, I do my Qigong. I allow the Qigong to work. To me
that means that I know the sensation of being connected, I have to reach that
sensation in order to keep it. (Participant 4)
The metaphor of Qigong as a tool in the participant’s toolbox was used to describe how
through Qigong techniques, including breathing, the participant was able to reconnect to a
greater whole. Through maintaining this connection, the participant was able to effectively
cope with difficult circumstances inevitably encountered in life. Through this connection and
awareness of energy, discussed earlier, Participant 2 was able to tangibly experience a
powerful connection with nature, subverting traditionally perceived boundaries between
the subject and object.
But, as you continue to practice working with energy and being aware of energy, the
natural process of focusing on something means you become more skilled with that,
you notice more about it. And for myself being able to tune into the energy - the land,
and the trees and the animals around. And to feel, not just like ‘oh there is a tree
there, or there is a hill there’ but to feel what is happening with the energy flowing
through the land. I think for a lot of people that’s something quite extraordinary.
(Participant 2)
The magnitude of this experience expanded what the participant perceived as their
traditional sense of self. The perception of an energy believed to connect humans to their

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surroundings allowed the participant to become aware of the interconnectedness of the
living world. Through this awareness their sense of self was challenged and broadened.
Brymer & Gray (2010) similarly described how profound connection to nature moved
extreme sport athletes beyond the duality of internal and external, challenging conceptions
of ‘self’ and ‘other’, facilitating a shift from egocentrism to ecocentrism (Brymer & Gray,
2010). As a result, extreme sports participants became aware of their place in the natural
world, not as a separate entity, but as an intricately connected part of a larger whole.
Participants in both Qigong and extreme sports report profoundly spiritual realisations
through this experienced connection. Practicing Qigong may offer a direct method for
experiencing this connection. These results support Brymer & Gray’s (2010) findings that
non-conventional physical activities may foster a transformative relational shift between
man and nature, facilitating feelings of closeness and intimacy.
The idea of connection seems to exist very closely to notions of Qi, or energy, as discussed
earlier. Participant 4 discusses how this energy is the catalyst for their connection.
Disconnection from this energy is perceived to lead to an emptiness, or lack of life.
Therefore, being connected was also about being connected to this energy, the life force.
Qigong differs from other forms of physical activity as there is a primary focus on working
with and becoming familiar with this energy. The metaphor below illustrates the
participant’s belief that without connection to this energy, they would eventually be left
with nothing inside, much like an empty thermos:
We talk a lot about Qi being the life force, the energy flowing through us above and
below into the person. So if you disconnect from that, that’s like having a Thermo can
and you keep pouring from it, and eventually, it is empty. So we have to keep filling it
up. And Qigong has for me has been filling up my can all the time, keeping it filled.
(Participant 4)

Becoming Well
Becoming well refers to the host of multidimensional wellbeing benefits experienced by
Qigong practitioners as a result of regular practice. The impact of prolonged Qigong practice
powerfully impacted participants’ sense of wellbeing. Wellbeing benefits were seen in a
variety of domains, including: physical, emotional and social wellbeing. These improvements
in wellbeing enhanced the participants’ everyday lives.
Physical wellbeing benefits were discussed by multiple participants, with Qigong
demonstrating a powerful ability to improve the physical health of the body. Participant 4
was diagnosed with fibromyalgia, which she described as “pain all over the body, and being
unable to grab a cup and hold it so yeah. The pain sometimes moves around in the body and
sometimes all over” (Participant 4). After her first Qigong practice, her excruciating pain
subsided for the first time since developing the condition.
Interviewer: So the immediate effect of Qigong helped the pain?
Participant: Yeah, it was just so, wow, that was so amazing. My pain I had been used
to having 9 ½ on a scale out of 10 on a daily basis. It felt like being in labour, all day.
These 10 minutes of being in no pain at all, it was being in heaven. So, I thought okay, I
went from 9 ½ on a daily basis to having no pain for 10 minutes after Qigong. I can do
that… I can do better. (Participant 4)

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A single glimpse of this pain free state allowed the participant to conceive that life could be
different and change was possible. Through intensive regular Qigong practice, the
participant was able to completely rid herself of this pain and feel that she had retaken her
autonomy back from her illness.
So, with my practice, I did 15 hours of Qigong practice every week. For nine months.
During that period I got rid of all of my pain, I recovered fully. My stress and anxiety
went down to what I would call normal state…I really felt that I had got my life back.
(Participant 4)
The notion of autonomy is imperative to several theories of wellbeing, arising across various
eudaimonic wellbeing theories. For example, Ryan & Deci (2000) describe autonomy as one
of the three basic needs for wellbeing and psychological growth. Ryff and Keyes (1995) also
describe the autonomy as a basic need for self-actualization. Therefore, autonomy is a
crucial dimension of eudaimonic wellbeing. Here Qigong allowed the participant to regain
autonomy of their own life and feel that they had taken back control from their illness.
The participant has since reached a high level of physical fitness and wellbeing through
regular practice of Qigong.
So I moved all the moving boxes, 32 of them, I moved from the second floor to the
ground floor, within an hour. I did that to see how strong my body had gotten … I
wanted to prove to myself how strong my body had gotten, so I did that. And that’s
the physical improvement from Qigong. (Participant 4)
Participant 2 reported other physical benefits surpassed what many would expect from the
gentle-flowing movements of Qigong. Feeling that the body was able to move freely
enhanced the participants’ ability to use their body in daily life.
Well I tend to not get sick very often, I tend to be physically very strong beyond,
beyond what would normally be expected. I amongst other things, I also teach and
practice Kung Fu and there are some aspects of physical resilience and strength that
you can develop and certainly I have developed to an extraordinary level through
Qigong. Not what you would normally expect. General mobility, ability to move freely
and easily. You know, for example, this is maybe not the best example but I pretty
much never stretch because I do Qigong. And if I do my Qigong, it applies to Kung Fu
because of something that replies a lot of flexibility, I can kick high and I can you know
no problem no stretching required. (Participant 2)
Another aspect of wellbeing improved through regular Qigong practice was emotional
wellbeing. Participant 1 discussed how Qigong helped them deal with severe anxiety.
It’s probably got to have helped my anxiety because in all honesty I did have to come
off the medication because of the side effects… So maybe if it wasn’t for going to the
class, I would still want to take the medications. (Participant 1)
Qigong was able to help the participant’s anxiety by “relaxing the racing mind,” (Participant
1)” slowing down their train of thoughts. This participant found Qigong to be the most
effective form of exercise for controlling their anxiety, as opposed to other types of
exercise, which increased anxiety symptoms. Here the unique benefits of Qigong as a gentle
mind-body exercise are explored.

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 Because I’ve done both and long distance running and personal training and all things
like that, I can compare the two and that actually would make you more anxious. This
does not make you anxious. This controls anxiety… that doesn’t. Because I suffer from
anxiety… and I don’t like to use the term suffer because I know what it’s like. But to
have generalised anxiety and I’ve done both…this is like a treat for it. (Participant 1)
Previous studies have suggested meditative movements may offer unique wellbeing
benefits in comparison to regular exercise. MMs significantly reduced levels of anxiety
(Payne & Godreau, 2013) and depression (Payne & Godreau, 2013; Wang et al., 2013)
compared with regular exercise. In this study, conventional forms of exercise were not
effective for this participant’s anxiety, often exacerbating symptoms. Qigong as an exercise
modality offered the participant unique wellbeing benefits from other forms of physical
activity.
Regular Qigong practice also allowed Participant 4 to fully relax and enjoy this feeling of
relaxation. This represented a dramatic change in state for Participant 4, who believed their
stress and anxiety was responsible for developing fibromyalgia: “I’m convinced that it was
mainly psychological, due to my anxiety and stress, my whole body was in a collapse.” The
participant disclosed: “So what made me sick with stress was I thought I had to be efficient
all the time, I had no respect for this relaxation period” (Participant 4).
The idea that the participant’s emotional or psychological state could impact their physical
wellbeing exemplifies Rachele et al.’s (2013) notion that wellbeing is a reciprocal interaction
between several domains. When Participant 4’s emotional wellbeing improved, their
physical wellbeing also improved through a full recovery from their illness
A distinct social wellbeing component from regular Qigong practice was also reported by
participants. Often Qigong is practiced in a group environment, led by an experienced
teacher. The group environment facilitated a sense of friendship and community between
participants, improving social wellbeing and connection to others. Participant 3, a Qigong
teacher, described this community as: “That class, people after they are going have a coffee,
chatting a little bit, so doing the social life.”
Qigong practice was able to profoundly influence participants’ relationship with others. One
participant described through an improved ability to look after themselves, they were
subsequently better equipped and better able to care for others.
Qigong made me realise and really feel the difference between setting myself first in
order to take care of others…When you go on an aeroplane, they always say put on
your oxygen mask first before helping someone else. Qigong is that. Qigong is putting
on your own oxygen mask. (Participant 4).
Participant 3 echoes these sentiments, as their enhanced ability to be calm and patient from
Qigong practice improved their ability to deal with stressful family situations. Qigong’s
ability to improve social wellbeing was not exclusive to the practitioner, as it also benefitted
those in close proximity: “Of course, yes. It’s benefit for me, but benefit my family. Because,
if I’m not running on 200%, I’m calm down, more relaxed, and this benefit is rolling through
to the family” (Participant 3).
This idea that Qigong allowed greater connection with other people was shared by many
participants. Through the process of understanding oneself, it was possible to relate to
others more easily.

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 The ability to connect to relate to other people and I think certainly Qigong for me, it
helps me to understand myself, but also helps me to understand other people more
easily as well. I would say it helps to improve that as well. (Participant 2)
Becoming well evidently impacted participants’ experience of social wellbeing, facilitating
meaningful connections and interactions with others. Various wellbeing theorists discuss
the importance of social wellbeing, referred to as relatedness (Ryan & Deci, 2000) or
positive relatedness (Ryff & Keyes, 1995). As a common element of wellbeing theories,
positive relationships clearly impact participants’ sense of overall wellbeing, as exemplified
by the experiences of Qigong practitioners.

Becoming Transformed
Regular practice of Qigong provided practitioners with a theoretical framework to
understand the world around them. Drawing on this theoretical framework, participants
were able to develop skills and capabilities to manage life events. These skills allowed them
to respond to their circumstances in a more balanced manner, with an improved ability to
consider the most appropriate response. Participants were able to utilize these skills and
theoretical framework to transform and enrich their lives.
Through the theoretical framework of Qigong, Participant 2 was able to develop an
understanding of how various elements of life were related. This was reinforced by
experiential knowledge, in this way, this knowledge became internalized.
It provides a theoretical framework for a start. And combined with experiential
knowledge, it’s not just a theory which you learn and memorise. Through my own
experience of working with things, you come to understand how my perception of the
world around me connects to that theoretical framework… which helps you to have a
better understanding of how things fit together. (Participant 2)
The experiential component was crucial for crystallizing this theoretical knowledge into
actionable principles for understanding the world around them. Through regular Qigong
practice participants were able to consider circumstances from different perspectives,
providing an opportunity to change their circumstances if desired.
It also gave me the ability to not react to things, from a stressful thought pattern but
respond to things from a more tranquil place, from a more from a capability to
consider different options and the consequences. And that actually meant, going
forward that I was able to change my situation. (Participant 4)
Participant 1 also explained when appraised with stressful situations, they draw on the skills
learnt in Qigong practice.
So on a day where I get really really tired, this is interesting because I thought this this
morning because I work in dispensary so I can’t be making any errors, so If I do wake
up tired it’s as if mind just says “let’s do everything in mindfulness” because I think
that Qigong has just taught me to go with the flow. Does that make sense?
(Participant 1)
Through Qigong practice Participant 4 was able to change existing patterns, providing a
glimpse of possible futures. Once the participant was no longer bound by existing patterns,
they were able to change elements of their experience in order to improve their wellbeing.

88
 I broke that pattern, just for a while. But knowing I could break it just for a while
meant I would be able to break it for more than just a while. Just practising and doing
more of what worked and gave me that ease and sensation of being tranquil inside.
(Participant 4)
Practicing Qigong allowed the participant to transform their life into the life they
envisioned, culminating in a radical shift from a state of chronic stress and worry to a state
of holistic wellbeing – physically, mentally and emotionally.
That’s what I was doing, being stressed, always worrying. And being angry and
resentful towards things, I had to let go of that. I had to transform that, into a vision,
so my vision was, oh this Qigong is doing great things for me, I want to build a life
around that. So I did, and released a lot of energy, and it made me get well, both
physically and mentally and emotionally. (Participant 4)
An Extreme sports participant similarly described how kayaking taught them about
themselves, changing them in a positive way (Brymer & Oades, 2009). These experiences
were transformative as they spilled over into other aspects of the participants life. The inner
transformation allowed participants to deal with significant stressful life events with a sense
of wellbeing (Brymer & Oades, 2009)
For Participant 4, these skills enabled the participant to fully engage in the present moment
and consider the complexities and nuances of a particular situation. Through enhanced
presence and awareness, they were able to flexibly shift their thinking to interpret the
situation from a place free of bias and preconceptions. These skills remarkably improved the
participant’s ability to connect and communicate with others.
What Qigong has given me is the ability to breathe, and be present, to listen better, to
ask questions, to investigate what is going on between us, what is going on in you and
within me. Look at things from various perspectives, so we can find a common
solution, something that works for both of us. Respectfully being in each other’s
presence, so it really helps me not to let these conflicts, possible conflicts, grow and
explode, but rather being able to help both myself and the other person get along and
meet each other and resolve these issues we sometimes have with each other.
(Participant 4)
Capabilities developed through extreme sports have also enhanced participants’ ability to
relate to other people (Brymer & Schweitzer, 2017). Participants’ views on life were
transformed, becoming more open and receptive to different viewpoints (Brymer &
Schweitzer, 2017), enabling them to consider multiple perspectives (Brymer & Oades, 2009).
In extreme sports these transitions were often sudden and instantaneous (Brymer &
Schweitzer, 2017), however, in Qigong the transformation was a product of repeated
practice and a gradual unfolding process over time. Both Qigong and extreme sports were
both described as transformational experiences with the benefits perceived as deep and
enduring over time, enhancing the participants lives beyond the activity.
Removal of limitations was also an important element of this transformational process.
Participant 3 explained how when “you can’t do something… you already put yourself in a
box. And the box is not alive” (Participant 3). Here participant 3 discusses how limitations
constrain individuals by placing them in a metaphorical box, restricting them from fully
enjoying or experiencing life.

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 Look if you can’t stand up, because you’re stiff. Then you’re not happy. And you all the
time you see yourself, of all the things you couldn’t do. When you have a block
flexibility or anything, your life is not your life anymore. (Participant 3).
Whilst the restrictions originate at a physical level, they clearly also effect the participant
psychologically. The participant focuses solely on their limitations, leading them to feel they
have lost control and agency of their life. Brymer and Schweitzer (2013) similarly discussed
how freedom from constraints, provided participants with feelings of liberation, providing
meaning and worth to their daily lives. For Participant 3 physical wellbeing clearly influenced
their emotional wellbeing, highlighting the intricate interplay between different domains of
wellbeing.

Becoming Embodied
Through regular Qigong practice participants were able to strengthen the connection
between mind and body. This was achieved through an improved awareness of physical
sensations. This enhanced ability to sense their body challenged notions of the duality
between mind and body. Through becoming in touch with their bodies, they were also able
to regulate their emotions and mental processes. Emotions were discussed as the bridge
between mind and body, as physiological representations of mental processes.
For one participant, the physical body described as a direct way to connect to the mind:
“Because focusing on your physical body helps take a shortcut to the tranquillity of the mind
stop and opening up the resources of alignment (Participant 4). Another participant
described how Qigong allowed the participant to become friends with their body.
It felt like I and my body were not communicating and we were not friends, we’re not
friendly at all. What I realised was through Qigong I could get an awareness of what
signals, sensations, evidence from my body really meant. (Participant 4)
The awareness of sensations from the body allowed a direct line of communication between
mind and body. Through developing a relationship between mind and body, they were able
to become amicable with these sensations. Morley (2001) described how through breath
control and postures, similar to those in Qigong, yoga practitioners were able to develop an
awareness of their bodies’ internal sensations. Developing embodiment and sensing the
body allowed Participant 4 to become aware of situations and sensations that were taking
up a large part of their attention, and react accordingly. This awareness allowed the
participant to remove themselves from situations causing stress, or change certain aspects
of a situation.
That’s what Qigong has given me, being able to sense, oh we are just about reaching
the limit now for the sensations that disturbed me. That makes it possible for me to
say okay, we just have to take a break, go pee, get some coffee, get some tea, or
whatever…And having that contact with my physical sensations was the one thing that
Qigong improved significantly. (Participant 4)
An interesting remark from one of the participants regarded emotions, appraised as an
experiential connection between mind and body. Emotions were described as physiological
reactions in the body in response to stimulus processed by the mind, thus directly bridging
mind and body. Qigong was described as a powerful tool in regulating and working with
these emotions, in order to bring balance to the mind and body.

90
 Essentially I talked about how emotions cross between the mind and the body, so this
reflects in different aspects of how the body functions. So one of those comes into the
posture, we assume different postures based on our emotions. So based on how we
are responding to the world around us, when we’re stressed we might hunch
shoulders, if we’re scared we might lean our body away, we might cave our knees in
and you know, there’s all sorts of different ways our posture changes in relationship to
our emotions. And Qigong practices or, or the right Qigong practices, help to
rebalance, so if you become stuck in the posture relating to an emotion it helps you to
release that posture and come back to a balanced posture. So quite literally physically
you’re relieving that physical part of the emotion, you’re clearing that away, which
helps to then clear the mental component as well. (Participant 2)
Through postural manipulation of the body, the participant was able to regulate their
emotional response through ‘clearing’ the physiological components of emotions. Once
these physiological aspects were cleared, the participant was able to respond with a fresh
and balanced perspective. As a result, the participant was able to experience a sense- of
wellbeing despite facing emotional turmoil.
I had an issue, and it was with a girl. And it was an ongoing thing where, she had made
some commitments and she was then going back on those commitments. And we
were physically geographically quite far from each other. I was overseas away from
her and this was causing me quite a lot of stress. Quite a lot of, you know emotional
turmoil and then practising, some Qigong practices, that again specifically helped to
clear the physiological aspects of emotions. Yeah, the situation hadn’t changed. You
know she was still the same, she still wasn’t keeping the commitments. But I, and I
wouldn’t say I wasn’t concerned about it all, it was still something that was something
for me to address in my life, but all of the emotional aspect of it was cleared away and
it didn’t distract me anymore, I was able to do what I wanted to do with a sense of
wellbeing, and not feel in turmoil because of it…Yes, it was clearly still something in
my life but it wasn’t something that was effecting me physically or cognitively to the
same extent as it did previously. (Participant 2)
Although the situation remained the same, through the practice of Qigong, the participant
was able to use their body to regulate their emotions, enhancing their capacity to respond
to the situation and reach a sense of wellbeing despite undesirable circumstances. The
participant was still impacted by the situation, but not to the same extent.
Through becoming embodied, participants developed an awareness that volitional control
of breathing patterns were able to influence their mind and body. Through a technique
described as diaphragmatic breathing, Participant 4 could directly influence the nervous
system to lower arousal and reduce stress: “Because you deliberately choose a rhythm for
your breathing, which affects your nervous system, makes a change if you are in a
sympathetic to a parasympathetic nervous system.” Through deliberating choosing a breath
rhythm, Participant 4 was able to quickly regain a sense of calmness after experiencing
stress: “but I can breath and calm my system down and calm myself down.”
Breathing is controlled by the autonomic nervous system and is an embodied process that
usually occurs beneath conscious awareness. Through consciously controlling an
unconscious process, the individual was able to connect both the conscious and unconscious
mind.

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 The keys to the breath, why the breath is included, is because the breath is that one
physiological function that easily crosses the barrier between conscious and
unconscious control. So by working with the breath, we start to consciously work with
some of the things that normally we just let run unconsciously. And so, we’re able to
use that to influence our mind consciously, consciously influence our mind and to
help, to deal with some of the stuff that normally we just let tick along unconsciously.
Similarly, with our body, we can start to consciously address things now body that
normally just tick along unconsciously. (Participant 2).
Morley (2001) described how through yogic control of the breath, the autonomic nervous
system was able to be influenced voluntarily. Through deliberately selecting a breathing
rhythm, the yogic practitioner was able to connect their ‘outer body’ (physical body) with
their inner body (Morley, 2001), best described as all perceptions beyond purely physical
sensations. In this way, the corporeal and the mind are able to be experienced as
interconnected, challenging the traditional distinction of the “inner” and “outer” body.
Through control of the breath Participant 2 was able to become aware of events occurring
below conscious awareness in both their mind and body. Through this awareness the
participant was able to move from “a state that is not ideal to a better state” (Participant 4),
thereby improving their wellbeing.

Strengths and Limitations

This study had a diverse pool of participants, effectively capturing a shared experience
across several socio-cultural contexts. Participants in this study resided from three different
countries, including: Australia, New Zealand and Denmark.
A possible limitation is the fact some of the interviews were face-to face and other
interviews were conducted online over video-conferencing software. Face-to-face
interviews fostered rapport building between the interviewer and the participant, however,
it was more difficult to note down key phrases as the interview progressed. In the Skype
video-conference interviews, it was much easier to note key phrases and themes for further
exploration, however, the rapport was qualitatively different compared with face-to-face
interviews. Therefore, both approaches had respective strengths and weaknesses, although
in this study the data yielded was of a consistent quality, regardless of interview modality.
A common limitation of many qualitative research methodologies is the inability for the data
to generalize to the wider population. This limitation is also a strength of our study, as the
study focused on participants’ direct lived experience, enabling an in-depth appreciation of
what the experience was like for the practitioner. This approach allows the researcher to
find what is right and what works for different individuals. Qualitative research can provide
rich descriptions of a phenomenon, whilst helping us understand the practical implications
of research findings (Sofaer,1999). Therefore, as Qigong is a growing research area,
qualitative research can provide future avenues for quantitative research to explore, also
supporting and facilitating different levels of research.

Implications and Future Directions

These findings reveal relationships and nuances of experienced wellbeing of the Qigong
practitioners that participated in this study, aiding in a deeper understanding of the
phenomenon in question and enhancing our understanding of how best to design wellbeing

92
interventions. Further research is required to understand the link between these finding and
the broader population. Future studies should investigate whether the themes and
descriptions reported are consistent in a large sample of participants. These results should
be considered in terms of whether they advance or support particular theories of wellbeing.
Future studies may want to test these findings in an experimental design. For example, our
results demonstrated Qigong had greater benefits for relieving anxiety than traditional
exercise, therefore, researchers could compare the effect of a Qigong intervention against a
standard exercise intervention on those with anxiety disorders.

Conclusion
Experimental evidence has shown Qigong demonstrates an ability to improve holistic
wellbeing in a variety of domains, including: various aspects of wellbeing, quality of life and
reduction of negative affect. Our study conducted a hermeneutic phenomenological analysis
on the lived experience of wellbeing through regular Qigong practitioners. We found two
distinct elements of experience in Qigong practice. The first was the moment-to-moment
experiences in the act of performing Qigong. These themes were labelled as ‘being’ themes,
including: being present, being alive and being connected. The second element was related
to the effects of regular Qigong practice over an extended period of time. These themes
were labelled as ‘becoming’ and included: becoming well, becoming transformed and
becoming embodied. In summary, Qigong has promise as a safe, non-invasive, low-cost and
nonpharmacologic modality suitable to improve wellbeing in a variety of populations and
warrants further investigation.

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 Supporting athlete mental health and wellbeing: A rapid review
Timothy P Chambers

Abstract
The recent proliferation of athlete mental health and wellbeing research, as highlighted by
the International Society of Sport Psychology’s (Schinke, Stambulova, Si, & Moore, 2017)
position stand, is an indication of the importance of this critical issue. Whilst most of this
research focuses on pathological issues as experienced by athletes, little attention is paid to
those who deliver holistic support to these individuals. Research that explores the
underpinning support structures that are designed to facilitate athlete mental health and
wellbeing is essential. This rapid review evaluated the findings from 13 independent
qualitative studies. The collective results were clustered into four domains: types of
support, outcomes of support, challenges in providing support, and future opportunities.
Following the review, there was a clear justification for providing holistic support to
athletes, which enabled them to develop both personally and professionally. New strategies
related to broadening the available support structures were also identified.
Keywords: mental health, sport, support, career transition, wellbeing.

Supporting athlete mental health and wellbeing: A rapid review

During the past decade, athlete mental health has received an exponential amount of global
attention from researchers and practitioners alike (Castaldlli-Maia et al., 2019; Henriksen, et
al., 2019; Reardon, et al., 2019). Between 5 and 35% of elite athletes experience mental
health symptoms and disorders on an annual basis (Castaldlli-Maia et al., 2019). Since the
release of the International Society of Sport Psychology position stand on athlete mental
health in 2017, there are concerted efforts to commit to a unified approach in dealing with
these issues, including diagnosis, treatment, and management (Reardon et al., 2019). The
International Olympic Committee (IOC) consensus statement and related publications are an
example of this collaborative effort to deal with the evolving issue. Common in these
research endeavours to date is a problem-focused (i.e., individual mental health issues),
diagnostically oriented approach to quantify the issue. Whilst quantifying the prevalence of
athlete mental health is critical to this research priority, so too is the investigation of various
strategies that can be employed to assist athletes with managing their mental health and
wellbeing. Given the apparent diversity of such efforts, it seems timely to review such
strategies and determine the potential benefits related to each. Hence, this rapid review will
evaluate the collected evidence related to holistic athlete support programs and services
that provide mental health assistance to athletes, either directly or indirectly.
Athlete mental health and wellbeing support services have a strong foundation in career
and education assistance. These pioneering programs were designed to provide athletes
with support and resources to enable them to navigate a series of complex transitions
across the sporting career. With time, these programs evolved beyond the service pillars of
career and education into holistic support programs that better catered for the array of
challenges experienced by athletes. Modern athletes now have access to a variety of
services and support personnel. However, the development and implementation of these

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programs and services was not uniform; decisions related to the creation of some services
were not transparent, with some initiatives lacking a clear evidence-base. In some cases,
there were operational differences in the execution of the service provision (e.g., Chambers
et al., 2019). Having firmly established that athlete mental health is a global issue that
requires attention, it is timely to take stock of these support programs and services and
determine what they contribute towards assisting athletes with managing mental health
and wellbeing. As this field continues to evolve at a rapid rate, and equally rapid synthesis
and evaluation of the available evidence is required.

Knowledge synthesis and translation

The benefits of knowledge synthesis are broadly recognised across many domains, including
medical and health related research (see Kastner, et al., 2012 and Tricco, et al., 2016 for
detailed reviews). By summarising the related studies on a topic, a knowledge synthesis can
remove conceptual and theoretical ambiguities, improve the collective understanding, and
direct future research attempts (Kastner, et al., 2012). Knowledge synthesis endeavours also
form the foundation to the translation of knowledge (Kastner, et al., 2012). Despite these
benefits, the multitude of approaches to performing knowledge synthesis serve to
complicate the process; researchers are advised to select the appropriate design that fits
best with the research question in order to maximise the relevance of the synthesis outputs
(Kastner, et al., 2012). Due to the ever-evolving landscape that is high-performance sport,
and the exponential attention directed towards investigating the prevalence of athlete
mental health research, it seems paramount that a rapid review is conducted on the
available athlete support services.
As a relatively modern type of knowledge synthesis, rapid reviews include components of
the systematic review process that are simplified or omitted to expedite the generation of
research outcomes in a shorter time frame (Haby et al., 2016; Tricco et al., 2015). Despite
mixed reviews regarding the quality of outcomes yielded by rapid reviews, there is no
evidence that demonstrates discernible differences between them and systematic reviews
(Haby, et al., 2016). In the absence of clear guidelines, researchers have offered suggestions
regarding the conduct of rapid reviews including: limiting the scope of the review, limiting
the data extraction such that the focus is on key findings, restricting study types (e.g.,
omitting the inclusion of grey literature), and ensuring methodological transparency is
documented (Haby et al., 2016). Accordingly, these procedural suggestions informed the
current rapid review.

The present investigation

The proliferation of support services and strategies now afforded to athletes reflects the
perceived importance of dealing with mental health and wellbeing in this context. In
particular, the evolution of such programs from traditional vocational outcomes to holistic
support suggests that an athlete sporting career is now more complex and better
understood than once previously believed. Whilst there are many commonalities to be
found within the high-performance sporting environment across different geographical
regions, the diversity in athlete support programs presents as a challenge for researchers
and practitioners alike to identify common strengths within these programs. To overcome
this challenge, the aim of this article was to conduct a rapid review of the available evidence
related to holistic support services and strategies provided to athletes to manage/facilitate

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mental health and wellbeing. The overarching research question is: what holistic support
services are available to elite athletes?

Method
Consistent with recommendations from recent rapid reviews (e.g., Haby et al., 2016;
Gannon et al., 2010), the author performed all stages of the review process to expedite the
preparation of information. The processes commenced with a literature search on a variety
of terms (e.g., athlete mental health, athlete support). The first stage of screening included
searching for key terms in the title and abstract, with the second stage including a full-text
analysis of the articles. The inclusion criteria and selection strategy were then confirmed,
with the view to expedite the process. Finally, the review focused on attempting to address
the following general questions:
• What approaches/strategies were employed to support athlete mental health and
wellbeing?
• Who was involved in helping athletes?
• What were the outcomes of the support?

Inclusion criteria
Type of study. Only peer-reviewed qualitative studies were included in the review. Meta
researcher endeavours (e.g., meta-summaries, meta-syntheses) and grey literature were
not included in the review.
Type of participants. Given the focus of the study, participants needed to be in direct
contact with athletes (e.g., practitioners, members of family, peers). Studies that included
participants who were more distal to athletes (e.g., senior organisational management)
were excluded from the review. It was not a requirement that the article included athletes
as participants.
Type of articles. Qualitative articles that focused on the provision of formal (e.g., structured
program) and or informal (e.g., mentoring) support to athletes were included in the rapid
review.
Search strategy.
A systematic search of MEDLINE, PSYCINFO, SPORTDISCUS was conducted between July and
August 2019. The following keywords were included as search terms: “athlete$ OR sport$”,
“support$ OR guidance OR assistance OR mentor$ or counsel$ or career or dual-career”,
“mental health OR mental illness OR wellbeing or well-being”, and “qualitative”. Figure 1
illustrates the flow of the rapid review search process.
Study screening and selection. The author searched for and screened the articles based on
the inclusion criteria between 2009 and 2019. Articles that met the inclusion criteria were
then reviewed in full.
Data extraction. The following information was extracted from the reviewed studies
including study objectives, sample, methodology, philosophical assumptions, and key
findings.

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 Figure 1. Flow of the screening process for the rapid review.

Results
The full literature search yielded 809 abstracts, with 35 articles reviewed at the full-text
level (see Figure 1). A total of 13 articles met the selection criteria for the rapid review, with
key data pertaining to each article (e.g., philosophical assumptions, participants, findings)
depicted in Table 1. Of the reviewed articles, nearly half failed to explicitly state the
researchers’ philosophical assumptions; where this information was available the most
common approaches were interpretivist or constructionist-relativist. A variety of methods
and analytical strategies were employed to investigate the experiences of an array of
participants (e.g., athletes, sporting organisation personnel (e.g., welfare managers), friends
and family, teachers, and mentors), the inclusion of whom further strengthen the collective
findings. Across the reviewed articles, the major findings were clustered into four domains:
types of support, outcomes of support, challenges in providing support, and future
opportunities.

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 Table 1 Brief results from the rapid review.
Article Epistemology Ontology Method(ology)* Participants Support provided Key findings
Brown et Not explicitly Not IPA 8 former Informal support (i.e., 3 superordinate themes related to social
al. (2018) stated explicitly elite athletes being available & support: (i) feeling cared for and
stated present) from family, understood, (ii) ability to seek and ask
mentors & peers; for support, (iii) role of support in the
minimal support from transition of the self.
within sport
Chambers Constructionism Relativism IPA 8 personal Formalised support (e.g., 6 superordinate themes related to the
et al. excellence one-on-one, group PE program: (i) rationale for change,
(2019) advisers counselling) embedded (ii)program architecture, (iii) essential
into a broad, national services, (iv) fundamental skills &
plan qualities, (v) limiting factors, (vi) future
opportunities.
Gledhill & Interpretivism Relativism GT 13 female Informal support (e.g., Holistic development is optimised when
Harwood athletes & a encouragement) from multiple social agents (i.e., athletes,
(2015) respective family and teachers teammates, peers, teachers, parents &
best friend siblings) interact.
(n=13); 4
soccer
coaches; 8
teachers.
Hoffman et Constructionism Relativism Not explicitly 14 elite peer- Formal mentoring 3 higher-order categories pertaining to
al. (2017) stated mentored between protégé and mentoring experiences: (i) instrumental
athletes mentor on a variety of mentoring, (ii) psychosocial mentoring,
topics (e.g., career (iii) mentoring outcomes for protégés.
assistance, mental and
physical preparation)
Lewis et al. Interpretivism Subtle Template 12 rugby Formalised welfare 3 core categories were identified: (i)
(2018) realism analysis player support that is provided PWM’s perceptions of welfare issues
welfare within rugby clubs and experienced by athletes, (ii) factors that
managers designed to target enhance welfare support, (iii) areas of
various holistic issues
 (e.g., forms of addictive further need in supporting athlete
behaviour, career welfare.
transitions)
Macdougall Not explicitly Not TA 32 para- Informal social supports Wellbeing needs and strengths identified
et al. stated explicitly athletes & 9 (e.g., family & friends) for subjective, psychological, and social
(2016) stated Australian were characteristic of wellbeing at a global and sport-specific
Paralympic the strength of level
Committee psychological wellbeing
employees
Marsters & Not explicitly Not GT 20 rugby Informal support from 4 factors perceived as most conducive to
Tiatia- stated explicitly athletes family members athlete mental wellbeing: (i) family
Seath stated contributed to wellbeing support, (ii) well-balanced life, (iii)
(2019) athlete performance, (iv) personal
development
Poucher et Critical realism Not TA 5 Olympic Informal support offered 3 higher order themes related to the
al. (2018) explicitly athletes and by the athlete’s main provision of social support: (i) purpose
stated their main support provider (e.g., and types of support, (ii) process of
support parent, friend) support provision, (iii) experiences of
providers support provision
Raabe et Not explicitly Not CQR 8 collegiate Informal support 3 domains pertaining to teammates
al. (2016) stated explicitly athletes provided by fellow acting as social factors who facilitate
stated athletes basic psychological needs: (i)
foundational components of a need-
fulfilling team environment, (ii) elements
in practice that nurtured athletes’
perceptions of competence, (iii)
teammate interactions outside the pool
which impacted athletes’ perceptions of
relatedness

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 Ryan Not explicitly Not Inductive 17 elite Formal support provided3 overriding themes related to factors
(2015) stated explicitly analysis athletes by New Zealand that impeded the pursuit of a dual-
stated Academy of Sport careercareer: (i) lifestyle conflicts resulting
& education personnel from elite sport involvement, (ii) athlete
career stage, (iii) the influence of others
(e.g., coaches, managers) within the
sport environment.
Sandardos Constructionism Relativism IPA 8 mentors & Informal mentoring 3 superordinate themes related to
& 3 athletes between the mentor and mentoring: (i) critical elements of
Chambers athlete mentoring, (ii) effective mentoring
(2019) relationships, (iii) perceived benefits to
psychological wellbeing.
Stansen & Constructionism Relativism IPA 13 player Formalised welfare 4 superordinate themes related to player
Chambers development support that is provided development management: (i) the PDM
(2017) managers within AFL clubs that is role, (ii) individual qualities, (iii), support,
designed to target (iv) club environment.
various holistic issues
Wood et al. Not explicitly Not IPA 7 Informal support from 1 superordinate theme pertaining to
(2017) stated explicitly professional staff within the football survival was elicited; 6 subordinate
stated footballers clubs themes included: (i) it resembles kind of
a battlefield, just constant, (ii) they must
have seen me as a golden nugget…now I
was like a dead duck, (iii) I was struggling
and this show, this outwards show
wasn’t the reality, (iv) I need somewhere
to go and talk about this but I don’t feel
like I can go anywhere with it, (v) I had
fallen out of love with the game, (vi)
playing stops and that’s it.
*Note: IPA (interpretative phenomenological analysis), TA (thematic analysis), GT (grounded theory, CQR (consensual qualitative research).

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Type of support provided
For the purpose of this review, type of support provided to athletes was classified into
formal (e.g., a staff member was employed by a club or organisation to assist athletes) or
informal (e.g., organic mentoring between mentor and athlete).
Informal support. Nine of the investigations reported informal support was provided to the
athletes, with family (Brown et al., 2018; Gledhill & Harwood, 2015; Macdougall et al., 2016;
Marsters & Tiatia-Seath, 2019), friends (Poucher et al., 2018; Macdougall et al., 2016), and
mentors (Brown et al., 2018; Hoffman et al., 2017; Sandardos & Chambers, 2019) the main
sources of the support. Within this category of support, specific examples of the support
extended to athletes included being present at a time of need (Brown et al., 2018),
providing meaning to life and an opportunity to grow (Macdougall et al., 2016), providing
motivation to improve on and off-field (Marsters & Tiatia-Seath, 2019), career assistance
and relationship development (Hoffman et al., 2017), and emotional and esteem support to
increase athletes’ confidence (Poucher et al., 2018). In some instances, the informal support
extended into offering temporary residence during a period of transition (Brown et al.,
2018).
Formal support. The remaining four investigations reported an array of formalised support
services were provided by personal excellence advisers (Chambers et al., 2019), player
welfare managers (Lewis et al., 2018), career and education personnel (Ryan, 2015), and
player development managers (Stansen & Chambers, 2017). Specific examples of formalised
support included the provision of traditional career and education assistance (e.g., tertiary
education support, career planning; Chambers et al., 2019; Ryan, 2015), welfare and
advocacy issues (e.g., additive behaviours, mental health; Lewis et al., 2018; Stansen &
Chambers, 2017), and wellbeing (e.g., personal growth opportunities; Chambers et al.,
2019). In the case of the player welfare managers (Lewis et al., 2018), career and education
support was outsourced to a career coach, thereby implying a deliberate decision to de-
emphasise the provision of traditional career and education assistance evident in this
context (Stambulova & Wylleman, 2019).
Unique to the formal category of support was the role of the high-performance
environment, as evident in the four investigations. For PDMs (Stansen & Chambers, 2017),
the ability to provide support to athletes was contingent on the club environment and how
accepting the club was of player development. In some cases, if the senior coach was
unsupportive, PDMs struggled to have an impact on the athletes. Obtaining ‘buy-in’ from
coaches was also experienced by PWMs, who reported varying degrees of support from
senior coaches (Lewis et al., 2018). These experiences in professional sport were not
dissimilar to those in elite amateur contexts, such as the personal excellence program
(Chambers et la., 2019) and the New Zealand Academy of Sport (NZAS; Ryan, 2015). In
NZAS, the support extended to carded athletes (i.e., talented athletes who have access to
various medical and sports sciences based on sporting success) was at times contingent on
key stakeholders in the high-performance sporting environment; some national sporting
organisations created environments that prioritised training over maintaining life balance,
which clashed with the athlete’s own self-interests (Ryan, 2015). Despite having strategies in
place to support these athletes to pursue a dual-career, it seemed that sporting
organisations had the authority to impose last-minute changes to athletes’ schedules that
compromised individual goals and objectives (Ryan, 2015; Stansen & Chambers, 2017).

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Outcomes of support
Unsurprisingly, athletes experienced numerous outcomes as a consequence of receiving the
support afforded by others, which were categorised into personally and professionally
meaningful outcomes.
Personally meaningful outcomes. This cluster of outcomes related to the perceived off-field
benefits and improvements that athletes experienced due to the support provided. These
outcomes included the creation of new social networks (Brown et al., 2018) and enhanced
empowerment with peers (Raabe et al., 2016) that resulted in social wellbeing (Macdougall
et al., 2016), a reframing of their involvement in sport that enabled them to support and
mentor others (Brown et al., 2018; Hoffman et al., 2017), improved psychological wellbeing
(Chambers et al., 2019; Macdougall et al., 2016; Sandardos & Chambers, 2019), and
improved life balance (Marsters et al., 2019).
Professionally meaningful outcomes. These outcomes were directly associated with athletic
development and performance. Included within this category were the establishment of
meaningful relationships with support personnel (Ryan, 2015; Stansen & Chambers, 2017),
which facilitated the improved sharing of information and experiences between athletes
and those providing support (Lewis et al., 2018; Poucher et al., 2018; Stansen & Chambers,
2017), improved confidence in sporting performance (Hoffman et al., 2017; Marsters et al.,
2019; Raabe et al., 2016), greater career clarity and progression (Gledhill & Harwood, 2015;
Wood et al., 2017), assistance in redefining the strong athletic identity (Brown et al, 2018)
and managing athletic role strain and stress (Gledhill & Harwood, 2015; Lewis et al., 2018).

Challenges in providing support

Across the reviewed investigations, there were some common challenges experienced by
participants when providing support to athletes. These challenges occurred distinctly at an
individual or organisational level.
Individual level. Several challenges for individual athletes and their immediate support
provider were evident in the reviewed literature. These included forced, ineffective, and or
insincere relationships between the athlete and support provider (Sandardos & Chambers,
2019) emotional labour and burnout (Poucher et al., 2018), and social conflict between
fellow athletes (Raabe et al., 2016).
Organisational level. For the studies that included the formal provision of support (e.g., by a
national institute), the overwhelming challenge referred to a lack of organisational support
(e.g., from coaches) and or resources (e.g., lack of time and finances) that manifested in
reduced support for athletes (Chambers et al., 2019; Lewis et al., 2018; Macdougall et al.,
2016; Ryan, 2015; Stansen & Chambers, 2017; Wood et al., 2017) and a lack of career
progression (Gledhill & Harwood, 2015). This lack of support appeared to be independent of
whether the support was provided to elite (i.e., Olympic) or professional athletes; in all
cases participants were critical of the lack of support underpinning the operation of the
various programs and initiatives.

Future opportunities for the provision of support

Despite the aforementioned challenges, numerous opportunities for the improved provision
of support were identified by the participants in the reviewed studies. Similar to the
identified challenges, the opportunities were categorised into individual and organisational.

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Individual level opportunities. At this level, there were several perceived opportunities by
the participants. These included providing timely support to assist athletes to successfully
transition out of sport (Stansen & Chambers, 2017), improved personal development
(Marsters et al., 2019) and greater social network (Sandardos & Chambers, 2019), improved
assessment of athlete mental health to better tailor the support provided (Wood et al.,
2017), and greater clarity of career pathways (Gledhill & Harwood, 2015) and career
outcomes for athletes (Poucher et al., 2018)
Organisational level opportunities. At the organisational level, there were two clear factors
that, if optimised, would enhance the support afforded to the athletes. These factors
included: increasing the available resources within and between sporting organisations (i.e.,
staff and finances; Chambers et al., 2019; Lewis et al., 2018), and facilitating better
collaboration between other formal service providers (Chambers et al., 2019) and coaching
staff (Lewis et al., 2018).

Discussion
Given the proliferation of athlete mental health and wellbeing research, the aim of this
rapid review was to evaluate the available evidence related to the provision of holistic
athlete programs, services, and strategies that assist in managing mental health and
wellbeing. Following the screening of related literature published during the last decade,
thirteen articles were included in the rapid review. Key findings were consolidated into four
domains: types of support, outcomes of support, challenges in providing support, and future
opportunities. The following section outlines a synthesis of the collective findings
considering the broader literature base.

Justification for athlete support

The basis for much of the reviewed research is the continued investigation of athletic
careers. Contemporary dual-career research highlights the individual benefits associated
with enabling athletes to pursue dual-careers (i.e., sporting and vocational endeavours;
Stambulova & Wylleman, 2019). Operating in parallel to dual-career research investigations
are those that explore the holistic support afford to athletes, which served as the
foundation for the present rapid review. Based on participants’ experiences and perceptions
in the reviewed literature, there was a clear justification for the provision of holistic support
for athletes. Whilst some of the investigations elicited non-athlete experiences (i.e., those of
the individual providing the actual support; e.g., Ryan, 2015), the consensus was that the
support mitigated several issues (e.g., decline in mental health, confidence; Hoffman et al.,
2017; Lewis et al., 2018), and enabled athletes to manage their wellbeing (e.g., Sandardos &
Chambers, 2019). Importantly, the perceived benefits related to receiving the support were
experienced across a myriad of formal (e.g., institute of sport programs; e.g., Chambers et
al., 2019; Ryan, 2015) and informal (e.g., mentoring; Hoffman et al., 2017) strategies.
However, what remains unknown is the effectiveness of such support services; whilst
beyond the remit of the reviewed investigations, quantifying the effectiveness of providing
athlete support, particularly the proactive initiatives designed to mitigate mental health
concerns, remains unchartered territory.
Despite the plethora of benefits for athletes who receive the support reported in the
reviewed literature, several challenges were also evidence, particularly in the delivery of
support services within and between sporting organisations and institutions (Chambers et

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al., 2019; Lewis et al., 2018). Often, the survival of such programs depends heavily on
government funding (Stambulova & Ryba, 2013b), with financial and temporal restrictions
often cited as stifling the efforts of personnel to provide holistic support. In order to
overcome the collective challenges, new initiatives are required. One such initiative is the
creation of a community of practitioners, who trained to provide preliminary support to
athletes (Chambers & Lim, 2020). Here, staff employed within Singapore’s sporting
environment created an informal network of professionals (e.g., university career
counsellors) to reduce their caseload and better cater to the athletes. In devising the
community of practitioners, the intention was to bolster the available support to athletes
across more diverse contexts; rather than limiting the available support to the immediate
sporting environment, the support extend to secondary and tertiary education
environments. Accordingly, the creation of extend support networks would serve to lessen
the impact related to the operational challenges experienced by some in these holistic
support programs.
Limitations
Rapid reviews are not published without limitations, and this one is no exception. Whilst
rapid reviews can provide an expedited view of the relevant landscape, their shortcomings
are documented elsewhere (e.g., Ganann et al., 2010; Grant et al., 2009). First, the present
review relied upon published studies. Given that career assistance programs come and go
on an annual basis (Stambulova & Ryba, 2013), it is likely that some programs were omitted
from the study as findings were not evident among the published literature. Second, the
rapid review was limited to studies published in English. It is known that holistic athlete
support programs and services exist globally (Stambulova & Ryba, 2013a), including those
operating in eastern European, Asian, and South American nations. Accordingly, it is also
possible that relevant studies were omitted from the review due to the restriction of only
including English articles.

Conclusion
Athlete mental health and wellbeing research continues to abound (e.g., Reardon et al.,
2019), as does athletic dual-career research (Stambulova & Wylleman, 2019). Parallel
research regarding the holistic support afforded to athletes provides some insight into the
various strategies that may enable athletes to manage their mental health and wellbeing. In
light of the growth in these domains, the present investigation conducted a rapid review of
the qualitative exploration of athlete support services, programs, and initiatives. The review
of 13 independent investigations revealed a myriad of strategies available to athletes that
afforded several positive outcomes. Inherent within these strategies were several
operational challenges and opportunities for future development. In sum, there appears
great benefit to offering holistic support to athletes, with further research required to
ascertain the effectiveness of the available support.
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 The relationship between climate change issue engagement, connection to nature and
mental well-being
Matthew Whelan and Eric Brymer

Abstract
As the threat of climate change becomes increasingly prevalent for people in both the
developed and developing world, the impact of climate change on mental well-being is a
crucial area of research. In addition to the direct, indirect, and psychosocial impacts of
climate change on mental well-being, there is also a question of how climate change driven
changes to the environment will affect the well-established positive relationship between
connection to nature and mental well-being. The aim of this study was to investigate the
relationship between climate change issue engagement, connection to nature, and mental
well-being in English speaking adults over 18 years of age. As the research examining this
relationship is particularly scarce, no hypotheses were made prior to the analysis. The study
explored the relationship between the variables by examining the average levels of
connection to nature and mental well-being in people with different levels of climate
change issue engagement; and by examining whether a connection to nature and/or mental
well-being predicted a person’s level of climate change issue engagement. The study found
that people with high levels of climate change issue engagement averaged significantly
lower levels of mental well-being and significantly higher levels of connection to nature. In
addition, the study found that both mental well-being and connection to nature predicted a
person’s level of climate change issue engagement. Notably, findings suggest that the most
climate-engaged segment of the global English-speaking population are distinguishable by
age, mental well-being, connection to nature, identification with nature, and level of
concern about the impact that human behaviour has on the environment and living things.
Keywords: climate change, climate change issue engagement, connection to nature, mental
well-being

Literature Review
According to climate science experts, climate change represents an urgent threat to the
planet (Allen, et al., 2018). Conceptualised as relatively stable changes in the meteorological
parameters, such as temperature and precipitation, as well as a progression of increasingly
extreme weather and environmental degradation at an unprecedented rate and scale
(Doherty & Clayton, 2011; Padhy, Sarkar, Panig, & Paul, 2015), climate change has already
resulted in profound alterations to natural and human systems (Allen, et al., 2018).
The influence of climate change on social, economic, political, and health systems is also
expected to have an enormous adverse impact on the mental well-being of those effected.
Indeed, climate change has been recognised as one of the greatest threats to mental well-
being in the 21st-century (Bourque & Cunsolo Willox, 2014).

Climate Change and Mental Well-Being

For the purpose of this study, mental well-being is defined as “relating to a person’s
psychological function, life-satisfaction and ability to develop and maintain mutually

113
benefiting relationships” (Stewart-Brown & Janmohamed, 2008, p. 2). Mental well-being
(MWB) consists of two perspectives: (1) hedonism (otherwise referred to as subjective well-
being); and (2) eudaimonism (otherwise referred to as psychological well-being) (Cleary,
Fielding, Bell, Murray, & Roiko, 2017).
According to Doherty and Clayton (2011) the increased frequency, duration, and severity of
climate change driven extreme weather events and changes to the global environment will
have three separate classes of climate change-related effects on MWB. Namely, (1) the
direct impact of more frequent and severe weather events, disrupted physical
environments, and natural disasters; (2) the psychosocial impact of the resulting chronic
social and community effects of large-scale refugee migration, conflict, and post-disaster
adjustment; and (3) the indirect impact of vicariously observing environmental changes,
natural disasters, and uncertainty over the long-term threat to humans and the natural
environment.
In order to estimate the future direct effect of climate change on MWB, much of the recent
literature has focused on the MWB outcomes of people following natural disasters, such as
Hurricane Katrina (Gifford & Gifford, 2016). Natural disasters are associated with an
increased prevalence of anxiety, acute depression, and posttraumatic stress disorder (PTSD)
(Edwards & Wiseman, 2011; Obradovich, Migliorini, Paulus, & Rahwan, 2018). However,
there is contrasting research on how people have and will respond to natural disasters
driven by climate change. As the perception that human behaviour is responsible for climate
change-related natural disasters can evoke strong negative reactions, such as anger and
distrust (NWF, 2011).
Current and future psychosocial impacts of climate change include: the destruction of local
and regional economies (Padhy, Sarkar, Panig, & Paul, 2015), a reduction in food and water
security, large-scale migration (Fritze, Blashki, Burke, & Burke, 2008), and conflict over
resources (Reuveny, 2008). For instance, threats to income security brought on by
prolonged drought has led increased levels of stress, social isolation, and rates of suicide (Bi
& Parton, 2008). Similarly, the destruction of local economies, reduced food and water
security, and climate change driven conflict are expected to displace millions of people
around the globe (Brown, 2008).
The indirect impacts of climate change are predicted to have a profound effect on MWB.
Research suggests that the mere threat or anticipation of harm resulting from climate
change can elicit moderate to severe levels of anxiety (Gifford & Gifford, 2016), undermine a
sense of personal security, and erode an individual’s sense of place (Cunsolo Willox, et al.,
2012), cultural and personal identity (Alston, Hargreaves, & Hazele, 2018), and belonging
(Tschakert, Ellis, Anderson, Kelly, & Obeng, 2019). In addition, a number of climate change-
related mental illnesses have been conceptualised to explain the experiences of people that
have observed, anticipated, or felt threatened by climate change driven changes to the
environment. Namely, ecological grief, eco-anxiety, and solastalgia.
Conceptualised by Cunsolo and Ellis (2018), ecological grief refers to the degree felt in
relation to anticipated or experienced ecological losses, including the loss of meaningful
landscapes, ecosystems, and species as a result of acute or chronic environmental change.
In particular, the incidence of ecological grief is more likely to be experienced by individuals
with a close living and working relationship with natural environments (Cunsolo Willox, et
al., 2012; Ellis & Albrecht, 2017).

