commitment therapy Pathways for general practitioners Background Acceptance and commitment therap... more commitment therapy Pathways for general practitioners Background Acceptance and commitment therapy (ACT) focuses on helping patients to behave more consistently with their own values and apply mindfulness and acceptance skills to their responses to uncontrollable experiences. Objective This article presents an overview of ACT, its evidence base and how general practitioners can apply ACT consistent practice in the primary care setting. It describes pathways for general practitioners to develop further expertise in the approach. Discussion Acceptance and commitment therapy has been associated with improved outcomes in patients with chronic pain (comparable to cognitive behaviour therapy) and several studies suggest that it may be useful in patients with mild to moderate depression. Preliminary evidence of benefit has also been shown in the setting of obsessive-compulsive disorder, psychosis, smoking, tinnitus, epilepsy and emotionally disordered eating after gastric band surgery. Acc...
International Journal of Environmental Research and Public Health
This research aimed to explore the self-management strategies that Australian male farmers use to... more This research aimed to explore the self-management strategies that Australian male farmers use to improve or maintain their psychological wellbeing and their views on what would assist them to overcome barriers to seeking professional mental health assistance. Individual semi-structured telephone interviews were audio-recorded with consent. Qualitative data were analysed inductively using thematic analysis. Fifteen male farmers participated, who were an average of thirty-nine years of age (23–74 years) with twenty years of farming experience (5–57 years). Seven themes relating to self-management strategies were identified: (1) interacting with a supportive network; (2) involvement in groups and teams; (3) physical activity; (4) proactively educating themselves; (5) self-prioritising and deliberately maintaining work–life balance; (6) being grateful; and (7) focusing on the controllable aspects of farming. Five themes were identified that related to mitigating barriers to seeking men...
Background: Behavioural activation (BA) is an effective front-line treatment for depression but s... more Background: Behavioural activation (BA) is an effective front-line treatment for depression but some consumers find it unattractive or aversive, and its rationale unconvincing. Aims: To investigate whether individual differences in symptoms of depression, borderline personality pathology or adverse childhood events would: (1) influence ratings of BA treatment credibility; (2) predict credibility rating differences in comparison to schema therapy (ST) exemplifying a contrasting theoretical rationale with a significant developmental history focus; (3) a third aim was to test whether BA credibility was increased by providing research evidence of its efficacy. Method: In an online within-subjects experiment, 219 Australian community adults completed the Credibility/Expectancy Questionnaire following written descriptions of BA and ST (presentation order randomized across participants), and again for BA after receiving information about research supporting BA's efficacy. Results: High...
Background Fatigue is a frequent complaint amongst children and adolescents with obesity, and it ... more Background Fatigue is a frequent complaint amongst children and adolescents with obesity, and it interferes with adherence to dietary and exercise regimes that could reduce obesity. The present study evaluated the effect of an inpatient 3-week body weight reduction program on body weight and fatigue. Method One hundred children and adolescents with obesity (64% female; aged 11–18 years) undertook an inpatient program of personalized diet, daily exercise, education, and counselling. Results The sample evidenced a mean reduction in body mass (females: ΔM = 4.3 (sd = 2.1) kg, p
Objective This study aimed to examine the factor structure, reliability, inter-rater agreement an... more Objective This study aimed to examine the factor structure, reliability, inter-rater agreement and convergent validity of the<br> child and parent Italian versions of the paediatric quality of life inventory multidimensional fatigue scale (PedsQL-MFS) in<br> paediatric inpatients with obesity and one of their parents.<br> Methods 100 pairs of children/adolescents (64% female, mean age = 15.34) with obesity and one of their parents completed<br> the PedsQL-MFS and the Child Behaviour Checklist (CBCL) or the Youth Self Report.<br> Results Conirmatory Factor Analysis indicated that the three correlated irst-order factors model corresponding to the<br> published subscales demonstrated acceptable it and achieved strict invariance across parent and child informants. Bifactor<br> Analysis supported the multidimensionality and the reliability of the total and subscale scores as multidimensional<br> composites. Parent–child agreement was low wi...