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‘Eco-anxiety’ refers to severe and debilitating worry about the future of self, family, and
future generations in response to observing the gradual and largely irrevocable impacts of
climate change (Gifford & Gifford, 2016; Albrecht, 2011). Eco-anxiety is characterised by
symptoms such as loss of appetite, helplessness, sleeplessness, and panic attacks (Nobel,
2007).
‘Solastalgia’ refers to “the lived experience of negatively perceived change to a home
environment” (Albrecht, 2011, p. 50). Solastalgia is characterised by symptoms such as
general distress, a sense of homesickness, dislocation, and melancholy that occurs when
environmental changes have harmed a person’s home environment (McNamara & Westoby,
2011). The symptoms of solastalgia are believed to be particularly salient among people
with a strong sense of place, place attachment, and connection to nature (Albrecht, et al.,
2007).

Connection to Nature
Conceptualised as “a measure of an individual’s trait level of feeling emotionally connected
to the natural world” (Mayer & Frantz, 2004, p. 503), connection to nature (CTN) is one of a
number of highly correlated conceptualisations of an individual’s connection to the natural
world (Capaldi, Dopko, & Zelenski, 2014). Although an individual’s subjective CTN can
fluctuate and may also be measured at the state level (Nisbet & Zelenski, 2011), CTN
remains relatively stable over time and within different situations and contexts (Nisbet,
Zelenski, & Murphy, 2009).
The most prominent theory that seeks to explain humans’ connection with nature is the
biophilia hypothesis. Popularised by Wilson (1984), the biophilia hypothesis proposes that
humans have a need to be among other living things (Cleary, Fielding, Bell, Murray, & Roiko,
2017). The hypothesis suggests that humans’ relationship with nature was driven by
biological evolution and that because humans evolved in relation to natural settings,
humans still have an innate need to connect with nature to help promote MWB (Kellert &
Wilson, 1993).
The positive association between CTN and MWB is well established in research literature
(Baxter & Pelletier, 2019; Capaldi, Passmore, Nisbet, Zelenski, & Dopko, 2015; Howell,
Dopko, Passmore, & Buro, 2011). Research suggests that CTN can improve an individual’s
general happiness and MWB (Howell, Dopko, Passmore, & Buro, 2011), improve attention
(Bratman, Hamilton, & Daily, 2012), reduce stress (Park, Tsunetsugu, Kasetani, Hirano, &
Kagawa, 2007; Lee, Park, Tsunetsug, Kagawa, & Miyazaki, 2009), as well as promote both
hedonic and eudaimonic aspects of MWB. However, evidence also suggests that some of
the pro-environmental aspects of CTN may have negative consequences for hedonic well-
being (Venhoeven, Bolderdijk, & Steg, 2013).

Climate Change Issue Engagement

According to Doherty in Clayton (2011), as the effects of climate change become more
apparent, a strong CTN could potentially decrease MWB, rather than promote it. In
recognition of this, one potential factor that may predict a diminishing or reversing of the
positive relationship between CTN and MWB is an individual’s climate change issue
engagement (CCIE). According to Lorenzoni, Nicholson-Cole, and Whitmarsh (2007), CCIE is
“a state of connection with the issue of climate change that concurrently encompasses

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cognitive, affect, and behavioural aspects”. Rather than just an attitude or concern, CCIE
also encompasses the motivation, willingness, and ability to take (or already taking)
personal and/or political action (Flora, et al., 2014).
As climate change’s impact on people’s physical and mental health becomes increasingly
prevalent, governments and non-government organisations have begun to develop
strategies for campaigns designed to inform and motivate CCIE. However, their efforts have
proved challenging, as climate change is often seen as a distant long-term threat, rather
than one that is already harming people in both the developing and developed world
(Hoegh-Guldberg, et al., 2018).

Predictors of Climate Change Beliefs and Issue Engagement

Variables that predict the level of a person’s CCIE include: gender (Christensen & Knezek,
2015), risk perception (Scannell & Gifford, 2013), perception of altered weather patterns
(Brügger, Dessai, Devine-Wright, Morton, & Pugin, 2015), media consumption (Feldman,
Maibach, & Roser-Renouf, 2012), emotion (Smith & Leiserowitz, 2014), nationality (Lee,
Markowitz, Howe, Ko, & Leiserowitz, 2015), education (Leviston, Leitch, Greenhill, Leonard,
& Walker, 2011), political orientation (Malka, Krosnick, & Langer, 2009; Zhao, Leiserowitz,
Maibach, & Roser‐Renouf, 2011), place attachment (Devine-Wright & Howes, 2010), and
exposure to nature (Clayton, et al, 2014).

Promoting Climate Change Issue Engagement

Research now suggests that five key beliefs significantly predict increased climate change
engagement. Namely, a certainty that climate change is: (1) real, (2) is human caused, (3) is
harmful, (4) can be effectively reduced by a collective human effort, and (5) knowledge that
97% of climate scientists are certain climate change is happening and is largely caused by
humans (Cook, et al., 2016; Roser-Renouf, Maibach, Leiserowitz, & Zhao, 2014; Roser-
Renouf, Atkinson, Maibach, & Leiserowitz, 2016).
In addition, audience segmentation has been used effectively to increase CCIE. Research
suggests that an individual’s CCIE is a strong predictor of what type of climate change
messaging they will attend to; how much they will contemplate the information provided
to them; and whether they are inclined to accept, reject, or counterargue with the
information (Roser-Renouf et al., 2018). Rather than developing messaging campaigns for
broad and diverse audiences, audience segmentation segments people into groups based
on beliefs, interest, values, and informational needs in order to tailor their message to
each particular group (Roser-Renouf & Maibach, 2018). One audience segmentation
program, Global Warming’s Six Americas (Maibach, et al., 2009; Maibach et al., 2011),
segments people into one of six groups based on their level of CCIE. Segmenting people
based on their level of CCIE and studying each of the specific audience segments has
enabled researchers to provide best practice messaging advice to government and non-
governmental organisations who hope to increase climate-engagement through strategic
communication campaigns (Roser-Renouf & Maibach, 2018).

Summary
Although research suggests that the MWB of individuals with a strong CTN might be
influenced by the environmental impacts of climate change, this contrasts with well-
established evidence, which suggests a strong CTN promotes MWB. Preliminary research

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suggests that the association between CTN and MWB may be influnced by CCIE, however,
the current research is still limited. Thus, Research Question One asked if people with
different levels of CCIE differ on scores of MWB and CTN. Research Question Two asked if
there was a relationship between MWB, CTN, and CCIE. As both research questions have
received scarce research attention, no hypotheses were made prior to the analyses.

Method

Participants
A sample of 407 English speaking people 18 years and over participated in the online
survey (M = 35.14, SD = 15.71). One hundred and seventy-two participants identified as
male (42.3%); 231 as female (56.8%); and 4 did not specify (1%). Forty-one different
nationalities were identified by participants, including: 189 who identified their
nationality as Australian (46.4%); 84 as American (20.6%); 26 as British (6.4%); 13 as
Canadian (3.2%); 12 as German (2.9%); 6 as Norwegian (1.5%); 5 as Danish (1.2%); 5 as
Scottish (1.2%); 4 as Dutch (1%); 4 as Finnish (1%); 4 as Indian (1%); 4 as New Zealander
(1%); 49 from 29 other nationalities (12.1%); and two who did not specify (0.5%).

Materials
Participants completed an online survey consisting of 7 demographic questions and a series
of questionnaires assessing Connection to Nature, Climate Change Issue Engagement, and
Mental Well-Being.
The Global Warming's Six Americas Survey is a 15-item ( = .86) scale designed to
measure CCIE (Maibach, Leiserowitz, Roser-Renouf, Mertz, & Akerlof, 2011). The
audience segmentation tool, which has been used to identify relatively homogeneous
subgroups that share similar psychological profiles. The six segments range across a
spectrum of climate change concern and issue engagement, with segments most
accepting (the Alarmed) and most rejecting of climate change science (the Dismissive) at
either end of a continuum. For a detailed explanation of the six audience segments, see
Roser-Renouf, Stenhouse, Rolfe-Redding, Maibach, and Leiserowitz (2015).
The Nature Relatedness Scale is a 21-item ( =.87) scale that measures ‘affective, cognitive,
and physical relationship individuals have with the natural world’ (Nisbet, Zelenski, &
Murphy, 2009; Nisbet & Zelenski, 2013). The scale consists of three subscales: NR-
Perspective, NR-Experience, and NR-Self, which measure external worldviews of nature,
physical familiarity with nature, and a personal connection to nature, respectively.
The Warwick-Edinburgh Mental Well-Being Scale (Tennant, et al., 2007) is a 14-item scale
( = .89) measure of mental well-being covering both the hedonic and eudaimonic aspects
of mental health.

Procedure
Participants were recruited via three methods: (1) through the ACAP School of Psychological
Sciences Research Participation System (SONA); (2) through social media; and (3) through an
email mailing list. Following the methodology developed by Maibach, et al. (2011),
participants were categorised into one of the six audience segments according to their
responses on the 15-item GWSA survey. This process was performed using the discriminant

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functions syntax (provided in the GWSA manual) derived from their original latent class
analysis that first identified the six audience segments, (Maibach, et al., 2011)

Results

Preliminary Statistical Analyses

To explore the relationships among the demographic variables Age and Gender, Mental
Well-Being (MWB), Connection to Nature (NR-Total), NR-Self, NR-Perspective, and NR-
Experience), Pearson Product Moment correlations were performed and are presented in
Table 2.

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 Table 1. Correlations of Demographic, Mental Well-Being and Connection to Nature Variables
Variable 1 2 3 4 5 6 7
Age (1) -

Gender (2) -.181** -

Mental Well-Being (3) .249** -.036 -

NR-Total (4) .154** .196** .175** -

NR-Self (5) .185** .138** .223** .921** -

NR-Perspective (6) -.059 .344** -.078 .708** .542** -

NR- Experience (7) .246** .020 .257** .745** .619** .175** -

*p <.05; **p <.01; ***p <.001

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 A one-way ANOVA was conducted to determine whether there were significant differences among the six CCIE segments on the
demographic variable Age. Results of the one-way ANOVA indicated that there was a significant effect of CCIE on Age, F(5, 375) = 16.18,
p <.001, ω2 = .17, obs. power = 1.00 (two-tailed). A significant linear trend, F(1, 375) = 68.88, p <.001, ω = .39, indicated that as level of
CCIE increased, Age decreased proportionally. The linear trend is represented in Figure 1.

Figure 1. Effect of CCIE Segments on Age

Research Question One

Data were analysed using a series of one-way ANOVAs and linear trend analyses were conducted to determine whether there were significant
differences among the six CCIE segments on Age, MWB, NR-Total, NR-Self, NR-Perspective, and NR-Experience.
Results indicated there was a significant effect of CCIE on MWB, F(5, 379) = 6.33, p <.001, ω2 = .06 (moderate effect), obs. power = 1.00
(two-tailed). Post-hoc revealed people in the Dismissive segment scored significantly higher on MWB than people in the: Alarmed,
Concerned, and Cautious segments. A significant linear trend, F(1, 379) = 27.87, p <.001, ω2 = .07 (moderate effect), indicated that as the
level of CCIE increased, MWB decreased proportionally. This trend is represented in Figure 2.

Figure 2. Effect of CCIE segments on Mental Well-Being

Results indicated that there was a significant effect of level of CCIE on NR-Total, Welch’s F(5, 46.30) = 14.61, p < .001, est. ω2 = .15
(strong effect). Post-hoc tests revealed people in the Alarmed segment averaged significantly higher levels of NR-Total than people in
the: Concerned, Cautious, Doubtful, and Dismissive segments. A significant linear trend F(1, 379) = 16.86, p <.001, ω2 = .04 (weak effect),

121
revealed that as the level of CCIE increased, NR-Total increased proportionally. This trend is represented in Figure 3.

Figure 3. Effect of CCIE segments on NR-Total

Results indicated that there was a significant effect of level of CCIE on NR-Self, Welch’s F(5, 46.51) = 12.84, p < .001, est. ω2 = .09
(moderate effect). Post-hoc tests revealed people in the Alarmed segment averaged significantly higher levels of NR-Self than people in
the: Concerned, and Cautious segments. A significant linear trend, F(1, 387) = 5.64, p = .02, ω2 = .01 (weak effect), indicated that as the
level of CCIE increased, NR-Total increased proportionally. This trend is represented in Figure 4.

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Figure 4. Effect of CCIE segments on NR-Self
Results indicated that there was a significant effect of level of CCIE on NR-Perspective, F(5, 381) = 51.27, p <.001, ω2 = .39 (strong effect)
obs. power = 1.00 (two-tailed). Post-hoc tests revealed people in the Alarmed segment averaged significantly higher levels of NR-
Perspective than people in the: Concerned, Cautious, Disengaged, Doubtful, and Dismissive segments. A significant linear trend, F(1, 387)
= 134.68, p <.001, ω2 = .26 (strong effect), indicated that as the level of CCIE increased, NR-Perspective increased proportionally. This
trend is represented in Figure 5.

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Figure 5. Effect of CCIE segments on NR-Perspective
Results indicated that there was a significant effect of level of CCIE on NR-Experience, F(5, 379) = 2.51, p = .03, ω2 = .02 (weak effect) obs.
power = .78 (two-tailed). Post-hoc tests revealed people in the Dismissive segment averaged significantly higher levels of NR-Experience
than people in the Concerned segment (weak effect). A significant linear trend, F(1, 385) = 4.03, p = .046, ω2 = .01 (weak effect), indicated
that as the level of CCIE increased, NR-Experience decreased proportionally. This trend is represented in Figure 6.

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 Figure 6. Effect of CCIE segments on NR-Experience

Research Question Two.

Data were analysed using a number of multinomial logistic regressions and investigated any possible relationships between MWB, NR-Total,
NR-Self, NR-Perspective, and NR-Experience, and CCIE.
Addition of predictors MWB and NR-Total to a model that contained only the intercept significantly improved the fit between the model
and the data, χ2 (10, N = 372) = 118.20, Nagelkerke R2 = .29, p < .001. MWB had a significant main effect on CCIE, χ2 (5) = 45.95, p <.001,
as did NR-Total on CCIE, χ2(5) = 86.14, p <.001. Parameter estimates for individual predictors used in this model are provided in Table 2.

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Table 2.
95% Confidence Interval for Exp(B)
B (SE) Exp(B)
Segment Lower Bound Upper Bound
Doubtful Intercept 2.92 (2.07)
Mental Well-Being -.03 (.03) 0.91 0.97 1.03
NR-Total -.47 (.47) 0.25 0.62 1.57
Disengaged Intercept 1.46 (2.80)
Mental Well-Being -.10 (.04)* 0.82 0.90 0.98
NR-Total .72 (.68) 0.54 2.06 7.77
Cautious Intercept 4.90 (1.78)**
Mental Well-Being -.11 (.03)*** 0.85 0.90 0.95
NR-Total 0.16 (.41) 0.52 1.18 2.66
Concerned Intercept 5.13 (1.61)**
Mental Well-Being -.12 (.03)*** 0.84 0.88 0.93
NR-Total .60 (.36) 0.89 1.82 3.72
Alarmed Intercept 1.14 (1.63)
Mental Well-Being -.14 (.03)*** 0.83 0.87 0.91
NR-Total 2.07 (.38)*** 3.80 7.94 16.60
p < .001. * p < .05, ** p < .01, *** p < .001

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Addition of predictors MWB, NR-Self, NR-Perspective, and NR-Experience to a second
model that contained only the intercept significantly improved the fit between the
model and the data, χ2 (20, N = 372) = 224.40, Nagelkerke R2 = .49, < .001. MWB had a
significant main effect on CCIE, χ2 (5) = 15.75, p = .008; as did NR-Self on CCIE, χ2(5) =
14.61, p = .01; as did NR-Perspective on CCIE, χ2(5) = 94.69, p <.001. Parameter
estimates for individual predictors used in this model are provided in Table 3.
Comparisons of the two models are presented in Table 4.

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Table 3.
95% Confidence Interval for Exp(B)
B (SE) Exp(B)
Segment Lower Bound Upper Bound
Doubtful Intercept 3.52 (2.21)
Mental Well-Being -.04 (.03) .90 .96 1.03
NR-Self .08 (.54) .38 1.09 3.12
NR-Perspective -.70 (.53) .17 .50 1.42
NR-Experience -.03 (.45) .40 .97 2.36
Disengaged Intercept -.45 (3.12)
Mental Well-Being -.08 (.05) .84 .92 1.01
NR-Self .37 (.76) .33 1.44 6.40
NR-Perspective 1.27 (.73) .85 3.56 14.87
NR-Experience -.58 (.63) .16 .56 1.91
Cautious Intercept 3.61 (1.97)
Mental Well-Being -.09 (.03)** .86 .92 .97
NR-Self -.02 (.46) .40 .98 2.44
NR-Perspective .64 (.46 .77 1.89 4.64
NR-Experience -.28 (.40) .35 .76 1.65
Concerned Intercept 1.74 (1.89)
Mental Well-Being -.09 (.03)** .86 .91 .97
NR-Self -.07 (.43) .40 .94 2.17
NR-Perspective 2.05 (.44)*** 3.27 7.77 18.46
NR-Experience -.75 (.38)* .23 .47 .98
Alarmed Intercept -3.18 (1.99)
Mental Well-Being -.10 (.03)*** .85 .90 .95
NR-Self .95 (.44)* 1.08 2.57 6.14
NR-Perspective 2.92 (.46)*** 7.58 18.59 45.62
NR-Experience -1.03 (.39)** .17 .36 .76
p < .001. * p < .05, ** p < .01, *** p < .001
 Table 4. Classification Tables of Model 1, Model 2, and Model 3
Model 1 Model 2
(N = 372) (N = 372)
Chi-Square Value 118.20*** 224.40***
18.8% 37.5%
% Correct Predicted Dismissive
0% 21.1%
% Correct Predicted Doubtful
0% 0%
% Correct Predicted Disengaged
0% 14.3%
% Correct Predicted Cautious
28.6% 35.2%
% Correct Predicted Concerned
90.4% 89.3%
% Correct Predicted Alarmed
% Correct Predicted Total 54% 59.1%

***p <.001

Discussion

Demographics
The average MWB score for this sample was 47.2, which was slightly below the established
norm (51.0) for adults on the Warwick-Edinburgh Mental Well-Being Scale. This was also
reflected in the average MWB for men and women in the study, which were both below
established norms for men (51.3) and women (50.3) (Tennant, et al., 2007). Furthermore,
the average MWB for each age group were all slightly below the established norms for each
age group, with exception for the 75+ age group (58), which was the norm for that age
group (51.2).

Mental Well-Being and CCIE

The study found that there was a linear trend between CCIE and MWB, indicating that as
CCIE increased, MWB decreased proportionally. Results also indicated that as MWB
increased, the probability of membership in the three most climate-engaged Cautious,
Concerned, and Alarmed segments decreased, when compared with the Dismissive
segment. Taken together, these findings support Doherty and Clayton (2011), who
suggested that the indirect impact of climate will have a negative impact on MWB.
The finding that the Dismissive segment averaged significantly higher levels of MWB than
the Cautious, Concerned, and Alarmed segments provide novel insights in both the
potentially protective factors of low CCIE and the potentially detrimental impact of
increasingly high CCIE. However, it should be noted that the Cautious, Concerned, and
Alarmed segments were well within one standard deviation of the average levels of MWB
for the whole sample.

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It is possible that the below average MWB found in the Cautious, Concerned, and
Alarmed segments in this study could be attributed to anxiety from the threat or
anticipation of harm from climate change, as found in Gifford and Gifford (2016).
Similarly, it is possible that the below average MWB in the Cautious, Concerned, and
Alarmed segments could be the result of a high prevalence of ecological grief in the
sample (Cunsolo Willox, et al., 2012). Believed to be more prevalent among those with a
strong CTN, an above average rate of ecological grief in these segments is plausible, as
the Cautious, Concerned, and Alarmed segments also averaged higher levels of NR-Total
than the Disengaged, Doubtful, and Dismissive segments.
The indirect impact of climate change has been linked with a reduction in cultural and
personal identity (Alston, Hargreaves, & Hazele, 2018), personal security, sense of place
(Cunsolo Willox, et al., 2012), belonging (Tschakert, Ellis, Anderson, Kelly, & Obeng, 2019),
and increased levels of anxiety (Gifford & Gifford, 2016). However, the results in this study
suggest that the indirect impact to MWB may warrant more investigation

Connection to Nature and CCIE

Findings indicating that as NR-Total increased, the probability of membership in the
Alarmed segment increased, support the results of Nisbet, Zelenski, and Murphy (2009),
who suggested that CTN is associated with a greater concern about the impact of humans
on the environment. Similarly, the results are also consistent with the findings of Luebke,
et al. (2012), who found that a strong CTN was associated with participation in
behaviours that help address climate change. The results in this study also support Mayer
& Frantz (2004), who suggested that CTN is associated with sustainable attitudes.
The results were not able to support suggestions that pro-environmental aspects of CTN
could have negative consequences for MWB (Venhoeven, Bolderdijk, & Steg, 2013).
Measured by NR-Perspective in this study, a preliminary analysis found that despite there
being a positive relationship between NR-Total and MWB, there was no significant
correlation between NR-Perspective and MWB. The results provide context to
suggestions that the well-established positive association between CTN and MWB could
be eliminated or reversed by climate change (Doherty & Clayton, 2011). Although the
results suggest that the most climate-engaged segments averaged significantly higher
levels of NR-Total, there were only significant differences between the Alarmed,
Doubtful, and Dismissive segments in NR-Self and NR-Perspective.
A possible explanation for the paradox between CCIE, NR-Total, and MWB is the
distinction between pro-environmental beliefs, measured by NR-Perspective in this
study, and engaging in pro-environmental behaviour, which distinguishes the Alarmed
and Concerned segments from the other less CCIE segments (Capaldi, et al., 2014;
Maibach, et al., 2011). This would make theoretical sense, as hedonic well-being involves
consumption, more sustainable behaviour could be perceived as forgoing the pleasure
derived from consumption, and thus depriving one’s hedonic well-being (Verplanken and
Roy, 2013). This is particularly relevant for people that have not internalized pro-
environmental behaviour is inherently ‘the right thing to do’, which is necessary for pro-
environmental behaviour to boost eudaimonic well-being (Capaldi, et al, 2014).
Results indicating that the Dismissive segment had significantly higher levels of both
MWB and NR-Experience in comparison to the Concerned segment could also explain the

130
paradox between scores on CCIE, NR-Total, and MWB. The biophilia hypothesis asserts
than humans have an innate need to affiliate with nature in order to help promote MWB
(Kellert & Wilson, 1993). Under this assumption, the Dismissive segment averaged higher
levels of MWB because they had a higher level of comfort with and desire to be out in
nature, in comparison to the Concerned segment.

Implications
An important implication of this study is that CCIE likely plays a role in the MWB of
people in the Cautious, Concerned, and Alarmed segments. While the growing interest of
the impact of climate change on mental health (Cunsolo Willox, et al., 2013; Doherty &
Clayton, 2011) was a catalyst for this study, the findings supporting the indirect impact of
climate change on MWB has important implications for both mental health practitioners
and policy makers.
A second important implication of this study is the non-association between NR-Perspective
and MWB, which provides more context to suggestions that climate change may influence
the association between CTN and MWB (Doherty & Clayton, 2011). The apparent distinction
between pro-environmental beliefs and pro-environmental behaviour in determining the
relationship between CCIE, CTN, and MWB is one that should encourage future research to
determine what factors account for the distinction, and what protective factors and
vulnerabilities can alter its influence.

Conclusion
In conclusion, the study revealed that people with high climate-engagement had
significantly lower average levels of MWB, and higher average levels of NR-Total, NR-Self,
and NR-Perspective. The study also revealed that MWB, NR-Total, NR-Self, and NR-
Perspective significantly predicted CCIE group membership.
Overall, results suggest that people in the Alarmed segment are younger, experience
lower levels of MWB, are more connected to nature, identify more with nature, and are
more concerned about humans’ impact on the environment than the less climate-
engaged segments. These findings are a novel contribution to the literature investigating
the indirect impact of climate change; the link between CCIE, MWB, and CTN; as well as
the Global Warming’s Six Americas project, which endeavours to gain more insight into
the attitudinal and behavioural characteristics of each of the six audience segments in
order to assist government and non-governmental organizations engage and inform
people about climate change.

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136
 Clinical
Interventions

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 Editorial: Clinical interventions
Katrina Andrews

Innovations in a Changing World, the theme of this ACAP 2019 conference, has many
implications. In an earlier session, innovations in higher education to meet the needs and
challenges in this changing world was explored (see Optimising Curriculum Environments).
In Physical Activity and Wellbeing (see above), we learn of research into aspects of living
sustainably (health and wellbeing), also a priority of the changing world (see UNESCO
Sustainable Development Goals, 2020). In this session, entitled Clinical Interventions, we are
confronted with conflicting implications of the changing world on the profession of Clinical
Psychology.
An example of contemporary clinical research enhancing our knowledge in cutting-edge
diagnostic categories is that by Rahimi-Golkhandan and Wilson. Rahimi-Golkhandan and
Wilson communicate latest innovations of clinical psychology research in the area of
Developmental Coordination Disorder (DCD), positing the role of deficits in executive
functioning skills in the well-known relationship between DCD and emotional regulation
skills. Implications of these findings include the realisation that DCD is not purely a motor
disorder, but possibly an example of a broader neurodevelopmental syndrome, findings of
which has implications for early intervention including the teaching of attention diversion
skills away from distressing stimuli. This would have the benefit of enhancing emotional
regulation in children with this disorder, thereby minimising secondary socio-emotional
consequences down the track.
As Rahimi-Golkhandan and Wilson demonstrate the innovations that emerge from research
in the field of clinical psychology, the next paper by Innes and Morrison confront us with
contemporary research that threaten the future of the clinical psychologist. Innes and
Morrison argue that innovations in artificial intelligence (AI) have produced profound
outcomes in the ability of learning algorithms to outperform humans, resulting in the
automation of many professionals including legal practitioners, accountants, financial
advisors and some health professionals (see link for example). Innes and Morrison posit that
AI has reached a level of sophistication that employment of psychologists are now possibly
under threat. The little known problem however, argue Innes and Morrison, is that the
information entered into the algorithms may be biased, leading to undesirable
consequences that would not occur, should a human remain in the role. Using our
knowledge of behaviouristic methodology and the inherent flaws in the design of human
experiments, psychologists have the added responsibility of defending their roles against
automation replacement.
These two papers, both arguing from a contemporary position in this changing world, are
both advancing the field of psychology, and defending the field of psychology. Are they
juxtapositioned, or are these examples of a future reality? I will leave you to decide.

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References
UNESCO and Sustainable Development Goals (2019). Retrieved from
https://en.unesco.org/sustainabledevelopmentgoals

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 Deficits of (hot) executive function in developmental coordination disorder: implications
for the contemporary models of the disorder
Shahin Rahimi-Golkhandan and Peter H. Wilson

Abstract
Developmental coordination disorder (DCD), which affects 5-6% of school-aged children, is
characterised by deficits of motor control and learning that are significantly lower than
expected given the child chronological age and intellectual ability, and not due to a
pervasive developmental delay or medical conditions. Apart from disrupting activities of
daily living and/or academic achievement, DCD is associated with a range of secondary
socio-emotional consequences. Contemporary aetiological accounts of DCD link the
consequences of the disorder to a range of co-occurring cognitive deficits that disrupt both
motor and cognitive control. The neuroscientific approach identifies reduced ability in
predictive control of action and rhythmic coordination and timing as well as deficits of
executive function (EF). EF refers to a set of neurocognitive processes (i.e., response
inhibition, working memory, mental flexibility) involved in conscious and effortful control of
thought, emotion, and behaviour. Our recent research suggests children with DCD exhibit
reduced cognitive control not only in response to ‘cold’, abstract stimuli (e.g., simple motor
tasks), but also ‘hot’, emotionally significant ones (e.g., delay of immediate gratification).
This paper discusses the implications of hot EF deficits for both the aetiological accounts of
DCD and the models developed to explain the link between the disorder and its secondary
consequences. One example of such models is the Environmental Stress Hypothesis which
posits that the effect of DCD on internalising problems is mediated by secondary stressors
as well as intra- and inter-personal resources. We postulate EF as another potential
mediator of the relationship between DCD and its emotional consequences, and propose a
novel task (based on the go/no-go paradigm) that may determine whether a reduced ability
to divert attention from distressing stimuli (e.g., active play) and to exercise inhibitory
control (e.g., not to engage in passive activities) contributes to reduced participation and
internalising problems in this cohort.
Keywords: Developmental Coordination Disorder, Executive function, Cognitive control

Developmental coordination disorder (DCD) is a neurodevelopmental disorder characterized

by delays in achieving developmental motor milestones (e.g., walking, sitting) as well as
deficits in fine and/or gross motor skills (e.g., issues with handwriting or performance in
sport). The disorder is associated with deficits in motor control, as well as a range of
disturbances in the cognitive domain, particularly deficits of response inhibition, visuospatial
memory, and executive attention (Wilson, Ruddock, Smits-Engelsman, Polatajko, & Blank,
2013). The criterion A of the DCD diagnosis (APA, 2013) identifies the disorder as a condition
in which children experience deficits in the acquisition/control of motor-related activities,
despite the opportunity to do so. The motor performance of children with DCD is often
slower, less accurate, and more variable than that of their same age typically-developing
(TD) peers (Zwicker, Missiuna, Harris, & Boyd, 2012). These challenges reduce the
participation of children with DCD in physical activities, and consequently lead to poor

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physical fitness and higher rates of obesity in this cohort. Motor coordination difficulties –
manifested at an early age – significantly disrupt daily living activities and academic
achievement (Criterion B). Reduced coordination includes difficulties with learning typical
childhood motor skills such as walking, running, catching, throwing, tying shoes,
handwriting, and so forth (Criterion C). The disorder is not due to a general medical
condition (Criterion D); and – unlike other motor disorders such as cerebral palsy – the
intelligence levels of children with DCD are in line with what is expected of them given their
chronological age (Kirby, Sugden, & Purcell, 2014). However, despite average or above
average intelligence, difficulties with self-care, writing, drawing, and play disrupt the
performance of children with DCD in academic settings.
Existing literature suggests a prevalence rate of 5-6% for DCD among school-aged children.
The diagnosis of ‘pure’ DCD (i.e., without comorbid problems) is the exception rather than
the rule as DCD often co-occurs with various other neurodevelopmental disorders, namely
attention deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and
specific language impairment (Kirby et al., 2014). In contrast to early conceptualizations of
the disorder (e.g., Fox & Lent, 1996; Sellers, 1995), children with DCD do not simply outgrow
their deficits of motor control and learning. Longitudinal studies have indicated that about
50% cases of motor difficulties persist into adolescence (Cantell, Smyth, & Ahonen, 2003)
and adulthood (Kirby, Edwards, & Sugden, 2011). For individuals with persistent DCD, new
challenges are faced during the transition to adolescence and early adulthood when higher
demands are placed on academic and occupational functioning (e.g., driving a car, working
with machinery).
In addition to deficits of motor control and learning, DCD is associated with a range
secondary emotional and mental health concerns that compromise psychosocial
development (Ferguson, Jelsma, Versfeld, & Smits-Engelsman, 2014). Motor and cognitive
control deficits in DCD may reduce participation and/or disrupt performance in group
activities (e.g., team games and sport), and, consequently, lead to low perceived self-
competence and limited social interactions with peers (Cummins, Piek, & Dyck, 2005).
Children with DCD also perceive they have limited social support (Skinner & Piek, 2001). This
in turn leads to feelings of frustration and social isolation, as well as reduced self-worth and
self-esteem, which may consequently exacerbate symptoms of anxiety and depression
(Zwicker et al., 2012). Missiuna, Moll, King, Stewart, and McDonald (2008) suggested a
developmental trajectory in DCD in which basic motor concerns in early childhood or self-
care, academic, and peer problems in middle childhood are replaced by more serious
concerns about emotional and behavioural issues in late childhood and adolescence.

The Cognitive Neuroscience Account of DCD: The Importance of Executive Function

The contemporary aetiological accounts of DCD adopt a cognitive neuroscience approach
and attribute the disorder to deficits of predictive control of action, problems with rhythmic
coordination and timing, and reduced cognitive control – or executive function. This section
focuses on the latter, that is the link between executive function deficits and the
consequences of DCD. Executive function is an umbrella term which refers to a set of
neurocognitive functions (i.e., working memory, response inhibition, and cognitive
flexibility) that underlie the planning of goal-directed action (Miyake et al., 2012). Executive
functions are involved in the conscious control of thought, emotion, and behaviour, and,
consequently, predict abilities in self-control, emotion regulation, academic achievement,

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and so forth over the course of development. Recent conceptualisations of executive
function make the important distinction between ‘cold’ and ‘hot’ executive function.
Cold versus hot executive function. Cold executive function – linked to dorsolateral
prefrontal cortex (DL-PFC) – is enlisted for exerting control in affectively-neutral contexts.
Tasks used to examine this aspect of cognitive control present scenarios in affectively-
neutral contexts that often have little resemblance to everyday problems where there is a
need to deal with stimuli that are not decontextualized and abstract, but emotionally and
motivationally meaningful (Zelazo & Müller, 2011). For instance, Wisconsin Card Sorting
Test (WCST; Grant & Berg, 1948), which presents cards that vary on three dimensions (i.e.,
shape, colour, and number), requires test-takers to discover the rules for sorting the cards
correctly. The task is not associated with any obvious rewards or punishers, and there is
little to be gained or lost. There is now converging evidence linking reduced motor
coordination to deficits of cold executive function. This is based not only on behavioural
data but also recent work into the neurobiological mechanisms of motor and cognitive
development which links DCD to reduced performance on measures of inhibitory control,
working memory, and cognitive flexibility (Wilson et al., 2013).
In contrast to recurrent findings on cold executive function in DCD, there are only a handful
of studies examining the ability of children with DCD to enlist inhibitory control in
emotionally-laden contexts. This other aspect of executive function, named hot executive
function is subserved by ventromedial prefrontal cortex (VM-PFC), and characterises skills
relevant to everyday contexts in which one deals with motivationally significant scenarios
(Zelazo & Müller, 2011). Hot executive function is generally elicited by problems that involve
resisting temptation (to approach rewarding stimuli), reappraisal of the motivational
significance of a stimulus, or suppression of particular emotions or behaviours. Thus, the
tasks assessing hot executive function (e.g., delay discounting, or gambling/card tasks)
involve some obvious rewards and losses, and often integrate tempting stimuli that must be
avoided. To illustrate, success on the Iowa Gambling Task (IGT; Bechara, Damasio, Damasio,
& Anderson, 1994) relies on one’s ability to forgo options that are initially rewarding but
lead to an overall loss, and instead opt for those options that are only rewarding in the long
run. Deficits of hot executive function have been linked to a reduced ability to anticipate
future consequences of actions, diminished impulse control, and consequently, sub-optimal
decision-making in situations with high emotional significance. Such deficits increase the
likelihood of disruptive or externalising problem behaviours and interfere with learning
ability and academic achievement (e.g., Shonkoff & Phillips, 2000). It is, therefore, likely that
some of the consequences of DCD, namely reduced self-care, self-regulation and planning,
as well as high incidence of internalising and externalising behaviours could be linked to
executive function deficits such as inhibitory control in emotionally-laden situations. The
hypothesis that deficits of not only cold, but also hot executive function may contribute to
secondary consequences of DCD has been examined in three cross-sectional studies by
Rahimi-Golkhandan and colleagues. Our focus now turns to summarising these studies and
discussing their implications for the contemporary aetiological accounts of DCD.

Hot Executive Function in Children with DCD

Study one (Rahimi-Golkhandan, Piek, Steenbergen, & Wilson, 2014a). Methodology:
Participants were 14 children with DCD and 22 TD children aged between 6 and 12 years.
Motor skill was assessed using the McCarron Assessment of Neuromuscular

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Development (MAND; McCarron, 1997). The MAND includes 10 tests of fine and gross
motor skills – five of each – and provides an index of motor functioning derived from
comparing the sum of scaled scores on the 10 tests to the age-appropriate norms. The
measure of hot executive function was the 100-trial version of the Hungry Donkey Task
(HDT; Crone & van der Molen, 2004), which is the computerised child-friendly version of
the IGT. The task is presented as a computer game in which children help a donkey win as
many apples as possible. Changing the IGT into a pro-social game makes the task more
meaningful and appropriate for the children and increases their engagement in the task.
The HDT utilises the same format and schedule of rewards and losses as the IGT. The
stimulus display included the pictures of four doors and a donkey sitting in front of them
(see Figure 1). In each trial, children choose one of the four doors which provide gains or
losses in rewards. Two doors (A & B) are disadvantageous in the long run (high
immediate reward, but high loss overall), while the other two (C & D) are advantageous
(low immediate reward, but low loss overall). The characteristics of the doors (i.e., the
win-loss schedule) are not disclosed to children; instead, they need to infer this using
feedback from earlier trials.Results and discussion: DCD group performed significantly
worse than the controls on the HDT, making more selections from A and B, and less from
C and D. While both groups chose doors with low frequency loss (B & D) more often, the
DCD group opted for door B which yields high infrequent loss, but also high reward. The
HDT, as a proportional reasoning task, can be adequately performed if one considers
frequency of loss on each choice as the dominant dimension, and the amount of loss as
the subordinate dimension. Both groups considered frequency of loss as the dominant
dimension; however, DCD group opted for a choice which yields infrequent loss, but also
high reward. Therefore, constant reward, instead of probabilistic loss, served as the
subordinate dimension of choice for the DCD group. This suggests DCD group may find it
harder to resist rewarding stimuli, and points to potential deficits of hot executive
function in this cohort. The aim of the second study was to determine whether this
apparent deficit of hot executive function in DCD could be explained selectively by a
heightened sensitivity to rewarding stimuli, or whether it was due to a general deficit of
inhibitory control.
Study two (Rahimi-Golkhandan, Steenbergen, Piek, & Wilson, 2014b). Methodology:
Participants were 12 children with DCD and 28 TD children aged between 7 and 12 years.
In addition to the MAND, children completed two versions of a go/no-go task tapping
cold and hot executive function. The cold version used neutral facial expressions of a
selection of men and women. For the hot task, the faces of the same individuals were
presented with happy and fearful expressions. Each of the two versions of the go/no-go
task in had two different runs. The go stimulus in one run (e.g., happy faces) served as
the no-go target in the second. Each run presented 40 pictures (28 ‘go’) in a pseudo-
randomised order in order to create a prepotent tendency to respond. The order of
presenting the two versions as well as the runs within each version was counterbalanced
across the participants. To make sure children understood the task, they were asked to
complete 12 practice trials before the onset of each run. Each picture was presented for
500ms, followed by a 1500ms inter-stimulus interval during which a white fixation cross
appeared at the centre of the screen (see Figure 2). The stimuli were grey-scaled pictures
of six men and six women from the NimStimTM collection, available at
www.macbrain.org. All the images had the same size and luminance. This type of
‘emotional’ go/no-go task has been used across a wide age range (e.g., Hare, Tottenham,

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Davidson, Glover, & Casey, 2005) as well as in developmental disorders like ADHD
(Köchel, Leutgeb, & Schienle, 2012) and ASD (Yerys, Kenworthy, Jankowski, Strang, &
Wallace, 2013).
Results and discussion: As in previous research, all children responded faster to happy
faces. Both groups showed comparable accuracy in response to go targets, and had
similar commission errors, except when the no-go stimulus was a happy face. The DCD
group had significantly higher false alarms than the controls and failed to withhold their
response to happy faces on more than 50% of the no-go trials. These results suggest a
heightened sensitivity to emotionally significant distractors in DCD. High sensitivity to
appetitive, rewarding cues may undermine the ability to control thoughts and actions,
and, consequently, disrupt self- and emotion-regulation. An additional aspect of
emotion-regulation and an important predictor of adaptive functioning in hot, affective
contexts is the ability to approach negatively-valenced stimuli. The ability to approach
negative stimuli can be measured experimentally by response time on a go/no-go task.
However, these effects can be moderated by the choice of no-go stimuli. The use of
happy no-go faces on 30% of the trials in the second study may have created an approach
bias that also influenced responses to go stimuli. Moreover, fearful faces might not be
the best expression to represent a negative stimulus, particularly for children. The third
study optimised the assessment of emotion-regulation and sensitivity to reward by
pairing emotional expressions with neutral ones, and enlisting negative stimuli (i.e., sad
faces) that were discriminable by children.
Study three (Rahimi-Golkhandan, Steenbergen, Piek, Caeyenberghs, & Wilson, 2016).
Methodology: The aim of the third study was twofold: First, to investigate potential
differences between TD and DCD groups in approaching negatively-valenced stimuli.
Second, to obtain more accurate measures of sensitivity to reward in DCD. The
participants were 12 children with DCD and 24 TD children aged between 7 and 12 years.
Children completed two blocks of an emotional go/no-go task in which neutral facial
expressions were paired with either happy or sad faces. Stimuli were therefore modified
to enhance the sensitivity of the paradigm to selective deficits in hot executive function.
Sad faces replaced fearful ones and all pictures were cropped to exclude hair. Han and
others (2012) suggest this modification makes facial expressions more salient. Stimuli
were taken from the widely-used battery of emotion pictures by Ekman and Friesen
(1976), borrowed with permission from the Sackler Institute for Developmental
Psychology (sacklerinstitute.org). The set of pictures comprised black and white images
of 10 adults (five men, five women) on a grey background, each of the same size and
luminance. The task had two blocks (happy and neutral, sad and neutral) each divided
into two runs. The ‘go’ target in one run became the ‘no-go’ in the other. Each picture
was presented for 500ms, with an inter-stimulus interval of 1500ms, during which a
fixation cross replaced the stimuli at the centre of the screen (see Figure 3). The number
of trials in each run, and the proportion of no-go trials were the same as those in Study
two (40 trials: 28 ‘go’, 12 ‘no-go’). As with study two, practice trials were completed prior
to the onset of each run, and all trials were presented in a pseudorandom order. The
runs within each block, as well as the blocks themselves were counterbalanced.
Results and discussion: There were no group differences in the ability to approach sad
faces; however, the DCD group made significantly more commission errors to happy no-
go faces. Analysis of reaction time, omission errors, and d’, which measures sensitivity to

144
each facial expression, showed that this difference was not attributable to emotion
recognition difficulties in DCD. Taken together, the DCD group’s performance does not
suggest any differences between DCD and TD groups in the ability to approach
negatively-valenced stimuli; however, it confirms earlier reports of (hot) executive
function deficits in DCD.
Next, we argue that apart from the general negative effects of reduced inhibitory control
in ‘hot’ contexts, executive function deficits may specifically disrupt psychological and
physical well-being in DCD by interacting with the environmental factors and stressors
specific to this disorder.

General Discussion
The three studies suggest executive function deficits in DCD are not confined to the cold
aspects of cognitive control, but also affect performance in hot, affective contexts. Study
one shows children with DCD opted for high immediate reward options associated with
overall loss. Study two links hot executive function deficit in DCD to a heightened
sensitivity in this cohort to emotionally-significant stimuli. Inhibitory control deficit –
operationalised as commission errors on the emotional go/no-go task – was stimulus-
specific in the DCD group. Rather than performing poorly on all no-go trials, the DCD
group had significantly more commission errors only in response to compelling cues.
Study three, which optimised the assessment of sensitivity to reward, once more showed
that rewarding stimuli disrupt inhibitory control in DCD. The go/no-go task, however,
failed to find any group differences in the ability to approach negatively-valenced stimuli.
Rahimi-Golkhadan and others (2014a, 2014b, 2016) suggest that the interaction of
cognitive control and emotion-processing networks underpins reduced inhibitory control
of children with DCD in affectively-laden contexts. A detailed discussion of this propsal is
presented in Rahimi-Golkhadan et al. (2016). Next, we discuss the main implications of
deficits of hot executive function in DCD.

The Implications of Hot Executive Function in DCD

Motor functioning. The learning and execution of different motor tasks do not occur in an
environmental vacuum, free from others. Children often attempt various tasks in the
presence of significant others, including family members, teachers, and/or peers; and it is
essential that they can regulate their emotional reactions and learn to modulate responses
to objects and events that are compelling and sometimes irrelevant. In the case of DCD, the
outcomes of movement may not always meet with success or the action itself performed
fluently, and as a result, movement contexts can be perceived as a source of stress.
Therefore, one default response by children with DCD may be to avoid physical activity and
take part in more passive tasks (Cairney, Veldhuizen, & Szatmari, 2010). Choosing a passive
activity here can be conceptualised as avoiding a negative consequence (e.g.,
embarrassment or ridicule), or indeed, opting for a sedentary activity that provides an
immediate but short-term relief, perhaps at the expense of gaining larger longer-term
rewards (e.g., self-competence, peer acceptance, etc.) through physical participation. In this
way, the ability to regulate emotional responses during motor activity ‘cools down’ the
affective components of motor task, reduces the significance of immediate ‘rewards’ (e.g.,
sedentary activities), and, consequently, increases the likelihood of participation in physical
activities. A modified go/no-go task with pictures of active and sedentary activities as stimuli

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may shed light on the preferences of children with DCD; more specifically, demonstrate
whether sedentary tasks are indeed viewed as ‘rewarding stimuli’ similar to how happy
faces were perceived.
Hot executive function deficits may disrupt the ability of children with DCD to regulate the
impact of emotional experiences on motor performance. Deployment of emotion-regulation
strategies (e.g., reappraisal or attention switching) is subserved by prefrontal areas that are
also involved in cognitive and motor control (Coombes, Corcos, Pavuluri, & Vaillancourt,
2012). The inhibition of automatic responses to compelling stimuli (e.g., opting for
sedentary tasks) – via strategies such as attentional deployment – effectively creates a
‘dual-task’ condition in that there is a competition for brain regions involved in both
planning of motor responses and implementation of the emotion-regulation strategy
(Beatty, Fawver, Hanock, & Janelle, 2014). For example, diverting attention from rewarding
stimuli via reappraisal strategies places demands on cognitive networks that have also been
implicated in motor planning. Given that DCD is associated with reduced cognitive control in
both hot and cold contexts, the ability to allocate attention and processing resources
appropriately to different task demands may be limited (i.e., resulting in higher response
latencies, and reduced accuracy). Supporting this argument are data showing poor dual-task
performance in DCD, whether the secondary task is cognitive or motor in design (e.g.,
Cherng, Liang, Chen, & Chen, 2009; Rodger et al., 2003). Taken together, reduced inhibitory
control increases task difficulty in affectively-laden contexts due to competition for brain
regions involved in both emotion regulation and action control. Affected are important
motor control functions (like prediction) and the ability to regulate actions in response to
compelling, emotional cues; the net effect is disruption to the process of learning functional
motor skills and participating broadly in activities that are dependent on them. Thus, hot
executive function deficits appear to mediate the relationship between DCD and reduced
participation in physical activities.
Goal-directed behaviour, and self-regulation. Hot executive function deficits disrupt self-
regulation which arguably relies on both the inhibitory control (e.g., to suppress thoughts
and actions) and the ability to hold active representations of task-relevant goals in mind
(Riggs, Blair, & Greenberg, 2004). Reduced self-regulation is associated with several
developmental outcomes, including difficulties in self-control, concentration, and academic
achievement. It may also contribute to the higher incidence of externalising behaviours,
such as aggression (Tseng, Howe, Chuang, & Hsieh, 2007) and conduct problems (Kanioglou,
Tsorbatzoudis, & Barkoukis, 2005) in children with DCD.
Reduced self-regulation and low impulse control in emotionally-laden contexts may also be
linked to the physical well-being of children with DCD, particularly greater risk for obesity in
this group, especially among boys (Cairney, Hay, Faught, & Hawes, 2005). A systematic
review of literature by Reinert, Po'e, and Barkin (2013) showed that obese children and
adolescents often perform significantly worse than their healthy weight peers on different
tasks of inhibitory control, including go/no-go task, delay of gratification, and the IGT. At a
neurological level, obese children and adolescents often show increased activity in the
orbitofrontal cortex (OFC) and dorsal striatum – the regions associated with inhibitory
control and reward anticipation, respectively (Rothemund et al., 2007). Hyperactivity of the
OFC in obese children and adolescents following food intake suggests that this region is
working to counter the effect of (over-active) appetite-stimulating areas (Reinert et al.,
2013). In the case of DCD, reduced ability to inhibit responses to compelling cues (e.g.,

146
sedentary activities, overeating), along with the avoidance of movement contexts that might
be experienced as aversive reduce participation and increase the risks for obesity. On the
flip side, there is also growing awareness that obesity has a negative impact on cognitive
functioning – possibly through hypertension – and leads to executive dysfunction (Sabia,
Kivimaki, Shipley, Marmot, & Singh-Manoux, 2009). This creates a vicious cycle whereby
executive function deficits disrupt physical fitness, which in turn have negative effects on
cognitive functioning.
Emotion-regulation. Deficits of hot executive function in DCD disrupt the development and
functioning of processes that support emotion-regulation. For instance, delay of
gratification in childhood facilitates coping skills, and predicts better self-control in
adulthood (Casey et al., 2011). In a similar vein, reduced inhibitory control in hot, affective
contexts hinders the use and efficiency of emotion-regulation strategies. Reappraisal
strategies (i.e., cooling down the hot aspects of motivationally significant stimuli), for
instance, facilitate suppressing and/or regulating responses to stimuli with some emotional
and motivational component. The ability to enlist reappraisal strategies in order to regulate
emotions is subserved by the neural systems involved in cognitive control of action,
including DL-PFC (selective attention, working memory), and VL-PFC (inhibition) (Ochsner et
al., 2012). However, given that DCD has been linked to executive function deficits, reduced
cognitive control – subserved by L-PFC – disrupts the ability of children with DCD to utilise
emotion-regulation strategies.
Hot executive function deficits in DCD may also disrupt emotion-regulation by interacting
with individual and environmental constraints specific to DCD. Based on the Environmental
Stress Hypothesis (ESH; Cairney et al., 2010), the motor coordination difficulty that is DCD
results in a visible performance issue in children that may not clearly be identified as a
disorder by their teachers or parents; this can create the impression that these children are
simply lazy or defiant, and their problems are due to lack of effort. Their performance
deficits can then leave these children open to criticism and ridicule (Miyahara & Piek, 2006),
as well as isolation by their peers (Cairney, Rigoli, & Piek, 2013). The net disruption to social
engagement can become a chronic source of stress that plays a significant role in the
aetiology of affective disorders in DCD. Prefrontal control circuitry can indeed counter the
effects of these environmental stressors that increase the signalling of emotion processing
centres (Hare et al., 2008). However, in the case of DCD, reduced inhibitory control in
affectively-laden contexts may compromise the regulatory function of control system, and
reduce the ability to cope with stressors. In this way, hot executive function deficits mediate
the effects of environmental stressors on emotional symptoms of DCD.

Conclusion: How Do the Findings Inform Contemporary Theoretical Models of DCD?

The pattern of executive function deficits in DCD provides a clear indication that DCD is not
purely a motor disorder, but rather a broader neurodevelopmental syndrome (Wilson et al.,
2013); one with secondary socio-emotional consequences (Zwicker et al., 2012). The
findings studies 1-3 complement the existing neurocognitive account of DCD by showing
that the disorder may need to be characterised by executive function deficits in both ‘cold’
and ‘hot’ contexts (Figure 4), and that some of the consequences of DCD may be linked to
reduced hot executive function. To illustrate, in addition to the processing costs associated
with poor inhibitory control, hot executive function deficits may contribute to disruptions in
psychological and physical well-being in DCD, as well as participation. This assertion is

147
consistent with the ESH which maps the important interaction between individual and
environmental constraints. Hot executive function deficit may mediate the relationship
between environmental stressors (for children with DCD) and the onset and/or intensity of
emotional issues. Environmental and other stressors increase the activity of the emotion
processing centres; and for one to adjust well, this activity must be properly regulated by
the prefrontal control circuitry (Hare et al., 2008). Reduced inhibitory control in DCD may
compromise this regulatory function and reduce the ability to organise coping responses.
The effect of DCD on poor physical fitness and higher rates of obesity is thought to be
mediated by inactivity and lower levels of participation (Cairney & Veldhuizen, 2013).
However, the relationship between DCD and participation is itself mediated by emotional
problems (e.g., anxiety, depression) experienced by children with DCD (Liberman, Ratzon, &
Bart, 2013). The relationship between DCD and internalising symptoms is also not direct but
rather mediated by self-perceived competence in different settings (Rigoli, Piek, & Kane,
2012). We propose executive function as another mediating variable in the relationship
between DCD and emotional problems. In short, reduced coupling of cognitive control and
emotion processing networks, which reciprocally modulate the function of one another and
underlie response inhibition in affective contexts (Kohls, Peltzer, Herpertz-Dahlmann, &
Konrad, 2009), undermines the efficacy of goal-directed action, and increases the risk for
the onset of affective disorders (Steinberg, 2005). For instance, a fearful approach style for
novel motor tasks and a tendency to partake in sedentary, passive activities will curtail
social interactions while creating a risk for affective disorders (Ferguson et al., 2014).
Conversely, the ability to divert attention from conflicting or distressing stimuli and to
exercise inhibitory control will enhance emotional regulation, a buffer against psychosocial
consequences of DCD.

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Figure 1. Stimulus and outcome displays in the Hungry Donkey Task (HDT)

Figure 2. Example of stimulus presentations in emotional go/no-go task of study two

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Figure 3. Example of stimulus presentations in emotional go/no-go task of study three

Figure 4. Neurocognitive basis, behavioural patterns, and real-world implications of

hot EF deficits in DCD

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 Can we predict the outcomes of deep learning algorithms that simulate and replace
professional skills? Understanding the threat of artificial intelligence.
J Michael Innes and Ben Morrison

Abstract
Technological developments in artificial intelligence (AI) have produced startling outcomes
in the ability of learning algorithms to outperform humans. The threat to employment from
AI has spread more widely than has been previously envisaged and now encroaches upon
the future employment of professionals. Specifically, legal practitioners, accountants,
financial advisors and members of a spectrum of health professions are affected. The
helping professions, including psychology, have in turn had the spotlight turned on them.
This paper will briefly outline the threats that are forthcoming in the employment of
psychologists. The main thrust of the paper, however, is concerned with an analysis of the
nature of the deep learning algorithms used to simulate human thought and behaviour.
These algorithms produce reliable simulations of behaviour. They also develop creative and
highly innovative solutions, going beyond the capabilities of many humans. Humans now
learn from the output of the algorithms. A problem, however, is that, while the algorithms
are the product of human thought, their actual processing is opaque; humans cannot
inquire into what is going on during the process. They only see the output. The paradox is
that the development of AI mimics methodological behaviourism, a former paradigm in
experimental psychology. Our work strongly suggests that the information entered into the
initial assumptions from which the algorithms proceed may be deeply and yet subtly biased,
due to methodological flaws in the design of experiments. The outcomes may, therefore,
have undesirable and unforeseen consequences. In understanding the burgeoning threat of
AI, professionals must be alert to the biases that exist, to enable a defence against
replacement. Psychology has a role to play in developing this defence through its history of
behaviouristic methodology and its understanding of the inherent flaws in the design of
human experiments.
Key words: Artificial Intelligence; Employment; Professions; Future; Psychology

Context of discussion on the consequences of AI: Strong and Weak Models.

We are not experts in the technical development of AI systems. We are not commenting
on the generalised or strong version of AI that envisages the development of
consciousness and self-awareness. Such developments would render obsolete what we
consider here. Neither are we dealing with the impact of quantum computing, or the
relationship between psychology and quantum cognition, the outcomes of which may be
enormous (cf. Busemeyer & Wang, 2015; Orrell, 2018) nor with the impact of virtual
reality systems upon the practice of psychology (Bailenson, 2018; Blascovich & Bailenson,
2011). We deal with the consequences of the narrow or weak version of AI.
Developments in machine learning and the ubiquity of large computing capabilities and
data sources have enabled enormous advances in automation (cf. Clegg, 2017, Rahwan,
et al., 2019 and Sejnowski, 2018 for contemporary accounts).

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Implications for employment, in particular the employment of health professionals.
The impact of technology upon employment has been debated over centuries. AI has
accelerated the intensity of the debate, whether there will be decline or increase in overall
employment, and upon which forms of employment the impact of AI will be greatest (e.g.
Acemoglu & Restrepo, 2017). (See Elliott, 2019 and Walsh et al, 2019 for reviews). We
address the implications of AI upon the employment of professionals in the health and
helping sectors.
These jobs are seen as relatively immune to automation (cf., Frey & Osborne, 2013;
Reese, 2018; Susskind & Susskind, 2015). Frey (2019) clarified the argument presented in
Frey & Osborne (2013). He predicts the probability that particular jobs can be replaced by
AI, not the likelihood that depends upon other socially contextual matters. Our position is
similar to Frey’s. We do not argue that the impact of AI upon professional employment is
inevitable. We argue, however, that job analysis of the reality of what the job
specifications and does not rely upon a superficial view can provide a superior means of
understanding any effects of AI on job replacement. This qualitative analysis of a
particular job, rather than a stereotypically based, quantitative analysis such as that of
Frey and Osborne, can sharpen our understanding of the consequences of AI.

The representation of psychology and the helping professions

Psychology is often regarded as a profession with a “calling” (e.g. Seligman, 2018), fulfilling a
person’s dream to help people, based upon the professional possessing extensive social
skills. The reality in the profession, however, does not meet those beliefs. Interaction with
clients and helping them deal with relationship problems can be much more mundane and
mechanical.
We construe the job of being a psychologist as being an expert in the analysis of the
causes and consequences of human behaviour. Training to be an expert is a process of
socialisation with close relationships between the expert trainer and the novice. Crucial
to the understanding of expertise is the distinction between explicit knowledge, the
shared and conscious skills that are necessary for the job (portrayed in text books and
lectures) and tacit knowledge, the deep understanding of the practices acquired through
social immersion in the groups who possess it (Collins, 2019; Collins and Evans, 2007).
Becoming a psychologist is not only learning the theories and the methods of the job
through explicit tuition. Expertise is based upon immersion with practising psychologists
and the extensive practice of the skills, a process that can be dull, exacting and, to use a
term from an ironic source, one requiring libidinal renunciation.
Mass higher education, however, with the difficulty of providing immersion training to
large numbers of trainees, has seen the development of lists of skills required for
performance: the attempt to make the tacit explicit. These include the “inherent
characteristics” and “graduate attributes” of being curious, creative, compassionate, able
to see patterns and empathic (e.g. Cranney et al., 2009; Thornton 2014).
These characteristics, however, are personal attributes, essential to the character of the
person. They are separated from skills, attributes of the job of being a psychologist,
which can be trained. The training regimen attempts to inculcate explicit skills to enable
the person to perform as an expert, without the necessity to acquire the deep tacit skills.

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The job of the psychologist and of the helping professional.
The job specification for a psychologist identifies four tasks, whatever the area of
specialisation (clinical, organisation, etc.). These are
• Assessment: the measurement of the client through a variety of methods, including
systematic behavioural observation, psychometric testing and structured interview.
• Formulation: the development of hypotheses to account for causal relationships
between observations and the behavioural and social outcomes that were the
primary reason for the client contacting the professional.
• Intervention: design of an intervention to change the causal relationships between
the measures which are seen as problematic, and allow other behaviours to occur
which will render the problems as less problematic.
• Evaluation: measurement after the intervention to ascertain whether change has
occurred or not, and whether the changes are beneficial or detrimental.
These tasks are based on the “evidence based” training of a professional helper. Evidence-
based practice is the idea that practices are based upon scientifically established evidence,
invariably quantified data from observations and experiments conducted in controlled
conditions. There is a belief that “science” is objectively separate from ‘pseudo-science”,
(Lilienfeld et al., 2015) even though within science more generally there are clear examples
where the former and the latter cannot be discriminated. There are extensive treatments of
the differentiation of science from non-science that render clear distinctions as simplistic. A
reading of Galison (Galison, 1997; Daston & Galison, 2007) and Gordin, (2012) with
subsequent commentary by Sherman, (2012) and Simon (2002) does show how complex are
the issues.
The adoption of a simple position enables a curtailment of the range of skills and practices
that are required in training; particular practices are insufficiently “evidence-based” and
therefore need not be included in the training regimes. An example, within psychology and
counselling, is the rejection of therapy based upon psychodynamic (Freudian) principles,
even though there is copious evidence for their efficacy (e.g. Shedler, 2010; Tracey et al.,
2014; Wampold & Imel, 2015; Westen & Bradley, 2005; Woolfolk, 2015). The argument is
that some “evidence” is better than others (Lilienfeld et al., 2015).

The explicit specification of skills enables their automation.

These four specified characteristics, based upon narrow definitions of what is reliable and
valid evidence, lead to the following:
• Assessment: Meehl (1954) more than sixty years ago demonstrated that statistical
aggregation of assessment was virtually always superior to aggregation by the
clinician. This demonstration has been extensively supported (e.g. Dawes, 1994). The
development of computerised tests has further supplanted assessment by clinicians.
Computers deliver test items and render scoring and monitoring of test taking
behaviour superior to anything that a psychologist can do in the room with a client.
Item–response analysis technology enables a test to be tailored to the response
profile of the client within real-time. The development of virtual reality technology
extends this even further (e.g. Formosa, et al., 2018; Bailenson, 2018; Blascovich &
Bailenson, 2011). Trainee psychologists have difficulties in conducting assessment
(Gilmore & Campbell, 2019). Computers have no such obstacles.

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 • Formulation: the tacit knowledge traditionally regarded as necessary in the
development of hypotheses of cause and effect is conceived to be the result of
training in environments wherein there are uncertain relationships between cues
presented by clients, decisions made about those presentation and feedback about
the efficacy of the decision. These uncertain relationships can be clarified and the
clinician trained to make more predictable links (Kahneman & Klein, 2009).
Machines, however, can detect these relationships and learn from them more
quickly and reliably than can humans (Morrison et al, 2017; Sadler & Regan, 2019).
Machines can also generalise to previously unseen cases and generate “Probably
Almost Correct” (PAC) responses to novel patterns, superior to the human operator.
Given these assumptions, intuition, a form of automatic generation of an expert
response, need not be something mysterious. It can be educated.
▪ Intervention: The evidence to demonstrate the efficacy of a narrow range of
interventions enables the adoption of a small number of therapeutic techniques that
can be formulaically treated in which clinicians can be trained intensively. Specific
components of therapy can be identified and introduced at specific points in the
therapeutic process that can be constrained within limited timeframes. The
dominance of Cognitive Behaviour Therapy (CBT) is testimony to the prevalence of
this methodology and its effects in the clinical profession. Intervention is conceived
in computational terms. The concept of computational psychiatry explicitly aims to
develop algorithms and generalizable principles that are reflected in biological signals
(Thomas & Sharp, 2019). This mechanistic approach to psychopathology replaces a
clinical intervention with an automated version. (Sharp & Elder, 2019).
The relationship between the therapist and the client (the therapeutical alliance, cf.
Wampold & Imel, 2015) previously regarded as essential, is as less robust than the
main effect of the therapeutic technique itself (Lilienfeld et al., 2015). Some go as far
as to proclaim that the alliance is the result of good therapeutic outcomes and not
the cause (Kazdin, 2008; Kazdin & Blasé, 2011).
• Evaluation: The assessment of the benefits of the intervention can be addressed in
the same manner as that prior to intervention. Evaluation can be computer based,
linking the pre and post-measures and the data actuarially examined. This eliminates
the biases identified when clinicians make judgments (cf. Lilienfeld et al., 2014). The
literature on the prevalence of unconscious biases in thinking and judgment (e.g.
Bargh, 2017; Kahneman, 2011) is used to argue for the superior use of explicit and
conscious processes for evaluation in automatic systems. Evidence to the contrary
(e.g. Guerin & Innes, 1981; Newell & Shanks, 2014) and the argument that the bases
of both conscious and intuitive thought are essentially the same (Kruglanski &
Gigerenzer, 2011) is not addressed.

Replacement of the psychologists by an automated procedure.

We make four points. First, the core elements of a psychologist’s job are specified to enable
an automated version to replace the human being. Not only can the automated version do
the job, it will do it better, with less bias, fewer procedural errors and with no burn out and
fatigue. Therefore, psychologists will be replaced by machines (cf. Boulos et al., 2014: Innes
& Morrison, 2017; Michie, et al., 2017). Second, while many psychologists may still be
required, namely psychologists with exceptional skills and insight, these will be a small
proportion of those presently employed.

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Third, the extent of any reduction in the workforce will be dependent upon the proportion
of the psychologist’s time spent with the four components. Already psychologists’ roles are
changing, from acting in a face-to-face role to one of monitoring the conduct of an
electronic therapeutic intervention, with equivalent outcomes in the delivery of CBT.
Changes are already occurring and the clock is ticking on how fast the replacement will
occur.
Finally, there are implications for the educational sector. Psychology as a university
discipline is presently in high demand, but any decline in employment will have an inevitable
trickle-down effect on the number of students desiring to study the discipline, with
subsequent reductions in the employment of tertiary institutional staff.
We note there are other less pessimistic views of the development of AI (e.g. Aoun, 2017).
They do not address the fact that the current model in psychology is based upon the
development of a technological structure that is ready for automation. Levesque (2017)
additionally makes an argument for the importance of “common sense” in the development
of models, but this can be negated by the argument based upon the possibility of training
intuition through the analysis of tacit knowledge. Collins (2018) argues persuasively for a
failure of AI to replace humans, but this again fails to take account of the degree to which
psychological practice has been simplified.
The likely replacement of human psychological practice by machines reflects processes that
have been occurring more widely. The automation of tasks carried out by humans, even
though those tasks continue to be carried out by humans, has long been an object of study
in psychology, sociology and anthropology (Graeber, 2018: Leary, 2001; Lyons, 2019;
Morawski, 2001; Schwarz, 1997).
The current position can be summarised thus:
“Technology can do what therapists cannot, and can do many things better. (cited in
Rodham, 2018).

Can there be a resistance to these developments?

While the developments outlined may appear to be inevitable, there are arguments to
enable a slowdown in the trend. We consider three issues. First, are there biases in the
development of the algorithms to supplant the activities of professionals? Second, what is
the quality of the data to provide the evidence upon which the systems are tested and
accredited? If these biases are detectable and pervasive, then there may be a recognition
that a deceleration in development is necessary to eliminate them, and improve the
trustworthiness of the systems. Finally, we ask whether the process of psychological
practice can be differently construed, to render it less liable to replacement by machines.
Psychologists, with their training in the methodologies to inquire into the functioning of
systems and in the accreditation of data quality, may be in a position to take a lead in such a
process.

Complexity, opacity and bias of the algorithms and whether they can be trusted
One feature which emerges from developments in narrow AI is that the outcomes of the
programs are surprising the people who created them. Machines, given basic principles,
develop outcomes that both exceed human capacity and provide no insight into how
they arrived at the outcomes (cf. Sadler & Regan, 2019 for analyses of the outcomes of

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the AlphaZero chess program and Sejnowski, 2018 for insight into the development of
learning machines). Rahwan et al, (2019) give an account of machine behaviour in their
recent review. The systems are opaque: very much the “black box” used to describe the
processes of the mind in psychology. If they are hidden, then the question can be asked.
Are there methodologies to infer what is occurring? Bridle (2018) suggests that the
“fourth law of robotics’, extending the famous Asimov three laws of robotics, should be
that the robot must be open to examination by a human.
We distinguish different senses of the term “opaque”, following Burrell (2016). We use the
term in the sense of a characteristic of machine learning and not something built into the
systems deliberately to keep a system secret. Neither is it a form of technical illiteracy. We
are also following a suggestion by Seaver (2017) to adopt an anthropological method, an
ethnography of systems. We view the experiment as a psychological form of ethnography.
This position may seem unusual, in that anthropologists characteristically perceive
psychologists as being naively scientistic and lacking in insight. We maintain it as the use of a
method that is actually artful in its social psychological form (Wilson et al., 2010) and
therefore designed to reveal the subtleties of behaviour. A true social psychological
experimenter may be more related to an ethnographer practising the art of “thick
description” (Geertz, 1973) than may at first appear.
This raises an analogy with the developments of behaviourism in psychology in the 1940s
and 1950s when there was debate about “intervening variables” and “hypothetical
constructs” which theorists such as Clark L. Hull were developing. It renders the possibility
that the experimental methods used then may be reconsidered and used to interrogate the
workings of the robotic mind. It is not too far a stretch to suggest that we, as investigators
of the complexities of the robotic mind, should pay attention to the attempts by ethologists
to understand the animal mind (De Wall, 2016). It may be that we may be better able to
understand biologically based systems, derived from evolutionary pasts (cf. Campbell, 1970;
Scerri, 2016), but we need to remember that the minds of robots capture the thoughts and
insights of human beings, hence an understanding of human insights may enable insights
into the robot.
If the programs, written by humans, operationalise the thought processes and the biases of
those humans, it would be fruitful to explore the cognitive belief systems and socio-
economic ideologies which are present. There is clear evidence that the algorithms used
encapsulate the beliefs of the programmers (e.g. Broad, 2018; Muller, 2018; O’Neil, 2016).
The exploration of the intrinsic and subtle biases of human experts, which are based upon
“common-sense” knowledge and socio-political beliefs, using technologies from the social
sciences, including social psychology, could clarify where the programs “come from”. We
have known for years about the intrinsic biases of human “experts” (e.g. Innes & Fraser,
1971; Kahneman, 2011; Nisbett & Ross, 1980) and, furthermore, about the opacity of
human decision making processes to conscious awareness (Nisbett & Wilson, 1977: Guerin
& Innes, 1981: Newell & Shanks, 2014). The same technical “opacity” can be removed,
however, through experimental investigation. There is a central role for psychology and the
use of psychological methodology in opening up the processes embedded in the
development of AI systems.
It is important to remember that a fundamental question within the history of AI has been
whether it is possible to distinguish between the behaviour of a robot compared with a
human, the Turing Test (Turing, 1950). While there is discussion whether or not the Turing
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Test has been “passed’ by the robot or whether the test is in fact invalid, the question is
based in behaviouristic methodology. It does not inquire into the processes generating the
outcome (the answer to a question) but solely on the observed behaviour. B.F. Skinner (e.g.
1953) asked the same question. So perhaps there is a key to peeling aside the opaque
curtain of the AI system, by adopting the processes of experimental psychology from the
1950s. There is, however, a clear irony here that we shall consider later.

The quality of data entered into the systems: Learning from experimental social
psychology
In the development and implementation of AI and robotic systems, there is an enormous
amount of experimentation used to develop models of interaction between robotic systems
and humans. Critical attention needs to be paid to the nature of the evidence so generated.
The first point is the examination of the use of randomised experiments in studies to
explore the development and utility of human/robot interactions. The preference for the
randomised control trial (RCT) (e.g. Leigh, 2018) does not address the clear evidence of
strong threats to the validity of the data from RCTs carried out in non-laboratory conditions.
The work of Campbell and his co-workers (Cook et al., 2008; Shadish & Cook, 2009; Shadish
et al., 2002), shows that there are systematic biases, in supposedly randomised
experiments, which result in severe doubts about the validity of the data. These issues
emerge over years of research in psychology and the social sciences; the biases exist and
there are consequences for human wellbeing that result. Such consequences may be
exacerbated in the ubiquitous development of AI systems.
More fundamentally, the use of laboratory experiments to claim benefits of interventions
in human-robot interaction has paid no attention to the literature in experimental social
psychology that has demonstrated biases inherent in the social interaction between
experimenter and respondent that severely prevent any inference of validity (e.g. Innes,
2005; Rosenthal & Rosnow, 1969). This is the literature concerned with artefacts in
experimental designs. The irony is that even in social psychology there has been a failure
to remember the past and learn from the mistakes. Much of the literature in this field is
now tainted (cf. Klein et al., 2012) and the so-called “silver bullet” of the experimental
method in social psychology has failed to have an effect (cf. Bless & Burger, 2016). The
double irony, which is of significance in this field of interaction with AI, is that people are
now thinking about the importance of biases that affect the ways in which research is
developed (cf. Hossenfelder, 2018) and then refer to work which itself is biased, because
of the failure in that research to implement appropriate experimental controls. Work on
bias and the effects of unconscious motivation affecting judgment, which have been
suggested to have relevance to studies of human versus computer judgment, is an area
where significant doubts about validity have been raised. (e.g. Doyen et al., 2012). The
detail, wherein lies the devil, is always in the method section of the journal article and
not in the abstract.
In pursuit of this argument, we have conducted an extensive review of the methodology
of experimental studies published in two high profile journals in the field of robot-human
interaction, the International Journal of Social Robotics and the Journal of Human-Robot
Interaction (Innes, & Morrison, 2019). Analysis of the methods sections of the articles
over a two year period reveals no instance where the designers took account of evidence
that such factors as experimenter theoretical expectations and presence, the extra-

161
scientific biases of the investigator or the expectations of the human respondents about
the intention and reason for participation, play a significant role in determining the
outcome of interactions.
The outcomes of the experiments are attributed to the impact of the manipulation of the
theoretical variables tested. If the effects, however, are due to variables independent of
those manipulated, then inferences about the consequences of effects in the longer term
will be invalid and the outcomes may be unforeseen. There may be outcomes that are
commensurate with the manipulated variables in direction and magnitude of effect size.
Therefore an invalid inference about efficacy may be drawn. The real cause of the outcome,
however, the artefact, may have very different longer-term implications in practice that will
be unforeseen and possibly detrimental. A knowledge of past research and methodology
can inform the studies that emanate from engineering and computer departments,
knowledge based upon a long history of experimental study of human social interaction.

A reconstruction of psychological practice?

This final point can be brief. A behaviouristic and cognitive paradigm in psychology which
has resulted in the strong movement to automation, could be replaced by one which is
more humanistic and existential. This has been debated interminably over the years (cf.
Leary, 2001; Morawski 2001). There certainly is a place for debate and a reconfiguration of
the standards developed for the curriculum in psychology, especially in Australia, that might
mitigate the degree to which the processes of the robot can replace the processes of the
human. Accounts of the personal experience of therapists who have evolved different
practices over years of treatment give vivid meaning to this possibility (cf. Marzillier, 2010).

Are these arguments a form of Canuteism?

We still have to ask the following. Are all of the arguments merely a form of the argument
posed by King Canute (990-1035), who demonstrated that the power of the King could not
hold back the waves? Developments in the strong, super-intelligent, version of AI, the
evolution of quantum computers and the increasing complexity of thinking about cognition
may eventually overcome any resistance. These developments may still be decades away
(Walsh et al., 2019), but they may still be inevitable.
Even before the advent of the hyper-intelligent, however, there is a fundamental irony. The
processes of contemporary AI systems, based upon principles of learning, are based in turn
on behaviouristic views of operation (note in Sejnowski, 2018 the reference to the work of
Skinner (e.g. 1953) and the dismissal of the importance of Chomsky, (1971). The underlying
paradigm of AI goes back to the past to reconstruct in robots a radical behaviourist
paradigm of psychology, back before the “cognitive revolution” of the 1950s. We are
literally going back to the past while inventing the future. The emergence of hyper-
intelligence will only amplify the changes.
The appreciation of the present threats, even from the weak version, however, can alert the
professions to what is happening, so that changes can be introduced into curricula, training
and professional development to dampen the impending tsunami.

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168
 Lifestyle
Enhancement

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 Editorial: Lifestyle enhancement
Larissa Clarkson

Wellbeing is a diverse concept that tends to elude definition, and work in the area tends to
focus on description of wellbeing rather than definition (Dodge, Daly, Huyton, & Sanders,
2012). As a basic structure, well-being consists of an interplay between life satisfaction,
pleasant affect and unpleasant affect (Diener & Suh, 1997). In this session, we explored four
papers that captured this diversity in the construct of wellbeing. In the first paper, Ward and
Vicary explore the impact of a brief, digital mindfulness meditation training on executive
functioning. Mindfulness has been linked to innumerous benefits including improvements in
social, cognitive, and emotional functioning. This has led to a surgence of app-based
mindfulness meditations, without clear empirical grounding. Ward and Vicary review the
literature around these apps and conclude that there is some indication for the use of these
apps for improving cognitive functioning.
Another construct related to wellbeing, is resilience. This is a construct that can be broadly
defined as our ability to retain our wellbeing in the face of adversity. At present, there is
little understanding of the cultural differences in resilience. As a first step to examining this,
Cabanes and Gunaratne examined whether measures of resilience employed in a Western
context, might also be applicable cross-culturally. They sought to validate a measure of
resilience in a Singaporean population, but instead found differences between the factor
structure of resilience in Australian and Singaporean populations. This study provides some
indication that resilience may be depend on the cultural context.
Another area explored in this session was the impact of problem solving on wellbeing. In
this paper, Tyrell and Gunaratne whether solving insight problems – problems where the
solution is solved via an ‘aha’ moment, rather than sequential working out – could impact
positive and negative affect. They found that simply attempting insight problems improved
wellbeing (increased positive affect and decreased negative affect), regardless of whether
the correct solution was reached. This finding has utility in workplaces in which creative and
innovative solutions are sought for continued growth and development; as well as
implications for psychotherapy where cognitive restructuring and affective change are
desired outcomes.
The final paper in this session also explored workplace success. In this paper, Charnock and
Vicary explored the overlap between workplace and leisure-time creativity. This is
important, as success in the workplace has implications for wellbeing by reducing the
likelihood of burnout (e.g. Veage, et al., 2014). In their review, Charnock and Vicary
presented evidence in support of the notion that individuals’ leisure-time creative pursuits
may be related to the motives that drive them creatively at work.

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 The impact of brief, digital mindfulness meditation training on executive function.

Jacqueline Ward and Staci Vicary

Abstract
Mindfulness meditation is an Eastern practice linked to benefits in social, emotional and
cognitive functioning. Given its capacity for broad, positive influence on human wellbeing,
various iterations of mindfulness meditation instruction have been developed, including formal
clinical interventions, such as Mindfulness Based Stress Reduction. Traditional mindfulness
meditation practice and clinical interventions are largely prohibitive due to financial and time
demands. The recent emergence of brief, digital mindfulness applications have met the
demand for accessible and affordable training. However, it remains largely unknown whether
these applications, with their shortened format and digital medium, provide the same benefits
as traditional implementations of mindfulness practice. This paper will first review the
theoretical explanations of mindfulness meditation and provide a model to explain the impact
of mindfulness on executive function. Then, results of empirical studies investigating the
impact of brief mindfulness training on task performance will be evaluated. Research provides
an early indication of significant increases in cognitive inhibition (the ability to inhibit
unwanted stimuli) after brief, online, self-directed training in mindfulness. Such results are a
promising indication that the benefits of traditional mindfulness meditation programs can be
achieved by novice meditators in a readily accessible medium. The ability to influence
executive function via brief self-directed training in mindfulness highlights an innovative
solution to the problem of access that limits the reach of many successful psychological
training programs. Thus, brief digital mindfulness training positions itself as an inclusive option
to enhancing cognitive function in diverse populations.

Interest in the Buddhist concept of mindfulness has proliferated, with evidence that intensive
mindfulness meditation practice can enhance executive functioning and improve emotional
wellbeing (Gallant, 2016). Clinical mindfulness interventions, including Mindfulness Based
Stress Reduction (MBSR) and Mindfulness Based Cognitive Therapy (MBCT), are widely
available and produce positive results across a range of outcome measures. However, the
financial and time investment that clinical mindfulness interventions demand are prohibitive.
Digital, short-form applications (“apps”) have made brief, self-directed iterations of
mindfulness meditation widely accessible with delivery via smartphones and tablets. Despite
their popularity, the efficacy of mindfulness meditation apps has not been adequately
considered, particularly when it comes to their impact on cognitive functioning. This review will
first outline the theoretical explanations of mindfulness meditation and provide a model to
explain the impact of mindfulness on executive function. Then, results of empirical studies
investigating the impact of brief mindfulness training on task performance will be evaluated.

Meditation in Western Culture

Meditation has been linked to a myriad of benefits spanning stress reduction, enhanced
cognitive functioning, spiritual enlightenment, increased psychological wellbeing, and
improved emotional regulation (Course-Choi, Saville, & Derakshan, 2017; Zeidan, Johnson,
Diamond, David, & Goolkasian, 2010b). Bishop et al. (2004) characterised meditation as a

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family of techniques that share a conscious attempt to focus one’s attention in a way that
avoids dwelling on discursive, ruminating thoughts. Outcomes of meditation appear to
depend in part on the approach taken to the meditative practice, including type of guidance
and the way objects are employed (Lippelt, Hommel, & Colzato, 2014; Sedlmeier et al.,
2012). Broadly, meditation can be organised into two categories distinguished by their
attentional characteristics: focused attention meditation (FA) and open monitoring
meditation (OM; Jensen, Vangkilde, Frokjaer, & Hasselbalch, 2012; Lippelt et al., 2014; Lutz,
Slagter, Dunne, & Davidson, 2008). FA requires the individual to focus their attention on a
designated object, such as their breath, a candle flame, or a mantra (Lippelt et al., 2014).
During FA practice, the individual must self-monitor their attention, recognising mind
wandering and subsequently restoring their attention back to the chosen object of focus
(Lutz et al., 2008). With OM there is no object to focus on, and instead the individual aims to
stay in a state of constant monitoring, attentive to any experience that may arise during the
course of practice, regarding it with non-judgemental awareness (Lippelt et al., 2014).

Mindfulness Meditation
Mindfulness meditation (MM) is a form of OM meditation that has its roots in Buddhist
meditative practice, including Vipassana, (‘insight’; Jain et al, 2007). MM requires no
meditative object, but rather a broad observation of one’s present moment experience,
accepted with non-judgemental awareness (Jain et al., 2007). The underlying premise is that
cultivating focus on the present moment in a non-judgemental way allows the mind to more
effectively notice and integrate one’s perceptions of both themselves and the wider
environment (Jain et al., 2007). While a unanimous description of MM is contentious, most
conceptualisations agree on two core components (Course-Choi et al., 2017). First, it is
agreed that during MM practice, one’s full attention is guided toward experiences in the
present (rather than past or future), and second, it is accepted that practice is guided by an
attitude of non-judgemental openness to all experiences (Rahl, Lindsay, Pacilio, Brown, &
Creswell, 2017). With MM practice, individuals cultivate a level of awareness that allows
them to view their thoughts and feelings as transient mental events, thereby interrupting
the human tendency to react to and evaluate them (Lueke & Gibson, 2016). As a result,
individuals can foster a greater level of focus and wellbeing.
In Western psychology, Mindfulness Based Stress Reduction (MBSR; Kabat-Zinn, 1982) is
currently one of the most widely implemented meditation interventions (Moore & Malinowski,
2009; Spijkerman, Pots, & Bohlmeijer, 2016). Typically, MBSR is eight weeks in length, includes
daily home practice, a full day of silent retreat, and requires a trained professional to facilitate
(Zeidan, Gordon, Merchant, & Goolkasian, 2010a). Due to the level of commitment and
investment of time and resources required, MBSR programs are not accessible to a large
portion of the population. Regardless, research over the past thirty years has demonstrated
that such mindfulness-based interventions are clinically effective for a wide range of issues,
including treating the affective symptoms associated with medical conditions, reducing stress
and anxiety, pain attenuation, symptom reduction in depression, decreased substance abuse,
and reduced binge eating (Anderson, Lau, Segal, & Bishop, 2007; Gallant, 2016).

Theoretical Underpinnings of Mindfulness Meditation

Most influential of the theoretical accounts that attempt to explain the beneficial effects
resulting from mindfulness meditation is Bishop’s Two-Component Model of Mindfulness

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(Bishop et al., 2004). This model presents an operational definition of mindfulness that
captures both the self-regulation of attention and focus on present experience, as well as
the adoption of an open and accepting awareness of internal and external experience in the
present moment (see Figure 1; Anderson et al., 2007; Bishop et al., 2004). Specifically,
Bishop et al. proposed that mindfulness involves “sustained attention to maintain
awareness of current experience, attention switching to bring wandering attention back to
the present moment, inhibition of elaborative processing to avoid dwelling or ruminating on
thoughts or feelings that are outside of the present moment, and non-directed attention to
enhance awareness of present experience, unfiltered by assumptions or expectations”
(Anderson et al., 2007, p. 450). Mindfulness thus places significant and often competing
demands on one’s cognitive abilities. Indeed, formal MM interventions, such as MBSR, work
to train participants in present moment awareness by way of repeatedly inhibiting
distractions while also shifting attention back to the present moment (Gallant, 2016).

Figure 1: Bishop et al.’s (2004) Two-Component Model of Mindfulness

Mindfulness Meditation and Executive Function

In accordance with general theoretical explanations, MM interventions have been associated
with significant improvements in general cognition and more specifically, executive functioning
(Chiesa, 2013). Executive functions (EFs) are higher-order cognitive abilities required for
volitional human thought and behaviour (Riggs et al., 2015). These prefrontal neural processes
are understood to regulate human cognition and action by way of planning, decision making,
self-regulation, disinhibition, and other such goal-directed behaviours (Gallant, 2016; Miyake
& Friedman, 2012). EFs allow flexibility in the face of cognitive or environmental demands, and
the regulation of task-relevant action to manage unwanted interference (Huguet, Ruiz, Haro, &
Alda, 2017). As such, EFs are integral to many aspects of everyday human life and their
efficiency has significant implications for physical and mental health, as well as psychological,
social and cognitive development (Huguet et al., 2017).
Miyake et al. (2000) identified three core EF abilities (see Figure 2). The core EFs include
Updating: the constant monitoring of working memory contents; Shifting: switching flexibly
between tasks or mental sets, and Inhibition: the deliberate overriding of prepotent
responses (Miyake & Friedman, 2012).

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Figure 2: Miyake et al. (2000) Model of Executive Function

While research is clear in identifying an effect of MM on cognition (e.g. Gallant, 2016), there
has been no distinct attempt to articulate an overarching cognitive theory of MM specific to EF.
However, it is prudent to note that ‘component one’ of Bishop et al.’s (2004) model of
mindfulness (Figure 1) implicates improvement in the same core executive functions as those
delineated in Miyake’s model (Figure 2). Figure 3, a new cognitive account of MM, builds on
both Bishop et al (2004) and Miyake (2000), providing a starting point from which to begin
considering how MM might differentially impact distinct EFs. Theoretically, MM engages the
EF termed Inhibition by promoting both the ability to sustain attention on the present moment,
as well as inhibiting the desire to engage in elaborative processing (Figure 3, C). Likewise, the
promotion of task Shifting arguably occurs via MM with the requirement to not only maintain
attention in the moment, but also bring one’s attention back to the present moment when it
deviates (Figure 3, B). Finally, task Updating may be promoted by MM but to a lesser degree
than the other EFs, given that updating requires one to focus on future events in order to
update held information, which is inconsistent with MMs directive to stay solely in the present
moment (Figure 3, A). Thus, following this theoretical conceptualisation, we should expect to
find that tasks requiring Shifting and Inhibition would be best facilitated via MM, while
Updating might be an EF skill less improved by mindfulness practice. A similar argument was
made in a recent review by Gallant (2016; explained below), although the paper did not
articulate a model by which the effects might be captured. Importantly, the model depicted in
Figure 3 also recognises the effect of MM on stress and trait mindfulness, both as direct
outcomes of ‘component 2’ of Bishops Mindfulness theory, and as likely modulating factors of
the proposed effects of MM on attention (Figure 3, D and E).
The effects of MM on stress and wellbeing are uncontroversial (Chiesa, 2013) and therefore
not reconsidered here. The following section uses this newly organised theoretical model to
analyse literature pertaining to the impact of MM on the EF skills of Inhibition, Shifting and
Updating. Two key observations are present: 1) results appear to depend on the length of
training and/or the method via which training is facilitated, and 2) digital implementations of
MM appear to be an accessible alternative to traditional approaches, but adequate ecologically
valid research is yet to be conducted.

Mindfulness Meditation

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Attention Awareness
Figure 3: Proposed cognitive account of Mindfulness Meditation and executive function. Model
builds on Bishop et al (2004) and Miyake et al (2000)

Improvement in EF from traditional MM practice

In a meta-analysis driven by Miyake et al’s (2000) model of EF, Gallant (2016) identified a
relatively specific effect of MM on executive function, with results that are only partially
supportive of the new model outlined in Figure 3. In a review of 12 recent studies, Gallant
(2016) identified a consistent improvement in Inhibition after MM, but only variable benefits to
the EF domains of Updating and Shifting. In the below, studies considered in the
comprehensive review by Gallant (2016), as well as recent studies and those outside of
Gallants scope, are used to summarise currently known effects of MM on executive function
implicated in the new cognitive account of MM in Figure 3.
Inhibition. Of the three EFs considered, it is Inhibition that appears to be most consistently
improved by MM training or experience. Gallant (2016), identified six well designed studies
that sought to determine the impact of MM on cognitive inhibition. Four of the six studies that
assessed Inhibition used a version of the popular Stroop task (Stroop, 1935) and of those, three
found that compared to controls, performance on the Stroop task was enhanced for
meditators. For example, Moore & Malinowski (2009) conducted a study comparing a group of
experienced meditators with a meditation-naïve control group and found that Stroop task
scores were significantly related to meditation experience. Meditators also performed

175
significantly better on all measures of attention, suggesting that MM experience decreases
Stroop interference and enhances concentration abilities (Hodgins & Adair, 2010; Moore &
Malinowski, 2009). Similar results were obtained by Allen et al. (2012) when they conducted a
study comparing one group who underwent six weeks of weekly MM training with an active
control group, finding that those in the meditation group displayed reduced Stroop conflict
relative to controls. Utilising a similar training time-frame, Heeren, Van Broeck, & Philippot
(2009) compared a group who had undergone the MBCT training protocol (eight weeks of
weekly two-hour sessions) with a waitlist control group and found that meditators had
improved Hayling task (an alternative outcome measure assessing Inhibition) performance at
post-test. However, by contrast using an altered Stroop paradigm, Anderson et al (2007) found
no improvement in inhibition after MM practice- despite an experimental protocol that
mimicked other studies in almost every way. Thus, there is evidence that Inhibition might be
improved by MM practice, but this might be dependant on the inhibition task used to assess
this skill.
Shifting. Given MM’s ability to enhance inhibitory control by limiting elaborative processing
and supporting the individual to focus on the present moment, measures of task Shifting
should also show improvement after MM training. Surprisingly however, results are less
consistent with respect to this domain, at least in comparison to measures of Inhibition. For
example, Gallant (2016) identified only one study producing a reliable effect on a measure of
task switching. Moynihan et al. (2013) identified improved performance on a Trail Making test
(a measure of ability to switch between stimuli) in a group of older participants who
underwent the MBSR program (eight weeks of weekly two-hour sessions plus one day of
intensive retreat) compared to a matched a no-contact waitlist. Similarly, in an 8-week study
paradigm, Teng & Lien (2016) identified an improvement in measures of cognitive flexibility
and task switching, despite a lack of effect for other EF measures. However, other studies that
included MM training periods ranging from 10 days of intensive practice (e.g. Chambers et al
2008) to eight weeks characteristic of the MBSR program (e.g. Anderson et al, 2007) did not
identify any effects of group or time on shifting ability. Thus, results seem inconclusive for task
Shifting, which is likely driven by the inconsistency across studies in MM protocol, shifting
outcome measure, and length of training.
Updating. Conceptually, Updating is expected to be less impacted by MM experience (see
Figure 3) given that the ability to update one’s incoming stream of consciousness is less
implicated in mindfulness practice than those domains of Inhibition and Shifting. Despite this,
research has identified some benefit to updating ability. For example, Zeidan et al (2010)
identified improved N-back (a measure of working memory updating) accuracy after just four
sessions in one week for 20 minutes per day, relative to an active listening control. Attempts to
identify improved Updating ability using other outcome measures (e.g. operation span)
produced varying results, seemingly tied to the amount of prior experience with mindfulness
before the study began, which is suggestive of a long-term expertise effect (e.g. Jha et al,
2010). Other evidence that stimulus Updating might be improved by MM is limited, but this
might be driven by a comparative lack of studies that specifically target this EF skill compared
to others (Gallant, 2016)
In sum, there is some empirical evidence to support the theoretical model outlined herein,
particularly for the EF domain of Inhibition. This is somewhat expected given inhibition draws
on the two most commonly implicated outcomes of MM across theoretical accounts- staying in
the present and inhibiting elaborative processing of unwanted input (Course-Choi et al., 2017).

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Crucially, conclusions drawn from the work briefly reviewed are limited by inconsistencies in
research approach, including variations in outcome measures used and the implementation of
the mindfulness training paradigm. A new wave of research focusing on brief, digital
implementations of MM provides another set of empirical data from which to continue to
evaluate the new theoretical account proposed. This research is reviewed in the context of the
theoretical model below, before suggestions for future research are given.
Improvement in EF from Brief MM practice
There are currently over one thousand commercially available apps targeting mindfulness
(Economides, Martman, Bell, & Sanderson, 2018). These short-form, self-directed versions of
mindfulness meditation are available for free or for low cost on smartphones or tablets,
making them widely accessible. However, it remains largely unknown whether brief, self-
directed digital practice supported by apps deliver the same benefits as traditional MM
programs. There is evidence to suggest that brief MM training administered in a traditional
face-to-face facilitator driven manner can improve general sustained attention (Zeidan et al.,
2010b), conflict detection (Mitchell et al., 2015; Tang et al., 2007), as well leading to increases
in pain threshold, and reduced state anxiety levels (Zeidan et al., 2010a). With respect to
cognitive function, Teng and Lien (2016) reviewed studies specifically relating to the three core
EFs included in Figure 3. Interestingly, where MM interventions were brief, rather than
mimicking traditionally lengthy programs, there appears to be a consistent effect for the
Updating skill, and variable effects for task Switching and Inhibition (Teng & Lien, 2016). This is
inconsistent with empirical research considering full length MM interventions which typically
show consistent effects for Inhibition, and variable effects for Shifting and Updating. Thus,
there is an inconsistency in outcomes observed for MM training and cognitive function when
the length of the program is considered.
Arguably, early practice in MM might induce an ability to engage in stimulus Updating as an
individual learns to actively pay attention to incoming information and then move their
attention back to the present. Thus, early stages of practice in MM might induce improvement
in EF Updating, as is apparent in the available empirical literature to date. However, as one
becomes more practiced in MM (either during a MM intervention protocol over time or via
self-directed practice) the tendency to actively pay attention to incoming information might be
suppressed in place of an ability to accept the presence of other information without the
desire to actually engage with it. Thus, overtime individuals might necessarily lose
improvement in Updating skill as they develop the ability to engage in task Switching
(switching between material without integrating new material) and finally, as the end goal,
Inhibition (accepting the presence of other information without engaging with it). The theory is
that MM might have a dynamic, rather than static, relationship with improvement in EF (as
articulated by the time component of Figure 3, F)
Importantly, the brief interventions outlined in the above have relied almost exclusively on
traditional face-to-face meditation administration. Thus, while the brief aspect of the studies
does mimic the nature of a MM app, these studies cannot conclusively speak to the efficacy of
MM apps. Spijkerman et al., (2016) conducted a preliminary meta-analysis to estimate the
overall effects of online Mindfulness-based interventions on mental health and concluded that
online MBIs have a small, but significant impact on depression, anxiety, well-being, and overall
level of mindfulness (Spijkerman et al., 2016). With respect to cognitive function, two studies
provide early evidence that digital applications of MM training are as efficacious as traditional
approaches, although specific effects on the core EFs considered herein are not yet clear. For
177
example, Rahl et al. (2017) used pre-recorded audio files to deliver MM training (and an active
reading control task) to participants in 20-minute sessions across four consecutive days.
Results of the study showed reduces mind wandering, as indexed by performance on the
Sustained Attention to Response Task (SART). Similarly, Basso et al., (2019) randomised
experienced meditators into either a daily 13- minute guided meditation session or a daily
podcast listening sessions for a period of eight weeks. Results demonstrated that, compared to
the control group, eight but not four weeks of daily meditation practice resulted in enhanced
attention and working memory, in tandem with decreased negative mood state and state
anxiety scores (Basso et al., 2019). An improvement in inhibition was also implicated, with
those in the meditation group only showing improved performance on the Stroop task over
time. Notably, the meditation used by Basso et al (2019) was akin to Focused Attention
meditation, which is not consistent with the methods typically associated with mindfulness
meditation within the literature.
Thus, while the rise in digital delivery for mindfulness meditation training has been fuelled by
significant demand, research in the field is still relatively sparse and is inconsistent in its
findings. Despite this, there is some early evidence to support the theoretical proposition that
improvements in cognitive function (specifically EF) develop dynamically over time with MM
practice.
Future research: evaluating the cognitive account of MM
The impact of MM training on wellness and stress is undisputed (Chiesa, 2013) and occurs
consistently even with digital, brief meditation practice (e.g. Economides, et al., 2018).
Growing too, is evidence to support a likely direct effect of MM on executive function,
although improvement in the specific EF domains appears to develop and change dynamically
over time as one gains ongoing expertise in meditation. To capture these likely effects and
provide a framework for ongoing research, we have proposed a new model of MM and EF.
Given the relatively specific effects observed in previous empirical literature, the cognitive
model of MM presented herein is proposed as an improvement over generalised
conceptualisations of MM as improving global cognitive function or sustained attention, as
these are unlikely to capture the nuanced nature of the effects observed.
Of course, this model is theoretical in nature and requires further empirical research to
validate the premise on which it is based and replicate the previously observed effects that
have thus far supported its structure. Specifically, we suggest that future research should 1)
specifically target the three core EFs outlined in the model as outcome measures in MM
training programs, in addition to (or in place of) general sustained attention or working
memory measures, 2) evaluate a battery of EF tasks for each domain within each study (e.g.
consider more than just the Stroop task for Inhibition) to confirm domain-specific, rather than
task-specific improvement in function, and 3) plan carefully designed studies that track
improvement in EF from MM protocols, relative to matched controls, over time and over
different modalities (e.g. online versus face-to-face) to confirm the proposed dynamic nature
of the model.
It is hoped that future research on this topic will help to identify MM as a training paradigm
that can improve general cognitive function in addition to mental wellbeing, as well as
facilitating access to MM training for those in the population who might previously been
limited in their ability to engage with traditional training approaches.