Despite its clear importance, there have been very few empirical investigations of boundary viola... more Despite its clear importance, there have been very few empirical investigations of boundary violation propensity among mental health professionals. The present study explored the relationships between self-reported propensity for boundary violations and predictors theorized to increase their likelihood. Australian mental health professionals (N = 275) completed an online questionnaire battery including demographics, the Sexual Boundary Violation Index, Boundaries In Practice Scale, Boundary Violations Propensity Questionnaire, Marlow-Crowne Social Desirability Scale, Circumplex of Interpersonal Problems, Brief Inventory of Pathological Narcissism, Barratt Impulsiveness Scale Brief Version, Satisfaction With Life Scale, Brief Experiential Avoidance Questionnaire, Adverse Childhood Experiences Questionnaire and the Interpersonal Reactivity Index. Regression analysis was used to identify unique predictors. Boundary violation propensity was associated with nurturant interpersonal styles...
The term ‘wounded healer’ is sometimes used to describe people with a personal experience of adve... more The term ‘wounded healer’ is sometimes used to describe people with a personal experience of adversity who enter a helping profession. Wounded healers have been thought to be both especially suited to counselling - perhaps through greater empathy for those in need - and at increased risk of making poor decisions due to the influence of their own psychopathology. Undergraduate students in psychology and social work (N=112) completed online questionnaires measuring childhood adversity, parentification, empathy, psychological inflexibility and a measure developed for this study of propensity to violate professional boundaries. Despite a high prevalence of childhood adversity among respondents, neither childhood adversity nor parentification were associated with empathy or willingness to violate boundaries. Instead, higher psychological inflexibility was associated with greater propensity to violate boundaries and more personal distress in response to others’ suffering. Notwithstanding ...
This study aimed to examine the factor structure, reliability, inter-rater agreement and converge... more This study aimed to examine the factor structure, reliability, inter-rater agreement and convergent validity of the child and parent Italian versions of the paediatric quality of life inventory multidimensional fatigue scale (PedsQL-MFS) in paediatric inpatients with obesity and one of their parents. 100 pairs of children/adolescents (64% female, mean age = 15.34) with obesity and one of their parents completed the PedsQL-MFS and the Child Behaviour Checklist (CBCL) or the Youth Self Report. Confirmatory Factor Analysis indicated that the three correlated first-order factors model corresponding to the published subscales demonstrated acceptable fit and achieved strict invariance across parent and child informants. Bifactor Analysis supported the multidimensionality and the reliability of the total and subscale scores as multidimensional composites. Parent–child agreement was low with latent means higher for parent reports. PedsQL-MFS total scores were strongly correlated with Somati...
BACKGROUND Acceptance and commitment therapy (ACT) focuses on helping patients to behave more con... more BACKGROUND Acceptance and commitment therapy (ACT) focuses on helping patients to behave more consistently with their own values and apply mindfulness and acceptance skills to their responses to uncontrollable experiences. OBJECTIVE This article presents an overview of ACT, its evidence base and how general practitioners can apply ACT consistent practice in the primary care setting. It describes pathways for general practitioners to develop further expertise in the approach. DISCUSSION Acceptance and commitment therapy has been associated with improved outcomes in patients with chronic pain (comparable to cognitive behaviour therapy) and several studies suggest that it may be useful in patients with mild to moderate depression. Preliminary evidence of benefit has also been shown in the setting of obsessive-compulsive disorder, psychosis, smoking, tinnitus, epilepsy and emotionally disordered eating after gastric band surgery. Acceptance and commitment therapy starts with a discussio...
Although it is well established that emotion-focused coping is associated with burnout, the schem... more Although it is well established that emotion-focused coping is associated with burnout, the schema therapy model may improve the prediction of who is most vulnerable to using emotion-focused coping and what kinds of emotion-focused coping carry the greatest risk of burnout. It is also unknown the extent to which resilience might buffer against maladaptive coping in protecting against burnout. The present study investigated whether maladaptive coping modes would incrementally predict emotional exhaustion (EE) adjusting for resilience and whether resilience might moderate the effect of maladaptive coping on EE. The possible role of maladaptive coping as a mediator of job demands on EE was also explored. Four hundred and forty-three clinical and counselling psychologists completed on-line measures of job demands, EE, resilience and maladaptive coping modes. The Detached Protector mode was associated with greater EE after adjusting for resilience. Bully and Attack mode was associated with greater EE when considered separately from other coping modes, but associated with decreased EE when considered together. Resilience did not moderate the effect of job demands on EE, or the effect of coping modes on EE, except for Compliant Surrenderer. Coping modes only partially mediated the effect of job demands on EE accounting for 20% or less of its effect. Maladaptive coping modes appear to make independent contributions to the risk of EE and efforts to reduce burnout in psychologists should focus dually on increasing resilience-building practices and decreasing maladaptive coping.
ObjectiveTo assess whether physically active yoga is superior to waitlist control, treatment as u... more ObjectiveTo assess whether physically active yoga is superior to waitlist control, treatment as usual and attention control in alleviating depressive symptoms in people with a diagnosed mental disorder recognised by the Diagnostic and Statistical Manual of Mental Disorders (DSM).DesignSystematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Data sourcesData were obtained from online databases (MEDLINE, EMBASE, PsychINFO, CENTRAL, EMCARE, PEDro). The search and collection of eligible studies was conducted up to 14 May 2019 (PROSPERO registration No CRD42018090441).Eligibility criteria for selecting studiesWe included randomised controlled trials with a yoga intervention comprising ≥50% physical activity in adults with a recognised diagnosed mental disorder according to DSM-3, 4 or 5.Results19 studies were included in the review (1080 participants) and 13 studies were included in the meta-analysis (632 par...
BACKGROUND Methamphetamine use is of deep concern to Aboriginal and Torres Strait Islander commun... more BACKGROUND Methamphetamine use is of deep concern to Aboriginal and Torres Strait Islander communities, but access to culturally appropriate treatment resources and services is limited. Web-based programs have potential as flexible and cost-effective additions to the range of treatment options available to Aboriginal people. The We Can Do This web-based therapeutic program (WBTP) is designed to incorporate evidence-based therapies in a culturally-relevant format using narratives from Aboriginal people to contextualise the therapeutic content. OBJECTIVE The effectiveness of the WBTP will be tested in a wait-list control, randomised trial across multiple sites in urban, regional and remote locations. METHODS Recruitment will commence in May 2019, and results are expected in early 2021. RESULTS Participants will be Aboriginal and Torres Strait Islander people aged 16 or over who have used methamphetamine at least weekly for the previous three months. They will be recruited online and v...
Psychologists are subject to multiple competing emotional demands that increase the risk of burno... more Psychologists are subject to multiple competing emotional demands that increase the risk of burnout. Research has demonstrated that burnout arises from both organizational and personal factors, including psychologists' personal beliefs and coping. Preliminary research indicates that early maladaptive schemas (EMS) are associated with high burnout, yet, to date, the role of EMS and associated coping responses (maladaptive coping modes [MCM]) in predicting high burnout amongst psychologists has not been investigated. Four hundred forty-three psychologists completed a self-report online questionnaire comprising the Maslach Burnout Inventory-emotional exhaustion scale (EE), Young Schema Questionnaire, and Schema Mode Inventory. The two most common EMS amongst psychologists were unrelenting standards and self-sacrifice. There was substantial indication of burnout, with 18.3% in the high range and 29.6% in the moderate range of EE. The most common MCM were detached protector and detac...
commitment therapy Pathways for general practitioners Background Acceptance and commitment therap... more commitment therapy Pathways for general practitioners Background Acceptance and commitment therapy (ACT) focuses on helping patients to behave more consistently with their own values and apply mindfulness and acceptance skills to their responses to uncontrollable experiences. Objective This article presents an overview of ACT, its evidence base and how general practitioners can apply ACT consistent practice in the primary care setting. It describes pathways for general practitioners to develop further expertise in the approach. Discussion Acceptance and commitment therapy has been associated with improved outcomes in patients with chronic pain (comparable to cognitive behaviour therapy) and several studies suggest that it may be useful in patients with mild to moderate depression. Preliminary evidence of benefit has also been shown in the setting of obsessive-compulsive disorder, psychosis, smoking, tinnitus, epilepsy and emotionally disordered eating after gastric band surgery. Acc...