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 Solving insight problems influences positive and negative affect
Deanne L. Tyrrell and Charini D. Gunaratne

Abstract
Insight thinking has been associated with many great scientific discoveries and creative
endeavours. An insight occurs when an ill-defined problem space is cognitively restructured,
and a problem solution appears without conscious processing. Most research has focused
on the aha! moment of realisation that precedes the problem solution. Little research has
examined changes in affect over time during insight thinking, and whether the product or
the process is responsible for affective change. The present study aimed to test whether
problem solution type (correct; incorrect) influenced positive affect and negative affect
across time (pretask; posttask). Participants were 95 adults from an Australian university
and the general public (Mage = 40.46, SDage = 16.02, age range = 18 to 72 years) including 79
females, 15 males, and one participant of other gender. A mixed between-within subjects
analysis of variance and Mann-Whitney U Tests revealed a significant increase in positive
affect over time, however, solution type did not significantly increase positive affect, and
there was no interaction effect between solution type and time for positive affect.
Surprisingly, both correct and incorrect solutions increased positive affect. Similarly, there
was a significant decrease in negative affect over time, however, solution type did not
significantly decrease negative affect and there was no interaction effect between solution
type and time for negative affect. Again, surprisingly, both correct and incorrect solutions
decreased negative affect. These results suggest that it is the process and not the product of
insight thinking that may account for changes in affect. This finding has particular utility in
workplaces in which creative and innovative solutions are sought for continued growth and
development. Furthermore, insight thinking has implications for psychotherapy where
cognitive restructuring and affective change are often desired outcomes.
Key words: insight, problem solving, creative thinking, positive affect, negative affect

Insight thinking has been associated with many great scientific and creative discoveries and
inventions; for example, Archimedes’ ‘eureka’ moment when he discovered how to measure
the volume of irregular solids (Klein & Jarosz, 2011); the development of the radar by British
physicist Arnold Wilkins; Thomas Edison’s invention of the lightbulb; and Impressionist painting
(Weisberg, 2015). Insights also commonly occur in 80% of the general population when
engaging in daily problems of life and work (Klein & Jarosz, 2011; Ovington, Saliba, Moran,
Goldring, & MacDonald, 2018). While creative behaviour has been robustly linked to mental
health effects, such as improvement of thought, affect, and well-being (Conner, DeYoung, &
Silvia, 2016; Cropley, 1990; Leckey, 2011), less is known on how creative thoughts, such as
insight thinking may influence mental health.
Gestalt psychologists were the first to propose two modes of problem solving: (a) reproductive
thinking, that transfers a solution from a similar problem to a new problem, and (b) insight
thinking, that puts aside one’s previous experience and knowledge to deal with the problem on
its own merits (Koffka, 2013; Weisberg, 2015; Wertheimer & Wertheimer, 1959). Most

182
researchers agree that an insight occurs when an ill-defined problem space is cognitively
restructured, and a solution suddenly appears without conscious awareness of any processing.
It is often accompanied by an ‘aha’ moment of realisation (Weisberg, 2015).
The research regarding mood and insight thinking suggests positive affect (PA) increases
insights (Isen, 2008; Lin, Tsai, Lin, & Chen, 2014). A study that induced positive, negative, and
neutral affect states prior to problem solving found that positive affect produced better
performance on insight problems compared to negative and neutral affect (Lin et al., 2014).
Furthermore, cognitive flexibility, the ability to switch mental sets, mediated the relationship
between positive affect and insight problem solving. Insight thinking requires switching
between Type 1 and Type 2 cognitive processing (Lin et al., 2014; Sowden, Pringle, & Gabora,
2015). Type 1 processing is expansive thinking such as idea generation, while Type 2 processing
is constrained and evaluative thinking. Increased positive affect is also related to activity in the
anterior cingulate cortex (ACC) associated with cognitive flexibility, and appears to increase
ACC activation and dopamine levels, promoting insight thinking (Lin et al., 2014).
The aha moment is the most studied phenomenon within the insight thinking process. There is
agreement that insight is sudden and surprising, includes positive affect, certainty/confidence,
tension relief, and drive/motivation (Amory H. Danek, Fraps, von Müller, Grothe, & Öllinger,
2014; Amory H Danek & Wiley, 2017; Topolinski & Reber, 2010; Webb, Little, & Cropper, 2016).
Researchers also suggest that an impasse is experienced if the problem cannot be solved
(Shen, Yuan, Liu, & Luo, 2016; Webb et al., 2016; Webb, Little, & Cropper, 2018). However,
little is known about the subjective experience of an impasse, and the affective state
associated with an incorrect insight solution.
Numerous studies have reported on the positive affect associated with the aha moment
(Amory H. Danek et al., 2014; Amory H Danek & Wiley, 2017; Shen et al., 2016; Webb et al.,
2016, 2018). In a study that required German undergraduates to repeatedly watch magic tricks
and determine how they were achieved, the aha moment was most often associated with
happiness, followed by other positive emotions (Amory H. Danek et al., 2014). A similar result
was shown in a study of 19 Chinese undergraduates who solved 138 Compound Remote
Associates (CRAs; verbal insight puzzles) under timed conditions (Shen et al., 2016). The most
frequent emotion was happiness, followed by certainty, calmness, excitement, ease, delight,
gladness, and joy. Another study of 193 Australian undergraduates that compared classic
insight problems and CRAs conducted under timed conditions found that accuracy was related
to the aha moment, and that aha was significantly positively correlated with confidence,
pleasure and surprise. However, surprise was not significantly related to solution accuracy
(Webb et al., 2016).
The research examining negative affect and insight thinking is limited. Shen et al. (2016) asked
Chinese undergraduates to report their emotional experience at the time of their aha moment
and found that negative affect states such as nervousness and doubt were present among
positive emotions. Participants who did not experience an aha moment significantly
experienced more emotions of loss, hesitation, and nervousness compared to those who
experienced an aha moment (Shen et al., 2016).
There is also a theoretical assumption that an insight occurs in the following sequence:
attempted problem solving, impasse, cognitive restructuring of the problem space, and
insightful solution (Amory H. Danek et al., 2014). However, in a study that required 60
participants to verbalise their thought processes while solving a range of insight problems,

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Fleck and Weisberg (2013) found that only 7% of insight solutions were solved using this
sequence. Furthermore, 58% of solutions were preceded by neither an impasse nor
restructuring. Of the 32% of solutions that involved restructuring, more than 80% did not
involve an impasse. Thus, it appears the cognitive sequence for achieving insight is unclear.
Further, experiments have focused on the subjective experience of the aha moment and its
associated affect. No previous studies have investigated whether the accuracy of one’s insight
influences affect. Quantitative research has also primarily focused on university
undergraduates with a mean age of 18 or 19, using banks of insight puzzles conducted under
timed laboratory conditions, thus effects of creative thinking in a wider sample is unknown.
The aim of this study is to investigate whether insight solution accuracy (correct versus
incorrect) will influence changes in positive and negative affect. Accordingly, it is hypothesised
that PA will increase for participants who correctly solve the insight problem, but not for those
who do not solve the problem. Furthermore, it is hypothesised that NA will increase for those
who do not solve the insight problem, but not for those who solve the problem.

Method

Participants and Procedure

Participants were 95 adults from an Australian university and the general public (Mage =
40.46, SDage = 16.02, age range = 18 to 72 years) including 79 females, 15 males, and one
participant of other gender. University students were provided with course credits. Other
participants were recruited using social media advertising with no incentives provided.
Participants accessed the study via an online link and provided informed consent. They then
completed a demographic survey and the pretask positive and negative affect scale. They
then attempted the insight problem followed by the posttask positive and negative affect
scale.

Materials
Positive and negative affect. The Positive and Negative Affect Scale (Watson, Clark, &
Tellegen, 1988) is a 20-item measure with 10 items that assess positive affect (PA; e.g.,
excited, inspired, interested), and 10 items that assess negative affect (NA; e.g., upset,
afraid, nervous). Items are rated using a Likert scale (1 = very little or not at all, to 5 = very or
extremely). Participants rate the extent to which they experience an affect in the present
moment. Watson et al. (1988) found high Cronbach alpha reliability using undergraduate
students and the present moment time frame (.89 for positive affect and .85 for negative
affect). The association between the PA and NA scales was low (-.15); the subscales share
approximately 2% of their variance (Watson et al., 1988). The Cronbach alpha reliabilities
were .903 for pretask positive affect and .875 for pretask negative affect subscales.
Insight problem. Participants were given the “the marrying man” problem and asked to type
their response into a text box (Ansburg & Dominowski, 2000; Weisberg, 2015):
A man married 20 women. He and the women are still alive, he had no divorces, he is no
bigamist and broke no law. How can this be? (The answer is, the man is a minister/priest,
or justice of the peace.)
Previous studies have produced correct response rates of 10% - 32% for American
undergraduates (between mean ages 18.8 - 19.7) (Ansburg & Dominowski, 2000; Beaty,

184
Nusbaum, & Silvia, 2014; DeYoung, Flanders, & Peterson, 2008), and 28% for Australian
undergraduates (mean age = 19.60) (Webb et al., 2018). The response rate for a correct
solution for the present study was 57% (mean age = 40.46).

Results
The G*power calculator by Faul, Erdfelder, Buchner, and Lang (2009) with power = 0.80, a
medium effect size = 0.15, and two between and two within groups, identified a minimum
sample size of 90 to achieve statistical power. Data were screened for incorrect responding.
Nineteen responses were deleted from the dataset. These included responses that did not
offer a single response but rather offered long narratives, explanations, or offered multiple
options in one response. Only single responses were considered. The original responses to
this problem were a priest or a justice of the peace. Answers that indicated qualifications to
ordain marriage in current society were accepted. These included rabbi, minister, priest,
marriage celebrant, religious leader, or a ship’s captain.
Examination of the histograms and normal Q-Q plots revealed that the normality
assumption conditions were violated for three of the dependent variables: posttask PA,
pretask NA, and posttask NA. Both the posttask PA zskewness score (z = 1.18), and the posttask
PA zkurtosis score (z = 1.83) were less than 1.96 indicating they were non-significant (p < .05)
(Field, 2009), which was also supported through inspection of the Q-Q plots. Thus,
parametric analyses were used for hypothesis-testing based on the PA scores.
Inspection of the Q-Q plots further revealed that the NA scores for both pretask and posttask
were substantially positively skewed, and kurtotic. Examination of the NA scores revealed
similarly shaped distributions that were in violation of the assumption of normality. A NA
difference score was calculated by subtracting posttask NA scores from pretask NA scores.
Visual inspections of the distribution further indicated that the difference scores continued to
violate the assumption of normality. Thus, non-parametric analyses were utilised for
hypothesis testing based on the NA scores.

Insight Problem Solving and Positive Affect

A difference was observed for pretask PA for the correct and incorrect answer groups, and
an independent-samples t-test was conducted to assess significance. The Levene’s Test of
Equality of Error Variances was not significant for pretask PA, F (93) = 1.33, p = .25,
indicating equal variance. There was no significant difference in scores for correct answers
(M = 27.63, SD = 7.59) and incorrect answers (M = 24.80, SD = 8.49; t (93) = 1.71, p = .09,
two-tailed).
A mixed between-within subjects analysis of variance was conducted to assess the impact of
the insight Problem answer type (correct; incorrect) on PA scores, across time (pretask;
post-task). The Levene’s Test of Equality of Error Variances was not significant for pretask
PA, F (1,93) = 1.33, p = .25, and posttask PA, F (1,93) = .46, p = .50, indicating equal variance.
There was no significant interaction between answer type and time, Wilks’ Λ = 1.00, F (1,93)
= .344, p = .56. There was a significant main effect of time, Wilks’ Λ = .96, F (1,93) = 9.03, p =
.046, partial η2 = .04, with both groups showing an increase in PA over time with small to
moderate effect. The main effect comparing answer type was not significant, F (1,93) =
3.615, p = .06. Participants with correct and incorrect answers increased in PA across time
(see Table 1). Thus, the hypothesis that PA will increase for participants who correctly solve

185
the insight problem, but not for those who do not solve the problem was partially
supported.

Table 1 Means and Standard Deviations for Positive Affect for Pretask,
Posttask, and Difference Scores for Insight Problem Answers

Pretask score Posttask score Difference score

S S S
Creativity task n M M M
D D D
Correct Answer 57 27.89 7.58 29.40 8.40 1.51 5.12
Incorrect Answer 58 24.86 7.95 25.97 8.06 1.10 4.16
Total 115 26.36 7.88 27.67 8.37 1.30 4.64

Insight Problem Solving and Negative Affect

Both parametric and non-parametric tests were conducted and compared for NA. Firstly, a
difference between pretask NA was observed for those with correct and incorrect answers,
and an initial independent-samples t-test assessed if this was significant. Levene’s Test for
Equality of Error Variances was significant, indicating unequal variance F (93) = 7.53, p =
.007. There was a significant difference in NA scores for correct answers (M = 12.83, SD =
4.90) and incorrect answers (M = 16.00, SD = 5.80; t (78) = -2.82, p = .006, two-tailed). The
magnitude of the differences in the means (mean difference = 3.17, 95% CI: -5.41 to -.93)
was moderate (partial η2 = .08). A non-parametric test confirmed this difference. A Mann-
Whitney U Test revealed a statistically significant difference in pretask NA for correct
answers (Md = 11, n = 54) and incorrect answers (Md = 14, n = 41), U = 656.50, z = -3.43, p =
.001, r = .35, indicating a medium effect size.
Secondly, a mixed between-within subjects analysis of variance was conducted to assess the
impact of the insight problem answer type (correct; incorrect) on participant scores of NA,
across time (pretask; posttask). The Levene’s Test of Equality of Error Variances for pretask
NA, F (1,93) = 7.53, p = .007, and posttask NA F (1,93) = 11.01, p = .001 were both
significant, indicating unequal variances, and a more stringent significance level (p = .01)
was set for evaluating results (Field, 2009). There was no significant interaction between
answer type and time, Wilks’ Λ = .99, F (1,93) = 1.36, p = .25. There was a substantial main
effect for time, Wilks’ Λ = .78, F (1,93) = 26.27, p < .001, partial η2 = .22, with both groups
showing a decrease in NA across time with large effect. The main effect of answer type was
also significant, F (1,93) = 8.51, p = .004, partial η2 = .08, suggesting a difference in the
decrease of NA for answer type with moderate effect; participants with incorrect answers
decreased in NA more than participants with correct answers as shown in Table 2. Thus, the
hypothesis that NA will increase for those who do not solve the insight problem, but not for
those who solve the problem was partially supported using parametric testing.
Finally, a Mann-Whitney U Test revealed no significant difference in the NA difference score
for correct answers (Md = 0.00, n = 54) and incorrect answers (Md = 1.00, n = 41), U =
990.50, z = -.91, p = .36, r = .09, indicating a small effect size. Both correct and incorrect
insight problem answers reduced NA across time when measured using the NA difference

186
score. Thus, the hypothesis that NA will increase for those who do not solve the insight
problem, but not for those who solve the problem was partially supported using non-
parametric testing.

Table 2 Means and Standard Deviations for Negative Affect for Pretask,
Posttask, and Difference Scores for Insight Problem Answers

Pretask score Posttask score Difference score

S S S
Creativity task n M M M
D D D
Correct Answer 54 12.83 4.90 11.67 3.91 1.17 1.97
Incorrect Answer 41 16.00 5.80 14.15 5.03 1.85 3.70
Total 95 14.20 5.51 12.74 4.57 1.46 2.85

Discussion
The aim of the current study was to examine the effect of insight thinking on positive and
negative effect, and whether the solution type would influence affect. The first hypothesis that
positive affect would increase for participants who correctly solved the insight problem, but
not for those who do not solve the problem was partially supported. Positive affect was
enhanced for both conditions; correct and incorrect responses, and those who gave a correct
response increased positive affect the most, although not significantly. No other study has
examined the overall effect of insight problems and answer type on positive affect. One
explanation is that the thinking process (and not the insight solution) provides the stimulus
that influences affect. Solving insight problems requires a range of processes: cognitive
restructuring, divergent thinking, the ability to break frame and overcome functional fixedness,
and convergent thinking (DeYoung et al., 2008). In essence, it requires cognitive flexibility to
switch between these processes (Lin et al., 2014; Sowden et al., 2015). Given that positive
affect is associated with cognitive flexibility and increased dopamine release, it is suggested
that the processes of insight thinking influences the dopamine release that improves affect.
Increased positive affect over time has also been found for insight and divergent thinking tasks
(Akbari Chermahini & Hommel, 2012; Bujacz et al., 2016; Tyrrell & Gunaratne, 2019; Zenasni &
Lubart, 2011). It may also be possible that pretask positive affect may have assisted in the ease
of insight problem solving. In a cross-cultural validation study of the PANAS, Thompson (2007)
found that on average most cultures exhibited average positive affect scores ranging between
18 and 20. Participants in the present study achieved higher mean affect scores (see Table 1).
Given that positive affect facilitates insight thinking, these high scores may account for the
higher than previously recorded accuracy rates in the present study for the ‘marrying man’
problem and subsequent increased positive affect over the time.
The second hypothesis that NA would increase for those who did not solve the insight problem,
but not for those who did solve the insight problem was also partially supported. Both correct
and incorrect solutions decreased NA, and surprisingly, incorrect solutions reduced NA the
most, however not significantly. Similar to results for solution correctness and positive affect,
the creative thinking process, and not the end product, may influence affect. Creative tasks

187
have been used as evidence-based interventions to assist with depression psychotherapy, and
the present study results support the response style theory of depression (Nolen-Hoeksema,
1991; Weeland, Nijhof, Otten, Vermaes, & Buitelaar, 2017) that underpins art therapy
research. Creative tasks provide short-term mood repair and insight problems may also achieve
this goal; they represent both a positive distraction and a means of changing cognitions and
affect through cognitive restructuring (Nolen-Hoeksema, 1991). Further research should
investigate how short duration insight thinking tasks may be used therapeutically.
The study instructions may also have influenced participants ideas about accuracy. The
experiment was presented to participants as a study about creative thinking. Participant’s
pretask affect levels were measured before they knew they would not be timed or tested, and
that they should have fun and be creative. Cognitive tuning theory (Schwarz, 2012) may explain
the reductions in negative affect for both correct and incorrect solutions. Cognitive tuning
theory suggests the purpose of affect is to provide the individual with information. In
particular, a negative mood indicates a problematic situation, a threat, or danger (Schwarz,
2012). The present online study context offered no threat to the self. Responses were
anonymous and not publicly evaluated, and participants were not required to defend their
responses. The creative context, and instruction to be creative and have fun may have relieved
participants of the expectations of a correct performance. This finding also suggests that when
engaging in creative activities, including creative thinking, the notion of correctness may not be
as important or as relevant as the possibility of a new and appropriate response. This idea in
particular deserves further investigation as to how insight thinking can be used therapeutically.
While this study is the first to evaluate whether insight problem accuracy influences affect, it is
recognised that only one verbal insight task was tested, and thus the generalisability of these
results is limited. The present study also highlights the importance of investigating problem
solving beyond the task level, at the level of cognitive processes. This study was also unable to
distinguish whether the problem was solved by insight, whether an impasse was experienced,
and whether these two events influence affective states. Therefore, findings are limited to
talking about insight tasks and not insight thinking, and future studies should investigate these
variables in greater detail.
Another study limitation was the use of the PANAS (Watson et al., 1988) for a general
population study. The negative affect scores were positively skewed; most participants were
experiencing low affect at the time of the study. The use of another affect scale that captures
affective states of mid to low intensity, such as happy, sad, calm, and lethargic, may be more
beneficial in a general population sample and provide further understanding of how the effects
of creative thinking can influence affect.
A strength of the present study was that it captured a wide range of ages. While many other
studies have produced accuracy rates for the “marrying man” problem of 23% - 32% for
undergraduates of 18 or 19 years of age (Beaty et al., 2014; DeYoung et al., 2008; Webb et al.,
2018), the present study produced a higher accuracy rate with an older mean age. In the
qualitative study by Ovington et al. (2018) age was a theme; insights improved with age and
age brought about the capacity for new perspectives. However, it must be noted that
participants in the present study may have been exposed to the insight problem before, and
future research should enquire whether participants have had previous exposure to the insight
problems in question. Finally, the presentation of the study as a creative thinking task, not a
test, that should be approached as a fun activity may have influenced participants’ affective

188
state. Further research should investigate how instructions (problem-solving versus creative
thinking) impact accuracy and affect.
While this study acknowledges a number of limitations of a single experimental task, it raises
questions regarding the future of insight problem solving experiments, accuracy and affect.
While much research attention has been given to positive affect and creative thinking, there
has been relatively few experiments that target negative affect. Cognitive restructuring already
exists as a therapeutic tool in cognitive behavioural therapy for psychiatric disorders (Beck,
2005) and insight thinking may be a small extension to this skill set that can assist in repairing
negative affect. Furthermore, insight thinking is an important skill for the future. As the global
workforce automates, individuals with increased flexible thinking skills will be highly sought
after (Bakhshi & Windsor, 2015; European Political Strategy Centre, 2016). Understanding how
creative thinking influences the affect and wellbeing of employees will certainly be a benefit to
the future workforce.

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 Exploring the link between Leisure-Time Creativity and Motives for Workplace Creativity: A
Literature Review

Trina Charnock and Staci Vicary

Abstract
The contribution of individual employee creativity to organisational success is well established,
and a plethora of research has investigated the motivational mechanisms driving workplace
creativity. However, the relationship between the motives for workplace creativity and
motives driving creativity in other domains, such as leisure-time creativity, has not been
adequately investigated. This review provides an overview of research linking the motives
driving leisure-time creativity and those driving workplace creativity. First, the theoretical
underpinnings of creative motivation are evaluated, and their shared relevance to both the
leisure-time and work environments is addressed. Then, the specific motives driving creativity
during work and leisure-time is reviewed. Although the workplace and leisure-time creativity
literature rarely converge, the motivational mechanisms driving creativity during work and
leisure show considerable overlap. Next, the domain-generality (relevant to leisure-time
creativity generally) and domain-specificity (relevant to specific hobbies) of motives driving
leisure-time creativity will be addressed. Finally, a new model of conceptualizing the motives
driving workplace creativity is drawn. Suggestions for future research to further understand
the relationship between creative motivation during leisure-time and at work are given. To
assist in this research, a new scale is required that is specifically operationalised to measure
the motives driving workplace creativity. It is hoped the review findings will encourage further
empirical investigations into the motivations driving workplace creativity.

Individual workplace creativity is the ability to produce new ideas related to products, work
processes, services and procedures, which are useful to the organisation (Amabile, Conti, Coon,
Lazenby, & Herron, 1996). Workplace creativity may range from minor adaptations to radical
breakthroughs (Mumford & Gustafson, 1988) and can be generated by employees at any level
in the organisation (Shalley, Gilson, & Blum, 2009). Individual workplace creativity plays a well-
recognised role in allowing organisations to sustain a competitive advantage and withstand
rapidly-changing business environments, thereby contributing to their long-term survival (Zhou
& Shalley, 2008). Thus, there is a growing need among policy-makers, educators, and business
leaders to find ways to foster workplace creativity. At present insufficient practical guidance is
available on how best to motivate individual creativity in the workplace, and managers admit
lacking confidence in their ability to motivate their employees’ creativity (Barsh, Capozzi, &
Davidson, 2008). Several commentators have considered tapping into employees’ creative
hobbies, and the motives driving them, to identify ways to motivate their creativity at work
(e.g. Sherwood, 2006). While this theoretical assertion represents a valid theoretical premiseis
valid, at present the empirical relationship between the motivational mechanisms driving
participation in leisure-time creativity and those driving workplace creativity have not been
adequately explored.

192
This review will consider research that explores links between leisure-time and workplace
creativity. In particular, the review will discuss the motivational mechanisms driving creative
engagement during work and leisure, and the potential relationship between those motives. In
approaching the research, this review will (1) discuss general theories that explain creative
motivation; (2) review empirical evidence linking specific motives to both leisure-time and
workplace creativity; (3) present evidence for the domain-generality and domain-specificity of
motives driving leisure-time creativity; and (4) propose a new preliminary conceptual model
that draws together the research reviewed in this paper. The purpose of this review is to
consider published empirical evidence supporting a relationship between the motives driving
leisure-time and workplace creativity with the aim of fostering further empirical investigations
of the motivations driving workplace creativity.

General theoretical perspectives

The motivational mechanisms underlying creativity are the forces that drive individuals to
initiate and maintain their involvement in creative processes (Liu, Jiang, Shalley, Keem, & Zhou
et al., 2016). Researchers have drawn on four major theoretical perspectives to understand
these motivational mechanisms. First, Amabile’s componential theory (Amabile, 1983;
Amabile & Pratt, 2016) asserts that individual creativity is dependent on three factors: the skills
and knowledge required to be creative; creativity-relevant processes; and intrinsic motivation,
defined as the desire to engage in an activity for its own sake because it is enjoyable, fun, or
challenging (Amabile, 1983; see Figure 1). Second, self-determination theory posits that
individuals are motivated to perform creatively when their need for competence (the need to
feel effective), relatedness (the need for social connection or belonging) and autonomy (the
need for freedom, independence and discretion) is satisfied (Deci & Ryan, 2000). Third,
drawing on Bandura’s social cognitive theory (Bandura, 1991), creative self-efficacy is defined
as the drive to engage in creative processes because success is anticipated (Tierney & Farmer,
2002). Fourth, providing a more direct theoretical link between leisure-time creativity and
workplace performance, the Recovery Model (Sonnentag & Fritz, 2007) posits that individuals
are motivated to engage in leisure-time creativity in order to cope with the stressors of work.
These theories differ in their explanation of the factors contributing to creativity, but converge
on the idea that creativity is driven by intrinsic factors across different environments.
Therefore, the motives underpinning leisure-time creativity could theoretically also translate to
workplace creativity.
Motivational mechanisms
Supporting the theoretical assumptions described above, researchers have shown that
participation in leisure‐time creativity is dominated by intrinsic motivational mechanisms with
external incentives such as money playing a more minor role (Hegarty & Plucker, 2012).
Leisure‐time creativity studies have traditionally focused on participants’ motives for engaging
in a particular creative domain, for example, textile handicrafts (Kouhia, 2016), or pottery
(Genoe & Liechty, 2017). However, Benedek, Bruckdorfer and Jauk (2019) identified nine
general motives for engaging in leisure‐time creativity: enjoyment, expression, challenge,
coping, social motive, prosocial motive, recognition, material and duty. The authors
demonstrated that some of these motives were more domain‐specific (e.g., enjoyment was
strongly important for all creative activities), while others were more domain‐general (e.g.,
prosocial motives were considered more relevant to handicrafts and creative cooking than to
literature, music and visual arts; Benedek et al., 2019).

193
 Figure 1.

Components influencing individual creativity

With respect to the workplace, an expansive body of literature has assessed the distinct
motivators driving individual workplace creativity, with authors proposing a complex array of
motivational mechanisms that drive workplace creativity either directly or indirectly (see Liu et
al., 2016, for meta‐analysis). However, while the motivations driving leisure‐time and
workplace creativity have been investigated separately, they have not been explicitly linked to
determine whether an individual’s creative motivation during leisure‐time is related to their
creative motivation at work. In order to better understand the overlap between the motives
driving leisure‐time and workplace creativity, evidence from both leisure‐time and workplace
creativity literature will be reviewed below. A summary of leisure‐time and workplace creative
motives, with examples of empirical research, is displayed Table 1.

194
Table 1 Motivational Mechanisms Driving Leisure-time and Workplace Creativity
Motivational Definition Studies showing a positive association between
Mechanisms motivation and creativitya
Leisure-time creativity Workplace creativity

Intrinsic Engaging in an activity because it is Amabile et al., 1994;

motives enjoyable, expressive or challenging de Jesus et al., 2013;
Zhang & Bartol, 2010
Enjoyment The need to create something because Benedek et al., 2019
it is enjoyable, pleasurable or fun Hegarty, 2009;

Expression The need to express feelings, thoughts, Benedek et al., 2019

personality Hegarty & Plucker, 2012

Challenge The desire to achieve, expand Benedek et al., 2019

skills/knowledge, prove competency

Coping motive The need to reduce tension or increase Benedek et al., 2019 Not applicable
emotional calm

Prosocial The drive to engage in an activity to Benedek et al., 2019, Grant & Berry, 2011
motive benefit, help or bring pleasure to Li & Bai, 2015
others

Social motive The desire for social connection or Benedek et al., 2019; Hirst et al, 2009;
positive peer group interactions Madjar & Oldham, 2002
Extrinsic
motives
Recognition Desire to gain acceptance, Benedek et al., 2019 George & Zhou, 2002
acknowledgement or appreciation
from others
Material motive Need for monetary reward or financial Benedek et al., 2019 Eisenberger & Aselage,
compensation 2009; Eisenberger &
Rhoades, 2001;
Baer et al., 2003
Duty Driven by feelings of responsibility or Benedek et al., 2019
obligation

Creative self- Driven by a self-belief in one’s ability Eschleman et al., 2014 Heo & Cheon, 2013;
efficacy to produce creative outcomes (conceptualised as Jaussi et al., 2007;
mastery) Tierney & Farmer, 2002

Need for Need for freedom, independence and Eschleman et al., 2014 Liu et al., 2011
autonomy discretion (conceptualised as Ohly et al., 2006;
control) Volmer et al., 2012

Need for The need for positive or significant Kouhia, 2016; Cohen-Meitar et al.,
meaning work Pöllänen, 2015 2009

Note. Studies represent examples of research demonstrating a positive relationship

between motives for leisure-time and workplace creativity and do not provide an
exhaustive list of all relevant research.

195
Coping motive. Leisure‐time creative activities have been recognised as a means of achieving
respite or wellbeing, and coping with work stress (Hunt, Truran & Reynolds, 2018). Creative
hobbies can help individuals cope with illness or disability (Creek, 2008), reduce anxiety and
depression (Cuypers, et al., 2012), facilitate recovery from mental illness (Iwasaki, Messina,
Shank, & Coyle, 2015), and enhance individual wellbeing both in sampling studies (Silvia, Beaty,
Nusbaum, Eddington, Levin‐Aspenson, & Kwapil, 2014) and across the lifespan (Gordon‐Nesbitt
& Howarth, 2019). According to the recovery model, creative leisure replenishes cognitive and
emotional resources allowing individuals to better meet their job performance requirements
(Volman, Bakker, & Xanthopoulou, 2013) and engage in creative problem‐solving (Weinberger,
Wach, Stephan, & Wegge, 2018). Given that the coping motive suggests people are creative in
their leisure time to cope with the stress of work, it has not, to our knowledge, been explicitly
measured as a motivational mechanism driving workplace creativity.
Intrinsic and extrinsic motivation. Benedek and colleagues (2019) demonstrated that
enjoyment (followed by challenge and expression) was the strongest driver of leisure‐time
creativity, while the material motive and duty were the weakest. In the workplace, a positive
relationship between intrinsic motivation and workplace creativity has been consistently
demonstrated in numerous empirical studies (e.g. de Jesus, Rus, Lens, & Imaginário, 2013;
Zhang & Bartol, 2010). However, a more complex, and generally unclear, relationship exists
between extrinsic motivation and workplace creativity (Einsenberger & Aselage, 2009),
influenced by factors such as job complexity (Baer, Oldham, & Cummings, 2003) and rewards
(Eisenberger & Rhoades, 2001).
Creative self-efficacy. Feelings of mastery, including accomplishment and self‐realisation, are
thought to play a central role in recovery through art making (De Bloom, Rantanen, Tement, &
Kinnunen, 2018; Tuisku et al., 2012). Creative self‐efficacy has also been shown to be positively
related to workplace creativity (Heo & Cheon, 2013; Jaussi, Randel, & Dionne, 2007), and is
considered to be due to greater persistence, questioning of established routines, and resilience
against failures (Tierney & Farmer, 2002).
Prosocial motive. Prosocial motivation is defined as the desire to benefit others or act out of
concern for others (Grant, 2008), or the drive to create or discover new things that may help or
be useful to others (Grant & Berry, 2011). Prosocial motives are strongly relevant to
participation in creative leisure‐time activities (Benedek et al., 2019) and are also positively
related to workplace creativity (Bolino & Grant, 2016; Li & Bai, 2015). Prosocial motivation has
been shown to strengthen the positive relationship between intrinsic motivation and creativity
(Grant & Berry, 2011). Moreover, in a study by Li and Bai (2015) individuals with high intrinsic
and prosocial motivation scores achieved the highest overall rates of creativity. Researchers
have posited that prosocial motives involve consideration of others’ needs and are therefore
likely to result in ideas that are not only novel, but also more useful to others (Bolino & Grant,
2016; Grant, 2011).
Social motive. Social motivation has been conceptualised as the need for relatedness (Deci &
Ryan 2000), and the drive to do something in order to build social connections or reduce social
isolation (Benedek et al., 2019). This need for social connection is an important motive for
individuals engaging in leisure‐time creativity, including artists (Reynolds, 2009), knitters (Riley,
Corkhill, & Morris, 2013) and community potters (Genoe & Liechty, 2017). The relationship
between social motivation and workplace creativity has been conceptualised as a need for
positive peer group interactions (Amabile, 1988; Hunter, Bedell, & Mumford, 2007), with social
support considered an antecedent of individual workplace creativity, both in terms of team
196
interactions and identification at work (Hirst, Van Dick, & Van Knippenberg, 2009), and creative
support from family and friends at home (e.g., Madjar, Oldham, & Pratt, 2002).
Need for autonomy motive. The perceived sense of freedom, or ability to express one’s “true
self” has been identified as an important factor driving engagement in leisure‐time creativity
(Hegarty, 2009). In the workplace, an individual who thrives on autonomy is more likely to be
creative in an environment that allows them the freedom, independence and discretion to
proactively seek personal enjoyment from their work (Humphrey, Nahrgang, & Morgeson,
2007; Liu et al., 2016). Indeed, creativity studies have shown that job autonomy is a significant
driver of workplace creativity (Liu, Chen, & Yao, 2011; Madjar and Shalley, 2008; Ohly,
Sonnentag, & Pluntke, 2006; Volmer, Spurk, & Niessen, 2012).
Need for meaningfulness motive. The need to find meaningfulness is a theme in qualitative
leisure‐time creativity research (Kouhia, 2016), and is thought to play a central role in recovery
through art‐making (Tiusku et al., 2016). Likewise, the most recent revision of Amabile’s
componential theory has recognised the critical contribution of meaningful work to employee
creativity (Amabile & Pratt, 2016). Meaningful work is thought to facilitate workplace creativity
by enhancing intrinsic motivation (e.g., Grant & Berry, 2011) and increasing persistence in
creative endeavours (Amabile & Pratt, 2016).
In summary, the motivational mechanisms driving leisure‐time creativity have considerable
overlaps with those driving workplace creativity. Liu and colleagues (2016) argued that certain
motivational mechanisms have unique powers to predict workplace creativity, with intrinsic
motivation providing the “want to”, creative self‐efficacy providing the “can do”, and prosocial
motivation providing the “usefulness” aspect of motivational forces (Liu et al., 2016, p. 238).
However, whether an individual’s motives for engaging in leisure‐time creativity are the same
or different from those motivating them creatively in the workplace has not been investigated.
For example, there is insufficient data to predict whether individuals whose leisure‐time
creativity is driven by prosocial forces would also be driven by altruistic motives to engage
creatively at work.
Other factors impacting motivation for workplace creativity
It is important to note that individual motivation does not drive workplace creativity in
isolation, but interacts with contextual and personal factors, creativity‐relevant skills and
experience, to influence individual creativity (Amabile, 1983, 1988; Amabile & Pratt, 2016).
Therefore, the environmental and personal factors influencing workplace creativity require
further consideration.
Environmental factors. Studies have shown that workplace creativity is positively related to
contextual factors such as job complexity (e.g., Humphrey et al., 2007) and creative goal setting
(Madjar & Shalley, 2008). In addition, these environmental factors have shown specific links
with individual motives for workplace creativity. For example, researchers have shown that job
complexity is positively related to both workplace creativity and creative self‐efficacy (Tierney
& Farmer, 2002). Supportive leadership has been shown to be positively related to intrinsic
motivation, need for autonomy, and prosocial motivation for workplace creativity (Shalley &
Gilson, 2004). Consistent with self‐determination theory (Deci & Ryan, 1985), researchers have
shown that intrinsic motivation for workplace creativity is positively related to supportive
leadership styles (e.g., transformational leadership; Afsar, Badir, & Bin Saeed, 2014) and
negatively related to more controlling styles (e.g., close‐monitoring; George & Zhou, 2001).

197
Further evidence suggests that supportive leadership may increase creativity by boosting
prosocial motivation and prosocial behaviour (Bolino & Grant, 2016).
Personal factors. Individual factors such as learning‐goal orientation (Dweck & Leggett, 1988)
and openness to experience (McCrae & Costa, 1987) have shown positive correlations with
workplace creativity. Learning‐goal orientation, defined as a propensity to seek challenges,
acquire new skills and knowledge, and generate ideas (Janssen & Van Yperen, 2004), is
positively associated with employee creativity (Hirst et al., 2009), while a mastery‐goal
orientation toward learning is more likely to be maintained in individuals high in creative self‐
efficacy. Trait ‘openness to experience’ has shown a positive and consistent relationship with
creativity (Dollinger, Urban, & James, 2004; Furnham, Zhang, & Chamorro‐Premuzic, 2005),
including leisure‐time creativity (Silvia et al., 2014), workplace creativity (e.g., George & Zhou,
2001) and intrinsic motivation for workplace creativity (Tan, Lau, Kung, & Kailsan, 2019). The
relationship between workplace creativity and the personality trait conscientiousness (e.g.,
Furnham et al., 2005) is less consistent, with negative correlations observed when individuals’
conformist tendencies are encouraged (George & Zhou, 2001).
In summary, the existing literature on workplace creativity is complex, and the link between the
motives driving leisure‐time and workplace creativity has not been adequately investigated.
Large meta‐analyses and regression modelling has been conducted to evaluate factors
contributing to workplace motives of creativity, with environmental and personal factors
conceptualised variously as mediators, antecedents and moderators (e.g. Liu et al., 2016).
However, the results of these studies are complex, and the relative contribution of different
factors to different motivational needs is not easily interpreted. For managers seeking to find
ways to apply this information in the real‐world to motivate their employees, more practical
and accessible guidance is required. An at-a-glance model that combines motives for
workplace creativity and factors relevant to creative motivation would provide a useful
solution. Such a model would help managers find ways to modify the work environment to
better suit an employee’s creative motivational needs, or identify new employees with high
creative potential whilst simultaneously determining how best to motivate that creativity. A
proposal for such a model, incorporating specific motives, environmental factors and personal
factors, is displayed in Table 2.
Future directions
This review has presented several lines of evidence in support of the notion that individuals’
leisure‐time creative pursuits may be related to the motives that drive them creatively at work.
First, the motivational mechanisms driving leisure‐time creativity (Benedek et al., 2019) show
considerable overlap with those driving workplace creativity, and are underpinned by the same
theoretical models. Second, preliminary evidence has indicated that engagement in leisure‐
time creativity is driven by general motives, but also by more domain‐specific motives
(Benedek et al., 2019). Finally, there is some evidence to suggest that creative leisure‐time
activities are positively associated with workplace creativity supporting the idea that people
who pursue creative hobbies are more creative in the workplace. This finding opens the
possibility for further research to investigate whether participation in specific creative hobbies
will predict the motives driving creativity in other contexts, such as the workplace. However,
such assumptions cannot be made until the relationship between leisure‐time and workplace
motivational mechanisms are better understood. Thus, further research is first required to
determine: (1) the mechanism underlying the relationship between leisure‐time and workplace
creativity (e.g., discovery experience); (2) the relationship between the specific motives driving
198
individual leisure‐time creativity and the motives for individual workplace creativity; (3) the
relationship between specific leisure‐time creative domains (specific hobbies) and individual
motivators of workplace creativity and (4) whether specific creative hobbies can predict
individual motives for workplace creativity. Research on this topic has thus far been limited by
the lack of a measurement scale specifically designed to identify motives driving workplace
creativity that adequately covers motives identified in the literature. Thus, further research is
required to construct a scale specifically operationalised to measure multiple motives for
workplace creativity. With greater understanding of the relationship between the specific
motives driving an individual’s engagement in leisure‐time and workplace creativity, it is hoped
that researchers will be able to create more practical guidelines to help managers identify the
most suitable way to motivate individual workplace creativity based on the creative hobbies
pursued by their employees.

Table 2 Models of factors relevant to individual workplace creativity for use in research
exploring motives for workplace creativity and construction of a self-report scale
Factors Proposed scales and theory for adaptation
Motivational mechanisms
Intrinsic motives
Enjoyment WPI; Amabile, Hill, Hennessey & Tighe, 1994)
Intrinsic Motivation Scale (Grant, 2008)
Challenge WPI (Amabile et al., 1994)
Prosocial motives Prosocial Motivation Scale (Grant, 2008)
Creative self-efficacy Creative Self-efficacy Scale (Tierney & Farmer, 2002)
Extrinsic motives
Financial reward WPI (Amabile et al., 1994)
Recognition and WPI (Amabile et al., 1994)
feedback Upddated componential theory (Amabile & Pratt, 2016)
Environmental factors
Autonomy WPI (Amabile et al., 1994)
Manager support Leader Encouragement of Creativity Scale
(Zhang & Bartol, 2010).
Creative goal setting WPI (Amabile et al., 1994)
Personal factors
Learning orientation WPI (Amabile et al., 1994)
Openness to experiencea IPIP (Donnellan et al., 2006)
Note. WPI = Work Preference Inventory. a = include as measure of convergent validity.

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 Cultural differences in measuring resilience across Australia and Singapore
Belinda L. Cabanes and Charini D. Gunaratne

Abstract

Resilience is operationalised in many ways with a lack of consensus on how it is measured and
defined. Current theory emphasises resilience as a multi-dimensional construct, however few
measures adequately evaluate the dimensions of resilience, particularly the socio-cultural
factors that influence resilience. In order to examine cultural differences in resilience, the
current study utilised an online survey design to compare 333 adults from Australia (n=203)
and Singapore (n=128). The two samples (Mage = 32.03, SDage = 11.24, age range = 17-74 yrs;
87% F) completed the Resilience Scale for Adults which has been cross-culturally validated and
is the only existing psychometrically adequate measure of resilience that evaluates family and
social influences on resilience. Exploratory factor analyses were conducted to compare the
underlying factor structures of the RSA for the two samples. As hypothesised, the factor
structure of the RSA for the Australian sample differed from the factor structure of the RSA for
the Singaporean sample. The factor structure of the Australian sample corroborated with
previous research identifying a six-factor solution; however the factor structure of the
Singaporean sample identified a three-factor solution, with the three factors representing
family relationships and social support, individual strengths and future goals, and social
competence. While the limitations of the study include the lack of a representative sample, the
results nonetheless emphasise the importance of considering cultural factors within resilience
theory and research, and underscore the need for refining existing measures of resilience
when accounting for cultural aspects.
Keywords: culture, resilience, factor analysis

Adversity is experienced by all; however people differ markedly in how they respond to, and
recover from experiences of adversity. Researchers have been keen to understand the
differences between individuals who recover and function well following adversity from those
who do not, as an alternative to "deficit" models focusing on illness and psychopathology
(Windle, 2011). Here, the strengths of human development, and our capacity for positive
adaptation, are understood generally as resilience (Masten, 2011). The key issue in current
resilience research is the lack of clarity in both definitions of resilience and subsequent
measures of resilience, as well as the limited consideration given to cultural processes that may
influence resilience.
Resilience has been defined in numerous ways, from early conceptualisations focusing on
individual characteristics in children associated with favourable outcomes later in life (e.g.,
Anthony, 1987; Garmezy, 1983; Kumpfer, 1999), to processes by which resilience is achieved
(e.g., Masten, 1994; Rutter, 1987; Zimmermann, Ramirez-Valles, & Maton, 1999). More
recently, researchers consider resilience to be a dynamic and multi-dimensional construct,
encompassing both internal and external characteristics, and resources that support positive
adaptation (Pangallo, Zibarras, Lewis, & Flaxman, 2015). This model embraces the complexity
and interdependency of factors that affect a person’s ability to adjust and thrive in the
presence of adversity, suggesting that resilience is best understood socio-ecologically, as a

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person-event-environment interaction. Each component mutually influences the others, and it
is this interaction that either supports or inhibits a resilient outcome (Harvey, 1996; Ungar,
2008).
A major limitation of current resilience research is that it has evolved within Western cultures,
and is influenced by Western beliefs of what constitutes resilient behaviour. Culture gives
meaning to experiences, affects how individuals interpret and respond to adversity (Clauss-
Ehlers, 2004), and thus underpins the psychological processes associated with these factors,
thereby also influencing resilience. The sociocultural context in which an individual operates is
both an integral part of their capacity for resilience, and will define what resilience is for that
individual (Clauss-Ehlers, 2008; Ungar & Liebenberg, 2011). Existing conceptualisations and
measures of resilience are largely Western-centric, and assume universality with little
consideration to cultural differences in resilience (Pangallo et al., 2015; Ungar, Ghazinour, &
Richter, 2013; Windle, 2011). There remains a lack of validation of assumptions and empirical
findings across cultures, particularly Asian cultures.
Limited cross-country validations of resilience measures that have been performed using Asian
populations have futher noted dissimilarities in the factor structures of resilience measures
between Western and Asian countries Lei et al. (2012) identified a four-factor structure of the
Resilience Scale (RS; Wagnild & Young, 1993) in a Chinese sample, noting this differed from
previous studies identifying a two-factor structure (American sample), a three-factor structure
(Brazilian sample), and a five-factor structure (Swedish sample). For the Connor-Davidson
Resilience Scale (CD-RISC; Connor & Davidson, 2003), Yu and Zhang (2007) proposed a three-
factor structure was the best fit in a Chinese sample, whereas Wu, Tan, and Liu (2017)
suggested a four-factor structure, and Jung et al. (2012) identified a five-factor structure in a
Korean sample. In comparison, within American samples, researchers prefer a four-factor
structure of the CD-RISC over the originally-published five-factor structure (Connor & Davidson,
2003; Lamond et al., 2008).
However, both the RS and CD-RISC are based on definitions of resilience as the outcome of
individual or individually-mediated factors, and do not adequately take the interactionist
conceptualisation of resilience into consideration when assessing resilience (Pangallo et al.,
2015). In contrast, the Resilience Scale for Adults (RSA; Hjemdal, Friborg, Martinussen, &
Rosenvinge, 2001) was developed within a social ecological theoretical framework of
resilience, and includes family, social, and environmental protective factors of resilience
(Morote, Hjemdal, Martinez Uribe, & Corveleyn, 2017). The RSA has been utilised primarily in
Western or Latin-American cultures, such as Norway, Belgium, Peru, and Brazil (Hjemdal, et al.,
2011; Hjemdal, Roazzi, da Graca, Dias, & Friborg, 2015; Morote, et al., 2017). It is therefore
unclear how this measure of resilience may differ when examined from an Asian-cultural
perspective.
The current study aims to address this gap in understanding the effect of sociocultural context
on resilience by examining how measurement of resilience compares between a Singaporean
and Australian sample. Exploratory factor analysis was utilised to determine the underlying
structure of resilience in both countries. In line with previous attempts to compare factor
structures between Asian and Western countries, it was hypothesised that the factor
structures of resilience for the two samples would differ.
Method
Participants and Procedure

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Participants accessed the survey online through the Survey Monkey platform. Of the 482
participants who began the survey, 333 participants completed it. The sample comprised two
subsamples: Australian (N=203), and Singaporean citizens (N=128). Participants’ ages ranged
from 17 to 74 (M = 32.03, SD = 11.24), with 287 (86.71%) females and 44 (13.29%) males.
Within the Australian sample, 129 first year psychology students were recruited, with the
remaining 74 Australian participants recruited via social media and snowball recruitment
methods. Singaporean participants were recruited through social media and snowball
recruitment methods. The Charles Sturt University Human Research Ethics Committee (CSU-
HREC) approved the study. Data were analysed using SPSS statistical software version 24.
Preliminary Demographic Comparisons
The demographic properties of the Australian and Singaporean samples are summarised in
Table 1. Chi-square tests indicated no significant differences between the Australian and
Singaporean samples with regard to sex or education. There was, however a small (Cohen,
1988) but significant difference between the two samples when income was examined.
Table 1 Comparison of demographic statistics of Australians and Singaporeans

AUS SG df n χ2 p phi
Sex
24 20
Male
(11.82%) (15.64%)
1 331 .68 .41 -.06
179 108
Female
(88.18%) (84.38%)
Education
114 82
Secondary
(56.16%) (64.06%)
61 33
Tertiary 2 331 2.17 .34 .08
(30.05%) (25.78%)
28 13
Postgraduate
(13.79%) (10.16%)
Monthly Income
70 56
< $5,000
(34.48%) (43.75%)
86 60
$5,000 - $14,999 2 331 10.49 .01* .18
(42.36%) (46.88%)
47 12
> $15,000
(23.15%) (9.38%)
*p< .05
An independent samples t-test was conducted to compare the ages of Singaporeans and
Australians. The results are presented in Table 2. Levene’s test was used to confirm that the
assumption of homogeneity was not violated. There was no significant difference in the ages of
Australians and Singaporeans.

Table 2 T-test for comparison of age between Australians and Singaporeans

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 Eta
Australians Singaporeans t-test
square
[95% CI]
n M SD n M SD df d
Age 203 32.29 11.94 128 31.63 10.04 329 [-1.83, 3.16] .00

* p< .05

Measures
Resilience Scale for Adults (RSA; Hjemdal, et l., 2001). The RSA is a 33-item self-report
measure consistent with a socio-ecological framework of resilience. The scale is used to assess
the presence of intrapersonal and interpersonal factors that have been empirically shown to be
associated with resilience (Hjemdal et al., 2011). The RSA contains six subscales; personal
strength/perception of self (PS), personal strength/perception of future (PF), structured style
(SS), social competence (SC), family cohesion (FC), and social resources (SR) (Hjemdal et al.,
2001). All items are based on a 5-point likert scale. An example of an item in the PF subscale is
“I feel my future looks… very promising/uncertain”. Scores are added to give subscale scores,
as well as an overall resilience score. Total scores range from 33 to 165, with higher scores
indicating higher levels of factors supporting resilience.
The psychometric properties of the RSA have been demonstrated to be sound across
European, Latin American, Iranian and South African cultures (Friborg, Hjemdal, Rosenvinge, &
Martinussen, 2003; Hjemdal et al., 2011, 2015; Jowkar, Friborg, & Hjemdal, 2010; Morote, et
al., 2017). The scale has shown good internal consistency, with Cronbach’s alphas for the total
RSA ranging between .84 and .88, and between .56 and .79 for each of the subscale scores
(Hjemdal et al., 2011, 2015). Four-month test-retest correlations varied between .69 and .84
for each of the subscales (Friborg et al, 2003). Construct validity for the scale was
demonstrated with a significant negative correlation between the RSA and the Hopkins
Symptom Check List-25 (Derogatis, Lipman, Rickels, Uhlenhuth, & Covi, 1974), which measures
depression and anxiety symptoms (r = -.38, p < .01), and a significant positive correlation with
the Sense of Coherence-13 scale (Antonovsky, 1993), which measures general positive
intrapersonal adjustment (r = .71, p < .01) (Hjemdal et al., 2015). Alpha values for the subscales
in the current study ranged from .33 to .84, with alphas of .90 (AUS) and .92 (SG) for the full
scale (see Table 3).

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Table 3 Internal Reliability of the RSA for the Australian (AUS) and Singaporean (SG) Sample
Cronbach’s Alpha
AUS SG
RSA (Full Scale) .90 .92
Structured Style .65 .33
Social Resources .81 .81
Social Competence .81 .78
Perception of Self .81 .79
Perception of Future .77 .82
Family Cohesion .84 .81

Results
To test the hypothesis that the factor structure of the resilience measures would differ
between the Australian and Singaporean samples, principal axis factoring were conducted for
the two samples to examine the underlying factor structures with an oblique (Kaiser Oblimin)
rotation applied due to the anticipation of inter-correlated factors. In terms of the sample size
meeting the necessary criteria, Suhr (2006) recommends at least 100 cases, with at least five
cases per variable, which was achieved by the Australian sample (n=186 complete cases).
While the Singaporean sample (n=117 complete cases) was less than the minimum required
sample (n=165), Field (2013) states communalities above ℎ2 = .20 indicate adequate common
variance; with the exception of item 14, this was achieved for the Singaporean sample.
Guadagnoli and Velicer (1988) also suggest examining factor-item relationships, whereby if
factors have four or more items with loadings over .60, the sample size is irrelevant. For the
Singaporean sample, as further discussed below, the final factor structure satisfied this aspect.
The Kaiser-Meyer-Olkin measure of sampling adequacy yielded scores of .86 for Australia and
.82 for Singapore, exceeding the recommended value of .60 (Kaiser, 1970). Bartlett’s Test of
Sphericity (Bartlett, 1954) was statistically significant for both the Australian and Singaporean
samples, and measures of sampling adequacy (MSA) from the anti-image matrices exceeded
.50, supporting the factorability of the correlation matrix. The data met the assumption of
linearity, and there were no outliers in the sample greater than three times the interquartile
range (Field, 2013).
Results showed that seven factors in the Australian sample had eigenvalues that exceeded 1
per Kaiser’s eigenvalue rule (Kaiser, 1960). Examination of the screeplot (Cattell, 1966)
indicated an apparent break after the sixth factor for the Australian sample, thus six factors
were retained for the Australian sample. The rotated solution was consistent with previous
research on the RSA scale, excepting two items loading strongly onto different factors than
those in the published literature. These were items 23 (“When I am with others…”), which
loaded onto Social Resources (SR) rather than Social Competence (SC); and item 12 (“When a
family member experiences a crisis/emergency…”), which loaded onto Family Cohesion (FC)
rather than SR. It was noted from the structure matrix that a number of items loaded on both
the FC and SR factors, possibly reflecting the two factors appearing to be related constructs,
and moderately correlated (r = .40). Similarly, SR and SC, as well as Perception of Self (PS) and
Perception of Future (PF) also appear to be related constructs, with moderate correlations
shown (SR, SC: r = -.31; PS, PF: r = -.25). These relationships may explain the majority of the
cross-loading items found within the structure matrix. Item 23 (above) is an example of cross-

209
loading between SR and SC. Item 12 on the other hand, appears to relate to family
relationships, so it is unsurprising that this item was found to load primarily on the FC factor.
For the Singaporean sample, initial analyses extracted nine factors with eigenvalues greater
than 1. The screeplot indicated an apparent break after the third factor for the Singaporean
sample. Examination of the factor-item relationships revealed a number of items correlating
across the factors, with only two of the previously reported factors clearly apparent (PS and
SC). A six-factor solution was then forced, which returned similar results, with only two clearly
aligned factors, thus indicating the other items were correlating across the remaining factors.
Per the screeplot, it was decided to force a three-factor solution. As stated above, the factor-
item relationships for this solution exceeded .6 for nine items in Factor 1, seven items in Factor
2, and three items in Factor 3. Within the Singaporean sample, the rotated solution differed to
previous research on the RSA scale. The first factor combined the FC and SR constructs, thus
relating to family relationships and social support. The second factor combined the PS and PF
constructs, thus relating to individual strengths and future goals. The third factor related to SC,
the ability to meet new people and enjoy the presence of others. A moderate correlation
between the family/social support and individual strengths factors is likely due to a conceptual
relationship between the two, explaining why a number of the items load on both factors. For
example, item 8, “I enjoy being… Together with other people” loads on both the relationships
and social competence factors. Item 26, “For me, thinking of good topics for conversation is …
easy” relates to both social competence and individual strengths. Item 23, “When I am with
others… I easily laugh” relates to both relationships and social competence. Thus, the multiple
loadings appear conceptually logical, due to referencing aspects of both factors. The rotated
factor loadings for both samples are presented in Appendix A. The hypothesis that the factor
structures of the two samples would differ is therefore supported by the results.
Discussion
The aim of the current study was to assess measurement of resilience in an Australian and a
Singaporean sample. Factor analyses of the RSA supported the hypothesis that the factor
structures underlying the resilience measure would differ between the Australian and
Singaporean samples. Within the Australian sample, the factor structure of the RSA (Appendix
A) replicated previous research (Hjemdal et al., 2015; Jowkar et al., 2010), as well as the
published RSA subscales (Hjemdal et al., 2011). The factor structure of the Singaporean sample
differed to the structures identified within published research, and the Australian sample. This
reflects similar attempts to validate other resilience measures within Asian populations, which
have identified differing factor structures (Jung et al., 2012; Lei et al., 2012; Wu et al., 2017;
Xie, Peng, Zuo, & Li, 2016; Yu & Zhang, 2007).
While it was expected that the factor structure of the RSA would differ between Australian and
Singaporean samples, the magnitude of the differencs shown is striking. An explanation for this
may lie in the development of the RSA. Resilience is a difficult construct to measure directly
within a person, as resilience refers to a relatively good outcome despite threats to healthy
functioning (Friborg, 2005). In developing the RSA, empirical evidence gathered over previous
decades of research was used to determine the factors associated with resilience (Hjemdal et
al., 2011). The RSA measures these factors to give an indication of the level of resilience that a
person is likely to possess. However, the vast majority of research is based on Western theories
of resilience, using Western samples to conduct the research (Meredith et al., 2011). As a
result, despite attempting to devise an empirically driven, culturally-sensitive measure of
resilience, the authors of the RSA were constrained to using prior research that was oriented
210
toward Western definitions of resilience, and limited to factors associated with resilience
within a Western culture. It is likely that this conceptual conflict within the RSA contributed to
inconsistencies in the factor structures for the two samples.
This outcome highlights the need for both grounded research into how resilience is defined
within non-Western cultures, the factors that are associated with resilience in non-Western
cultures, as well as further research into factors previously identified as being associated with
resilience, to determine whether these factors are indeed universal or are specific to Western
cultures. Such research would support the development of a resilience measure that more fully
incorporates the sociocultural aspects of resilience.
Despite these limitations, the factor analysis performed within the current study provided
valuable insight into how resilience emerges within Australia and Singapore, and how the two
cultures contrast in terms of the factors supporting resilience. Within both the Australian and
Singaporean samples, relationships emerged as by far the strongest factor in explaining
variance in resilience. In the Australian sample, family cohesion accounted for 27% of the
variance in resilience, while in the Singaporean sample, the family relationships/social support
factor accounted for 29% of the variance in resilience. The next strongest factor in explaining
resilience was perception of self in the Australian sample (9%) and the individual
strengths/future goals factor in the Singaporean sample (8%). This result echoes the findings of
prior research (see Meredith et al., 2011 for a review), supporting the argument that positive
relationships are a universal facilitaor of resilience across cultures, and highlighting the
importance of supportive relationships, both within and outside the family unit, in fostering
resilience.
A noteworthy finding was the consolidation of the family cohesion and social resources factors
within the Singaporean sample. It is proposed that, in a collectivist and family-oriented society
such as Singapore, much of the social support usually received from friends in a Western
culture is provided by the family unit. This outcome reflects Markus and Kitayama’s (1991)
assertion that within collectivist cultures, well-being is derived from family and relationships,
which are an integral part of life, with reduced reliance upon support outside the family.
Similarily interesting was the merging of the perception of self and perception of future factors
within the Singaporean sample into an overall individual strengths/future goals factor.
Oyserman, Coon, and Kemmelmeier (2002) argued that within collectivist cultures, there is less
of a distinction between the self and others, and that self-esteem is less important to well-
being than it is in individualist cultures. The current study appears to support this viewpoint,
whereby individual strengths and future goals were considered one entity, and separate to the
other social/external factors. The differing relationship between resilience, individual
strengths, and social factors across cultures is however largely theoretical, with little empirical
support, thus warranting further examination in future research.
Finally, the structured style factor did not emerge within the Singaporean sample, with items
for this subscale not loading onto any other factor. It appears that structured style, relating to
organisation and planning, was not associated with resilience within the Singaporean sample.
This result somewhat reflects the finding of Morote et al. (2017), who observed some
weakness in the structured style factor within a Hispanic sample. Further examination of the
relationship between structured style and resilience within both Western and non-Western
samples may be beneficial to understanding the contribution of structured style as a factor of
resilience. The absence of this factor was supported by poor internal consistency (alpha = .33;

211
Table 3) for the structured style subscale within the Singaporean sample, and thus inclusion of
this subscale as a measure of resilience needs further consideration.
The study is limited in a lack of a representative sample from both groups of participants, due
to convenience sampling measures, which may not be reflective of actual levels of resilience
within these populations. The study is also limited to individuals who were fluent in English,
and thus other cultural aspects may not have been captured.
Summary
The results of the current study lend further support for a socio-ecological model of resilience.
Cultural considerations have been largely overlooked in traditional resilience research, and
emerging research, such as with the current study, and further shows how this oversight may
limit our understanding of resilience. This study emphasises the importance of considering
sociocultural factors within resilience research, not only in studies examining resilience from a
cultural or social perspective, by demonstrating the differences in factor structures of
resilience between Australian and Singaporean samples using an established measure of
resilience. This finding highlights both the limitations of existing resilience measures, and the
scarcity of knowledge of non-Western cultures within the field of psychology. Despite
attempts by the authors of this scale to incorporate social and cultural factors into their
measures, insufficient research into resilience within non-Western cultures limits the ability of
these measurement scales to apply to these cultures.
Together these findings underscore a critical need for culturally-grounded research into how
resilience is defined, and the factors that are associated with resilience, within non-Western
cultures. This is required not only in order to develop measures that are able to incorporate a
more nuanced, complex, and accurate assessment of resilience, but also allow for determining
the universality of previously identified factors associated with resilience, enabling practical
and clinical interventions applicable across different cultures particularly in the face of ever
changing multicultural societies within a global context.
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Structure Matrix for RSA with Oblimin Rotation, Eigenvalues and Variance Explained
Factor Loading
RSA Sub
Item Australians Singaporeans
scale
1 2 3 4 5 6 1 2 3
13. Family FC .817 .720
connectedness
7. Family happiness FC .798 .744
29. Family togetherness FC .678 .449 .423
25. Family loyalty FC .755 .440 .690
3. Family priorities FC .693 .532 .482
12. Family emergencies SR .608 .540
16. Family optimism FC .639 .472 .668 .416
33. Uncontrollable PS .740 .506
events
18. Judgement PS .733 .661
confidence
2. Unexpected events PS .678 .639
17. Confidence in ability PS .685 .674
11. Problem solving PS .573 -.518 .518 .564
31. Optimism PS .544 -.535 -.514 .420 .635
22. New people SC -.851 .806
19. New friendships SC -.844 .410 .817
26. Conversations SC -.729 .491 .686
14. Social Flexibility SC -.620
8. Social enjoyment SC -.556 .545 .408
24. Planning SS .745
30. Rules and routines SS .719
28. Organisation SS .439 .665 .542

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21. Goal orientation SS .480
5. Goal confidence PF -.770 .745
1. Future plans PF -.715 .694
4. Future optimism PF -.765 .753
32. Goal clarity PF -.738 .789
6. Feel supported SR .791 .634
15. Support SR .503 .785 .701
10. Friendship bonds SR -.401 .662 .552
20. Help available SR .455 .696 .666 .512
9. Feel encouraged SR .532 .638 .654
23. Enjoy others SC -.445 .581 .411 .681
27. Feel appreciated SR .486 .592 .730
Eigenvalues 8.83 3.03 2.37 1.94 1.47 1.31 9.43 2.77 2.24
% Variance explained 26.76 9.19 7.17 5.89 4.45 3.98 28.58 8.39 6.79

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 Learning and
Teaching

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 Editorial: Learning and teaching
John Reece

The papers that make up this section provide two very different perspectives on the
theme of Learning and Teaching. These papers are authored by two experienced
researchers from different disciplines (psychology and counselling), and demonstrate the
diversity of issues that are relevant to learning and teaching in the modern higher
education context. Each paper has a different methodological approach. In Chambers’
case, we see a mixed method approach to investigating a new approach to facilitating
deep level understanding of core concepts in social psychology, and the paper is
formatted in classic APA style. Hutton provides a qualitative study with associated
background and commentary on the importance of personal pronoun use for students in
the modern class space, where gender identity issues can have a significant impact on
student wellbeing. Despite their very different topic areas and methodological
approaches, both papers consider important issues in current higher education.
Chambers’ paper, titled “A good sketch is better than a long speech”: A pilot study on the
use of sketchnoting to teach undergraduate psychology, presents the results of a pilot
trial run by the author himself that involved integrating the use of a visual tool,
sketchnoting, into his undergraduate social psychology program. Sketchnoting is a
learning technique that involves students representing core theoretical, methodological,
and empirical concepts by the use of self-generated drawings and sketches rather than
via the usual written summaries. The theoretical argument behind sketchnoting is that it
fosters a deep level of learning for some students by allowing them to represent
concepts in a way that more closely aligns with their preferred learning style. Further, it
is argued that the sketchnotes provide an easily accessible representation of complex
concepts.
In Chambers’ case, he was able to compare the academic performance of students taught
sketchnoting with another cohort who were taught exactly the same curriculum by the
author in a previous offering without the use of sketchnoting. Although the author does not
report any significant differences in overall academic performance between the two
cohorts, the descriptive results are encouraging, and the qualitative data taken from
selected student interviews provides a positive perspective on sketchnoting, with several
students indicating positive attitudes toward the technique. Students also indicated that
they would continue to use sketchnoting in other subjects. The author points out that there
are some limitations to sketchnoting that need to be acknowledged, including how the
effectiveness of the method seems closely correlated with students’ confidence in sketching
and drawing. Nevertheless, despite the lack of significant quantitative outcomes, the
qualitative data certainly indicates that there is potential for the use of sketchnoting in
higher education psychology, and that further research on the technique is warranted.
Chambers’ paper demonstrates the importance of evidence-based practice in informing
decisions about pedagogical approaches.

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Hutton’s paper, titled Getting it right: Preferred pronouns and inclusive language, deals
with a completely different, but equally important, topic. For many students, gender
identity is a central personal characteristic. Historically, gender has been defined using
the binary terms male and female; however, there is a growing recognition and
acceptance of gender as a non-binary construct, with a significant number of higher
education students not identifying with the traditional binary labels. Hutton provides
important historical and social context for this issue, and presents a series of case studies
that vividly illustrates the importance of the use of appropriate personal pronouns in
higher education. A strong theme that emerges from Hutton’s paper relates to the
impact that the use of inappropriate personal pronouns can have on a student’s
wellbeing in the class space. Hutton advocates that the use of gender non-specific
personal pronouns such as “they”, “their”, and “them” can provide a welcoming
approach for students who do not identify with traditional binary gender identifiers.
Hutton provides some useful suggestions for how this topic can be approached by
teachers, but she also recognises that this is not a straightforward area to navigate.
Further, Hutton describes the policies and practices that several higher education
institutions and professional associations have taken in order to acknowledge this issue.
Related to this, it is worth noting that the newly released 7th edition of The Publication
Manual of the American Psychological Association (i.e., “APA style”) now formally
recognises the use of non-binary personal pronouns.
Despite dealing with very different topics, these two papers share the common goal of
discussing approaches to improving students’ classroom learning experiences. While
Chambers addresses the theme via a mixed method empirical study of a targeted learning
method, Hutton makes a compelling case that creating a comfortable and welcoming
learning environment for students by the use of appropriate personal pronouns can have
the flow-on effect of improving learning. Despite their differences, both papers provide a
worthy contribution to our understanding of topical and important issues in learning and
teaching in modern higher education.

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 “A good sketch is better than a long speech”: a pilot study on the use of sketchnoting to
teach undergraduate psychology
Tim Chambers PhD

Abstract
Visual presentation refers to the suite of techniques that enable individuals to synthesise
written and verbal communication into a series of images. Preliminary evidence suggests
that these techniques can build cognitive skills among educators and students (Sibbet,
2008) across a variety of disciplines (e.g., engineering, design, IT). Whilst much of the
related research focuses on two of the more common techniques, graphic recording and
graphic facilitation (Dean-Coffey, 2013), less is known about sketchnoting. Furthermore,
no research has investigated the utility of sketchnoting in teaching psychology. This
article will report the findings from a two-year pilot project on utilising sketchnoting to
teach undergraduate psychology. The academic performance from two student cohorts
(n = 112, 77 female) was compared; one cohort received sketchnoting during live
lectures, in addition to the accredited curriculum. Results indicated that there was no
difference in academic performance between cohorts for coursework (p > .05) nor the
final exam (p > .05). Content analysis of the student feedback revealed that the graphic
recording assisted students to learn several key concepts within the curriculum. Despite
not finding group-level differences in academic performance for psychology students,
the existing literature supports the inclusion of visual presentation techniques in the
classroom to aid academic performance. This study is the first of its kind to examine the
influence of incorporating graphic recording into the higher education teaching
environment. Suggestions for future research, including trialling the technique in
alternative classrooms (e.g., workshops, seminars) will be also be discussed.
Keywords: Teaching, psychology, students, drawing, higher education

The benefits of higher education are well-known and wide reaching, including enhancing
quality of life and job prospects of those who obtain a tertiary degree (Schneder & Preckel,
2017). To facilitate the delivery of higher education, several approaches have been
evaluated, with active learning (Freeman et al., 2014) and problem-based learning (Jin &
Bridges, 2014) two such examples. Alternative classroom strategies have also undergone
investigation (e.g., the flipped classroom; O’Flaherty & Phillips, 2015) to determine
enhanced methods of content delivery. An alternative to these approaches is a focus on the
visual presentation of content, referred to as the suite of techniques that enable individuals
to synthesise written and verbal communication into a series of images. To date, much of
the visual presentation research focuses on graphic facilitation (Sibbet, 2008) or graphic
recording (Dean-Coffey, 2013). A less well-known technique is that of sketchnoting (Bollini,
2017). Born for the works of mind-mapping (e.g., Buzan, 1996) and graphic design (Rohde,

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2013), sketchnoting is an engaging visual activity that results in the creation rich and visual
notes. Therefore, in the current dynamic environment that is higher education, the purpose
of this pilot study was to investigate the application of sketchnoting in teaching
undergraduate psychology.

Brief literature review

Unlike the aforementioned content delivery strategies and associated learning approaches,
the evidence-base related to visual presentation techniques is limited. In broad terms,
visual presentation techniques capture and represent dialogue in a visual format that
utilises both words and drawings (Dean-Coffey, 2013). Graphic facilitation, colloquially
termed as public listening, involves “live visual recording in large format with the intention
that people can both access and contribute to the emerging record” (Mendonca, 2016,
p.135). Based on an ongoing dialogue between the facilitator and the group, this technique
employs metaphor and imagery to draw out the group’s implicit knowledge of a topic
(Mendonca, 2016). In contrast, graphic recording refers to the visual recording of content
when the practitioner has limited opportunity to engage with group participants
(Mendonca, 2016). Whilst the graphic recorder is less engaged in the dialogue, both the
facilitator and recorder are responsible for the synthesis of information yielded by the
group, and the development of a large-scale visual representation of the discussion (e.g.,
wall map; Dean-Coffey, 2013).
Whilst much of the visual presentation research recounts the experiences of practitioners
implementing these techniques across various contexts (Sibbet, 2008), there appears to be
some preliminary evidence that suggests learners may benefit from such techniques. For
example, students who adopted visualisation strategies (i.e., drawing) experienced
improved problem solving (Newcomb, 2007). Sibbet (2008) supposes that the visual
patterns apparent in graphic facilitation represent a form of visual intelligence that enable
the facilitator to make inferences about incoming data (i.e., group discussion). Evidence
from applied cognitive psychology may provide some support for this interpretation.
Individuals who were required to simultaneously listen to a recorded conversation and
complete a drawing task had better memory recall of the conversation compared with
those who were not required to draw (Andrade, 2010). Whilst this applied evidence is a far
cry from mirroring the higher education learning environment, the dual task findings
provide some support for the benefits of drawing on learning. Yet these collective results
largely rely upon a trained practitioner (i.e., graphic recorder or facilitator) leading and or
synthesising the knowledge of an informed group of individuals. A more organic and
dynamic version of these techniques that does not rely on the individuals being informed is
sketchnoting.
Positioned at the lower end of the visual presentation continuum (Paepcke-Hjeltness,
Hetherton, & Grote, 2018), sketchnoting is positioned as another visual listening tool that
results in the creation of visual maps comprised of text and images (e.g., dots, lines, arrows
etc.; Paepcke-Hjeltness, Mina, & Cyamani, 2017). A lower fidelity version of graphic
recording and facilitation, sketchnoting enables the illustrator to document their visual
voice in a manner that breaks free from traditional linear notetaking (Paepcke-Hjeltness et

222
al., 2018). Whilst the application of sketchnoting in tertiary education is in its infancy, the
technique has been employed with engineering students (Paepcke-Hjeltness et al., 2017,
2018), with findings demonstrating the improvements in utilising the technique among
students. However, the researchers did not focus on the students’ perceived benefits of
employing sketchnoting to aid their learning. Hence the perceived benefits of sketchnoting
from students’ points of view remains unknown.
The present study
Undergraduate psychology courses are content-heavy as students attempt to become
familiar with the curriculum. The traditional teaching delivery model for psychology is
comprised of live lectures and tutorials or laboratories, whereby the lectures are a one-way
static learning environment with minimal student engagement. In an attempt to reverse
this text-heavy and static learning environment, a pilot program was devised to determine
the benefits of incorporating sketchnoting into the teaching of an undergraduate
psychology unit. Specifically, the present study aimed to investigate the benefits of
sketching between two second year cohorts for psychological science. As this study was a
pilot program, no hypotheses were devised. Rather, the investigation was guided by the
following broad research question: What are the perceived benefits of including
sketchnoting in the teaching of undergraduate psychology?

Method

Participants
112 students (77 female) who were enrolled in a second-year social psychology unit, and
were from two separate cohorts, provided feedback on the sketchnoting.

Materials
To determine the impact of sketchnoting on academic performance, students’ total
coursework and exam marks were analysed. Written feedback on the inclusion of the
sketchnoting was provided via a Qualtrics survey. Specific questions included: “What did
you like best about the sketchnotes? What did you like least about the sketchnotes? What
suggestions do you have about how we can improve the sketchnotes in the future?”

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Procedure
Prior to the start of one teaching trimester, the author completed a two-day professional
development course on visual presentation using the Bikablo® technique. The author then
prepared several sketches for each of the 10 lectures to be delivered during the trimester.
During each lecture, the author utilised a digital overhead projector to draw the
sketchnotes that were then digitally recorded via Echo360. Each sketchnote was preceded
by an introduction to the topic area (e.g., norm development; Tuckman, 1965), with the
sketchnote serving as a visual illustration of the topic area. Following the lecture, the
sketchnotes were completed (e.g., colour and minor details added) and were digitally
scanned and published on the learning management system for students to access at their
convenience.

Figure 1. The final product of a live sketchnote.

Data analysis
All statistical analyses were performed using SPSS Version 25 (IBM). Text-based feedback
was analysed using the stages of thematic analysis as outlined by Braun and Clarke (2013):

224
(i) reading and familiarisation of the text, (ii) coding the entire text dataset, (iii) search for
themes, and (iv) reviewing the themes and devising a thematic map.

Results

Academic performance
Descriptive statistics were calculated for students’ coursework and exam marks for each
cohort and are reported in Table 1. Prior to undertaking any analyses, data were
screened, and results revealed that there were no violations of assumptions of normality.
An independent samples t-test was performed to determine whether any differences
existing between the two cohorts for coursework, exam mark, and overall unit
performance. The results indicated that there were no significant differences for
coursework (p = .38, d = 0.26), exam mark (p = .57, d = 0.22), or overall unit mark (p = .35,
d = 0.03).

Table 1 Descriptive statistics for academic performance.

Traditional cohort Sketchnoting cohort
M SD M SD
Coursework mark 32.94 7.36 34.72 6.23
Exam mark 32.19 1.08 31.07 7.18
Total unit mark 65.54 12.90 65.80 11.63

Thematic analysis
In total, nine students from the sketchnote cohort provided qualitative data via the
Qualtrics survey. These raw data were inductively analysed that yielded one general
dimension: a visual learning experience. This general dimension encapsulated students’
perceptions related to the process of including live sketchnoting in lectures, and the
subsequent benefits to their learning experience. As one student remarked:
I am a visual learner, so it helped me in studying and remembering the important
concepts for my exam. It was a great way to explain the concepts as just talking about
the concepts may not be enough for the information to sink in. I think it was nice that
[the lecturer] took the time to draw and explain them, he understands that people
have different learning styles.
Whilst the ongoing debate related to different learning styles continues (e.g., Nancekivell,
Shah & Gelman, 2019), in this case, the visual elements of sketchnoting resonated with their
learning preference (i.e., visual).
Nested within this dimension were two second-order themes: consolidation of learning, and
social inclusion. For some students, the inclusion of the sketchnotes provided them with
another strategy to consolidate their learning. As noted by one student: “I felt that it

225
[sketchnoting] contributed to my understanding when sometimes I was a little confused.”
Higher education can be a confronting and challenging experience for students, and
psychology is known as a theoretically heavy discipline. The pressure to learn and recall
content under stressful conditions (i.e., examinations; Richardson, et al., 2012) can impair
memory processes. Here, sketchnoting acted as a complimentary learning strategy for
students to actively engage in the unit content. Another student commented that
sketchnoting “helped to remember things in a different way, not just written or spoken. I
really enjoyed them and thought they were based on relevant content.” Whilst the
quantitative data did not support the notion that sketchnoting may lead to tangible
improvements in academic performance, students perceived that the strategy was
beneficial to their learning.
The act of engaging with the class to conduct the sketching during the lectures also
represented an alternative communication method to improving social inclusion. This
was particularly salient for an online student (i.e., a student who received a recorded
lecture) who commented that “As an online student, it helped as I wasn't just watching
someone talk AT me.” Given that instructional scholars seek to inform and influence the
development of students (Turnman & Schrodt, 2006), the sketchnoting technique
appeared to meet this objective. In this case, the practice of engaging with students and
formulatinbg the sketchnote was a collaborative one whereby the student contributed to
the end result. Therefore, rather than have the learning material presented to the
student, the practice of sketchnoting ensured that they were embedded in the learning
material.
Further support for the social inclusiveness that occurred during and following sketchnoting
was the use of the discussion forum in the student learning management system.
Specifically, students created a forum for the sharing of individual sketchnotes with a view
to creating a community of sketchnoters. As one student reflected “I enjoyed the discussion
thread where students could add their own”. Another student remarked that sketchnoting
itself enabled greater interaction with the lecturer: “As a form of facilitation I think it
[sketchnoting] was a great addition.” Whilst the uptake from all students was minimal, the
inclusion of sketchnoting in the unit clearly had an impact on some students. For example,
GK printed the sketchnotes in colour and annotated them with additional comments to
consolidate learning (n.d. 2018) and provided a photograph at the end of the trimester (see
Figure 2).

226
 Figure 2. GK’s use of sketchnotes as a study aid.

Discussion
The aim of the current pilot study was to explore the perceived benefits of using
sketchnoting in the teaching of undergraduate psychology. Whilst quantitative findings did
not reveal any significant differences in academic performance between the two cohorts,
students who did receive the sketchnoting commented that it aided in the consolidation of
learning, promoted social inclusion, and facilitated the visual learning experience. As a novel
teaching strategy in higher education, the following section will explore the alignment
between these findings and existing literature.

Benefits of sketchnoting
Following the brief review of the available sketchnoting evidence some similarities with the
current findings were evident. Qualitative feedback from students indicated a strong
preference for including sketchnoting in the live lectures. That the students perceived a
sense of social inclusion is similar to the ethos of sketchnoting; the global sharing of
sketchnotes gave rise to the notion of a sketchnote community (Rohde, 2013) whereby
ideas and techniques are shared among sketchnoting practitioners. Students who
volunteered to share their sketchnotes reported perceiving a greater sense of social
inclusion. This was particularly salient for online students. As noted elsewhere, academic
success in online tertiary environments is less a function of time spent in the online class-
space, and more due to maintaining discipline self-regulatory behaviour (Broadbent & Poon,
2015). As online students benefit from potentially greater collaborative opportunities due
to the uncapped time restrictions associated with their learning (Ku & Chang, 2011),

227
perhaps online students in the current investigation capitalised on the inclusion of a new
learning strategy and were willing to share their sketchnotes.
Whilst it was beyond the scope of the current study to exclusively test curriculum recall
across various study techniques (i.e., traditional learning approaches), these pilot data
indicated that there were no observable differences between cohorts for overall academic
performance. Many logical explanations for this finding are relevant here, including that
specific study strategies (i.e., whether students incorporated sketchnoting into their study
habits) were not assessed.

Limitations and Future Research

Like many pilot investigations, the present one was not without limitation. First, no data
were recorded as to whether students employed sketchnoting as part of their study thereby
making it difficult to ascertain the relationship between sketchnoting as a study tool and
academic performance. Second, students were not extensively taught how to sketchnote
and were instead encouraged to develop their own style. Whilst this approach is congruent
with the philosophy of sketchnoting, previous investigations have dedicated classes that
focussed on learning various sketchnoting skills (Paepcke-Hjeltness et al., 2017, 2018).
Despite these limitations, student qualitative feedback indicated overwhelming support for
the inclusion of the strategy as part of curriculum delivery. That students reported
experiencing a consolidation of learning and greater social connectivity sufficiently justifies
the need to continue investigating the merits of employing sketchnoting in the delivery of
tertiary education. One clear direction for future research is the design, implementation,
and assessment of a student learning support program that provides individuals with the
requisite skills to incorporate this approach within their learning.

Conclusion
This pilot study investigated the perceived benefits of utilising sketchnoting in the teaching
of undergraduate psychology. During live lectures, sketchnotes were created to teach
critical aspects of the unit curricula, with students encouraged to employ the technique for
their own learning purposes. Following a comparison between two cohorts, in which one
received live sketchnoting, there were no observable differences in academic performance.
However, qualitative student feedback did reveal that students perceived a benefit to
learning in the form of greater consolidation of knowledge, and greater social inclusion in
the form of sharing sketchnotes. Collectively, these findings pointed towards sketchnoting
as a visual learning experience that appeared to complete traditional higher education
teaching strategies. Clearly, more evidence is required to better substantiate the influence
of sketchnoting on student learning, but these findings hint at it being a useful addition in
the lecturer’s toolbox.

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 Getting it right: Why personal pronouns matter
Vicki Hutton

Abstract
Language can be a powerful tool for determining gender where gender is perceived as a
dichotomy (male/female). Respecting a person’s personal pronoun – whether that be he,
she, they, ze, co, xe or others – exposes and confounds society’s taken-for-granted
gender binaries, but can also create tensions and controversy. Inclusive language such as
the routine use of personal pronouns should not be adopted for political correctness,
rather because it is a respectful, fair and accurate response. Pronoun, name and gender
are all important parts of identity, and their correct application is fundamental to
supporting intersex, trans or gender diverse students’ experiences of university life.
While some universities are exploring and moving towards the methodical inclusion of
personal pronouns in their student information databases, it is not widespread. Similarly,
routinely asking and adhering to personal pronouns in the classroom is sometimes
overlooked, not followed up, or treated as too ‘challenging’ or ‘too hard’ to remember.
This paper reports on experiences of misgendering and the impact of not using a person’s
personal pronouns. Strategies to help staff and students move past the discomfort of the
unfamiliar, and understand the normalising effect of inclusive language, are presented and
critiqued. Asking students to share their personal pronouns (even if they are cisgender) at
the beginning of class is respectful and direct and goes some way to normalising gender-
neutral pronouns. It is also a great tool to introduce conversations around inclusivity with
students who may not have considered the gender binaries inherent in a simple pronoun. It
is proposed that this activity, and similar ones, should become as natural as asking a
person’s name.
As gender-neutral pronouns become more widely accepted, it is important for educational
institutions to develop, promote and adhere to inclusive language at all levels and on a day-
to-day basis.
Keywords: gender pronouns; gender binaries; misgendering; gender diverse

Introduction
Language plays an important role in shaping a person’s identity and interactions with others
(Bradford et al., 2019). Developmental psychologist Lev Vygotsky emphasised the role of
language as a symbolic cultural tool to consolidate the internalisation of cultural knowledge
(Vygotsky, 1986). More recent theories suggest that systems of language can also shape a
person’s cognitive understanding of the world around them (Prewitt-Freilino, Caswell &
Laakso, 2012). In this way, language becomes a powerful tool for determining gender

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where social norms favour and seek to perpetuate gender as a dichotomy of male/female,
feminine/masculine (Gustafsson Sendén, Bäck & Lindqvist, 2015). There is some evidence
that societies with gendered language reflect greater gender inequality than societies with
gender neutral language (Prewitt-Freilino et al., 2012), implying that deliberate and
consistent use of gender fair language could start to challenge gender perceptions and
contribute to gender equality (Gustafsson Sendén et al., 2015). One area where this is
becoming evident is the naming and use of personal pronouns.
In the English language, pronouns are function words that convey information on gender
and number (Boren, 2016). Binary models of gender identity favour pronouns such as
he/she and his/hers that are applied to a person based on outward appearance and
behaviours categorised and perceived as appropriate to the assumed gender. These models
fail to accommodate the diversity and fluidity of intersex, trans and gender diverse
identities. Intersex is an umbrella term describing people with natural variations that differ
from traditional ideas around ‘female’ and ‘male’ bodies, while trans can be a collective
term that captures the diverse life experiences of anyone whose gender characteristics
differ from society’s expectations (National LGBTI Alliance, 2013). Gender diversity is also an
umbrella term that encompasses people who identify as agender (having no gender),
bigender (both a female and male) or as non-binary (neither female or male). A person who
identifies as non-binary may also identify as genderqueer or as having shifting or fluid
genders (National LGBTI Alliance, 2013). In this paper, the terms intersex, trans and gender
diverse will be adopted, but this in no way privileges this terminology over other names that
appear in the literature, such androgynous, genderfluid, gender nonconforming, gender
nonbinary, gender questioning, gender neutral, and pangender (Bradford et al., 2019).
Categorisation has the power to affect a person’s life and being (Kiesling, 2019).
Therefore, it is no surprise that people who do not identify with gendered categories
reject the conventional gender binary language of these categories and adopt a pronoun
outside the normative of he/she, him/her. Respecting a person’s personal pronouns –
whether they be he/him, she/her, they/them [used as a singular pronoun], zie/hir/hirs,
xe/xem/xyr, or ey/em/eir – exposes and confounds society’s taken-for-granted gender
binary (Matsuno & Budge, 2017; McGlashan & Fitzpatrick, 2018). It also challenges the
unconscious heteronormative expression of sex-gender-sexuality (Butler, 1999) and
allows gender nonconforming individuals to deny and de-stabilise traditional
conceptualisations of gender and gendered categories (Elliot, 2009). This means that no
assumptions should be made about the pronouns that an intersex, trans or gender
diverse person chooses to use at any given time. Pronouns may align with the person’s
gender identity at that current moment, with the pronouns assigned at birth, or with the
safety of their environment (Matsuno & Budge, 2017).
As with any challenge to traditional ways of being and thinking, identification and
routine, respectful use of correct pronouns can sometimes be associated with tensions
and controversy. Where an intersex, trans or gender diverse person has already
experienced stress and anxiety over the lack of congruity between gender identity and
sex assigned at birth, they can feel further disrespected, invalidated and alienated when
referred to by the wrong pronoun (Deakin University, 2018). Increasingly intersex, trans
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or gender diverse persons are challenging and resisting gender and sexuality norms and
stereotypes in their educational institutions, and in social media spaces such as Twitter,
Instagram and Facebook.
Pronoun, name and gender are all important parts of identity, and their correct application
is fundamental to supporting intersex, trans and gender diverse students’ experiences of
higher education. As universities and colleges in Australia and worldwide grapple with the
need for methodical inclusion of personal pronouns in the classroom and in their student
information databases, the approach is not consistent and sometimes hampered by system
limitations or other structural challenges.
Drawing on reported misgendering experiences of two individuals, this paper discusses the
importance of understanding and respecting the use of non-binary personal pronouns.
Developments in the normalisation of personal pronouns within social media and higher
education institutions are examined, and strategies to help staff and students move past
the discomfort of the unfamiliar and routinely adopt inclusive language are presented and
critiqued.

Literature review
The use of gender-neutral pronouns to describe an individual person has received growing
acceptance over recent years (Clarke, 2019). International Pronouns Day, launched in 2018
‘to make respecting, sharing and educating about personal pronouns commonplace’
(International Pronouns Day, 2019), draws attention to the correct use of pronouns as basic
to human dignity and the avoidance of gender assumptions. Using ‘they’ or other gender-
neutral options thus supports the shift in the evolution of how society understands,
categorises and defines gender (Vivienne, 2018).
Supporting this move is the increased acceptance and use of the pronoun ‘they’ to refer
to singular gender diverse people in media outlets. The Washington Post included
singular ‘they’ in their style guide from 2015, while the Associated Press Stylebook
allowed singular ‘they’ from 2017 (Vivienne, 2018). The APA Publication Manual (6th
edition; 2010) specifies the use of bias-free language, further clarifying this directive in a
2015 APA Style blog commentary that: “when transgender and gender nonconforming
people (including agender, genderqueer, and other communities) use the singular they
as their pronoun, writers should likewise use the singular they when writing about them”
(Lee, 2015). Purdue University Online Writing Lab (2019) clarifies that using gender-
neutral pronouns is not just for ‘political correctness’. Rather, these practices are
increasingly being recognised by language organisations and other official bodies, with
the American Dialect Society crowning singular ‘they’ as its word of the year in 2015
(Purdue University, 2019).
Despite literary recognition and changes, there is evidence that the more strongly a person
identifies with their gender identity, the more negative will be their attitude to using a
gender-neutral pronoun, and the less often they will use one (Gustafsson Sendén et al.,
2015). Resistance to change has also been identified amongst people – especially adults –
who often express preference for the system they are currently in that is stable and

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predictable (Gustafsson Sendén et al., 2015). Being exposed to and expected to use gender-
neutral pronouns can challenge the binary gender system with which they are more familiar
and elicit strong opposition.
This is ironic considering gender-neutral pronouns are not a modern-day phenomenon. The
Merriam-Webster dictionary included the gender-neutral pronoun ‘thon’ (short for ‘that
one’) from 1934 to 1961 (Merriam-Webster, Incorporated, 2019). ‘Thon’ also appeared in
the Funk and Wagnall dictionary from around 1903 for much of the twentieth century.
‘Thon’ was dropped from the Merriam-Webster dictionary for lack of use, but single-person
‘they/their/them’ remained. In fact, ‘they’ has been used as a singular gender-neutral
pronoun since the sixteenth century (Knutson, Koch & Goldbach, 2019). In the early
twentieth century there was a move towards using the generic ‘he’ instead of ‘they’, with
suggestions that counter-arguments to using ‘they’ were based on identity politics rather
than incorrect grammar usage (Knutson et al., 2019).
Despite evidence of long-term alternatives, when attaching pronouns to someone in the
English language there can be a tendency to draw on implied gender out of habit rather
than factual knowledge or consent. Where that implied gender is based on the other
person’s appearance, name or behaviours, it reinforces and perpetuates internalised
biases and gender norm messages that people have to look a certain way to match the
gender that has (correctly or incorrectly) been ascribed to them (Boren, 2016). When the
selected pronoun is incorrect, misgendering can result, with a flow-on effect of
emotional exhaustion, lower self-esteem and feelings of anger and invalidation (Knutson
et al., 2019). During an interview, Archie Bengievanni, a genderqueer author and
illustrator, and co-author of the graphic novel A quick and easy guide to they/them
pronouns (2018) describes being misgendered as “feeling like a brick in my backpack…
every time I’m misgendered, it feels like another brick is added to my backpack. So by the
end of the day I can feel weighted down” (Dar, 2018, p.22).
Research studies indicate that as a population group, individuals with nonbinary gender
identities are at increased risk of mental health problems (e.g., depression, anxiety, eating
disorders, non-suicidal self-injury, and suicidality), bullying victimisation and substance
abuse compared with cisgender individuals (Gustafsson Sendén et al., 2015; Guss et al.,
2019; Lefevor, Boyd-Rogers, Janis & Sprague, 2019). This can be related to inequities
associated with cisnormativity, and the stress related to marginalisation (Clarke, 2019). In
primary health care settings there is evidence that transgender and gender diverse
adolescents can be made to feel more comfortable through affirming practices, such as
pronoun checking and correct pronoun usage (Guss et al., 2019). Appropriate pronoun use
has also been identified as an important marker of what makes a space feel safe, and is in
line with current best practice clinical guidelines (Brown et al., 2019). In fact, using gender
pronouns that are not gender affirming can be harmful and signal to the individual seeking
help that this is not an inclusive or affirming clinical environment (Brown et al., 2019).
However, naming pronouns can also be a confronting and challenging experience for
individuals with shifting identities and fluid relationships with gender (McGlashan &
Fitzpatrick, 2018). Some research suggests that cisgendered individuals find it easier to

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name personal pronouns. Thus, being able to confidently name pronouns may reinforce sex
and gender binaries and assumptions around stability of gender identity by allowing those
who relate to normative gender identities to consolidate their legitimacy (McGlashan &
Fitzpatrick, 2018). This means that asking someone to identify with a stable pronoun may
work against recognition of gender fluidity and further alienate a person. While this
highlights the complexity of pronoun checking and usage, the following verbatim extracts
from gender diverse persons indicate why – despite potential challenges and tensions –
pronoun checking is essential, and misgendering through incorrect use of pronouns can be
so destructive.

Voices of lived experience

FF’s story, part of a larger collection of lived experiences of diversity, poignantly illustrates
the impact of misgendering on mental health and wellbeing (Hutton, in press). When
describing their own experience of changing gender identity, FF writes:
Now that I have a new name and pronouns that fit, I dissociate when others call me
by my dead-name or I am called by feminine pronouns a lot. Dissociating is like your
brain just going ‘nope, I’m out’ and then leaving, and all that is left is a body. It’s hard
to come back from.
It took FF four months to get their name and gender changed in the work system, and they
describe their anxiety and subsequent acceptance when the formal email went out: “I got
lucky. I was accepted….I’m still called she/her at work, but it is often followed by a
correction to my name or my correct pronoun.”
Increasingly, discussion around personal pronouns feature in social media communications.
Associate Professor Sandy O’Sullivan, Wiradjuri, trans/genderqueer, used Twitter to clearly
articulate why gender pronouns matter:
Using correct gender pronouns matters. 6 months ago I’d often wake in a sweat,
worried because I hadn’t told my family yet. I’d had dreams that it was my funeral and
nobody there knew, and all of my friends and family were saying ‘she’ and ‘her’.
It was terrifying. I know a lot of people don’t understand this and think it’s trivial or
that it doesn’t matter. Because often words don’t, actually. But in this case they are
much more than words, they are ideas about who we are and how we are perceived
in the world.
I’m sharing this because for most people being called the wrong pronoun is not the
most terrifying part of a dream about your own funeral (O’Sullivan, 2019).
English singer and song-writer Sam Smith also turned to social media when announcing
their change in pronoun, making an announcement on Twitter and Instagram in September
2019:
Today is a good day so here goes. I’ve decided I am changing my pronouns to
THEY/THEM ❤ after a lifetime of being at war with my gender I’ve decided to
embrace myself for who I am, inside and out. I’m so excited and privileged to be

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 surrounded by people that support me in this decision but I’ve been very nervous
about announcing this because I care too much about what people think but f… it! I
understand there will be many mistakes and mis gendering but all I ask is you please
please try (Smith, 2019).

Pronouns and higher education institutions

Over recent years the growing awareness that gender is not binary and pronouns do matter
has prompted movements in the higher education sector to provide a safe and inclusive
environment for intersex, trans and gender diverse students. In the United States, a number
of universities have made changes to respect and recognise the broad and sometimes
confusing area of gender (Carroll, 2015). For example, from 2013 Elon University, a private
university in North Carolina specialising in liberal arts and sciences, sought ways to update
and modify existing student systems, eventually enabling students to self-select a pronoun,
preferred name (or campus name), title and gender at point of application (Parks & Straka,
2018). Changes to the University of Vermont’s information system allows students who
identify as both genders, neither gender, transgender or a mix of genders, to be called by
whatever name they select (regardless of whether they have legally changed their name),
and offers gender-neutral pronoun options such as ‘ze’, ‘they’ or first name only (University
of Vermont, 2019). Harvard University, the oldest institution of higher education in the
United States, allows students to update their preferred name and pronoun at any time
electronically, although official documents may not reflect this chosen name unless it is
changed legally (Harvard University, 2019).
An inspection of endorsers of International Pronouns Day mentioned earlier indicates
around 100 colleges, universities and other school organisations from all around America –
including Berkeley, North Carolina, Central Michigan, Colorado State, Cornell, Nebraska,
Maryland, Western Washington, New York, Penn State ad Suffolk, Southern California,
Virginia, and Wisconsin – are supportive of this initiative and gender-neutral pronouns.
In the United Kingdom, pronoun badges during university ‘welcome weeks’ have become
increasingly visible over the last few years; for example, Brighton and Edinburgh Universities
have included badges since 2018 (Busby, 2018). Pronoun badges are also the norm at
student union events. The Sussex University Student Union, one of the first in the country to
officially promote the use of gender-neutral language, issued a statement advising students
and staff that: “If a person’s pronouns have not yet been stated, gender neutral language
must be used. Once stated, a person’s pronouns must be respected” (Pells, 2017).
In Australia, most universities have guides to inclusive language readily available on their
websites, with mention and/or recommendations around gender-neutral pronouns
featuring to varying degrees. For example, RMIT University’s Guide to Inclusive Language
recommends that staff and students: “Be respectful of people’s preferred pronouns. If in
doubt, ask them privately” (RMIT University, 2019, p.6), while Monash University
emphasises that “using ‘they’, ‘their’ and ‘them’ to refer to singular subjects is
increasingly regarded as grammatically correct and to recognise the dignity of an
individual by respecting their wishes about personal pronouns” (Monash University,

236
2019a). The Monash University Library’s Inclusive Teaching Toolkit provides inclusive
suggestions such as listing pronouns in email signatures and teaching materials to signal
to transgender and gender nonconforming students that they are in a safe space
(Monash University, 2019b).
The Deakin University Gender Transition Guide states that respecting pronouns
contributes to an inclusive environment that enhances academic success and ensures
compliance with Deakin’s Diversity and Inclusion Policy (Deakin University, 2018). Deakin
students, past and present, can update their gender online with no supporting
documentation required. The University of Melbourne similarly offers students the
opportunity to change their preferred name and gender identifier with no
documentation (University of Melbourne, 2019). The University of Western Sydney has
compiled an Equity and Diversity and Inclusive Practice document that recommends
referring to a person by their preferred name and pronouns (Western Sydney University,
2019), while the University of Queensland contains similar advice in the UQ Guide to
Using Inclusive Language (University of Queensland, 2018). This document stresses the
importance of not making assumptions about someone’s gender, rather: “Ask someone
what their preferred pronouns are (e.g., he, she, they, zie) and respectfully use them
correctly” (University of Queensland, 2018, p.4).
Some universities are not as specific or directive around gender neutral pronouns usage.
This ranges from the University of Wollongong’s (2019) guidelines for inclusive language
that advise not to use the pronoun ‘he’ when referring to both sexes, but does not
discuss gender neutral pronouns per se to the University of Western Australia (2017)
which does not specifically mention pronouns when discussing inclusive language,
instead stating ‘All employees and students are expected to use inclusive language when
conducting the business of the university’.

Discussion and application of findings

Pronoun, name and gender are all important parts of a person’s identity, and educational
institutions are at various stages of formally acknowledging and operationalising this fact.
While administration systems capable of routinely incorporating information on personal
pronouns are currently not available at all educational institutions, creating an open,
accepting and safe community of learning through basic respectful strategies – such as
correct pronoun use – should become the norm.
According to Deakin University’s (2018) Gender Transition Guide, “it is a privilege to not
have to worry about which pronoun someone is going to use for you based on how they
perceive your gender” (p.19). When people with this privilege disregard someone else’s
gender identity through incorrect use of pronouns, it is disrespectful and oppressive.
Associate Professor Sandy O’Sullivan draws attention to the concept of privilege in their
Twitter thread when they comment that: “for most people being called the wrong
pronoun is not the most terrifying part of a dream about your own funeral” (O’Sullivan,
2019).

237
Although unintentional, it can also be insensitive to ask for a person’s ‘preferred’
pronoun. This implies that a person’s pronouns are a preference, choice or arbitrarily
selected, rather than an authentic fact about them (Knutson et al., 2019). For this reason,
the Monash University library’s (2019b) Inclusive Teaching Toolkit recommends asking
‘which pronoun do you use?’ rather than ‘what’s your preferred pronoun’.
Archie Bongiovanni, co-author of A Quick and Easy Guide to They/Them Pronouns, offers
the following advice for educators who want to foster an inclusive learning environment:
Asking students what name and pronouns they’d like to be called at the beginning of
the class can mean a lot for students who don’t go by their birth names. It’s also a
great way to start a conversation about inclusivity with students who may be new to
the topic (2018, p.22).
When all students – intersex, trans, gender diverse and cisgender – have the opportunity to
share their personal pronouns, this goes some way to normalising gender-neutral pronouns
and raising awareness of the gender binaries inherent in a simple pronoun. The educator
should lead this by first introducing themself and their personal pronoun before expecting
students to do so. However, as mentioned earlier, some people may not be able to identify
with a stable pronoun. Expecting them to publicly select a pronoun may in fact work against
recognition of gender fluidity and further distress and alienate a student (McGlashan &
Fitzpatrick, 2018). Conversely, phrasing the request for pronouns as optional puts the onus
on those who are not cisgender to identify themselves and seek special accommodation
(Harris, 2017).
Distress may also arise where a student’s name on the attendance list does not match their
preferred name or gender, leaving less room to safely and comfortably disclose a
contradictory personal pronoun. While some higher education institutions offer the option
of updating preferred name and gender identifier without documentation, this may not
always be available. The onus then falls on the student to advise the educator in advance,
reinforcing the notion that not having to worry about pronouns remains a privilege.
Alternatively, the educator may ask all students to email or write down their preferred
names and pronouns, thus avoiding potential distress but lessening the opportunity for
open conversation and normalisation of gender diversity.
Other ways that educational institutions can normalise non-binary pronouns is to include
personal pronouns in email signatures or on social media bios. Again, this helps normalise
the concept that pronouns should not be based on assumptions or traditional gendering of
a name.

Conclusion
As gender-neutral pronouns become more widely accepted, it is important for educational
institutions to develop, promote and adhere to inclusive language at all levels and on a day-
to-day basis. Pronouns are an important part of that inclusive language, serving as a label
with the power to categorise a person and affect their life and being (Kiesling, 2019).
Intersex, trans and gender diverse people, already at risk of experiencing distress and social

238
tension when not fitting neatly into the binary categorisation of gender, may be further
disrespected and alienated through misgendering by pronoun. While educational
institutions are moving towards gender inclusive language, the naming of personal
pronouns is not always straightforward. Gender pronouns that are self-assigned and
disclosed at the discretion of the person themself can be empowering and validating.
Conversely, when others fail to respect, acknowledge or use appropriate pronouns, this can
be damaging to a person’s wellbeing, sense of self and feelings of safety. The growing swell
of commentary in social media continues to draw attention to the power of pronouns and
provides a platform for individuals to articulate why getting these basic words right is so
important.

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Language-Guide.pdf
O’Sullivan, S. [Dr Sandy O’Sullivan – Wiradjuri, trans/genderqueer]. (2019, May 13). Using
correct gender pronouns matters [Tweet]. Retrieved from
https://twitter.com/sandyosullivan/status/1145242997220495362
Parks, R. & Straka, R. (2018). Gender pronouns to support identity: Creating a campus of
difference. Phi Kappa Phi Forum, Fall 2018. Retrieved from https://www.elon.edu/
Pells, R. (2017, Jan 2). Sussex University to use gender neutral pronouns as students request
greater respect for transgender. The Independent (online). Retrieved from
https://www.independent.co.uk/student/news/sussex-university-gender-neutral-
pronouns-transgender-lgbt-rights-brighton-sexuality-politics-a7505671.html
Prewitt-Freilino, J.L., Caswell, T., & Laakso, E.K. (2012). The Gendering of Language: A
Comparison of Gender Equality in Countries with Gendered, Natural Gender, and
Genderless Languages. Sex Roles, 66, 268–281 DOI 10.1007/s11199-011-0083-5
Purdue University (2019). Gendered pronouns and singular ‘they’. Purdue Online Writing
Lab. Retrieved from
https://owl.purdue.edu/owl/general_writing/grammar/pronouns/gendered_pronou
ns_and_singular_they.html
RMIT University (2019). Guide to inclusive language. Retrieved from
(http://mams.rmit.edu.au/n6jbtjbp7hwe.pdf)
Smith, S. [samsmith]. (2019, September 13). My pronouns are THEY/THEM [Instagram post].
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University of Melbourne (2019). Change to personal details form. Retrieved from
https://students.unimelb.edu.au/?a=1467267
University of Queensland (2018). UQ guide to using inclusive language. Retrieved from
https://staff.uq.edu.au/files/242/using-inclusive-language-guide.pdf
University of Vermont (2019). Preferred name and pronoun. Retrieved from
https://www.uvm.edu/registrar/preferred-name-and-pronoun
University of Western Australia (2017). University policy on: Diverse sexualities and genders.
Retrieved from http://www.hr.uwa.edu.au/policies/policies/equity/sexualities
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Vivienne, S. (2018, September 14). The pronoun ‘they’ still divides. RMIT University News.
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they-still-divides).
Vygotsky, L.S. (1986). Thought and language (rev.ed). Cambridge, MA: MIT Press.
Western Sydney University (2019). Inclusive practice. Retrieved from
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y_and_gender_diversity/inclusive_practice

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 Therapeutic
Interventions

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 Editorial: Therapeutic interventions
Katrina Andrews

According to Ritchie and Roser (2018), mental and substance use disorders globally, as at
2017, was approximately 1-in-7 people or 15% of the global population. This ranges from
some countries reporting 7.5 to 10% of their population (Vietnam) to up to 20% of their
population (Australia, Greenland, and Iran), costing Australia up to $180 billion a year
(McCauley, 2019).The World Health Organisation released a mental health action plan
(2013 – 2020) aiming to address this problem with a number of strategies, all underpinned
with six principles and approaches, including universal health coverage, respecting human
rights, evidence-based practice, life course approach, multisectoral approach, and
empowerment of persons with mental disorders (WHO, 2013).
Locally, the recent conference held by the Australian College of Applied Psychology (ACAP)
touted the theme Innovations in a Changing World, encouraging mental health workers to
share scholarly evidence-based outputs in line with this timely theme, given the statistics
above evidencing up to 20% of Australians suffering a mental and/or substance use
disorder. The first keynote speaker, Prof. Jackie Cranney (University of NSW, School of
Psychology), shared her call to “give psychology away”, extending on Miller’s (1969) thesis
that psychologists have skills and knowledge (psychological literacies) to promote human
welfare, and it is thus their responsibility to share these literacies beyond their profession
with the goal of promoting human welfare, in mind.
This thesis was followed by a series of counselling and psychotherapy related presentations,
under the banner of “Therapy”. Firstly, Prof. Denis O’Hara and Fiona O’Hara argued that an
appreciation of how the known common factors of therapeutic effectiveness are inter-
related and integrated (such as trust, self-identity, play, strategic action, and review) and
how this integration can lead to the application of these common factors in any or all of the
known and preferenced therapeutic modalities of a given mental health practitioner,
without that practitioner sacrificing his or her own practice-based evidence techniques in
the therapy room. A central theme arising from this symposium was the importance of
psychological safety in the therapy room, giving rise to increasing therapeutic expectation
and hope, and therefore trust, all of which are necessary precursors for the therapeutic
change process.
Following on, Dr Kieran O’Loughlin shared his experience of creating different options in
therapy for clients newly diagnosed with the Human Immunodeficiency Virus (HIV) in the
wake of the availability of new medications to effectively manage the condition, whilst
adhering to resource constraints imposed by external stakeholders, including funding
agencies. A model of therapy, known as Single Session Therapy (SST), was defined as one
effective therapeutic option for this population, given that clients may no longer want to
attend long term therapy. This approach involves the therapist and client taking one session
at a time and making the most each one without the expectation that the client will want to

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commit to further sessions. A final thought included that the SST model, although brief, did
not preclude the provision of a sense of psychological safety in the therapy room, thereby
allowing a sense of trust and hope to grow, both of which are necessary variables to realise
positive therapeutic outcomes for this population
A final symposium in this series of presentations, was by Ms Fatmata Parkinson and Dr
Katrina Andrews, who summarised arrived-at themes by practitioners whom recounted
their lived experience when working with African Refugees within the Australian context.
The practitioner participants recounted the reality of being both a relational counsellor and
case worker when working with this population, all the while being cognisant of the current
Australian political climate that has a direct impact on this population. Within the therapy
room, the practitioner participant discussed the importance of being mindful and respectful
of religious and cultural differences, but also of the variables that an inexperienced
interpreter may add to the therapy room, that need to be managed. Unsurprisingly, a
dominant theme was the importance of self-care, supervision, professional development,
and support from like-minded colleagues for this practitioner population. Comments from
the audience highlighted that the reported outcomes of this research echoed key themes
from the other symposiums, including the importance of psychological safety, trust, and
hope when working effectively with African Refugees.
In conclusion, this series of presentations under the overall theme of counselling and
psychological therapy, highlight the paramount importance of psychological safety that is
needed to engender trust and hope, both of which are needed to bring therapeutic change.
This is a timely message given the prevalence of mental health and substance use disorders
in Australia, as quoted by Ritchie and Roser (2018), being 20 percent. I argue that Australia
can address this appalling statistic by paying attention to the second keynote address at the
conference, Prof. Lindsay Oades, whom introduced us to the teaching of wellbeing literacies
in our social institutions, in order to build a wellbeing literate society. This includes learning
to communicate with each other about and for wellbeing.
References
Miller, G. A. (1969). Psychology as a means of promoting human welfare. American
Psychologist, 24(12), 1063-1075. Retrieved from
http://dx.doi.org/10.1037/h0028988
Ritchie, H., & Roser, M. (2018). Mental Health. Retrieved from
https://ourworldindata.org/mental-health
McCauley, D. (2019). Mental illness and suicide “costing $500 million a day”. The Sydney
Morning Herald. Retrieved from https://www.smh.com.au/politics/federal/mental-
illness-and-suicide-costing-500-million-a-day-20191030-p535r6.html
WHO (2013). Mental health action plan 2013-2020. Retrieved from
https://www.who.int/mental_health/publications/action_plan/en/

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A metatheoretical framework for the integration of the common factors of psychotherapy
Denis O’Hara and Fiona O’Hara

Background:
Extensive research has established the effectiveness of counselling and psychotherapy and
identified a number of common factors involved in the therapeutic change process. The
current disciplinary understanding is that therapeutic outcomes are dependent on the
enactment of these key factors of therapeutic change, which explains why quite different
theoretical approaches can achieve similar therapeutic outcomes. However, simply knowing
what these common factors are, and attending to them in a way that is not necessarily
systematic, limits their potential to support positive therapeutic outcomes. A robust
metatheoretical framework which guides the integration of these key influencers of
therapeutic change, whilst providing space for individual professional expression and
preference, is what is proposed in this paper.
Approach:
The proposed metatheoretical framework interlinks the different common factors by
focusing on the relationship between the following elements, trust, self-identity, play,
strategic action and review. Erikson proposed that as trusting relationships are
established, a sense of basic hope emerges providing a confident foundation for the
ongoing development of the self. This self-development is further activated through the
emergence of the capacity for play and reflective function supported by a trusting
relationship. Genuine play stimulates neurological changes which support an expanding
self-awareness. This expanding self-awareness is evidenced in therapy by clearer
therapeutic goals that can help direct a process which utilises a variety of interventions
drawn from relationship focused, task focused, and transpersonal strategies.
Significance:
The metatheoretical framework outlined in this paper integrates current research, providing
clarity and focus for the therapeutic enterprise. This framework allows for the integration of
a variety of strategic practices within a comprehensive understanding of the change
process.
Key Words: Metatheory, Therapeutic Change, Trust, Hope, Self, Play

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Introduction
The twentieth century has provided the world with an impressive array of psychological
theories about human personality, psychic structures, neuropsychology, and relational
functioning. Within these theories are found expansive explanations about how we make
sense of our world and respond to it. Each theory provides a nuanced insight into how and
why we do what we do. Having said this, research has also demonstrated that essential
elements of the human change process are common across the various theories. Broadly,
four key elements of change are typically identified: the therapeutic relationship, the
client’s own resources and personal supports, a framework of understanding psychological
change, and hope that change is possible (Wampold, 2015). Each of these elements can be
broken down further elucidating finer points of the change process. Given the fundamental
and seemingly invariable nature of these common factors, specific theories serve not so
much as primary sources of change, rather, as principle adjuncts of change. That is, they are
important not so much in their own right but in their provision of a sufficient explanatory
system of understanding of self and of human functioning in which we can believe (Frank,
1973).
While this view may take the glitter off theories to some degree, it still highlights the
importance of theory. However, it does suggest that our understanding of the beneficial
mechanisms of psychological theories needs to be reconsidered. The existence of common
factors of human change which can be found across individual theories, implies the
existence of a theory at a higher order of abstraction – a theory which subsumes aspects of
individual theories. Theories which have the capacity for higher order abstraction are
referred to as metatheories (Pepper, 1942). Without pursuing a detail discussion of the
notion of metatheory, it is the central tenet of this paper that the human change process
requires an expanded metatheory beyond individual theories. The benefit of such a theory
is that it provides a framework or guide to the change process which is essentially common
across theories but not limited to individual theories. Such a metatheory respects the
knowledge and practices of individual theories but provides a more inclusive view of the
change process. This paper proposes a metatheory of human change that is sufficient to
guide the change process while valuing and incorporating the benefits and insights of
individual theories. The following discussion is an outline and explanation of this framework
entitled a “Hope in Practice Framework”.

Hope in Practice Framework

Hope and Trust

As noted above, hope is one of the common factors of therapeutic change. Hope in this
context is more than a naive optimism but a higher order category incorporating varied
meanings of hope including its counterpart, hopelessness. In any human change process, it
is impossible to escape the question of hope or hopelessness as change requires that we
believe in the possibility of positive change or, at the very least, in maintaining equilibrium
without hope. Either way, the issue of hope is present. So where and when does hope
begin?

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One of the earliest theorists to identify the significance of hope was Erik Erikson (1961) who
noted that the first primary task of the individual in psychosocial development was the
establishment of basic trust. Erikson argued that an essential outcome of gaining basic trust
was ‘hope’. In gaining hope the child acquires the belief in possible futures. As Erikson
states,
The gradual widening of the infants horizons of active experience provides, at each
step, verifications which inspire new hopefulness. Even as the infant learns to
renounce and repress … he also learns to dream of what is imaginable and to train his
expectations on promises to prove possible (Erikson, 1961, p. 154).
In a similar vein Trzebiński & Zięba (2004) assert that gaining trust results in the
establishment of a foundational worldview position which they call “basic hope”. Basic hope
is a fundamental belief in two features of the world, (1) its order and meaning, and (2) its
positiveness. They state, “The role of basic hope is to stimulate and to support an
individual’s constructive way of dealing with important loss or with challenges and new
opportunities in an individual's life” (Trzebiński & Zięba, 2004, p. 174). This is different from
the more common view of hope as expectation of goal attainment. Basic hope is less about
the process of goal attainment and more about belief in order and meaning in life. As
Trzebiński & Zięba (2004) express it, “Basic hope is a precondition to openness to
experience and to a tendency to search for new possibilities (p. 175).
Basic trust and basic hope while not identical are intricately related. Developmentally,
trust precedes hope as trust is founded on the experience of relational attachment.
According to Erikson (1961) “… the rudiments of hope rely on the new beings first
encounter with trustworthy maternal persons who respond to his reach for intake and
contact with appropriate provision …” (p. 153). This view is consistent with later research
on attachment which highlights the significance of early attachment on a sense of
personal security and trust in childhood and later in adulthood (Feeney, Noller, & Callan,
1994; Fraley, 2002). Research suggests that attachment schemas, whether secure or
insecure, persist into adulthood as relatively stable traits and are internalised in the form
of internal working models of self and other (Bowlby, 1988). There is also research which
suggests that these internal working models can be updated and adapted depending on
later attachment experiences (Fonagy & Allison, 2014). The current understanding is that
early attachment schemas tend to have a degree of latency into adulthood but can be
adjusted when new and facilitative attachment relationship are experienced.
If it is possible that early attachment schemas or internal working models can be positively
adjusted, it raises the question, “How can psychotherapy actively encourage this
adjustment?” According to Fonagy and Allison (2014), the mentalization process is the
primary process in attachment and therefore is also the primary mechanism through which
any schemas are adjusted. To clarify, mentalization is ‘the capacity to evoke and reflect on
one’s own experience to make inferences about behavior in oneself and others’ (Levy,
Meehan, Kelly, Reynoso, Clarkin, & Kernberg, 2006, p. 1029). The mirroring process is an
essential aspect of mentalization through which parents engage infants and young children
to reflect their different emotional states. Mirroring is possible because human brains have

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the capacity to note non-verbal cues, especially facial cues, in others eliciting similar neural
activity in the observers as in the observed (Carr, Iacoboni, Dubeau, Mazziotta & Lenzi
2003). Mentalization builds on the mirroring process by providing a more conscious
reflective dimension to the natural mirroring feedback received from the other (O’Hara,
2013). The more aware and intentional a parent is in mentalizing their child’s cognitive and
affective states, the more the child learns about their own internal experiences, thus
increasing the chance of developing secure attachment (Ringel, 2011).
In a reciprocal manner, secure attachment increases an individual’s acquisition of
mentalizing capacity and, according to Fonagy and Allison (2014), is also the key to the
development of epistemic trust – “that is, an individual’s willingness to consider new
knowledge from another person as trustworthy, generalizable, and relevant to the self” (p.
373). Secure attachment creates favourable conditions in which the child is able to relax
epistemic vigilance and accept and receive knowledge from a trusted other. This openness
to receive knowledge founded on epistemic trust and the openness to experience central to
basic hope are clearly associated and complementary. Given the significance of epistemic
trust and its interconnectedness with secure attachment and basic hope, it is clear that
epistemic trust is essential in providing the possibility for the establishment of healthy
internal schemas in childhood, and for their adjustment in later life.
We propose that the link between epistemic trust and hope functions in the following way
in therapy. The establishment of epistemic trust through appropriate communication cues
within the therapeutic relationship and the resulting increase in mentalizing function, opens
the individual to believing in life as being full of possibility and potential. This shift is a
worldview shift or movement towards basic hope. Living in a world internally constructed as
full of potential in which there is a reduction in epistemic vigilance allowing for an increased
trust in others’ communication and also in one’s own agency is qualitatively a different
worldview than one which is characterised characterised by epistemic mistrust both in
others’ and in oneself.

Identity and Direction

Erikson (1968) asserted that psychosocial development is fundamentally about the
development of self- identity whereby one knows oneself and one’s roles, knows who
one is in relation to others, and knows one’s values and purpose in life. Erikson theorised
that each stage or phase of identity development is facilitated by a personal crisis related
to being in the world and that the relative degree of resolution of each crisis propels the
individual to the next level of development. Erikson’s work spurred extensive research in
the field of identity development with many researchers extending and adapting his
foundational ideas (Marcia, 1966; Chickering & Reisser, 1993; Berzonsky & Kuk, 2005).
One of the most prominent developmental theories to emerge in recent years is Self
Determination Theory (Deci & Ryan, 2000; Ryan & Deci, 2000). Deci and Ryan explored
the place of motivation in human development and behaviour, especially highlighting the
significance of intrinsic motivation to personal development and wellbeing. In reviewing
Erikson’s stages of development, they assessed that there were three basic human needs
that were inherent drivers of psychosocial development, autonomy, competence and

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relatedness. They proposed that any stage or phase view of development reflected
processes aimed at meeting these needs. When acting autonomously a person’s
behaviours are freely endorsed and wholeheartedly engaged. Such commitment reflects
a search for, and a consolidation of identity based on personal values, goals, and actions.
The drive towards competence is the desire to gain mastery which is exemplified in an
attitude of curiosity and preparedness to stretch oneself. Again, the central motivation
for a drive towards mastery is not external rewards but a desire to extend one’s
capacities. Relatedness is the need to connect with others who encourage and affirm
one’s genuine self. Relatedness also involves the offering of one’s genuine self in support
of others. As La Guardia (2009, p. 92) states, “In sum, the needs for autonomy,
competence, and relatedness underlie natural inclinations towards engaging in
interesting and self-valued activities, exercising capacities and skills, and the pursuit of
connectedness with others.”
Identity is strongly linked to life purpose, and our sense of purpose is based on how we
understand the world and appreciate its sense of coherence (Swann & Buhrmester, 2012). A
central window through which we can view our purpose is through the goals we choose.
Carver and Scheier (1998) propose that human behaviour is largely organised around goals
and that goals are ordered hierarchically from more abstract higher order goals to more
concrete lower order goals. Higher order goals provide organisation and help to direct the
more concrete lower order goals. The higher the level of goal the more it reflects an
individual’s identity and values. Higher order goals also are important as they provide
motivation for behaviour and furthermore have been positively linked to health and
wellbeing. Those who have a clear sense of purpose, that is, are able to identify their higher
order goals and can make appropriate adjustments to these goals as they attempt to
achieve them, tend to have better health outcomes than those who do not have such clarity
of purpose (Sheldon & Elliot, 1999). Given the link between identity and goals and the
collective link with wellbeing, it is reasonable to propose that working with goals in therapy
focuses attention on the client’s personal identity and purpose and give direction to the
therapeutic process.
Carver and Scheier’s approach to goals has much in common with Deci and Ryan’s notion of
self-determination being based on the pursuit and fulfillment of the three basic needs of
autonomy, competence and relationship. In this respect goals can be seen to reflect how we
seek to achieve these basic needs and pursue our purpose. Within the therapy context,
clients do not always have clarity around their goals as the life issues or state of
demoralisation which has brought them to therapy often clouds perspective. Whether
clients are clear about what they want to achieve through the therapeutic process or not, it
remains the case that dialogue around goals provides a window into the client’s sense of
self, encourages hope for change, and ultimately focuses the task of therapy.

Play and Reflective Function

The need to establish direction for the therapeutic process is often a problematic task either
because the client is not clear about their own needs and intentions or because they are
clear about their goals but don’t know how to pursue them. In both situations the challenge

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for the therapist is to help the client gain clarity, insight, and strategies for action. Cognitive
focused interventions such as psychoeducation and cognitive reframing, may resolve some
unclarified self-understandings and provide direction for personal growth. However, the
more common need is the facilitation of a reflective process which accesses that which is
yet unknown or only partially known. Processes such as transference, free association, and
expressive activities such as artwork, music, and dance are all potential avenues through
which greater self-awareness is gained. All these therapeutic mechanisms employ
imaginative play.
To appreciate the play process and more consciously incorporate it into therapy, it is helpful
to understand the links between neural processes and sense of self. According to Panskepp
(1998) one of the main tasks of the brain is to create maps of the body and its systems for
the purpose of maintaining homeostasis. Consciousness allows us to experience these maps
as images so that we can manipulate these images and apply reason to them (Damasio,
2012). Such images are not simply abstract maps of the body but felt body states and are
connected to emotions and related behavioural action tendencies. Damasio and Panskepp
argue that from these internal images, emotions, and motor experiences, emerges the basic
sense of self. In support of this view is the finding that emotions activate the part of the
brain that map the body and stimulate it to action. In other words, there appears to be a
neural interrelationship between self, image, emotion, and motoric activation
(Faranda,2016).
The maps or images of the body and felt body states that give rise to a sense of self are both
non-conscious and conscious in form. As Damasio (1999) notes,
“… not all images the brain constructs are made conscious. There are simply too many
images being generated and too much competition for the relatively small window of
mind in which images can be made conscious, that is, in which images are
accompanied by a sense that we are apprehending them and that, as a consequence,
are properly attended (p. 319).
When we gain conscious access to these images, they are predominantly metaphorical in
type. The function of metaphor is to provide a wordless storytelling in which the mind can
move from what is known to what is unknow. As Faranda (2016) expresses it, “In this leap of
understanding, the brain uses concrete somatic experience to point to what feels similar”
(p. 606). In real terms, the brain uses metaphor to provide an inner play space in which
potentialities and possibilities can be tried out without consequences. Piaget (1951)
referred to this type of experimental play as ‘symbolic play’. Symbolic play is an interplay of
illusion and reality. For example, the objects of play or ‘transitional objects’ as described by
Winnicott (1960) act as points of reference between inner experience and outer reality. For
the child, a toy or favourite blanket may represent both a parent’s security and a projected
aspect of the self. Transitional objects and symbolic play in childhood are part of the
development of reflectivity, the inner sense of self or theory of mind (Meares, 2000). The
process of symbolic play does not disappear with maturity as it is an essential dimension of
selfhood because without it, there is no capacity to mentalize and experiment with inner
experience and outer reality.

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One significant and fascinating finding from research on child development is that for the
child to enter symbolic play, he/she requires the presence of a securely attached other.
When a parent is present and attending to the child, symbolic play flows freely. It is as if
the child takes the presence of the parent into the play space in some way. Piaget used
the term life of union to describe this state and Meares (2000) agrees asserting, the
experience of union “is necessary for play to begin and to be maintained” (p. 30). Of
course, we also observe children enjoying symbolic play by themselves. This is possible
via the benefit of the transitional object which represents, in part, the secure other. Play
supported by transitional objects, or in later development, selfobjects, as described by
Kohut (1971), are part of building the capacity for aloneness while still feeling relationally
connected. This fact has significant implications for therapy as it implies, and has been
observed, that a client’s movement into playful reflection is enabled in the context of
what Hobson (1985) has called a sense of fellow feeling. By this term he is trying to
convey a sense of a relationship of mutuality and connection. As Meares explains, “Out
of this feeling of resonance between my inner, essential and highly valued experience
and response of the other, there emerges the sense of myself” (p. 33). The dynamic of
mutuality, of aloneness-togetherness (Hobson, 1985), explains, in large part, the
significance of the therapeutic relationship in creating an environment for therapeutic
change. What must be recognised is that a relationship of mutuality and fellow feeling
provides the opportunity for the client to enter into reflective play and experiment with
his or her inner sense of self and reality. It is in this play space that therapeutic change is
made possible.
The nature of the play space sits somewhere between the norms of social communication
and non-linear free association, or as William James described it, the ‘stream of
consciousness’ (1890). The language of play is not bound by grammatical conventions of
social communication as it is grounded in the felt sense of the body, best grasped by images
and metaphor. However, for this play experience and its insights to be brought into
consciousness, it must be able to be communicated. There needs to be a movement to and
fro between social language and subjective experience. The therapist’s role is to pay
attention to each aspect of the client’s process, both the conscious, and the non-conscious
as evidenced in bodily communication and metaphor and help hold the client in the
reflective process.

Activating Strategies for Self-Expansion

So far, we have noted three critical metatheoretical dimensions of the change process. The
first of these is the establishment of a trusting mutual relationship which allows the client to
relax epistemic vigilance and be open to giving and receiving information. Within the
context of such a relationship, the second dimension, that of engaging an exploration of the
self and identity, predominantly through clarification of personal purpose and goals, is
made possible. However, the exploration and identification of purpose and related goals
should not be understood as a purely linear and cognitive process. If this were the case, the
client would likely have already identified and achieved his or her intentions. Rather, such
clarification is usually a process of reflection and experimentation, that is the process of

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symbolic play, which represents the third metatheoretical dimension of change. As the
change process is not sequential, there is normally an iterative movement between goal
clarification and play. According to Andreasen (2005) this essentially creative process
requires a constant self-deorganisation and a self-reorganisation, a movement between the
known and the unknown. Effective therapy provides opportunity for the uncertainty of this
creative process, trusting that the movement between play and the desire for self-
clarification will provide new direction and purpose. Now with new insights and awareness,
the client and therapist need pathways or strategies to effect the desired change. The
fourth metatheoretical dimension involves identifying strategies to enact this change.
One of the benefits of a metatheoretical focus on the change process is that it is inherently
integrative in nature. This means that action strategies and interventions in therapy can be
drawn on from any reputable theory (O’Hara 2008). While therapists tend to have a
preferred or default theory, ultimately any strategic intervention should reflect the needs of
the client at that moment in time (Cooper & McLeod, 2011). Research has demonstrated
that when client preferences are considered, there is a significant decrease in client drop
out and an increase in beneficial therapeutic outcomes (Lindhiem, Bennett, Trentacosta, &
McLear, 2014; Swift, Callahan, Cooper, & Parkin, 2018).
Client preferences are typically organised into three categories. First, activity or role
preferences refers to the client’s hope for the type of activities the therapist will engage
in during therapy. Examples of such activities include being challenging, prescribing
homework, or being directive or not. A second preference category is the type of
therapeutic approach. This typically refers to schools of therapy such cognitive
behavioural, psychodynamic, or person-centred, etc. While clients may or may not know
the names of these approaches, they usually associate a style of therapy with their
related interventions such as a focus on the unconscious, behaviour modification, or
empathic journeying. The third type of preference concerns therapist characteristics.
These can range from gender to personality styles (Swift, et al., 2018).
Client preferences by their nature intersect with therapist preferences. While the assertion
in this chapter is that therapeutic efficacy is increased when client preferences are taken
into consideration, there are other factors which influence therapist choice of approach
including their personality and training (McLennan, & Poznanski, 2004). Tartakovsky (2014)
found that there is a measurable link between therapist values and their choice of
approach. For example, those who highly value self-direction prefer employing person-
centred therapy, while those who highly value security prefer the use of cognitive behaviour
therapy.
The important issue in seeking to use strategies and interventions to help expand the
client’s development and facilitate change, is the need to prioritise the flexibility of
approach based on the client’s expressed and observed need (Bohart & Wade, 2013). While
the client is the most active and significant change agent by far, the therapist who
engenders trust and facilitates an exploration of the self through symbolic play and
reflection will more ably discern strategic approaches which resonate with the client and
which are consistent with the therapist’s own strengths and values. These metatheoretical

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principles active within the therapeutic change process are in constant motion, with shifts in
one dimension affecting others. Trust which is established in the first phase of therapy may
need to be re-established in later sessions, just as a goal identified at one point may be
reshaped or even discarded later. An intervention which appeared effective for one issue,
may be a hindrance for another.

Client Feedback and Review

A confronting finding from research on the therapeutic relationship has found that
therapists aren’t always as aware of the client’s experience and progress in therapy as they
might think and that the clients’ perception of the relationship is more predicative of
outcomes than the therapist’s (Horvath, 2010). The development of a range of outcome
measures has provided valuable insights into how clients have experienced individual
sessions and therapy as a whole (Lambert, 2007; Miller, Duncan, Sorrell, Brown, & Chalk,
2006). Evidence suggests that when such measures are used organically as part of the
therapeutic process through incorporating feedback into session discussions, the therapist
relationship is strengthened and client outcomes are improved (Cooper & McLeod, 2011).
The reality is that when the therapist and client are aligned and feel a sense of connection,
as discussed above, therapeutic outcomes are improved. While the use of psychometric
measures is a more formal process, when incorporated into therapy and used as a vehicle
for maintaining the relationship, it supports and further facilitates connection and the
therapeutic process.

Conclusion
Psychotherapy at its core is a deeply personal and intimate experience of connection with
another human being. As such it requires of the therapist a deep sensitivity to the needs
and experiences of the other. The key to effective therapy has two parts; one, a
comprehensive understanding of the human condition and a knowledge of the various
elements of the therapeutic change process, and two, a keen ability to connect genuinely
with another. While we know that well-established psychological theories provide the
therapist with a wealth of insight into the change process, any application of these theories
needs to be consistent with the fundamental metatheoretical principles outlined above.
When trust, a genuine identification and sense of self, play and reflectivity, appropriate
strategic responsiveness and openness to feedback are present within the therapeutic
process, positive change is more likely to occur.

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An innovative approach to counselling newly diagnosed HIV positive clients: Applying the
single session therapy model.
Kieran O’Loughlin

Abstract
Counselling is traditionally conceived as an episode of care comprising a shorter or longer
series of client sessions. However, findings from studies of a range of counselling contexts
reveal that the most common (modal) number of sessions clients attend is in reality only
one, and that many clients find this single encounter sufficient. Single Session Therapy
(SST) is a process that assists counsellors to make the most of the first, and what may be
the only, session for clients (Bouverie Centre, 2019). This paper will describe and
evaluate the effectiveness of an innovative application of the SST model to
counselling clients newly diagnosed with the Human Immunodeficiency Virus
(HIV). In Australian cities these clients are often fast-tracked into a full
psychosocial assessment within specialised community-based counselling
programs. In the 1980s and 1990s such clients would have typically then chosen
to enter long-term therapy in these settings to support them through what often
became a fatal combination of AIDS-related conditions. With the advent of life-
saving antiretroviral medications, these initial assessments are often also required
to fulfil the role of a single counselling session as clients may not necessarily wish
to return for ongoing therapy in the short or long term. The session must
therefore serve a variety of functions to support the client’s physical and
psychological health. The significance of the paper lies in its critical exploration of
the challenges to implementing the SST approach within a changing counselling
program and broader organisational culture. Instead of counselling HIV positive
clients on a mostly longer-term basis, the service gradually implemented several
therapy options, including SST, to meet its clients’ needs in the current climate
where a new HIV diagnosis is usually no longer a death sentence. The findings
have implications for the introduction of SST in other community-based
counselling programs.
Key words: Counselling; HIV; Single Session Therapy

Introduction
This paper examines a recent application of Single Session Therapy (SST) to counselling
people newly diagnosed with the Human Immunodeficiency Virus (HIV) in a community-
based health agency which was established in the early 1980s when the HIV epidemic began
in Australia. The inclusion of SST into the counselling service over the last five years
represents a significant addition to the delivery options available to clients in this agency in
which more open-ended and often longer-term therapy had previously established itself as

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the norm, beginning (and strongly justifiable) in an era when a HIV diagnosis was ultimately
likely to be fatal. The introduction of SST occurred in the context of HIV positive people
having ready access, since the turn of the century, to the new antiretroviral therapies (ART)
which have changed a HIV diagnosis from a death sentence into a chronic but manageable
condition similar to diabetes.
This paper offers a detailed critical reflection on the implementation of SST from
perspective of the author, a staff member the counselling service in the relevant period of
time, who is no longer an employee of the organisation but still works there as a volunteer
counsellor. Being critically reflective requires the capacity not simply to be reflective but “to
understand how that reflection is influenced by social context.” (Gardner, 2014: p. 23). It
also involves understanding how the history of an organisation within its social context has
influenced its past practices and its readiness to embrace new ones. The expectation of
change is therefore also integral to critical reflection, in particular, “change that is based on
values of social justice” (Gardner, 2014, p. 24). The paper begins with a brief overview of
SST, provides brief statistics on the current state of HIV in Australia, describes how HIV
testing is conducted in healthcare settings (including the use of pre and post test
discussions) before moving onto a detailed critical analysis of the inclusion of SST within a
community-based counselling service.
The state of HIV in Australia
The Kirby Institute (2018) reported that in 2017 there were an estimated 27,545 people
living with HIV in Australia. Of those an estimated 89% had been diagnosed through HIV
testing. There were 963 new HIV diagnoses in 2017, the lowest number of diagnoses since
2010, with a 7% decline over the last five years, and a 5% decline between 2016 and 2017.
Male‑to‑male sex continued to be the major HIV risk exposure in Australia, reported for
63% of HIV diagnoses in 2017, with heterosexual sex reported for 25% of diagnoses, both
male‑to‑male sex and injecting drug use for 5% of diagnoses and injecting drug use for 3%
of diagnoses. The decrease in overall new HIV diagnoses was attributable to an 11% decline
in new HIV diagnoses reporting male‑to‑male sex as the most likely exposure over the past
five years, and a 15% decline between 2016 and 2017.
In comparison, there was a 10% increase between 2013 and 2017 in diagnoses reporting
heterosexual sex, with a 14% increase between 2016 and 2017. Of 238 HIV diagnoses in
2017 that were attributed to heterosexual sex, 61% were in males and 54% were in people
born in Australia. A further 13% were in people born in Sub‑Saharan Africa, and 13% in
people born in Southeast Asia (Kirby Institute, 2018).

HIV Testing
Since the late 1980s in Australia HIV testing been widely available. Until the late 1990s, in
the absence of effective medical treatments, a HIV positive test result was very often a
death sentence as the virus would gradually destroy the person’s immune system leaving
them vulnerable to the range of opportunistic infections characterising AIDS (Acquired
Immune Deficiency Syndrome). The threat of a positive result for at-risk populations
therefore acted as a deterrent to testing for a virus which could not be effectively treated.

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However, the advent of ART in the late 1990s testing resulted in many at-risk people coming
forward for testing which has increasingly made a vital contribution to effective HIV
treatment and prevention. Only a small minority of people in Australia are now still at risk
of AIDS, namely HIV positive people whose immune systems have been severely
compromised either because they were diagnosed some years before ART became available
or else were exposed to the virus some years before their diagnosis (evidenced by them
having a high HIV viral load in their post-diagnosis blood tests), and had therefore not
accessed ART during that time.
Given the potentially serious health implications of contracting HIV, an established practice
for the last thirty years in Australia has been for the medical or other trained health worker
to engage the person presenting for HIV testing in pre and post test discussions (as is also
the case now for Hepatitis B and C). Accredited competency-based training programs were
gradually developed to enable health workers conducting the testing to effectively carry out
these discussions. This model of pre and post test discussion has undergone a number of
developments over the last three decades, particularly in response to the availability of ART
for both the treatment and prevention of the HIV virus. During the 1980s and 1990s in the
absence of effective medical treatment, the focus of these discussions was restricted to
behavioural change intervention to encourage newly diagnosed people not to expose their
sexual partners and/or people with whom they shared needles to the virus. This has evolved
now into a practice whose main aim is to link people into treatment and care (Johnson &
Lenton, 2017). The author of this paper successfully completed this training in 2012 and a
refresher course in 2015. HIV pre and post test discussions provide the main pathway into
counselling for the majority of client referrals to the community health based agency whose
adoption of the SST model is critically examined this paper. The nature of these discussions
are therefore described below.
Pre and post HIV test discussions
Johnson & Lenton (2017) provide the most recent guidelines for pre and post test
discussions for HIV as well as Hepatitis B and C. They recommend that the pre test
discussion for HIV testing should include the following: information about confidentiality,
public health requirements for the notification of results; consideration of the client’s
capacity to provide informed consent; enquiry about the client’s test history; a plain
language statement about the virus and the test (an antibody test that looks for relevant
markers rather than the virus itself), “stigma-sensitive” description or patient-led discussion
about risk and transmission; information or discussion about the availability of treatment
and support services in the event of a positive result; and details of when and how the
result will be delivered. Other considerations include the importance of a) explaining the
implications of the test window period (as the result will only be accurate for exposure to
the virus six weeks prior to the test date) b) discussing strategies and supports for managing
a positive result with people who may have significant risk factors or concerns about the
result. The client returns to see (normally) the same health worker a few days later for their
test result and the post-test discussion.

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The delivery of HIV negative results in the post-test discussion should include: the
immediate delivery of the result, and the opportunity for the person to respond; re-
explanation of the window period and discussion about the potential need for further
testing; and a reminder that individual results are not indicative of the HIV status of their
partners or other contacts with whom they have in engaged in unprotected sex or sharing
needles.
For the purpose of this paper the most relevant post-test discussion between health care
worker and client occurs when a HIV positive result is delivered and this event is the
precursor to a newly diagnosed counselling referral. This discussion may occur over one or
several sessions depending on whether the client returns to the same provider for follow-up
care such as baseline blood tests to determine their current HIV viral load. The following
elements are considered essential when conveying a positive result for HIV (and Hepatitis B
and C): preparation before delivering the result including locating printed information and
contact details for support services; focusing on the non-medical and psychosocial needs of
newly diagnosed people; providing reassurance but minimising the amount of information
given on the day of diagnosis; “stigma-sensitive” provision of information about
transmission and prevention; discussion about personal, community and peer supports; and
discussion about privacy, disclosure and contact tracing. Additional considerations for the
delivery of HIV positive results in particular include: preparation for the significant
emotional impact of HIV diagnosis, avoiding any physical examinations or blood tests on the
day of diagnosis; the timing and stigma-sensitivity of discussions about risk, prevention of
onward transmission and contact tracing; and the importance of focusing on support needs
and referral to community and peer support (including counselling services) (Johnson,
2019; Johnson & Lenton, 2017).
Single Session Therapy
The term “Single Session Therapy” (SST) was first coined by Talmon (1990) and referred to
the use of one counselling session only. He justified its application with the support of
plentiful research indicating that the most common (modal) number of sessions clients
attend for counselling is actually only one. After initially inferring that his clients had opted
out of of counselling because he had failed, Talmon (1990) found in follow-up surveys that
for many of them the single encounter had been sufficient and had led to positive
outcomes. In a later publication Talmon (1993) contended that “…the first session tends to
be the most important, powerful and effective - regardless of the length of the therapy”
(p.5).
The definition of SST has evolved over the last twenty-five years and now designates a
process by which counsellors and clients make the most of their first session together as if it
may be the last, while allowing for the possibility that they may agree to further sessions as
required. It is important to note that SST is an approach to service delivery rather than a
therapeutic model per se. Therefore, counsellors are still able to use their preferred
modalities but need to adapt them to fit the SST model (Young, Weir and Rycroft, 2012).

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Incorporating SST into a HIV Community-based Counselling Service
McLeod (2019) argues that much of the literature on counselling and psychotherapy ignores
organisational issues and is written as though the most common type of therapy is offered
in private practice whereas, most therapy is actually provided through organisations. This
fact, as McLeod (2019) suggests, makes aspects of organisational theory, such as the
notions of the organisations as ‘open systems’ consisting of a set of overlapping and
interconnecting parts, as well as their structure, culture and values, highly relevant to the
study of changes in counselling practices within agency settings. The agency, in which the
implementation of the SST approach is described in this paper, is an Australian community-
based health organisation. It was established in 1984 by activists with the dual mission of
providing HIV prevention and support, and improving the health of gay men (the most at-
risk population) in general. Newly diagnosed HIV positive clients who are referred to
counselling at the agency have traditionally been fast-tracked into the service’s psycho-
social assessment lasting 60-90 minutes. Prior to the advent of ART in the late 1990s, many
of these clients would have then been prioritised for immediate entry into unlimited
ongoing or intermittent long-term therapy which was provided by qualified staff and
volunteer counsellors. They also received medical assistance from the agency’s medical
clinic, its community support program, and had access to meals and other services such as
massage and art therapy at the agency’s dedicated centre for positive people.
Around 2008, with many HIV positive people now living fuller and longer lives by virtue of
increased low-cost access to ART, the agency’s counselling service gradually identified
through exit evaluations that clients were not always seeking long-term counselling to deal
with consequences of a new diagnosis. This trend, combined with a growing waitlist
following the expansion of the agency’s brief to cater for members of the broader LGBTI
communities unaffected by HIV, resulted in the decision by the agency in 2010 to employ an
external consultant to review its model of counselling service. The review was also hastened
by the state government’s decision to merge the counselling service of the agency with that
of another peer-based organisation focused exclusively on HIV support for people
regardless of their gender and sexuality, and managed entirely by people living with HIV,
not just gay men. Counselling in this other peer-based organisation had operated almost
solely within a longer-term service model so the merger of the services was viewed by their
counsellors with scepticism even before the consultant’s review had been undertaken.
The consultant’s final report recommended the adoption of more flexible counselling
options for all new clients of the newly merged counselling service irrespective of their HIV
status including: a) a single session or brief intervention (1-2 sessions), b) a course of 6 or 12
sessions, or possibly (with formal management approval) 18 sessions where there was clear
evidence of clinical need and c) extended duration psychotherapy for existing long-term
clients and a limited number of new clients. Decisions about eligibility for option c) would
be made on the basis of evidence of clinical need for the longer-term approach, lack of
viable and affordable alternative options and counselling resource availability. In the initial
implementation of the new service model, only option b) was adopted by the newly
appointed manager in 2012 but without appropriate staff, volunteer or client consultation.
The notion of limiting the number of counselling sessions with clients to 6, 12 or, in limited
263
cases, 18 sessions, was strongly opposed by most of the counselling workforce (staff and
volunteers), and especially those therapists whose use of longer term therapy had served
many of their clients well in the past. These counsellors had qualifications in and were
committed to long-term psychotherapy, including psychodynamic, person-centred and
gestalt therapies. Their view was that decisions about the duration of therapy should be a
mutual one made by the client and therapist, and not imposed arbitrarily by management.
Some of them then resigned in protest while others remained but continued to resist the
change, largely by ignoring its implementation.
The controversy about the new time-limited service delivery model remained unresolved
until mid-2013 when the counselling service lost important aspects of its autonomy and
distinctiveness due to an organisational re-structure. Prior to that time the service was
separate to other services in the agency and the counselling manager was part of senior
management reporting directly to the general manager. However, in 2013, counselling was
re-positioned under the umbrella of all of the services offered by the agency. This meant
that its manager was effectively demoted to the same level as team leaders in other service
areas reporting to the newly created senior manager position, director of services. This re-
structure resulted in the counselling manager resigning while the controversy surrounding
the implementation of the new service model had still not been fully resolved. At the end of
2013 the first director of services was promoted to CEO and, the incoming director of
services immediately instructed the manager of counselling services (the author of this
paper) to strictly enforce the implementation of option b) from the counselling review (i.e. a
maximum of 12 or 18 sessions) for all clients, and options a) and c) were then abandoned. It
was thus strictly enforced as the sole model for the delivery of counselling. The author
reluctantly acceded to this direction as it seemed to be an inflexible, one-size-fits-all
approach with arbitrary exit points over which clients in particular had not been consulted.
The new model of counselling service still allowed for newly diagnosed HIV positive clients
to be fast-tracked into the comprehensive assessments and prioritised for entry to further
counselling. However, by the start of 2015, the author (who by then had stepped out of the
role of manager of counselling services to take up the position of senior clinician, training &
capacity building) had collected clear evidence that these newly diagnosed clients were also
presenting with a range of different attitudes towards their counselling needs in these
assessments, largely as result it seemed of the availability of ART to treat and manage their
condition. These client attitudes varied from ambivalence to even attending for an
assessment, to willingness to engage in counselling on a wait-and-see session by session
basis, through to wanting immediate entry into regular on-going (and possibly long-term)
counselling. The assessment frequently came to serve by default in these circumstances, as
an initial single session therapy extended for up to 2 hours duration, after which newly
diagnosed clients may or may not have chosen to follow up with further counselling. The
importance of getting the balance right between assessment and counselling in this initial
session was further underscored by the highly variable quality of post-test discussion
experiences newly diagnosed clients reported having had with their health care provider at
the time their positive results were delivered to them. Thus, an integral part of the
assessment was checking what the clients had gained from their post-test discussions.

264
In early 2015, the author (still in the role of senior clinician, training & capacity building) re-
visited the external consultant’s 2010 report, specifically the rejected option a) a single
session or brief intervention (1-2 sessions). This presented a possible solution to the
diminishing number of newly diagnosed clients seeking ongoing, longer-term counselling
after their initial assessment. The author subsequently undertook formal training in SST at
the Bouverie Centre in a bid to explore the possibilities of formally incorporating SST as one
approach to providing counselling at the agency. This would require staff conducting
assessments with newly diagnosed clients to make the most of this opportunity to provide
counselling to clients who might choose to return for follow up sessions, and, if so, to wait
for a suitable counsellor to become available. Both the manager of counselling and the
director of services supported this initiative on the grounds of better meeting the
immediate counselling needs of newly diagnosed clients. The author was then asked to
conduct a short training session in the use of the SST model as an approach to incorporating
counselling into the assessments for all staff counsellors. The SST model was also suggested
as applicable to the counselling sessions which may have followed the assessment rather
than assuming that all clients who chose this option would need 6 or 12 more sessions.
Again, there was resistance to adopting the SST approach by some of the counselling staff
who saw it as an even greater threat than the already implemented limited session
approach to the open-ended, longer-term therapy models to which they were committed.
This was especially the case for staff who had not completed the pre- and post-test
discussion course. In retrospect this training helped them to understand better how the
initial client assessments needed to follow more coherently (in content) and cohesively (in
form) from these discussions with their health care provider at the time clients were tested
and informed of their positive result. The training also effectively inducted them into
conversational practices which closely resembled the focused, one session-at-a-time SST
approach which they then applied in the ensuing counselling assessment. The staff opposed
to applying the SST model were persuaded, however, by the argument that the provision of
brief and, sometimes, single therapeutic interventions for some clients could allow other
clients to be able to engage in longer-term therapy which had been the previously rejected
option c) in the 2010 consultancy report.
The standard assessment used by counselling services comprised a full psychosocial
evaluation of each client irrespective of HIV status. These assessments were undertaken
face-to-face with each new client by a staff counsellor soon after the client had initially
contacted the agency. Newly diagnosed HIV clients remained prioritised for these
assessments. The assessment gathered the following from clients: relevant demographic
information; details of their other professional supports or workers; other past and current
medical conditions; medications; current legal issues; presenting issues (including but not
restricted to their HIV diagnosis); and the predisposing, precipitating, perpetuating and
protective factors related to them, their counselling history, goals for counselling, current
alcohol and other drug use (using the AUDIT and DUDIT tools), concerns about their current
sexual practices with their partners, the Kessler Psychological Distress Scale (K10)
questionnaire yielding a global measure of distress based on questions about anxiety and

265
depressive symptoms, a full risk assessment (including risk of suicide, and harm to self and
others) and finally a Mental State Examination.
The incorporation of SST into the initial client assessment was trialled later in 2015 and
carefully monitored by the author over the next twelve months using documentation from
these initial sessions and voluntary post-interviews with counsellors and clients. Clients
were advised from the outset of the session that it would include an assessment and some
initial counselling if clients so wished. Possible counselling foci grew organically out of the
assessment questions, the post-test discussions (see above) they had already had with their
health provider who had given them their positive result. The main priority for nearly all
clients was to begin processing their diagnosis at both the cognitive and especially,
emotional levels. Clients were reminded of the excellent treatments available to them and
encouraged to start thinking about when they might commence ART. This can be a complex
question for some clients, whose life situations may not be sufficiently routinised, to be
compatible with embarking on an uninterrupted daily regime of ART for the rest of their
lives. However, this discussion needs to be culturally safe and guided by the participant’s
questions, concerns and emotional state. It was important to for clients to identify support
people as well as external stressors in their lives such as relationships, housing, employment
and mental health emerging out of the assessment. They frequently sought assistance with
referrals to community and peer support both within and outside the agency so that they
could ask questions and learn from other HIV positive people in a non-clinical environment.
Some clients struggled to make sense of their own fear and devastation in an era when HIV
is now framed as a chronic manageable infection. For some of these clients there was a risk
of suicide.
Another very important topic raised by clients in these sessions was whether they should
disclose their result to anyone in the immediate timeframe while they were still in shock.
Premature disclosure to significant others could sometimes have a negative result,
especially if these people were not educated about HIV and the current treatments
available. Concerns about suggesting HIV testing to their sexual partners were also
sometimes raised although not always in this initial session. Those whose blood test results
indicated they had a very high viral load and therefore probably had only recently acquired
the virus were informed that they would be more likely to pass on HIV to their partners.
While all of these topics may have been broached in their post-test discussions with their
health worker many clients were unable to recall these conversations because of the shock
of being delivered a positive result. At the end of the initial session a joint decision was
made between the counsellor and client about further counselling if any.
The incorporation of SST into the initial assessment was evaluated by the author (in his
ongoing capacity as senior clinician, training and capacity building) at the end of the twelve
month trial in late 2016. The documentation and interview data gathered during the trial
were carefully analysed. The use of the SST approach in the assessment was found to be
successful only when counsellors had a sound knowledge of the biomedical and
psychosocial dimensions of HIV care and management. In particular, counsellors who had
successfully completed formal training in pre and post HIV test discussions (a requirement
that had been dropped by management in 2013 as counsellors did not actually conduct
266
testing and thus these discussions) were far more competent in quickly identifying and
adapting to meet the immediate (and potentially ongoing) counselling needs of their clients.
This appeared to be true of all assessments irrespective of the quality of the pre and post
test discussions that had been previously conducted with these clients by their respective
health worker at the time of their diagnosis. It was concluded that both the content and
brief nature of these pre and post test discussion training very effectively prepared these
counsellors for the use of SST in the assessments and further single session work (if
appropriate) with their newly diagnosed clients.
In response to the author’s evaluation, the counselling manager decided to halt the use of
SST in the assessments given that not all assessors had completed the pre and post
discussion course. A new procedure was temporarily introduced whereby clients would be
allocated as soon as possible after their assessment to one of the counsellors who had
successfully completed the training to begin SST work. However, newly diagnosed clients
were still given the choice to opt out of counselling after the assessment or at any stage of
further counselling. The funding of the pre and post HIV test discussion competency-based
training was re-instated for new counselling staff in 2017 but only on an opt-in basis. So,
there was still no guarantee that all counselling staff conducting the assessment would have
undertaken this training. The SST approach to the initial counselling assessment was
subsequently resurrected, but only for counsellors who had successfully completed the pre
and post test discussion course. Their competence in using the approach was further
strengthened through formal training in SST by the Bouverie Centre which was offered to all
staff and volunteer counsellors in the same year. The selective use of SST in the initial client
assessments by counsellors, who are trained in both pre and post HIV test discussions and
SST, has continued up to the present time.
Conclusion
This paper has demonstrated the complexities of expanding a counselling service model to
incorporate SST as a new approach to counselling newly diagnosed HIV positive clients
within a community-based health setting. In doing so it has attempted not only to critically
examine the history of the structure, culture and values of the organisation and its
counselling service, but to situate this history within the broader context of significant
medical advances to HIV support and prevention and their impact on HIV positive clients’
futures. The following factors all significantly impacted (positively or negatively) on the
adoption of SST: the recent availability of ART and consequent meaning of a HIV diagnosis;
changes in the agency’s culture, structure and management personnel; and variability in
necessary specialist HIV counsellor competencies for full implementation of the SST
approach. It is recommended that other community-based health agencies take these kind
of factors into consideration, not only in incorporating the SST approach specifically, but
also when planning to include or replace other counselling practices in their service models.
Finally, it is hoped that this paper has also demonstrated the key ethical importance of
clients having the choice of a range of approaches, including briefer interventions such as
SST, to suit their different needs at the time they present to community-based and other
counselling services.

267
References
Bouverie Centre (2019) Single Session Therapy
https://www.bouverie.org.au/support-for-services/our-specialist-
areas/specialist-area-single-session-therapy-sst-alternatively-referred-to-as-
sin. Accessed 28 June 2019.
Gardner, F. (2014) Being Critically Reflective. New York: Palgrave Macmillan.
Johnson, J. (2019) Normalising HIV testing in a changing epidemic. HIV in
Australia, 12 July.
Johnson, J & E. Lenton (2017) HIV and hepatitis pre and post test discussion in
Victoria Consultation Report. Melbourne: Australian Research Centre in Sex,
Health & Society
Kirby Institute (2018) HIV in Australia: Annual Surveillance Short Report. Sydney:
Kirby Institute, UNSW.
McLeod, J. (2019) An Introduction to Counselling and Psychotherapy: Theory,
Research and Practice. London: Open University Press
Talmon, M (1990) Single-Session Therapy: Maximising the Effect of The First (&
Often Only) Therapeutic Encounter. San Francisco: Jossey-Bass.
Talmon (1993) Single Session Solutions: A Guide to Practical, Effective and
Affordable Therapy. New York: Addison-Wesley Publishing.
Young, J., Weir, S. & Rycroft, P. (2012) Implementing Single Session Therapy. The
Australian and New Zealand Journal of Family Therapy, 33(1), 84-97.

268
 Counselling African refugees: How is the process observed and experienced by
practitioners?
Fatmata Parkinson and Katrina Andrews

Abstract
Papadopoulos (2002) identified that while there is already an enormous amount of
research on refugee mental health, inadequate attention has been given to the therapeutic
care viewpoint. Moreover, some studies have also shown that it is a moderately new area
and as a result very few studies have been shown to explore the experiences of
practitioners working with refugees (Papadopoulos, 2002). Akinsulure-Smith (2012)
stressed the need to recognize the plight of refugees and the tribulations they face pre and
post migration as the number of refugees coming to the western industrialized countries
increases. Furthermore, practitioners who work with African refugees should learn to apply
skills and approaches appropriate to service users’ cultural tradition and background
(Akinsulure-Smith, 2012). This study provides a qualitative account of the experiences of six
practitioners, five male and one female, who have worked with African refugees. Thematic
analysis was used to categorize several experiences and complexities that practitioners
face in their work with African refugees. Therefore, four themes of the reported
experiences of the practitioners were generated: the therapeutic practice as observed by
the practitioner; the impact of the therapeutic process on the practitioner; practitioners’
use of interpreters; available supports for therapists. Result shows that while there are
numerous factors that act as an obstacle when working with African refugees, supervision
and support from colleagues and other services were shown to assist the practitioners to
attain good therapeutic outcome. Results identified some similarities and differences
within the literature. Study limitations, implications and future recommendations were
discussed.
Keywords: thematic analysis, interpreters, African refugees, self-care, migration,
practitioner.

This work was supported by the Australian College of Applied Psychology, under the ACAP
HREC approval number 319260417.
According to the United Nations Convention Relating to the Status of Refugees (1951), a
refugee is defined as:
a person, due to justifiable fear of being victimised for purposes of race, religion,
nationality, affiliation of a specific social group or political opinion, is outside the
country of his nationality and is incapable or, due to such fear, is reluctant to avail
himself of the security of that country; or who, not having a nationality and being
outside the country of his previous habitual home as a result of such events, is
incapable or, due to such apprehension, is reluctant to return to it (p. 14)

269
According to the Australian Human Rights Commission (2012), Australia is a signatory to this
convention and in the past decade has accepted around 13,000 to 14,000 offshore and
onshore humanitarian visas annually. Around 30 percent of these candidates are from
Africa (Australian Human Rights Commission, 2012).
Department of Immigration, Multicultural and Indigenous Affairs (DIMIA), commissioned a
national longitudinal study, concluding that refugees experience more resettlement
difficulties such as a very high level of anxiety, social problems and stress when paralleled to
non-humanitarian immigrants (McLennan, 1997). As the number of refugees migrating to
the western industrialized countries continues to flourish, Akinsulure-Smith (2012)
underlined the need to acknowledge the plight of African refugees and the complications
they encounter pre and post migration. For instance, 25% of Sudanese refugees described
elevated levels of psychological problems (Schweitzer et al., 2006). One of the motives as
reported by Sudanese Australians was a feeling of seclusion by the broader community as
they were characterised as being dissonant with the conventional Australian image due to
their colour and refugee background (Dandy & Pe-Pua, 2015). Correa-Velez et al., (2010)
affirmed that there is normally a negative perception of refugees from the broader
community, which leads to discrimination and racialism and creates a barrier in refugees’
development of a sense of connection to their new environment. Therefore, Century et al.,
(2007) advised that counsellors should comprehend the complexity of the interrelationship
between these factors and its effect on the resettlement process and welfare of refugees
(Century et al., 2007). Moreover, practitioners who work with African refugees must learn
to use skills and approaches suitable to clients’ cultural heritage and upbringing (Akinsulure-
Smith, 2012).
According to Papadopoulos (2002), although there is already an immense body of
knowledge on refugee mental health, limited attention has been given to the therapeutic
care perspective. Furthermore, there are limited studies of the subjective experience of
therapists and their understanding of therapeutic practice with refugees (Schweitzer et al.,
2015). For many practitioners, the counselling methodology employed in addressing the
mental health problems of refugees is a comparatively new area given medication has been
the key intervention (Takhvar, 2002).
To the authors knowledge, only four qualitative studies investigating therapists’
perspectives in working with refugees have been conducted (refer Century et al., 2007;
Cariceo, 1998; Schweitzer et al., 2015; and Guhan & Liebling-Kalifani, 2011). A review of
these studies elucidated four common themes: therapeutic practice; impact on therapists;
the use of interpreters; support for therapists.
Therapeutic practice
According to Century et al., (2007) primary health care workers grappled with their client’s
refugee experiences and indicated that counsellors’ intentions in seeking to develop a
therapeutic relationship and context for the counselling process may be confusing and
misunderstood by the client due to cultural differences. The counsellors therefore, engaged
approaches that were outside to the normal counselling practice and evaded traditional

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counselling limitations, which may result in disparities and uncertainties for practitioners
who are new to the field (Century et al., 2007).
However, Schweitzer et al., (2015) believed that the therapeutic relationship was valued
more than the techniques and it was considered as a genuine, shared relationship that
permitted the clients to experience a sense of trust and security, which was therapeutic in
itself. It accelerated the building of rapport, enhanced therapeutic outcome and assisted
the clients to overcome the trials of resettling in their new environment (Cariceo, 1998).
Nonetheless, the therapists find the political situation in Australia as having a significant
consequence on therapeutic method and outcome due to government funding policies
(Schweitzer et al., 2015). Browne, Glass and Holyoak (2016) reported that providers’
dedication to assisting immigrants is regularly dampened by the organisational constrictions
due to restricting state laws and growing competition over insufficient funding.
Impact on therapists
It was common for new psychologists to feel ineptitude as most therapists find the stories
and experiences of the refugee complicated and sometimes frustrating due to their work
demand and the training they received (Schweitzer et al., 2015). More importantly, burnout
and vicarious traumatisation are other risk factors that therapists must be aware of (Van
der Veer, 1998).
Guhan and Liebling-Kalifani (2011) stated that the notion of vicarious resilience and
vicarious adversarial growth was found to be present in the participants through learning
from clients and as a result they became emotionally resilient and have established a
different outlook of their life. Moreover, the notion of compassion satisfaction appeared to
serve as a protection against impending adverse effect of their work when they gain a sense
of reward, worth and competence in their role as a helper.

The use of interpreters

While counsellors regard the use of interpreters as necessary, they also believe that they
disrupt the smoothness of the therapeutic procedure and relationship (Century et al., 2007).
Cariceo (1998) established that they have to cope with communication difficulties, which
frequently leads to problems of, neutrality, confidentiality and fairness as a result of getting
the support of interpreters. Furthermore, some refugees may not be accustomed to the
western vocabulary and psychological terminology (Schweitzer et al., 2006).

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Support for Therapists
Therapists use practical approaches and proper breaks to retain self-care (Schweitzer et al.,
2006). According to Guhan and Liebling-Kalifani (2011), the majority of therapists wanted
extra supervision and help. Therefore, Century et al., (2007) advised that “Specialist input,
in the form of training or specialist supervision, may also provide containment for this
difficult work, as would easier access to resources such as information on cultural and
practical issues and trained interpreters” (p. 38).

Research Question
This study aims to explore the therapeutic experiences of practitioners who work with
refugees from an African background, to investigate their viewpoints and identify certain
practices that work as well as any problems or gaps that may occur that needs to be
addressed in this complicated area of work. Numerous studies have shown that very little
research has been done to investigate this area. It is anticipated that this research will shed
some light into an area that is very complex and challenging to work in as a practitioner.
Century et al., (2007) also recognised that it is a complicated area and acknowledged the
problems experienced by primary health care workers who were working with refugees in
North London. Hence, this study will also make other practitioners working with refugees to
identify the challenges and resolve any budding problems. It also allows new practitioners
to circumvent any possible injury to them or clients. Consequently, it is possible that by
tapping into the experiences of practitioners working with African refugees, practitioners
and their clients will benefit from the outcome of this study by providing increased
knowledge and awareness of how best to facilitate effective therapeutic processes and
outcomes. According to Bryman (2004), one of the political motives people conduct
research is to effect change.

Method

Data Design
A qualitative semi-structured interview was conducted for this research as it permits the
preliminary course or stage of the interview to be set by the researcher. Qualitative
approach gives researchers the chance to study and comprehend the viewpoint of others
(Bryman, 2016). The gathered data was simultaneously transcribed and analysed using
thematic analysis.

Participants
A total of six practitioners who have worked with African refugees partook in the study. One
was female and five were male. Only three of the participants were from African
background. All participants identified as having worked with African refugees in Australia
as either a counsellor, psychologist or social worker. They each had over one year of
experience working with African refugees. A pseudonym was used for the participants in
the interview transcripts to protect their identity and anonymity. All participants were

272
treated in accordance to the Human Research Ethics Committee in which this research was
guided.

Materials
The research was conducted using open ended questions, in a semi structured interview
layout, that asked about the practitioner’s counselling experience with their clients, it’s
effect on them, how they self-cared and accessed support services. A voice recorder was
also used throughout the interview with the permission of the participants through face-to-
face, telephone and zoom online collaborative software. Finally, Google Text-to-Speech was
used to transcribe the data.

Procedure
Two recruitment methods were implemented to gain participants. Firstly, a dedicated
research Facebook page was created to enlist participants, using snowball sampling.
Secondly, an announcement was placed in the online student lounge within the institute
which supported the research, as well as on the website of “The Multicultural Network in
Sydney” (a community development organisation dedicated to working with people from
non-English speaking background).
Interested participants were emailed a research package (including information and consent
forms) and encouraged to ask any additional questions via a specified phone number. Those
that contacted the researcher and wanted to continue were vetted for eligibility to
participate. A suitable date and time was arranged for the interview, which was conducted
within a sound proof room at the institute within which the research was done. Participants
gave written permission and were given the chance to ask any further questions at the time
of the interview.
A semi-structured interview was conducted using for a period of about 45 to 60 minutes at
The Multicultural Network in Bankstown, Sydney, as well as on telephone and zoom to
overcome any geographic barriers. The interviews were audio recorded with the approval of
the participants.
Thematic analysis was used to expand the themes enclosed in the qualitative data using the
five-step method outlined by Braun and Clarke (2006). Open coding was used to identify
resemblances and differentiations and collected the data (Strauss & Corbin, 1998). To
finalize, the report strived to present a rational account that presents an interpretative
representation of the data set and a critical argument regarding the experience of
therapists in working with African refugees.

Bracketing
The legitimacy of coding and theme development was warranted through a process of
bracketing. Bracketing is a methodology used in qualitative research to manage potential
adverse effects of researcher assumptions on the research process (Tufford & Newman,
2010). The researcher used memo to reflect throughout the gathering of data and analysis
procedure of the research to reduce judgement or prejudice.

273
Results
Four themes arose from the thematic analysis. These were: the therapeutic practice as
observed by the practitioner; the impact of the therapeutic process on the practitioner;
practitioners’ use of interpreters; available supports for therapists. The subthemes varied
from zero to three for each theme. Participants have been identified by code and
designated as participants 1, 2, 3, 4, 5 or 6 in accord with the interview number.

Theme 1: The therapeutic practice as observed by the practitioner.

The refugee experience of the clients was witnessed by the participants as having a
pronounced traumatic consequence on the clients. Furthermore, they supposed that for
many clients, problems with mental health often develop after the resettlement process.
Four of the participants indicated that they struggled to deal with the stories and
experiences of clients from refugee background. “…so when they are telling me such
things it's really really affects me. When I say it affects me we're all human being so it will
have an adverse effects on me.” (4.1192-1194). Similarly, Participant 4 also stated that
“yourself you become traumatized you become stressed and sometimes up to the extent
of having a depression” (4.1399-1400). Most of the participants stressed their ability for
authenticity, honesty and curiosity as underlining their therapeutic work with refugee
clients. They also realised the therapeutic relationship and clients’ condition of primary
importance.
1.1 Developing rapport with clients. Three of the participants reported that the formation
of official contract and responsibility in the therapeutic relationship between counsellor and
client might have little meaning for refugees. Four of the practitioners described using
methods that were external to the normal traditional confines of counselling. Hence, one of
the participants experienced some incongruities and uncertainties in building rapport with
his clients, as he was new to the field. Nonetheless, they perceived the therapeutic
relationship as fundamental to the therapeutic process and valued more than the
techniques as they realised that an authentic, mutual relationship permitted their clients to
experience a sense of security and trust which they believe was therapeutic as well.
“What I'm looking for in all my clients is to really find out who are they in their inner
core, what are they in their inner core and what's the beauty in them in their inner
core? And if I can find that and I'm recognising that, I think they feel bigger, they feel
stronger. We always feel good when somebody see the best in us. And I think that's
something that I just sort of do without thinking really. I'm always looking for that and
I think that helps them trust me too” 2.460-466.
1.2 Practitioners duty as advocates and caseworkers. All of the practitioners offered
support to their clients to access other services. They stated that it aided their refugee
clients to manage the challenges of resettling, assist with building rapport, and give the
counsellor fundamental information as well as prospects for wholesome therapy.
“The majority was client who where kind of looking for assistance and help in a more
practical way.” 1.225-226.

274
 “I quite often go outside the normal boundaries of counselling. I'll follow things up so if
they've got a particular issue and I know there's a service who could help them. I
would often say ‘would you like me to ring them now?’ so I ring them while the clients
is there with me so we have the conversation together.” 2.450-454.
1.3 The religious and cultural influence in therapy. All of the participants stated that the
cultural and religious upbringing of the clients persuaded their behaviour and approach to
therapy.
“I think the cultural issues that arise are also probably the stronger cultural issues. I
think I've noticed for the people who didn't have the advantage of education and
therefore the culture maybe a stronger influence on the difficulties.” 2.341-344.
Theme 2: The effect of the therapeutic procedure on the practitioner
The magnitude of the challenges and experience of working with refugee clients was
acknowledged by all of the participants.
2.1 Navigating the political systems and context and its impact on practitioners. Five of
the participants discovered that the political environment in Australia was having a
substantial effect on the therapeutic procedure and outcome due to government funding
policies. Moreover, some providers’ obligation to supporting immigrants is often changed,
modified and reduced by the organisational restraints. Therefore, they reported feeling
isolated, tired, helpless, unproductive and furious because of some of the limitations
enforced on their clients.
“Challenging day for me, it's when I don't find a resource for my clients because many
of my clients when they come they need mostly social support because with
counselling support I do it and I deliver it but when it comes to social support when
they don't give them and I know that there is some resources somewhere and they
don't provide for them I feel sick because I have to develop a way of going to those
managers going to those social workers to reason with them.” 6.1885-1891.
2.2 Practitioners’ experience of compassion satisfaction and a sense of accomplishment.
Although the various challenges confronted by the participants such as the feeling of
helplessness and fatigue, feeling unprepared to deal with their client’s wishes, needs and
expectations, professional boundaries, cultural, religious and language barriers, all of the
participants reported large reward in their work due to a feeling of a sense of achievement
and gratification. The majority of the participants appeared to have experienced
compassion satisfaction, which acts as an armour against imminent negative consequence
of their work when they obtain a sense of effectiveness, knowledge and reward in their role
as a helper (Guhan & Liebling-Kalifani, 2011). They also experienced a feeling of gratification
and achievement in seeing their clients progress and when the clients offer their gratitude.
“When the human spirit is inspiring, I feel well how lucky and I get paid to do this you
know… I'm looking for that spiritual aspect which is the beauty and the uniqueness in
every individual. …when I feel sometimes I just come out feeling elated like I've just
come out from a wonderful concert or something because it was a special

275
 conversation. When I feel that usually the client also feels a bit uplifted. They are my
best days.” 2.600-617.
2.3 Practitioner’s need for self-care. All of the participants conveyed that they engaged
practical approaches and take enough breaks to maintain self-care.
“Sometimes it makes me to become very very stressful when I listen to their horrible
experiences. You take some days off. If you go to leave you socialize with your family,
with friends, you can travel to places like going to area where there's very beautiful
landscape vegetation just to relax there. Nature also plays very important role. So
these are some of the things that you use to deal with the stress. You cannot continue
working with that. We are stressed... Sometimes too it's good you walk. You involve
yourself with a physical activity or physical exercise which is very good in dealing with
stress.” 4.1078-1265.

Theme 3: Practitioner’s use of interpreters.

While the participants consider the use of interpreters as necessary, three of them also
believe that an inexperienced interpreter could interrupt the flow of the therapeutic
procedure and relationship.
“The skill level of the interpreter of course is a big factor that's variable. Many are
good. I mean the best ones don't get into a conversation themselves with the clients,
but you do find it quite often.” 2.532-535.

Theme 4: Available supports for therapists

All of the participants acknowledged that supervision, adequate training, and easier access
to resources such as information on cultural and practical problems were very significant in
offering support for their demanding work.
4.1 The role of supervision. All the participants conveyed that supervision offered them
with the support and education required to manage and or reduce any detrimental effect or
impediments that were met while working with refugee clients.
“For people who are counsellors or psychologist, we have weekly clinical supervision
with an internal supervisor so we have an hour a week to discuss our clients, to discuss
the effects of the clients … obviously we have our team leaders who can be supportive
as well …and also in the organisation there is a lot of peer support as well. Some of it is
kind of official or unofficial...There is always people around to support you… I know we
have the option I think to see external supervisor or external counsellor if we want and
there are circumstances but I haven't done that. I was quite happy with the support I
get within STARTTS.” 5.1405-1422.
4.2 The significance of support from colleagues and other services and additional
resources. All of the participants reported excessive workload and having external
organisations that they could work in partnership with or refer their clients to generally
assists to moderate the workload and stress. Three of the participants also revealed that
they would share complex cases with their colleagues at clinical meetings. They also

276
recognised the use of smaller community organisations that work exclusively with members
of their communities to tackle various cultural concerns. Some of them indicated that they
attain their resources and acquire their network through colleagues, partnerships, inter-
agency meetings and trainings.
“We have developed a relationship…with the local psychiatrist... he's a great
resource… There is a really good network we have built up … with HSS providers, the
refugee health nurse, and the migration agent … I would say that network is a strong
resource we have.” 2.619-645.

Discussion
The present study aimed to investigate the experiences and practices of those counselling
practitioners who worked with African refugees. Using thematic analysis as a
methodological approach, the analysis of interview transcriptions stressed that refugees
experienced many forms of trauma during pre-migration, migration and post-migration.
This presents pronounced risks to their mental health as well as disrupts their resettlement
process. Consequently, it added to the challenges and complications encountered by the
practitioners working with these African refugees. Although there are several factors that
act as an obstacle to accomplishing successful therapeutic relationship and result, self-care,
supervision and support from colleagues and other agencies were shown to help the
practitioners in attaining and preserving a healthy balance. Moreover, practitioners feel a
sense of accomplishment and reward when their clients get a good outcome.
The results of this study supports the earlier studies done by Cariceo (1998); Century et al.,
(2007), Guhan and Liebling-Kalifani (2011) and Schweitzer et al., (2015). These earlier data
were also collected using a qualitative methodology and the authors described comparable
results and themes of working with refugees including the therapeutic practice, its impact
on therapist, the use of interpreters and support for therapists. Similarly, these previous
findings also emphasised the therapists’ need for cross-cultural clinical training, experience
and supervision to prepare them to address the multiple challenges and complex problems
they confront when working within the refugee context.
There is no precise study reporting the therapeutic consequence of working with people
from an African background. So, this study is distinctive in that it is the only study that has
been conducted to investigate practitioners’ experience in working with African refugees.
Additionally, it also underlines the importance of former results of all refugees to this
population.
It is recognised that there were some limitations in the present study such as the over
representation of male participants. Likewise, disparities were identified in the participants’
experience, qualification and cultural background. Though three of the participants were
from African background, they were from different countries and cultural backgrounds. It is
thus suggested that further study be conducted of practitioners who have worked with
African refugees from specific regions or cultures as some distinctions in cultures were
identified among refugees coming from diverse parts of Africa.

277
It is likely that by tapping into the experiences of practitioners working with African
refugees, practitioners and their clients will gain from the result of this study by affecting
changes in the practice in this field as well as help them to attain a successful therapeutic
practice and result. Moreover, understanding the development of this field of study is very
significant as it reinforced the development of this literature and establishes possible future
guidelines for therapy, and training.
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Schweitzer, R., Melville, F., Steel, Z., & Lacherez, P. (2006). Trauma, post-migration living
difficulties, and social support as predictors of psychological adjustment in resettled
Sudanese refugees. Australian and New Zealand Journal of Psychiatry; 40, 179-187.
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for developing grounded theory (2nd Ed.). Thousand Oaks, CA: Sage.
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practice. Counselling Psychology Quarterly, 12(3), 233-243.
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Tribe, R. (1999b). Bridging the gap or damming the flow? Some observations on using
interpreters/ bicultural workers when working with refugees, many of whom have
been tortured. British Journal of Medical Psychology, 72(4), 567-576. DOI:
10.1348/000711299160130
Tufford, L. & Newman, P. (2010). Bracketing in qualitative research. Journal of Qualitative
Social Work, 11(1): 80–96. DOI: 10.1177/1473325010368316
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Protocol relating to the Status of Refugees. Retrieved from
http://www.unhcr.org/protect/PROTECTION/3b66c2aa10.pdf.
Van Der Veer, G. (1998). Counselling and Therapy with Refugees and Victims of Trauma:
Psychological Problems of Victims of War, Torture and Repression. Chichester: Wiley.

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 Integrative
Psychological
Therapies

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 Editorial: Integrative psychological therapies
Fiona Ann Papps

Since its inception as both discipline and profession, psychology has been grounded in a
fundamental assumption of mind-body dualism: the premise that the mind and the body
are divided (Hamilton & Hamilton, 2015; Mehta, 2011). For much of the twentieth century,
then, psychology as a field of study, as an institutionalised discipline, and as a profession,
has consequently concerned itself with the study of mental processes, consciousness, and
behaviour at the expense of the body. Indeed, in the contemporary scape, dominant
approaches to psychotherapy, such as Cognitive Behavioural Therapy, focus on the
examination of internal irrational cognitions using evidence drawn from the external world
(Straker & Winship, 2019, p. 2). However, advances in neuroscience are encouraging the
discipline and profession of psychology toward a mind-body holism (e.g., Friedman &
Hartelius, 2013; Hartelius, Caplan, & Rardin, 2007; Kazdin, 2000). These advances have
prompted a new understanding of the mind and body as an integrated unit in constant
interaction with the environment (Mehta, 2011), an understanding reflected in the World
Health Organisation’s definition of health as ‘a state of complete physical, mental and social
well-being, and not merely the absence of disease and infirmity’ (Daugherty et al., 2016, p.
404). From this perspective, wellness becomes a complex, multidimensional concept (Duff,
Rubenstein, & Prilleltensky, 2016; Snook & Oliver, 2015), which integrates physical health,
social engagement, culture, being self-determining, and having emotional and spiritual
states of well-being (Snook & Oliver, 2015).
This disruption of the dominant epistemological framework of psychology and the
consequent broadening of the construct of wellness has implications for the applications of
psychology through therapy. Rather than simply treating the mind, psychological therapies
need to direct themselves toward treating what Candice Pert (1997) has labelled the
‘bodymind,’ thus embracing a more integrative psychological practice. An integrative
psychology practice stands to unlock possibilities for clients in two ways. First, it can address
the holistic needs of clients (Holland, 2001); and second; it encourages practitioners to
apply reflexive, culturally appropriate, and sensitive psychological knowledge and skills, as
currently required of psychology graduates by the Australian Psychology Accreditation
Council Limited (APAC) standards which came into effect on 1 January 2019
(https://www.psychologycouncil.org.au/standards_review).
The two papers in this chapter explore the possibilities of innovative and integrated clinical
practices for psychology. In their qualitative exploration of therapeutic presence from a
Hakomi perspective, Scott Kelly and Fiona Ann Papps argue that the Hakomi perspective, a
mindfulness based, psychodynamic psychotherapy developed by Ron Kurtz that integrates
the body into the therapeutic process, places significant focus on the personhood of the
therapist as a therapeutic tool. In their analysis of interviews with four graduates of the full
professional Hakomi training, Kelly and Papps note that from a Hakomi perspective, central
to the creation of therapeutic presence is a particular personhood of the therapist, in which
Hakomi practitioners are explicitly and specifically trained. This therapist personhood

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emphasises qualities such as embodiment, mindfulness, slowness, self-regulation, non-
judgement, sacred love, and faith in healing, all of which enable the therapist to invite the
client into therapeutic presence. Kelly and Papps finally note that this unique Hakomi-based
understanding of therapeutic presence recognises that the relationship between the
therapist and client is the key to understanding, insight, and potential therapeutic change
(Straker & Winship, 2019, p. 2)
In further development of the theme of the potential of integrated clinical practices for
psychology, Amanda Kassis and Fiona Ann Papps probe the perspectives of three
practitioners trained or training in psychology and complementary and alternative therapies
(CATS) around potential benefits of and barriers to an integrative psychology practice.
Kassis and Papps define CATs as health care approaches that are not typically part of
conventional medical care or that may have origins outside of usual western practice
(National Centre for Complementary and Integrative Health, 2019), including biophysical
modalities (e.g. acupuncture, massage, subtle energy, yoga & meditation), biochemical
modalities (e.g. herbs & nutrition), and spiritual practices (e.g. prayer & pilgrimage)
(Holland, 2001). The analysis of practitioner responses presented by Kassis and Papps
suggests that the practitioners saw an integrative psychology practice as important and of
benefit to holistic well-being in clients. Simultaneously, they saw it as a practice that was
unable to be implemented due to the operation of barriers such as continued stigmatisation
of CATs, professional regulation of the professions, a lack of training and supervision, and
the continued adoption of the positivistic oriented scientist-practitioner framework for
psychology. Overall, Kassis and Papps conclude that by embracing an epistemological
pluralism and an integrative clinical practice, a both a door to client-centered holistic
treatment would be opened and a re-visioning of psychology as discipline, institution, and
profession achieved.
Overall, the combined findings presented in the two papers in this chapter suggest that the
dismantling of the epistemological dualistic foundation of psychology as discipline and
profession would enable the uptake of a new framework that recognises the integration of
the mind and the body. Accepting the integration of the mind and body recognises the
necessity of treating clients in more holistic ways to enable them to achieve a state of
health that reflects ‘…complete physical, mental and social well-being, and not merely the
absence of disease and infirmity’ (Daugherty et al., 2016, p. 404). Indeed, the embrace of
epistemological pluralism and an integrative practice would enable psychology as discipline
and profession to ‘unlock possibilities for innovative practice in a changing world’ (Bettman,
2019).

References
Australian Psychology Accreditation Council. (2019). Accreditation Standards for Psychology
Programs Evidence Guide. Melbourne, Australia.
Bettman, C. (2019). Counselling and psychotherapy: is there a difference and does it matter
in a changing world? Paper presented at the ACAP Conference: Possibilities
Unlocked, ACAP, Melbourne, October 2019.

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Daugherty, T., Julian, H. M., Lynch, N. M., Chen, S. J., Whipple, T. L., & Ginsburg, A. F. (2016).
Beyond the absence of disease or infirmity: The case for sexual wellness. College
Student Journal, 50(3), 404-408.
Duff, J., Rubenstein, C., & Prilleltensky, I. (2016). Wellness and fairness: Two core values for
Humanistic Psychology. The Humanistic Psychologist, 44(2), 127-141. doi:
10.1037/hum0000020
Friedman, H. L., & Hartelius, G. (Eds.). (2013). The Wiley-Blackwell handbook of
transpersonal psychology. Chichester, England: Wiley Blackwell. Retrieved from
https://ebookcentral.proquest.com
Hamilton, S., & Hamilton, T. J. (2015). Pedagogical tools to explore Cartesian mind-body
dualism in the classroom: philosophical arguments and neuroscience illusions.
Frontiers in Psychology, 6, 1-6. doi: 10.3389/fpsyg.2015.001155
Hartelius, G., Caplan, M., & Rardin, M. A. (2007). Transpersonal psychology: Defining the
past, divining the future. The Humanistic Psychologist, 35(2), 135-160.
Holland, D. (2001). Interdisciplinarity and the cross training of clinical psychologist:
preparing graduates for hybrid careers. North Journal of Psychology, 3(1), 139-170.
Kazdin, A. (2000). Encyclopaedia of psychology, Vol. 8. (Vol. 8). American Psychological
Association.
Mehta, N. (2011). Mind-body dualism: A critique from a health perspective. Mens Sana
Monograph, 9(1), 202-209. doi: 10.4103/0973-1229.77436
National Centre for Complementary and Integrative Health. (2019). Complementary,
Alternative, or Integrative Health: What’s In a Name? Retrieved from
https://nccih.nih.gov/health/integrative-health.
Pert, C. (1997). Molecules of emotion: Why you feel the way you feel. New York, NY: Simon
and Schuster.
Snook, J., & Oliver, M. (2015). Perceptions of wellness from adults with mobility
impairments. Journal of Counseling & Development, 93, 289-298. doi:
10.1002/jcad.12027
Straker, G. & Winship, J. (2019). The talking cure: Normal people, their hidden struggles and
the life-changing power of therapy. Sydney, Australia: Pan McMillan.

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 ‘The Wisdom Lies Within’: Investigating therapeutic presence from a hakomi therapy
perspective
Scott Kelly and Fiona Ann Papps

Abstract

Therapeutic presence (TP) is the ability to be fully human and fully engaged with another
person on multiple levels: emotionally, cognitively, physically, and spiritually. TP is a
fundamental skill which underpins efficacious interventions, with research showing that
therapist personhood is more important than any particular technique or theoretical
orientation in facilitating therapeutic change in clients. The Hakomi method, developed by
Ron Kurtz, is a mindfulness based, psychodynamic psychotherapy that integrates the body
into the therapeutic process. The Hakomi perspective places significant focus on the
personhood of the therapist as a therapeutic tool. Relatively little research has been
devoted to the exploration of TP, and none has been conducted with a focus on Hakomi
therapy. The present research, therefore, used a qualitative framework informed by
phenomenology to explore Hakomi therapists’ understanding of TP. Four graduates of the
full professional Hakomi training were interviewed about their lived experiences of TP.
Interpretative Phenomenological Analysis applied to the resultant verbatim transcripts
showed TP as comprised of two elements: therapeutic state of being and a dual awareness.
Central to creating TP is a particular personhood of the therapist, in which Hakomi
practitioners are explicitly and specifically trained. This personhood is inclusive of particular
qualities which enables them to invite the client into TP. This unique Hakomi-based
understanding of TP may be particularly important for supporting therapeutic change and
one that could be incorporated into future training of mental health practitioners,
regardless of therapeutic modality.
Keywords: Therapeutic Presence, Hakomi Therapy, therapist personhood

Therapeutic presence (TP) is defined as the ability to be fully human and fully engaged with
another person on multiple levels: emotionally, cognitively, physically, and spiritually (Geller
& Greenberg, 2002, 2012), and has been shown to underpin efficacious therapy (Hycner,
1993; Moustakas, 1969; Rogers, 1986). A growing body of research shows that therapist
personhood (a concept closely linked to TP) is more important than any particular technique
or theoretical orientation to therapeutic success (Cozolino, 2002; Lambert & Ogles, 2013;
Mahoney, 1991; Orlinsky & Howard, 1986). The Hakomi method, developed by Ron Kurtz, is
a mindfulness based somatic psychotherapy that integrates the body into the therapeutic
process and that places a strong focus on the personhood of the therapist in both training
and practice (Johanson, 2009, 2011; Kurtz, 1990, 2015; Weiss, 2015). This perspective

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means that Hakomi therapy may offer unique insights into the nature and practice of TP
that are as yet unexplored (Bageant, 2012; Himanen, 2015).

Therapeutic Presence
References to aspects of TP can be seen in the work of Freud (1912), who highlighted the
importance of the therapist’s evenly suspended attention (Epstein, 2007). Reik (1948) then
introduced the idea that the therapist’s mind should be actively searching for useful data
during a session. Perls (1969) discussed the need for a present moment focus and also
linked his understanding of therapeutic presence with Buber’s (1966) I/Thou relationship
(Geller & Greenberg, 2002, 2012). TP is also important in the humanist therapeutic
tradition. In his later work, Rogers highlighted the importance of therapeutic presence as
being the essential underlying process in all therapeutic relating (Bageant, 2012; Baldwin,
2000; Rogers, 1980).
Geller and Greenberg (2002) undertook a qualitative study to develop a formal
understanding of the concept of TP from a therapist’s perspective. The participants in the
study were experienced practitioners from various different theoretical orientations
including: humanistic/experiential, Cognitive Behavioural, Adlerian/transpersonal, and
Eriksonian frameworks. This study resulted in a model of TP containing three dimensions:
Preparing the Ground for Presence, involving both pre-session and larger scope ‘in life’
preparations for presence; the Process of Presence, incorporating both the internal process
of the therapist and the process of establishing presence with the client; and Experiencing
Presence, involving the lived experience of Presence from the therapist’s point of view
(Geller, Greenberg, & Watson 2010; Geller & Greeenberg 2012, Geller 2017). Although this
study provides the groundwork for an understanding of TP, it is far from an exhaustive
account from different theoretical standpoints. Colosimo and Pos (2015) performed a task
analysis in order to establish measurable behavioural correlates of Geller and Greenberg’s
(2002) findings and other sources on TP. Their rational model proposes four key modes of
presence: Being Here, Being Now, Being Open, Being With and For the Client. Geller,
Greenberg, and Watson (2010) operationalised a measure of both client and therapist
experiences of TP. In this study, the client measure of presence reliably affected therapeutic
outcome, while the therapist measure did not. Therefore, what is of importance is the client
perception of the therapist’s presence. This finding, taken together with Bageant’s (2012)
assertion that a gap exists around the training of TP in psychologists, raises the issue of how
to successfully train therapists in TP.

Hakomi Therapy
The Hakomi method is a mindfulness based, psychodynamic psychotherapy that integrates
the body into the therapeutic process (Johanson, 2015a; Kurtz, 1990, 2015; Weiss, 2015).
The Hakomi Method views people as complex living systems, organized psychologically
around core beliefs, which are expressed through habits and attitudes that guide people
unconsciously (Kurtz, 1990, 2015; Weiss, Johanson, & Monda, 2015). Hakomi is a method
through which therapist and client mindfully discover these limiting core beliefs and
challenge them through experiential learning (Johanson, 2015b).

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Hakomi therapy is based in five major principles derived from the work of Gregory Bateson
(1979), which are: Mindfulness, Non-violence, Unity, Organicity, and Mind-body holism
(Johanson, 2015a). Held together these principles form the ideological backdrop upon
which the technique of the method is built. The Hakomi method takes the perspective that
the personhood of the therapist is their most important therapeutic tool (Bageant, 2012;
Weiss, 2009); a perspective in line with personhood research conducted by Cozolino (2002),
Lambert and Ogles (2013), Mahoney (1991), Orlinsky and Howard (1986), and highlights the
centrality of TP in the method. The importance of the body in the Hakomi method brings a
somatic dimension to its understanding of TP (Marlock & Weiss, 2006). Here, the bodily ‘felt
sense’, a term borrowed from Gendlin’s (1969) Focusing paradigm, and also strongly linked
to Fogel’s (2013) embodied self-awareness, becomes an important source of information
for the therapist (Weiss, 2009). From their embodied felt sense, the therapist can then look
for clues into the client’s state, known as tracking (Kurtz, 1990), and by noting these to the
client, demonstrate their attunement, allowing the client to ‘feel felt’ (Seigel, 2009). The
Hakomi concept of loving presence, a synthesis of presence and Rogers’ unconditional
positive regard (Rogers, 1980, 1986) and Buddhist compassion practices (Epstein, 2007;
Johanson, 2009), involves the therapist finding attributes within the client that offer them
non-egocentric nourishment, and offers a systematic way of cultivating TP within a therapy
session (Bageant, 2012; Weiss, 2009). These ideas form an approach to developing and
maintaining TP that is unique to the Hakomi method (Bageant, 2012) and also addresses the
lack of research and theoretical constructs relating to love in the therapeutic dyad, as
identified by Bodenheimer (2011).

Rationale and Research Question

The Hakomi perspective places significant focus on the personhood of the therapist as a
therapeutic tool. The technique of loving presence adds a layer of compassion, and Hakomi
training includes a framework of techniques for cultivating this stance. Therefore, because
TP is a central focus of the Hakomi method, it would be useful to explore Hakomi therapists’
experience and understanding of TP given its importance in predicting therapeutic
outcomes (Geller et al., 2010). Furthermore, a gap exists in the training of psychologists
around TP (Bageant, 2012). Consequently, discovering more about this construct is crucial in
terms of what it can add to the training of psychologists. Given the unique insights offered
by the Hakomi method in relation to therapeutic presence and the lack of prior qualitative
examination of this theoretical standpoint, this study aims to add to the work of Geller and
Greenberg (2002) on TP by providing the perspective of experienced Hakomi therapists.
Specifically, we ask: how is TP understood by experienced Hakomi therapists?
Method

Participants
The first author recruited four Hakomi therapists through purposive sampling methods as is
theoretically consistent with Interpretative Phenomenological Analysis (IPA; Smith, Flowers,
& Larkin, 2009) given that such samples can offer insight into the particular phenomenon
under investigation (Powell, Overton & Simpson, 2013). To ensure the recruitment of a

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relatively homogenous sample, the participation selection criteria stipulated that
participants be at least 18 years of age, proficient in English, and a graduate of the full
Hakomi professional training with at least five years of experience. To ensure anonymity,
we collected no information about the participants except what was required to ensure
they met our selection criteria and the first researcher assigned each participant a
pseudonym and changed other potentially identifying information in the transcribing phase.
Measures
We devised a semi-structured interview schedule to guide the interview process. This
schedule comprised a minimal number of questions directed toward participants’
understandings of therapeutic presence and what a Hakomi perspective could add to our
understanding of this phenomenon. The interview schedule was used flexibly, depending
upon the individual interview context. We also devised short prompts and probes to be
used if necessary during the interview process.

Procedure
The Human Research Ethics Committee (HREC) of our institution granted ethics approval
for the research, and our research complied with the NHMRC Statement on Ethical
Conduct in Human Research (2007). Following ethics approval, we recruited participants
through an advertisement posted to a dedicated Facebook research page and the official
Hakomi Australia webpage. The first researcher conducted semi-structured, in-depth
interviews, and audio-recorded the entire interview. The interviews ranged in length
from 60 to 120 minutes (M = 85 minutes).

Data Analysis
Following each interview, the first author transcribed the audio recordings verbatim.
Analysis followed the flexible process for IPA outlined by Smith et al., (2009). In the first
step, we immersed ourselves in and actively engaged with the data by independently
reading and re-reading each interview transcript, and highlighting portions of text deemed
significant. In the second step, we independently made exploratory comments on each
transcript, noting any descriptive, linguistic, and conceptual features of importance. Third,
we independently condensed our notes into emergent themes, which represented a
‘synergy between the participants’ description and analysts’ interpretation’ (Powell et al.,
2014, p. 565). We then had several meetings in which we discussed and verified codes that
we felt were common to each interview. These commonalities became the emergent
themes. In the fourth stage, we drew superordinate connections among the emergent
themes by identifying those that were related, and the primary researcher then constructed
a summary table for each individual transcript in which the themes were listed with salient
excerpts from the original text. In the fifth stage, we examined all texts for shared and
unique moments in the emergent themes identified in the fourth stage, modifying some
initial themes, but ensuring that at all times, the themes remained grounded in the data.
Finally, we created a figure representing the final superordinate themes.

Quality, Trustworthiness, and Transferability

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We endeavoured throughout the research process to ensure trustworthiness of the analysis
to establish the quality of the research. We used Yardley’s (2000) principles of sensitivity to
context, commitment and rigour, and transparency and coherence. We selected IPA for the
present research to show sensitivity to context, as it permits participants the chance to have
their experiences heard in a safe and respectful environment. Given the nature of the lived
experience we chose to explore, therapeutic presence, we needed to show empathy,
interest, and sensitivity both through the interview process and throughout the entire
analytic process. We displayed commitment and rigour through a process of member
checking (Braun & Clarke, 2013), where we invited each participant to check and verify their
verbatim transcript. We demonstrated transparency and coherence by engaging in a
rigorous and systematic analytic process, as explicated. We grounded our interpretations in
direct quotations from the data, and we took care not to take examples out of context. We
attempted to exercise reflexivity during the data analytic process to ensure that our analysis
allowed the privileging of the voices of our participants, rather than our own voices.
Qualitative research is grounded in the assumption of the existence of multiple realities that
are argued to be fashioned through talk (Braun & Clarke, 2013). Because that talk is specific
to the research context, it cannot be replicated, and so generalisability is not a useful
criterion for establishing rigour of the research (Braun & Clarke, 2013). We therefore used
the idea of transferability (Smith, 2018). By transferability, we mean the extent to which the
results of our research also represent the experiences of other therapists who are members
of the population that was our focus of our research (Smith, 2018). Following Smith (2018),
we have attempted to encourage transferability by ‘gathering testimony and providing rich
description’ (Smith, 2018, p. 141), evidenced in direct quotations from participants.
Results and Discussion
The participants in the present research understood TP as comprised of two elements:
therapeutic state of being and a dual awareness, where the therapist is able to be with the
experience of themselves and the client simultaneously. Central to creating this state of
being and dual awareness, is a particular personhood of the therapist, in which Hakomi
practitioners are explicitly and specifically trained. This personhood is inclusive of particular
qualities which enables them to invite the client into TP. Therapist qualities (TQs) identified
as key to the personhood of the therapist were embodiment, mindfulness, slowness, self-
regulation, non-judgement, sacred love, and faith in healing. This final thematic structure is
illustrated in Figure 1.
Personhood of the Therapist
The personhood of the therapist is identified by Tiama as ‘the prime instrument of
therapeutic process’ (55.1125), a perspective that aligns with previous findings on therapist
personhood (Cozolino 2002; Labert & Ogles 2013; Mahoney 1991; and Howard 1986). For
Tiama, therapist personhood forms the bedrock of the healing context: ‘…so in other words
that personhood is not separate from the provision of a healing context or a therapeutic
situation... That it's not just intrinsic to it. It is it’ (55.1102). Susie believes the deliberate
cultivation of this personhood begins initially with Hakomi professional training: ‘Hakomi,
ah, places a lot of emphasis on therapeutic presence. It’s one of the major aspects of

288
Hakomi really. We spend a lot of time in the trainings on cultivating that in the students’
(5.110). After training is completed, Tiama expressed the need for ongoing cultivation of
personhood: ‘Hakomi supports therapists to develop their personhood, supports and
encourages and invites therapists to develop their personhood and that ongoing whole-of-
life journey’ (56.1136). This view supports Geller and Greenberg’s (2012) In Life, dimension,
which also highlighted the importance of therapists cultivating their TP in an ongoing
manner. In order to do so, the participants identified key qualities that the therapist needed
to engender: embodiment, mindfulness, slowness, self-regulation, non-judgement, sacred
love, and faith in healing.
Embodiment. All four of the participants noted embodiment as a key therapist quality. Rex
frames embodiment in terms of the following questions:
…it’s “can I bring my consciousness into my tissue? Can I have it reside there? Can I be
sitting in the room with my client and can I be in touch with the sensations that are
streaming through my body?” (71.1479)
For Rex, to be embodied is to have one’s consciousness reside within the experience of the
body, suggesting that mind and body are not separate. This interconnection of the
body/mind, echoing the Hakomi principle of the same name, in in direct disagreement with
the Cartesian mind/body dualism, which dominates theoretical conceptions in the field
(Hamilton & Hamilton, 2015). This double aspectism is more aligned with Buddhist and
Daoist conceptions, where the mind and the body are not separate entities but are parts
the same whole (Kurtz, 1990, 2015; Marlock & Weiss, 2006). Consequently, the participants
in the present research could not reference the theme of embodiment without also
referencing mindfulness, as to be observant of direct embodied experience, the therapist
must also be in a state of mindfulness.
Mindfulness. Susie states: ‘…before I work, I also take time to arrive in my own body, which
is another kind of mindfulness practice if you like, to feel grounded, to feel present, and to
be in that living presence state’ (18.399). Susie conceives of embodiment as a form of
mindfulness practice which is grounded, present, and alive. Similarly, Rex notes:‘to sit in
your seat as a Hakomi therapist is to my understanding, is in some sense to be practicing
open awareness practice’ (20.417). Both of these quotations directly reflect Fogel’s (2009)
embodied self-awareness, and show that mindfulness forms a fundamental part of the
Hakomi therapist’s presence. This approach, then, is in direct contrast to other modalities
which use mindfulness as what Tiama terms a ‘bolt on’ (59.1192), or adjunct focused
exclusively on the client (Weiss, 2009). The unique Hakomi perspective on mindfulness is
also characterised by another TQ, the willingness to move through the process with
slowness.
Slowness. Rex posits: ‘there’s a certain kind of intelligence I think is only available to us
when we slow down’ (80.1680). Tiama also links Slowness to Embodiment by referring to:
‘…the language of the body, which is much more slow paced than their, their usual pace of
communication…’ (62.1269). Lastly, Bruce notes that moving slowly helps to create an
‘intimate and whispering’ (37.876) environment, which encourages clients to attune to their
own embodied experience (Fogel, 2009). This focus on time by the participants echoes the

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dynamic link to flow of time and synchrony identified by Colosimo and Pos (2015) as critical
to their ‘Now’ dimension of TP; however, the focus on deliberately moving through the
therapeutic process slowly represents a unique contribution of the Hakomi perspective.
Slowness also affords the therapist both the awareness and the capacity to engender the
self-regulation essential for being present in the therapeutic encounter.
Self-Regulation. For Tiama, self-regulation begins with pre-session preparation:
…so I’ve got fresh air, I’ve got a clearing scent, I’ve got the room at the right
temperature, I’ve, I already have gone through what we did, I’ve debriefed myself on
the last session and I’ve re-briefed myself. And so that’s sort of paves the way for the,
or none of those things to intrude during the session. (40.807)
Tiama notes how this mental and physical preparation ‘paves the way’ for a smooth and
comfortable therapeutic encounter. Similarly, once the session has begun, Rex sees the
ability to notice what needs attending to as an extension of the therapist’s embodied
mindfulness:
So there’s a tendency, or a capacity to be able to, to rearrange your mental state from
moment to moment. It also allows you to look for if you’re getting, you know in
therapy speak we might say getting into some kind of countertransference that’s not
helpful... (6.110)
For Rex, this ability to notice and rearrange his mental state acts as a foil against therapist
industriousness, moving too fast, and possible issues of countertransference. Tiama sees
self-regulation as a process of ‘not getting in the way’ (21.416) of TP: ‘…it feels like, just me
getting my, you know, the parts of my humanness that get in the way of it, facilitating them
to be not in the way’ (71.1454). Taken together, these quotes show that the TQ of self-
regulation allows a therapist establish a preparatory process in which the literal (i.e., the
physical space) and metaphorical grounds (i.e., the mental state of the therapist) are
prepared for presence (Colossimo & Pos, 2015; Geller & Greenberg, 2002; 2012) so that
they are then able notice when something has gone awry and to make adjustments to
rectify the issue. This recalibration allows the therapist to stabilise and enhance their TP,
and through this process of co-regulation, the state of the client (Fogel, 2009). An important
feature of both self-regulation and the therapy process as a whole is the ability to act in a
way which is discerning but non-judgmental.
Non-Judging. Bruce highlighted the quality of Non-Judgement, or having ‘no agenda’
(23.522), as follows: ‘You can’t judge, you just accept what's here … Get all all that
preconceived possibilities out of the mind’ (31.737). For Bruce, Non-judgement is having an
attitude that accepts whatever is present within the therapy session, without relying on
preconceived formulations. Rex highlights the non-pathologizing aspect of this TQ in this
example: ‘it’s like “where are you? I get it, I see it, We don’t have to make it good or bad,
right or wrong, we don’t have to see it as something that’s desirable or undesirable, this is
just where things are”’ (68.1427). Rex’s perspectives again show links to Buddhist and Taoist
mindfulness practice, particularly that of ‘beginners mind’ (Epstein, 2007), which suggests
approaching an experience as if it is the first time you have done it (Johanson, 2009). This

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emphasis on non-judgement as a core therapist quality also echoes the empty mind aspect
of Colosimo and Pos’s (2015) ‘Open’ dimension of TP. Susie also links Non-Judgement with
the TQ of Sacred love: ‘…there’s some sort of non, there’s a non-judgement, non-
judgemental attitude in the being in loving presence’ (13.296).
Sacred Love. For Tiama, initially the idea of having love for her clients was ‘ridiculous’
(29.578) and ‘crazy’ (29.579). However, with experience she now believes that TP and
sacred love are very closely linked: ‘…to me as part of the present the therapeutic presence
or the holding a therapeutic presence, is the capacity for that love to arise’ (29.582). She
goes on to describe the experience: ‘…it’s like a beholding or something. “Whoa, I just
beheld something. I just was witness to something. I just saw a kernel of something that
was special, or sacred, or unique to this person in this moment”’ (31.622). Bruce echoes this
sacred connection and draws attention to the nourishment he receives from relating in this
way: ‘it’s connection and it’s my nourishment to connect to there… that’s what I think love
is… It’s an awakening, it’s a recognition, it’s precious man... It is really, really, really precious’
(46.1093). This kind of non-erotic love has its roots in the classical conception of platonic
love as abiding, deep, spiritual connection between two individuals (Bodenheimer 2011)
and relates directly to Buber’s (1966) I/Thou relationship, where the discrete bounds
between subject and object are blurred in the recognition of a shared, sacred connection.
Links can also be seen to Geller and Greenberg’s (2002; 2012) notion of love and awe for
the client. Additionally, for Bageant (2012), this Hakomi concept of Sacred Love, or loving
presence as it is also referred to, represents a natural extension of Roger’s (1980, 1986)
Unconditional Positive Regard, which is an essential component of a successful therapeutic
encounter from the humanist perspective. Tiama also linked the TQ of sacred love to a
belief in the ‘childlike healing impulse’ (30.589), which represents the final TQ, faith in
healing.
Faith in Healing. Susie holds a belief in what she calls an ‘innate healing impulse’ (3.48),
which is located within the client and relates directly to the Hakomi principle of Organicity,
which holds that within a living system, when all parts are connected within the whole, the
system is self-organising (Johanson, 2009). Susie describes this process as follows:
…we have sort of faith, if you like, in what we call organicity, and organicity is a belief
that there is an innate healing impulse in the client and but that can’t be forced, or
that can’t be stressed. That’s something that will, that impulse will sort of come alive
when the right conditions are there and we have to be patient and wait for that
healing impulse to come forth. (3.48)
Susie states that although the healing impulse is innate, it cannot be rushed or forced,
arising naturally when the right qualities are present, reinforcing the importance of the TQs
of slowness and non-judgement. For her, trusting that the healing impulse will come alive
when it’s ready is an essential part of the therapeutic stance. When the right conditions are
present and the healing impulse does arise, Bruce believes it is best to let the process
develop by itself, which he states using a cooking metaphor: ‘When they get it… you don’t
have to do anything, just sit with it and let that cook. It’s really important, it’s precious,
those moments’ (46.1085). Faith in healing is closely aligned with Roger’s conception of

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client centred therapy (Bageant, 2012, Rogers, 1986), and contrasts with traditional
psychoanalytic frameworks, which favour therapist interpretation (Freud, 1912), or
modalities emerging from a behaviourism, which preference client behaviour over their
lived experience, and thus emphasise an underlying epistemology of mechanism over
vitalism (Greco, 2005).
In summary, the qualities identified by the participants as central for the therapist, allowing
them to be simultaneously present to self and other, reference qualities identified in
models of TP proposed by Colosimo and Pos (2015) and Geller and Greenberg (2012),
although the focus on embodiment, sacred love, and faith in healing mark understandings
of therapist personhood from a Hakomi perspective as distinct and unique. Once the
therapist has engendered the qualities necessary for the personhood, they are then able to
create the presence required for the unfolding of the therapeutic process.

Therapeutic Presence
Emerging from the analysis is the idea that therapist qualities form the personhood of the
therapist. These TQs then make possible TP through the therapist’s state of being and the
possibility for dual awareness that is opened. In this understanding of TP, the therapist is
able to meet the client wherever they are in a way that promotes spaciousness and a deep
exploration in clients which is nourishing for both therapist and client. This
conceptualization of TP reflects the ways in which the loving, mindful presence of the
therapist enables the therapist to create a sacred space, and in which the therapist’s ability
to tune into the somatic cues of the client allow clients to feel ‘felt.’ State of Being and Dual
Awareness as central to TP will be discussed.
State of Being. For Rex, Hakomi is: ‘…way more than a method. It's a way of being. It's a way
of being with yourself and a way of being with other people’ (17.349). He explains further in
this example:
So, presence to me starts with being, cultivating that state… so there’s a, there’s an
aspect of calmness, and part of what that calmness delivers is the ability to be with
whatever’s arising if you’re working as a therapist. To meet whatever’s arising for your
client in a way that’s spacious and you might say that there’s an attitude of “there’s
no problem here.” (4.75)
The capacity to reside in this calm, spacious, and non-judging state of being, draws directly
on the cultivated personhood of the therapist, as it is informed by the TQs outlined above.
Susie sees this state of being as ‘a felt sense in the therapist of being present, of having the
capacity to have a felt sense of experiences that arise in both the client and the therapist’
(1.14). For Susie, the embodied felt sense of the therapist’s being state forms the bedrock
upon which the therapeutic encounter can occur, a position which is absent in previous
literature on TP. Susie’s use of the term ‘felt sense’ implies that the sense of being present
experienced by the therapist, is experienced on a somatic, bodily level, echoing Gendlin
(1969) who originally coined the term to refer to bodily sensations that contain meaning.
The theme of State of Being, strongly echoes Roger’s (1980, 1986) later conceptions of
presence and also relates to Colosimo and Pos’s (2015) Being-here dimension, which

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highlights the importance of the therapist being firmly grounded in body and place. Parallels
can also be seen in Geller and Greenberg’s (2012) ‘Process of Presence’ dimension, which
refers to sensorial and bodily receptivity, along with using the self as an instrument.
However, in contrast to previous research, our findings demonstrate the central focus on
the embodied, felt sense of the therapist as the primary mechanism for both establishing
and maintaining TP within the therapist and the client. The sense of simultaneity
encapsulated in this idea of felt-sense alludes to the dual awareness required by the
therapist, which was the second superordinate theme.
Dual awareness. Suzie discusses a calm, dual awareness in this example: ‘I as a therapist is
present, as in calm and um attuned to my own experience and also attuned to my client’s
experiences’ (2.34). Susie’s comment here captures the notion of dual level of
consciousness (Robbins, 1998 cited in Geller & Greenberg, 2012, p. 55), in which paradoxical
dualities of perspective arise from the need to be aware of both self and the client during
the therapy process. All four participants noted the importance of a dual awareness to TP;
for example, Tiama says: ‘It’s a subtlety of being with myself but being available to be with
someone else…and being with myself enables me to be available to someone else. They’re
not mutually exclusive’ (14.277). In this example, Tiama alludes to how being present to
herself allows her to be present with a client. She states that they are linked and can be
held concurrently, as part of the larger awareness that is the therapist’s state of being.
Related to this dual awareness, Bruce refers to the process of ‘holding your seat’ (4.73)
while being present with the client, which highlights the need for therapist self-regulation
during the therapeutic process. The findings of the present study suggest that it is vital for
the therapist to be aware of their embodied self-state in this context, that this self-state
may require regulation to remain calm and present, and that this awareness may act as a
precursor to awareness of the client, as suggested by Fogel (2009) and Seigel (2009).

Conclusions and clinical implications

The present research was a qualitative investigation, guided by the epistemological
framework of interpretative phenomenology. Specifically, we were interested in the unique
insights offered by the Hakomi method in relation to TP and the lack of prior qualitative
examination of this theoretical standpoint. Our research was guided by one question: how
is therapeutic presence understood by experienced Hakomi therapists? Overall,
Interpretative Phenomenological Analysis applied to the resultant verbatim transcripts
yielded two superordinate themes: Felt State of Being and Dual Consciousness. Central to
creating this state of being and dual awareness is a series of interrelated TQs, which, when
held together, form the cultivated personhood of the therapist. The therapist’s embodied
(Embodiment), mindful state (Mindfulness) and their commitment to a slow pace
(Slowness) allows them self-regulate (Self-Regulated), and hold their client in a loving way
(Sacred Love). These TQs set the right conditions for the innate healing impulse to emerge
(Faith in Healing). Many of these TQs find analogues in the work of Geller and Greenberg
(2002) and Colosimo & Pos (2015); however, the centrality of embodiment, sacred love, and
faith in the innate healing impulse that emerged from the interviews suggest that the

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understanding of TP from a Hakomi perspective builds on current conceptualisations of the
concept.
In the Hakomi framework, embodied mindfulness of the therapist forms the bedrock on
which the therapeutic process unfolds. This foundation is in direct contrast to other
modalities which use mindfulness as an adjunct focused exclusively on the client (Weiss,
2009). The mind/body holism described by the participants also represents a departure
from Cartesian mind/body dualism, which dominates current theoretical conceptions in the
field (Hamilton & Hamilton, 2015). This double aspectism is more aligned with Buddhist and
Daoist conceptions, where the mind and the body form one unified whole (Kurtz, 1990;
Marlock & Weiss, 2006). The use of the embodied mindfulness of the therapist as a
therapeutic tool also challenges current conceptions on the role of the therapist arising
from more manualised frameworks such as those arising from the behaviourist tradition.
Therefore, Hakomi therapy’s focus on the training and cultivation of therapist personhood,
which precedes and underpins the learning of therapeutic techniques (Kurtz, 1990, 2015;
Marlock & Weiss, 2006), represents another unique perspective which addresses the deficit
found in current psychology training programs as outlined by Bageant (2012).
The findings on therapist personhood align with previous research into therapist
personhood as a common factor contributing to therapeutic outcome (Cozolino 2002;
Labert & Ogles 2013; Mahoney 1991; and Howard 1986), and also relate directly to Rogers’s
(1980, 1986) later conceptions of presence, particularly in relation to the sacred aspect of
presence. However, the nourishment available to the therapist from their contact with
sacred love and the innate healing impulse represents an additional aspect of this state
which Rogers (1980) did not examine. This nourishment was identified as a preventative foil
against therapist burnout and rumination outside the therapy space. Further to this, the TQ
of sacred love addresses the paucity of research into love in the therapeutic dyad, as
outlined by Bodenheimer (2011). Given the existing Hakomi framework of loving presence,
specific exploration of this area in the future, may help to further address this gap in the
research.
In conclusion, from this understanding of TP, the therapist is able to meet the client,
wherever they are at, in a way that promotes spaciousness and a deep exploration in
clients, which is nourishing for both therapist and client. This unique understanding of TP is
particularly important for supporting therapeutic change and one that could be
incorporated into future training of mental health practitioners, regardless of therapeutic
modality, allowing them to understand that, in Susie’s words, ‘the wisdom lies within.’

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Figure 1: Final Identified Superordinate Themes

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 ‘It is not a closed door but it is a locked room safe:’ Integrative psychology practice from
the perspective of practitioners with training in psychology and complementary and
alternative therapies (CATs)
Amanda Kassis and Fiona Ann Papps

Abstract
Modern theories of psychology assume epistemological dualism: the division of mind and
body, with definitions of psychology emphasizing the treatment of the mind separate from
the body. However, advances in nervous system investigation and neuroscience are
encouraging the discipline and profession of psychology toward a mind-body holism,
leading to diversification of practice where mindfulness, spirituality, meditation, and yoga
(grounded in Eastern philosophies and spiritualities) are being incorporated into research
agenda and psychotherapy. A simultaneous move toward the integration of Complementary
and Alternative Therapies (CATs) into traditional medicine is encouraging an integrative
health practice. Yet, there remains ongoing skepticism about integrative psychology
practice, despite a growing evidence base to support the effectiveness of CATs in addressing
psychological issues. The present research used a qualitative framework to explore the
perspectives of three practitioners trained or training in psychology and CATs around
potential benefits of and barriers to an integrative psychology practice. Thematic analysis of
verbatim interviews yielded findings that all practitioners had had life experiences that
implicitly disrupted their assumptions of mind-body dualism, encouraging them in the belief
that an integrated psychology with CATs had greater benefits for clients and psychologists
through options for specialization and working within a field that is reflective of the times
and embraces holism and a wider evidence base. Individual biases, institutional boundaries,
and the scientist-practitioner model were perceived barriers. Results are important in
opening conversation about the importance of integrative psychological practice for the 21st
century, potentially informing clinically relevant service delivery and policy.
Keywords: integrative clinical practice, CATs, qualitative research

The fundamental assumption of most modern theories of psychology is dualism: the

division of the mind and the body, with definitions of psychology emphasizing the
treatment of the mind separate from the body. However, advances in nervous system
investigation and neuroscience are encouraging the discipline and profession of psychology
toward a mind-body holism, as represented in the emerging field of Transpersonal
Psychology (TP) (e.g., Friedman & Hartelius, 2013; Hartelius, Caplan, & Rardin, 2007; Kazdin,
2000). This paradigm shift is encouraging a diversification of psychological practice, where
mindfulness, spirituality, meditation, and yoga (practices grounded in Eastern philosophies
and spiritualities and co-opted by the West) are being incorporated into research agenda
and psychotherapy (ABS, 2019; Barnett & Shale, 2012; United States Census, 2010). A
simultaneous move toward the integration of Complementary and Alternative Therapies
(CATs) into traditional medicine is encouraging an integrative health practice. Yet, there

299
remains ongoing skepticism about integrative psychology practice, despite a growing
evidence base to support the effectiveness of CATs in addressing psychological issues. Such
skepticism regarding the use and benefits of CATs has meant that there is a gap in
knowledge regarding the ways in which it might be appropriate for CAT principles to be
integrated into psychological practice and the ways in which this integration might be
perceived to be of benefit to clients. Our research aims to begin to fill this gap by
investigating the perspectives of three practitioners, trained or training in both psychology
and CATs, on the perceived benefits and barriers to an integrative psychology practice, as
grounded in their stories of training in both modalities.

Mind-body Dualism in Psychology as Discipline and Profession

A fundamental assumption underlying many modern theories of psychology is dualism: the
division of the mind and the body (Hamilton & Hamilton, 2015). This assumption, grounded
in the philosophy of Rene Descartes, represents the metaphysical stance that mind and
body are two distinct substances, each with a different essential nature which cannot not
exist in unity: whereas the mind is an unextended and immaterial but thinking substance,
the body is an extended, material but unthinking substance (Mehta, 2011). Consequently,
from the perspective of mind-body dualism, “a person… lives through two collateral
histories, one comprising of what happens in and to the body, the other consisting of what
happens in and to his mind… The events in the first history are events in the physical world,
those in the second are events in the mental world” (Ryle, 1949, p. 11-12).
Our earliest definitions of psychology, from Wilhelm Wundt’s definition as the total content
of experience in its immediate character (1896; Walsh, Teo, & Baydala, 2014, p. 3) to
William James’s definition as the science of mental life, both in its phenomena and their
conditions (1890; Walsh et al., 2014, p. 3), are grounded not only in this Cartesian dualism,
but stress the importance of only one arm of the duality: the mind. For much of the
twentieth century, psychology as a distinct field of study, as an institutionalised discipline,
and as a profession, has consequently concerned itself with the study of mental processes,
consciousness, and behaviour at the expense of the body. However, in the twenty-first
century, with advances in nervous system investigation and neuroscience, there has been a
movement in psychology as a discipline and profession toward the embrace of mind-body
holism that is antithetical to the assumed binaries of dualistic epistemology (Hamilton &
Hamilton, 2015). From a Western perspective, these holistic understandings have their
origins in Merleau-Ponty’s notion of the ‘lived-body,’ in which the body is understood to be
‘multiphasic, experiential beings of finite freedom’ (Gold, 1985, p. 664). Furthermore, ‘living
systems have come to be seen as systems (of which mind and body are a unit) which are
integral parts of larger systems, in permanent interaction with their environment and
capable of constructing their own subjective realities’ (Mehta, 2011, p. 203). These shifts
have culminated in the World Health Organisation’s definition of health as ‘a state of
complete physical, mental and social well-being, and not merely the absence of disease and
infirmity’ (Daugherty et al., 2016, p. 404). Wellness, then, is now understood to be a
complex, multidimensional concept (Duff, Rubenstein, & Prilleltensky, 2016; Snook & Oliver,

300
2015), which integrates physical health, social engagement, culture, being self-determining
and having emotional and spiritual states of well-being (Snook & Oliver, 2015).
Complementary and Alternative Therapies (CATs)
This shift to a broader understanding of wellness has paralleled a reported increase in the
use of a range of complementary and alternative therapies (CATs). CATs are health care
approaches that are not typically part of conventional medical care or that may have origins
outside of usual western practice (National Centre for Complementary and Integrative
Health, 2019). CATs have three broad areas of focus: biophysical modalities (e.g.
acupuncture, massage, subtle energy, yoga & meditation), biochemical modalities (e.g.
herbs & nutrition), and spiritual practices (e.g. prayer & pilgrimage) (Holland, 2001).
Approximately 70% of the population in Australia and New Zealand are currently reported
to use complementary medicine, often alongside their conventional healthcare, and
without discussion with their primary care physician (Xue et al., 2007). The growing use of
complementary medicine in the community has encouraged the emergence of integrative
medicine, where conventional medicine is combined with evidence-based lifestyle, natural,
and complementary medicine interventions, to deliver holistic, patient-centred care (Pan &
Zhou, 2014).
CATs have a long history of use, with some modalities being in existence for thousands of
years. Many people who use CATs believe that they result in improved health with two-
thirds of people using CATs in the USA reporting improved overall health as a result of their
use (Clarke, Black, Stussman, Barnes, & Nahin, 2015), and people who use CATs in Australia
much more likely to use CATs for the management of mental distress than they are to seek
psychological services (ABS, 2019; Clarke et al., 2015). Research also shows that 42% of
people using CATs have a priority health condition, 3% have a mental or behavioural
disorder and 5% have high/very high levels of psychological distress (ABS, 2019). It is
therefore not surprising that the majority of people in psychological treatment have used at
least one form of CAT in the past year (Elkins, Marcus, Rajab, & Durgam, 2005).
Toward an Integrative Psychology Practice?
CATs are receiving increased attention in the field of psychology with the emergence of
empirical reviewed journals that focus exclusively on CATs and the establishment of an
active APS Psychology and Complementary and Therapies Interest Group (APS, 2019;
Hindawi, n.d.). There is a growing body of empirical support regarding the effectiveness of
CATs to promote health and wellness and ameliorate a wide range of conditions treated by
psychologists (e.g., Hofmann, Andreoli, Carpenter, & Curtiss, 2016; Kirsch, Montgomery, &
Sapirstein, 1995; Lee, Lim, Song, Kim, & Hur, 2017; Pilkington et al., 2005). CATs that have
shown positive mental health and wellbeing benefits include dietary supplements, yoga,
meditation, aromatherapy, progressive and acupuncture, for example (see Barnett & Shale
(2012) for a detailed review of CAT evidence). CATs have also been shown to successfully
augment traditional psychotherapy. For example, yoga can produce positive outcomes for
individuals with social anxiety who also attend regular therapy sessions (Brown & Gerbarg,
2005; Nolan, 2016; van der Kolk et al., 2014).

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Yet although the evidence for CATs is building, there remains ongoing scepticism about
integrative practice, given that CATs have been criticised by some researchers as
intrinsically unscientific and therefore contradictory to the empirical foundations of
psychology (Field, 2009; Hughes, 2008). Furthermore, the APS Code of Ethics recommends
practices that work specifically against the integration of CATs into clinical practice, stating
that ‘Psychologists refrain from engaging in multiple relationships that may: (a) impair their
competence, effectiveness, objectivity, or ability to render a psychological service; (b) harm
clients or other parties to a psychological service; or (c) lead to the exploitation of clients or
other parties to a psychological service’ (APS, 2007, p. 28).
The Present Research and Research Questions
Such skepticism regarding the use and benefits of CATs has meant that there is a gap in
knowledge regarding the ways in which it might be appropriate for CAT principles to be
integrated into psychological practice and the ways in which this integration might be
perceived to be of benefit to clients. Therefore, the present research is largely exploratory
and aims to explore the stories of three practitioners, either trained or training in
psychology, and one or more CATs. We ask three questions: first, what factors encouraged
these practitioners to consider training in both psychology and CATs? Second, what do
these practitioners believe the use of CATs could bring to a psychology practice that has
been informed largely by a western way of doing psychology? Third, what barriers do these
practitioners perceive to the adoption of an integrated psychology practice?

Method

Participants
We recruited three individuals who either have trained or are currently training in
psychology and one or more CATs and/or TP through purposive sampling methods as is
theoretically consistent with qualitative research (Braun & Clarke, 2013). Participants were
aged between 31 years and 45 years (M = 36.33 years). Our initial recruitment criteria
stipulated that participants be over 18 years of age and a registered psychologist, currently
in practice, who is also a fully trained provider of a CAT with registration through a
recognised professional body and/or who practices from a standpoint informed by TP. Due
to the difficulty is recruiting a sample of participants, we relaxed our inclusion criteria so
that all participants were over 18 years of age, either trained or training in psychology, and
one or more CATs. Table 1 provides an overview of participant characteristics. To ensure
confidentiality, we collected no information about the participants except what was
required to ensure they met the selection criteria for inclusion in the research, and we
changed each participant’s name in the transcribing phase.
Measures
We devised a semi-structured interview schedule to guide the interview process. This
schedule comprised a minimal number of questions directed toward participants’ stories of
how they came to train in dual or multiple modalities and their perceptions of what the
integration of CATs could add to psychology practice, and what barriers existed to the

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integration of CATs into psychology practice. The interview schedule was used flexibly,
depending upon the individual interview context. We also devised short prompts and
probes to be used if and where necessary during the interview process.

Procedure
The Human Research Ethics Committee (HREC) of our institution granted ethics approval for
the research, and our research complied with the NHMRC Statement on Ethical Conduct in
Human Research (2007). Following ethics approval, we recruited participants through an
advertisement posted to a dedicated Facebook research page and the webpages for APS
special interest groups (Psychology and Complementary Therapies, Transpersonal
Psychology) and the Australian Natural Therapists Association. The first author conducted
and audio-recorded semi-structured, in-depth interviews, which ranged from 57 to 78
minutes (M = 69.67 minutes), and participants received $50.00 as reimbursement for their
time.

Data Analysis
The first author transcribed each interview verbatim. We then used a process of inductive
data analysis driven by the data, following the process for thematic analysis outlined by
Braun and Clarke (2006). First, we each immersed ourselves in the data by reading and re-
reading each transcript. In the margins of the transcripts, we noted any features that we felt
were important. These features became our initial codes. Second, in line with
recommendations for thematic analysis (Braun & Clarke, 2006), across the three transcripts,
we independently mapped these codes into initial themes, by clustering common codes and
drawing out the higher order understandings that the clusters represented. Third, again
across the three transcripts, we independently examined these initial themes, noting what
was common to them and drawing out further higher order understandings that the
commonalities represented. Fourth, we had several meetings where we reviewed, refined,
and triangulated our findings. At this stage, we compared the emergent thematic structure
against the interviews to ensure the thematic structure was faithful to what participants
had shared in their interviews. This process enabled us to identify the themes that were
superordinate across each of three questions that guided our research (stories of coming to
integrative practices; benefits; and barriers to practice), and to note key quotations that
were examples of the themes for each of the three research questions. As we coded our
interviews independently, this final analysis represented a triangulation of our perspectives.
Fifth, we created a table that summarised the results of this clustering process for each of
the three research questions (see Table 2).
To demonstrate the quality and trustworthiness of our analysis, we adopted Yardley’s
(2008) principles of sensitivity to context, commitment and rigour, and transparency and
coherence. We demonstrated sensitivity to context by our choice of a qualitative
framework informed by a narrative approach (e.g., McAdams, 2014), as the narrative
approach values case studies for their ability to offer vivid illustrations of theoretical ideas
and provide a vehicle for the discovery of new theory (McAdams, 2014). We demonstrated
rigour and commitment through our use of member reflection, where we invited each

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participant to check and verify their verbatim transcript, and where, once we had
completed the analysis, invited participants to share any comments or concerns with the
final thematic structure (Smith & McGannon, 2017). This process enabled us to write
comments and concerns into the final analysis (Smith & McGannon, 2017). Finally, we
demonstrated transparency and coherence by engaging in a systematic and iterative
process of analysis as outlined. We also grounded all themes explicitly in direct quotations
from the participants, which enabled us ‘to stay close to the participants’ language and
concepts’ (Huxley, Clarke, & Halliwell, 2014, p. 210). Finally, we attempted to identify and
bracket our own standpoints on the research questions during the process of data analysis
to limit their influence on our final explication of the data (Brymer & Scweitzer, 2017).
Analysis and Findings
Only one participant (Vanessa) requested changes to their transcript (minor wording and
grammatical changes) and no participant indicated that they had any questions or concerns
with our analysis. The participants’ agreement with our analysis supports that it captures
their perspectives on coming to a point in their professional lives where they saw an
integrative practice as both important and of potential benefit to clients, but as a practice
that could not be implemented due to the operation of a variety of barriers. Overall,
participants’ responses to the three research questions could be clustered according to
three over-arching themes of the Intra-personal (personal factors), Extra-personal (career-
based factors), and Super-personal (epistemologically-grounded factors). We present the
results of analysis in Table 2.
Research Question One: Factors Encouraging Training in Psychology and CATs
Intra-personal factors. All participants identified long-time personal interests and
experiences as significant in prompting their choices to train in both psychology and CATs.
For example, both Poppy and Peter indicated having ‘always been interested’ in aspects of
human behavior and self-help, with the adverbial intensifier ‘always’ signifying a long-
standing interest in psychology, and Vanessa described that that there was ‘nothing else’
that she wanted to be besides a psychologist. This long-standing interest was further
encouraged by distinct life experiences, which crystallised an awareness for them of the
potential benefits of a practice that integrated both psychology and CATs. For example,
Vanessa states ‘…definitely a pivotal moment for me was a friend …she was diagnosed with
multiple sclerosis and she went and saw a naturopath and seeing the difference it made in
her…’.
Extra-personal factors. All participants noted the importance of extra-personal factors
related to career options as significant in prompting their desire to train in two modalities.
All participants identified experiences encountered in vocational planning and the work
setting as pivotal. Poppy notes a desire to push past the typical focus of psychology as an
important vocationally motivating force:
… psychology I found through my studies was a lot more about how do we get people
who are way down here to up here where they are barely coping, you know…but that
wasn’t as interesting to me as, how do we kind of push past that.

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For Peter, experiences encountered while practicing in one profession prompted a
realization of the limitations of working in one duality only. He states, ‘being a naturopath, I
saw a lot of mental health cases around me…we would see anything from depression, from
anxiety, from general worrying from some trauma here and there as well.’ The participants
also observed the possibilities that integrative practice opened for them in terms of career
progression as significant.
I can study… I can progress myself…I can specialize… to leapfrog to a more lucrative
career. (Peter)
I am moving in a direction that is quite niche and so I will find clients that are open to
that and are interested in that and I really think that this area is going to grow.
(Poppy)
Finally, all three participants indicated that factors connected with a deeper
epistemological and philosophical set of principles encouraged their interest in training in
two modalities. These principles referenced deeper beliefs in mind-body holism (e.g.,
Hamilton & Hamilton, 2015) and the importance of a practice emphasizing the client as
central in promoting healing (e.g., Pan & Zhou, 2014). Poppy’s statement is exemplary here:
Psychology was just that one part… and often that is not enough. I think you need to
look at people more holistically and have various strategies to help them deal with the
mental health issue or whatever it is that they are dealing with.
Research Question Two: What CATs Can Bring to Psychology Practice
Intra-personal benefits. All participants believed that their experience with CATs had
encouraged them to move beyond a personally-held position of mind-body dualism (e.g.,
Mehta, 2011; Ryle, 1949). For example, all participants expressed that CATs had provided
them with a deeper understanding of the physiological connection between the body and
the mind. Vanessa states ‘…naturopathy offers that deeper understanding of the
physiology, of why different physical interventions work or don’t work, why is diet
helpful…’. Poppy references the connections between nutrition, gut health, and mental
states as being central here:
I had no idea before I started looking into this, that there is so many things that effect
our brain and our mood like what you eat and your gut health and all these things are
connected to mood disorders, to behavioural issues and there is so much research on
it and there is so much more coming out.
Extra-personal benefits. In addition to the intra-personal benefits of challenging their
beliefs in mind-body dualism (Mehta, 2011; Ryle, 1949), participants also noted extra-
personal benefits to career through specialization and working within a culturally and time-
reflective profession. Participants identified that integrated clinical practice could provide
specialisation options for psychologists. For example, Peter states ‘I think alternative forms
of treatment sort of allows stability through the practitioner. They don’t just do that, they
can do counselling they can do other forms of therapy, it just adds more feathers in their
boa… so they can just do more.’ This specialization provides alternate treatment options to

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ultimately produce better outcomes for clients, consistent with arguments for integrative
medical practice (e.g., Pan & Zhou, 2014). Vanessa states:
I think that psychologists that are armed with a second specialty can provide a unique
service to their clients, one that may be able to offer less side effects… one where
treatment can be stopped abruptly without fear of withdrawal and again side effects.
Participants also referenced the belief that integrated clinical practice would benefit the
field of psychology through provision of services that are reflective of the current cultural
and empirical environment (in which approximately 70% of Australians use some kind of
CAT [Xue et al., 2007], especially for management of mental distress [ABS, 2019; Clarke et
al., 2015]). For example, Vanessa states ‘I think if we do not get on board and be more open
to the value of complementary medicine and patients’ choice in terms of complementary
medicine, and the affordability of complementary medicine, that we will do ourselves out of
a job.’
Super-personal benefits. All participants also identified that an integrated clinical practice
would provide super-personal benefits to the field of a psychology through a wider
evidence base, providing an increase in knowledge regarding the effectiveness of CATs to
treat mental health issues (e.g., Barnett & Shale, 2012; Nolan, 2016; van der Kolk et al.,
2014). Vanessa states: ‘Some of these evidence based herbal interventions…have great
evidence, there is no disputing the evidence.’ Vanessa’s comments here reference the
growing body of evidence that supports the effectiveness of CATs in promoting health and
well-being (e.g., Barnett & Shale, 2012; Hofmann et al., 2016; Kirsch et al., 1995; Lee et al.,
2017; Pilkington et al., 2005) and augmenting psychotherapy (e.g., Brown & Gerbag, 2005;
Nolan, 2016; van der Kolk et al., 2014). Furthermore, a field of psychology that opened itself
up to the evidence base around the effectiveness of CATs and an integrated clinical practice
would help to promote changes to underlying philosophical frameworks of western
psychology based upon mind-body dualism. Poppy states:
I think psychology can be… so separate, the brain, the mind, not even the brain, the
mind is like sitting here and your body is over there and your environment is over
there… and we are just focused on the mind here and to me that doesn’t really make
any sense.
Ultimately, for all participants, the intra-personal, extra-personal, and super-personal
benefits led to better treatment outcomes for clients with fewer side effects. Peter states:
‘…the benefits to the patient would be that they have better outcome with less side
effects.’ Poppy noted the ways in which these improved client outcomes would benefit the
needs of psychologists: ‘…if you do help people in this way, in a more integrated way then
they are going to have better outcomes and as a psychologist that’s what you want.’
Research Question Three: Barriers to an Integrated Clinical Practice
Intrapersonal barriers. Participants identified stigma, personal biases, and registration fears
as intrapersonal barriers to the adoption of an integrative practice. Peter notes the stigma
that arises from a practice that works against the dominant scientist-practitioner model: ‘I
think there is a systemic level of mistrust and miscommunication there… there is a lot of

306
stigma around natural medicine from psychology because they are so heavily indoctrinated
in the scientist-practitioner model.’
Another perceived intra-personal barrier identified by participants was individual biases
towards CATs that restricted the adoption of integrative clinical practice and affected the
ability to provide client centred treatment. For example, all participants shared a perception
that cognitive biases towards the growing body of evidence for CAT efficacy was a
significant barrier. Reflecting the common stereotype that CATs are intrinsically unscientific
and therefore contradictory to the empirical foundations of psychology (Field, 2009;
Hughes, 2008), Vanessa states: ‘I think … it is easy for people to say we are not science
based and there is not enough evidence; I think that argument is starting to dry up.’ Peter
also notes: ‘I think we have lost touch a little bit, and we should all take a step back and take
a deep breath and put the patient first and put our egos and modalities aside.’ Overall, this
finding corroborates the understanding of an integrative practice as one that transcends
disciplinary and modality-based boundaries to enable the needs of the client to be
privileged (Pan & Zhou, 2014). Finally, participants identified loss of registration as a
psychologist as a significant intra-personal barrier impacting the adoption of an integrated
clinical practice. Vanessa stated: ‘I saw very quickly after graduating from the naturopathy,
that as much as I was absolutely desperate to combine the two disciplines, I wasn’t willing
to lose my status as a psychologist within my profession.’
Extra-personal barriers. Participants identified three extra-personal regulatory and ethical
barriers to integrative clinical practice. Firstly, all participants identified regulation of
treatment modalities as a barrier for integrated clinical practice. Peter’s statement is
exemplary here:
Naturopathy is an unregulated field that opens itself up to a diverse range of healing
skills so it’s not a protected name…so anyone can call themselves a naturopath and
that’s part of the problem it.
Furthermore, all participants identified a lack of guidance around the regulatory boundaries
for integration of CATs into psychological treatment. When talking about regulatory
guidelines for psychologists, Peter states ‘what do they need and how do I traverse…they
have got the keys… to doing it…how do I play by their rules and still get the best outcome
for my patient.’ Vanessa states ‘it is not a closed door, but it is a locked room safe… we can
see through, but we can’t get through.’
Secondly, ethical issues associated with integrative clinical practice, such as those identified
in the APS Code of Ethics (2007) around dual relationships, were also identified by
participants as a key barrier to integrated clinical practice. Vanessa states ‘it’s a breach of
our ethical guidelines….we are not allowed to have a second profession, and we are not
allowed to use that on one person at one time… black and white… do not progress past
go….’. Participants also expressed that the lack of guidance around the extent to which CAT
principles and practices can ethically be integrated into clinical practice as a barrier. For
example, Vanessa states ‘…hypnosis and mindfulness, were all on the fringes before, so
again it’s that fuzzy boundary, who sets that boundary and who says when it’s accepted.’

307
Thirdly, participants identified the need for appropriate training as an extra personal
barrier. All participants noted the key knowledge and skills required for the implementation
of integrative clinical practice. Peter used the word ‘art’ to describe the skills required to
perform psychology as well as naturopathy. Poppy discussed the need for training in core
subjects for both psychology and CATs as a barrier, and Vanessa commented that ‘adequate
supervision from… both sides’ may also be a barrier to integrated clinical practice due to
unavailability of appropriately skilled supervisors.
Super-personal barriers. All participants identified the positivistic oriented scientist-
practitioner framework for psychology (e.g., Hamilton & Hamilton, 2015) as a super-
personal barrier to integrative clinical practice. Peter also identified inconsistencies within
the evidence base across treatment modalities as significant here:
I think there is some validity … that, there is a double standard between what the
criteria of a drug that comes out and the level of entry to the evidence needed for
that and the level of entry of evidence needed for a herb. I don’t think it’s equivalent.
Additionally, he described the challenges of empirically testing the effectiveness of CATs
through the positivist frameworks of the scientist-practitioner model, stating ‘... I mean how
do you have a study for that – it’s a totally different paradigm, so you can’t test that in the
same paradigm western medicine does and that’s the problem is that when you are dealing
with a herb for example.’

Discussion
The present research was an exploratory qualitative investigation, guided by the
epistemological framework of narrative psychology. Specifically, we were interested in the
unique insights contained in the stories of three practitioners who are trained or are
currently training in psychology and CATs about the possibilities inherent in and barriers
against an integrative psychology practice. Overall, all participants described experiential
moments in their lives where they saw an integrative practice as both important and of
potential benefit to clients, but simultaneously, a practice that could not be implemented
due to the operation of intra-personal barriers, extra-personal barriers, and super-personal
barriers.
All participants identified life experiences that implicitly disrupted their assumptions of
mind-body dualism, moving them toward an embrace of mind-body holism (Hamilton &
Hamilton, 2015), and more holistic understandings of health, consistent with current
perspectives advanced by the World Health Organization (Daugherty et al. 2016; Snook &
Oliver, 2015). This understanding encouraged their beliefs that an integrative practice
would have significant benefits in treating the client as a whole person, enabling the
delivery of holistic care with the patient at its centre (Pan & Zhou, 2014). Furthermore, all
participants identified the greatest perceived benefits of an integrated practice as improved
client outcomes through increased knowledge of mind-body connection, specialisation
options for psychologists, times and culture-reflective practices, holistic paradigms, and
wider knowledge of the evidence base. These benefits particularly reflect the awareness of
the participants of the ways in which CATs have been widely embraced by the population in

308
Australia and New Zealand (ABS, 2019; Xue et al., 2007), especially as adjuncts to or
replacements for traditional treatments for mental distress (ABS, 2019; Brown & Gerbarg,
2005; Clarke et al., 2015; Elkins et al., 2005; Nolan, 2016; van der Kolk et al., 2014). Finally,
all participants believed that personal stigma and biases, the dominance of western
empirical scientist-practitioner paradigm, and institutional boundaries, including those
attached to loss of registration and ethical practice (as embedded in the APS Code of Ethics
[2007]), and the lack of appropriate training and supervision created barriers to an
integrative practice. Overall, the positivistic approach grounded in mind-body dualism and
privileged by psychology as both a discipline and profession (Walsh et al., 2014) continues
to shape practice, impeding the uptake of a more culturally and time-reflective integrative
approach that can transcend the western psychological limits of behaviorism, mind-body
dualism, and ego (Hartelius et al., 2007; Kazdin, 2000), embracing epistemological pluralism.
Clinical Implications and Conclusions
Our results are important in opening conversation about the importance of integrative
clinical practice for the 21st century, contributing to the growth of a body of high-quality,
clinically relevant research to inform service delivery and policy. Information and guidance
by bodies such as the APS could help to facilitate the development of additional specialist
areas that consider an integrative practice that expands the continuum of care provided by
psychologists. Furthermore, some CAT leaders have called for increased collaboration and
inclusion of CATs within clinical psychology while others have called for a complete
reformulation of the historical perspective that perceives culture to be secondary to the
influence of the mind (Barnett & Shale, 2012; Holland, 2001). There has also been a
recommendation for the development of specific hybrid psychological professional
pathways that integrate education of psychology and specialisation in CATs to better
address the holistic needs of clients (Holland, 2001). Indeed, the Australian Psychology
Accreditation Council Limited (APAC) standards which came into effect on 1 January 2019
(https://www.psychologycouncil.org.au/standards_review) emphasise the importance of
graduates being able to apply reflexive, culturally appropriate, and sensitive psychological
knowledge and skills (APAC, 2019).
In conclusion, consistent with the goals of a more transpersonally oriented psychology (e.g.,
Friedman & Hartelius, 2013; Hartelius et al., 2007; Kazdin, 2000), it seems that the field is
ripe for encouraging the possibilities that an integrative practice can offer for the treatment
of the client as a whole entity, recognising them as ‘…systems (of which mind and body are
a unit) which are integral parts of larger systems, in permanent interaction with their
environment and capable of constructing their own subjective realities’ (Mehta, 2011, p.
203). Indeed, an integrative clinical practice has the potential to encourage the uptake of a
broader understanding of wellness as inclusive of physical health, social engagement,
culture, being self-determining and having emotional and spiritual states of well-being (Duff
et al., 2016; Snook & Oliver, 2015). Ultimately, by embracing epistemological pluralism and
integrative clinical practice, we may not only be able to open the door to client-centered
holistic treatment, but completely crack open the institutional safe.

309
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Table 1 Descriptive Data for Participants
Name Age Qualifications
Peter 31 Dip. Applied Science (Naturopathy); MCommunityPsych
Vanessa 45 BBehSci(Psych and Disability Studies); BPsychSci(Hons);
MCounsellingPsych; Advanced Dip. Nutritional Medicine
and Naturopathy
Poppy 33 BA(Hons Psych); MPsych; PhD (Clin Psych); ACT; 200 hour
Yoga Alliance Teacher Training

Table 2 Identified Themes from Analysis

Master Theme Question 1 Question 2 Question 3
Subthemes Subthemes Subthemes
Intra-personal Personal Increased knowledge of Stigma
Interests body-mind connection Registration fears

Personal Individual biases

Experiences
Extra-personal Vocational Specialization Regulation of
experiences modalities
Work related A profession reflecting Ethical barriers
experiences the times
Career Training requirements,
progression including lack of
supervision
Super-personal Holistic Wider knowledge and Scientific method/
principles evidence base for the positivism limitations
field
Client centered Holistic principles
principles

313
 Index

accreditation, 8, 163 higher education, 7, 10, i, 6, 7, 8, 9, 10, 11, 13, 14,

anxiety, 12, 11, 27, 28, 29, 31, 32, 42, 43, 44, 46, 63, 64, 15, 16, 21, 24, 35, 45, 53, 55, 56, 104, 110, 111,
65, 66, 71, 72, 74, 76, 81, 90, 91, 97, 99, 100, 102, 114, 120, 137, 142, 160, 167, 212, 225, 226, 227,
118, 119, 134, 145, 151, 170, 176, 181, 182, 200, 228, 229, 232, 233, 234, 235, 236, 239, 242, 244,
205, 213, 219, 238, 240, 241, 271, 276, 308, 312, 245, 281, 282, 317
317, 318 embodied, 9, 84, 95, 97, 293, 296, 297, 299, 300, 301,
artificial intelligence, 9, 10, 142, 159, 167, 170 302, 303
athlete, 8, 59, 104, 105, 106, 109, 110, 111, 112, 113, emotional, 12, 6, 11, 12, 18, 24, 27, 28, 29, 30, 36, 37,
114, 115, 116 63, 65, 79, 80, 81, 85, 89, 90, 91, 94, 95, 111, 112,
biophilia hypothesis, 58, 76 142, 144, 145, 146, 147, 148, 149, 151, 152, 153,
biophobia, 65, 70 154, 155, 157, 174, 175, 176, 183, 187, 199, 200,
capabilities, 7, 20, 80, 86, 92, 159 240, 255, 268, 272, 288, 308, 317
career, 8, 9, 11, 7, 104, 105, 106, 108, 110, 111, 112, emotions, 17, 18, 29, 30, 31, 35, 37, 86, 94, 95, 146, 151,
113, 114, 115, 311, 312 152, 187, 258, 263
climate change, 58, 59, 60, 61, 117, 118, 119, 120, 121, employment, 6, 7, 11, 142, 159, 160, 163, 168, 193, 272
134, 135, 136, 137, 138, 139 environmental threat, 66
climate change, 58, 61, 117, 119, 120, 121, 135, 136, environments, 8, i, 24, 65, 72, 77, 111, 114, 118, 137,
137, 138, 139 162, 196, 197, 233, 235
cognition, 12, 14, 18, 40, 154, 155, 159, 166, 167, 177, evidence based, 10, 161, 171, 313
178, 219 global, 6, 7, 8, 9, 11, 13, 14, 15, 24, 32, 35, 37, 58, 59,
communicate, 9, 17, 93, 97, 142, 252 104, 105, 109, 117, 118, 135, 136, 137, 138, 139,
competencies, 9 182, 193, 217, 233, 251, 271
conflict, 52, 63, 70, 73, 74, 112, 118, 180, 181, 184, 216 globalisation, 45
counselling, 8, 10, 11, 12, 38, 48, 108, 161, 225, 251, goals, 6, 7, 9, 10, 11, 28, 111, 150, 208, 210, 215, 216,
252, 253, 263, 265, 266, 267, 268, 269, 270, 271, 253, 257, 259, 271, 317
272, 273, 276, 279, 280, 281, 283, 303, 312 graduates, 7, 9, 37, 288, 290, 291, 317, 318
creativity, 9, 18, 174, 184, 193, 196, 197, 198, 199, 200, happiness, 17, 20, 28, 41, 60, 64, 75, 79, 87, 102, 119,
201, 202, 204, 205, 206, 207, 208, 209 187, 221
critical thinking, 9, 45, 236 hope, 10, 60, 137, 138, 253, 254, 263
cultural, 9, 10, 18, 24, 39, 45, 46, 47, 50, 51, 52, 56, 60, identity, 48, 49, 63, 67, 68, 72, 74, 112, 118, 134, 207,
76, 96, 115, 116, 118, 134, 167, 174, 191, 205, 210, 225, 226, 237, 238, 239, 240, 241, 244, 246, 247,
211, 217, 218, 237, 252, 275, 276, 277, 278, 281, 251, 253, 256, 257, 259, 262, 263, 264, 278
282, 283, 284, 313, 318 innovation, i, 208
curriculum, 12, i, 6, 9, 10, 11, 12, 13, 15, 20, 24, 46, 166, interpretative phenomenological analysis, 291, 293, 300
225, 227, 229, 234 interventions, i, 18, 19, 27, 28, 29, 36, 37, 80, 81, 84, 97,
depression, 12, 27, 28, 29, 31, 32, 37, 42, 43, 44, 64, 66, 142, 162, 165, 169, 170, 175, 176, 177, 181, 184,
77, 81, 91, 102, 118, 145, 151, 176, 182, 192, 194, 192, 217, 251, 253, 258, 260, 271, 273, 291, 308,
195, 200, 205, 213, 219, 240, 280, 312, 317, 318, 319 312, 313
developmental, 12, 100, 142, 143, 144, 148, 152, 153, intrinsic, 64, 73, 74, 75, 77, 101, 164, 197, 200, 201, 202,
154, 155, 156, 168, 195, 217, 236, 237 205, 206, 207, 209, 256, 264, 295
disconnection from nature, 58, 60, 65, 67, 72, 76 language, 17, 18, 20, 56, 236, 237, 242, 243, 246, 247
diverse, 7, 45, 46, 47, 48, 49, 50, 51, 53, 54, 55, 56, 75, learning, i, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 24, 46,
96, 114, 120, 139, 174, 175, 194, 237, 238, 239, 240, 48, 50, 54, 61, 142, 143, 144, 145, 146, 149, 150,
241, 242, 244, 245, 247, 283, 314 159, 160, 164, 166, 167, 170, 202, 225, 226, 227,
diversity, 8, 9, 10, 8, 9, 24, 45, 46, 47, 48, 50, 51, 52, 54, 228, 229, 230, 231, 232, 233, 234, 235, 244, 252,
55, 56, 60, 104, 105, 154, 174, 225, 238, 241, 245, 277, 292, 301
248, 320 learning and teaching, 7, 15, 225
dualism, 288, 290, 296, 301, 303, 306, 307, 312, 313, life satisfaction, 17, 28, 58, 64, 66, 80, 100, 174
316, 318, 319 lifestyle, i, 63, 110, 308
education mental health

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 wellbeing, 7, 8, 9, 10, i, 15, 16, 18, 19, 20, 27, 28, 38, psychology, 7, 8, 9, 10, 11, 12, 6, 7, 8, 9, 10, 13, 14, 15,
40, 59, 60, 61, 66, 75, 99, 104, 105, 106, 111, 113, 16, 17, 21, 29, 37, 39, 40, 65, 77, 99, 116, 142, 159,
114, 115, 116, 120, 121, 135, 136, 137, 138, 145, 160, 161, 163, 164, 165, 166, 167, 169, 171, 176,
177, 181, 184, 186, 193, 220, 240, 241, 251, 252, 194, 204, 212, 217, 225, 227, 228, 229, 232, 233,
272, 275, 276, 280, 283, 291, 301, 308, 312, 313 234, 251, 284, 288, 289, 290, 301, 302, 304, 306,
mental wellbeing, 58, 59 307, 308, 309, 311, 313, 314, 315, 316, 317, 318,
mindfulness, 9, 12, 27, 28, 29, 30, 31, 35, 36, 37, 38, 39, 319, 320
41, 64, 76, 80, 85, 92, 97, 98, 99, 137, 174, 175, 176, psychotherapy, 10, 38, 168, 169, 170, 171, 174, 186,
177, 178, 180, 181, 182, 183, 184, 288, 291, 292, 192, 251, 253, 255, 262, 263, 264, 269, 288, 290,
295, 296, 297, 301, 303, 304, 306, 314, 318 291, 292, 302, 303, 304, 306, 308, 313, 318, 319
mindfulness meditation, 175, 176, 183 refugee
motivation, 11, 12, 101, 111, 120, 165, 187, 196, 197, refugees, 284
198, 199, 200, 201, 202, 205, 206, 207, 209, 219, relationship, 9, 10, 11, 12, 18, 24, 27, 28, 30, 34, 35, 37,
256, 257, 264 39, 47, 52, 58, 60, 63, 66, 72, 74, 75, 76, 77, 80, 84,
motor control, 143, 144, 145, 149 88, 91, 94, 95, 98, 111, 117, 118, 119, 121, 134, 135,
natural world, 58, 59, 63, 64, 67, 70, 71, 72, 73, 80, 89, 136, 142, 144, 150, 151, 154, 159, 160, 162, 181,
119, 121 187, 196, 197, 199, 200, 202, 206, 207, 209, 215,
nature, 11, 41, 47, 58, 59, 60, 63, 64, 65, 66, 67, 68, 69, 216, 219, 234, 253, 254, 255, 256, 257, 259, 261,
70, 71, 72, 73, 74, 75, 76, 77, 78, 80, 88, 89, 98, 117, 263, 264, 276, 277, 280, 282, 283, 289, 292, 298
119, 120, 121, 135, 136, 137, 138, 159, 165, 181, researchers, i, 30, 33, 47, 48, 54, 58, 63, 64, 65, 67, 68,
182, 184, 254, 259, 260, 267, 273, 292, 295, 302, 307 97, 104, 105, 107, 120, 169, 187, 197, 201, 203, 210,
nature deficit disorder, 65 211, 225, 229, 256, 278, 309
nature-connectedness, 59, 63, 64, 66, 71, 72 resilience, 210, 211, 213, 215, 218, 219, 220
negative affect, 29, 30, 79, 80, 81, 97, 174, 186, 187, self
188, 192, 193, 194, 195 self management, 7, 10, 6, 7, 9, 10, 11, 12, 13, 14, 15,
neuroscience, 6, 145, 262, 263, 288, 290, 302, 303, 306, 16, 18, 19, 24, 27, 28, 29, 30, 31, 35, 36, 37, 38,
307, 318 39, 41, 46, 48, 49, 51, 52, 53, 54, 55, 58, 67, 74,
organisation 77, 79, 80, 81, 88, 89, 90, 97, 108, 111, 119, 144,
organisational, i, 48, 107, 111, 161, 196, 216, 257, 145, 146, 148, 149, 150, 152, 159, 175, 176, 177,
266, 269, 273, 279, 282 181, 185, 192, 193, 197, 199, 200, 201, 202, 204,
outcomes, i, 6, 7, 8, 9, 11, 14, 15, 19, 24, 27, 29, 45, 81, 205, 206, 207, 208, 209, 213, 216, 218, 219, 225,
104, 105, 106, 107, 108, 112, 113, 114, 118, 142, 233, 240, 242, 245, 251, 252, 253, 254, 255, 256,
149, 150, 159, 161, 162, 163, 166, 174, 178, 181, 257, 258, 259, 260, 262, 263, 264, 272, 275, 278,
186, 199, 206, 207, 210, 225, 252, 253, 257, 260, 279, 282, 283, 288, 289, 293, 295, 296, 297, 298,
261, 268, 278, 293, 308, 313, 316 299, 300, 302, 303, 304, 308, 311, 317
perfectionism, 12, 24, 27, 28, 30, 35, 36, 37, 38, 40, 41 self-determination theory, 79
phenomenology self-efficacy, 27, 28, 29, 30, 31, 35, 36, 37, 39, 81, 197,
phenomenological, 67, 76, 77, 82, 98, 100, 102 199, 200, 201, 202, 207, 209
physical activity, 58, 59, 80, 89, 91, 98, 99, 100, 142, social disconnection, 66
149, 282 society, 7, 13, 17, 19, 64, 74, 116, 189, 216, 237, 238,
play, 70, 72, 144, 159, 166, 200, 201, 247, 251, 253, 258, 239, 252
259, 260, 262, 314 strengths, 10, 50, 96, 105, 109, 115, 210, 215, 216, 260
positive affect, 79, 80, 87, 174, 186, 187, 188, 191, 193, stress, 12, 28, 29, 32, 42, 43, 44, 63, 64, 71, 72, 77, 79,
194 80, 81, 85, 90, 91, 93, 94, 95, 98, 99, 101, 102, 112,
practitioners, 7, i, 10, 17, 20, 37, 50, 59, 80, 82, 84, 89, 118, 119, 149, 151, 152, 175, 176, 178, 182, 183,
92, 94, 96, 97, 104, 105, 106, 114, 135, 142, 159, 200, 207, 219, 238, 240, 247, 276, 282, 307, 317,
228, 233, 252, 275, 276, 277, 278, 280, 281, 283, 319, 320
284, 288, 289, 291, 292, 295, 301, 306, 307, 309, 316 stressors, 11, 12, 144, 148, 151, 197, 272
problem solving, 8, 45, 174, 186, 187, 191, 192, 193, support, 8, 10, i, 12, 13, 29, 34, 46, 52, 59, 79, 89, 97,
194, 195, 228 104, 105, 106, 107, 108, 109, 110, 111, 112, 113,
procrastination, 11, 12, 24, 27, 28, 29, 30, 31, 32, 33, 34, 114, 116, 133, 134, 145, 150, 174, 181, 182, 192,
35, 36, 37, 39, 40, 41, 42 200, 202, 208, 210, 215, 216, 217, 228, 232, 234,
professional, 9, 10, i, 6, 7, 9, 47, 50, 110, 111, 112, 116, 242, 247, 252, 253, 255, 257, 258, 265, 267, 268,
159, 160, 161, 166, 170, 176, 226, 230, 252, 253, 269,272, 273, 274, 275, 276, 277, 279, 280, 281, 282,
271, 281, 288, 289, 291, 294, 295, 309, 311, 317 283, 285, 306, 307, 308
psychological literacy, 6, 13, 14, 15, 16 sustainable, i, 19, 73, 74, 77, 78, 134

315
 teaching, 9, 10, i, 10, 13, 14, 15, 16, 46, 47, 52, 53, 142, wellbeing, 7, 8, 9, 10, 11, 12, 14, 15, 17, 18, 19, 20, 21,
225, 226, 227, 228, 229, 230, 233, 234, 243, 247, 252 24, 45, 58, 59, 60, 63, 66, 79, 80, 81, 82, 83, 84, 86,
therapeutic change, 10, 251, 252, 253, 254, 259, 261, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100,
262, 289, 291, 301 101, 104, 105, 106, 109, 110, 111, 112, 113, 114,
therapeutic process, 162, 257, 261, 262, 275, 280, 288, 115, 136, 137, 142, 165, 170, 174, 175, 176, 178,
291, 292, 295, 297, 299, 300, 301 183, 193, 200, 208, 225, 226, 241, 245, 252, 256,
therapy, 8, 9, 38, 154, 155, 162, 175, 183, 184, 208, 251, 257, 284, 308, see mental health
263, 265, 268, 274, 285, 288, 291, 292, 303 wellness, 13, 17, 20, 79, 100, 101, 182, 288, 290, 308,
undergraduate, 7, 9, 12, 6, 7, 8, 9, 10, 13, 14, 15, 24, 27, 317, 318, 319
28, 30, 31, 32, 35, 36, 41, 42, 167, 188, 225, 227, 228, white privilege, 46, 54, 56
229, 233, 234

316

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