International Journal of Environmental Research and Public Health
This research aimed to explore the self-management strategies that Australian male farmers use to... more This research aimed to explore the self-management strategies that Australian male farmers use to improve or maintain their psychological wellbeing and their views on what would assist them to overcome barriers to seeking professional mental health assistance. Individual semi-structured telephone interviews were audio-recorded with consent. Qualitative data were analysed inductively using thematic analysis. Fifteen male farmers participated, who were an average of thirty-nine years of age (23–74 years) with twenty years of farming experience (5–57 years). Seven themes relating to self-management strategies were identified: (1) interacting with a supportive network; (2) involvement in groups and teams; (3) physical activity; (4) proactively educating themselves; (5) self-prioritising and deliberately maintaining work–life balance; (6) being grateful; and (7) focusing on the controllable aspects of farming. Five themes were identified that related to mitigating barriers to seeking men...
Background: Behavioural activation (BA) is an effective front-line treatment for depression but s... more Background: Behavioural activation (BA) is an effective front-line treatment for depression but some consumers find it unattractive or aversive, and its rationale unconvincing. Aims: To investigate whether individual differences in symptoms of depression, borderline personality pathology or adverse childhood events would: (1) influence ratings of BA treatment credibility; (2) predict credibility rating differences in comparison to schema therapy (ST) exemplifying a contrasting theoretical rationale with a significant developmental history focus; (3) a third aim was to test whether BA credibility was increased by providing research evidence of its efficacy. Method: In an online within-subjects experiment, 219 Australian community adults completed the Credibility/Expectancy Questionnaire following written descriptions of BA and ST (presentation order randomized across participants), and again for BA after receiving information about research supporting BA's efficacy. Results: High...
Background Fatigue is a frequent complaint amongst children and adolescents with obesity, and it ... more Background Fatigue is a frequent complaint amongst children and adolescents with obesity, and it interferes with adherence to dietary and exercise regimes that could reduce obesity. The present study evaluated the effect of an inpatient 3-week body weight reduction program on body weight and fatigue. Method One hundred children and adolescents with obesity (64% female; aged 11–18 years) undertook an inpatient program of personalized diet, daily exercise, education, and counselling. Results The sample evidenced a mean reduction in body mass (females: ΔM = 4.3 (sd = 2.1) kg, p
Objective This study aimed to examine the factor structure, reliability, inter-rater agreement an... more Objective This study aimed to examine the factor structure, reliability, inter-rater agreement and convergent validity of the<br> child and parent Italian versions of the paediatric quality of life inventory multidimensional fatigue scale (PedsQL-MFS) in<br> paediatric inpatients with obesity and one of their parents.<br> Methods 100 pairs of children/adolescents (64% female, mean age = 15.34) with obesity and one of their parents completed<br> the PedsQL-MFS and the Child Behaviour Checklist (CBCL) or the Youth Self Report.<br> Results Conirmatory Factor Analysis indicated that the three correlated irst-order factors model corresponding to the<br> published subscales demonstrated acceptable it and achieved strict invariance across parent and child informants. Bifactor<br> Analysis supported the multidimensionality and the reliability of the total and subscale scores as multidimensional<br> composites. Parent–child agreement was low wi...
Despite its clear importance, there have been very few empirical investigations of boundary viola... more Despite its clear importance, there have been very few empirical investigations of boundary violation propensity among mental health professionals. The present study explored the relationships between self-reported propensity for boundary violations and predictors theorized to increase their likelihood. Australian mental health professionals (N = 275) completed an online questionnaire battery including demographics, the Sexual Boundary Violation Index, Boundaries In Practice Scale, Boundary Violations Propensity Questionnaire, Marlow-Crowne Social Desirability Scale, Circumplex of Interpersonal Problems, Brief Inventory of Pathological Narcissism, Barratt Impulsiveness Scale Brief Version, Satisfaction With Life Scale, Brief Experiential Avoidance Questionnaire, Adverse Childhood Experiences Questionnaire and the Interpersonal Reactivity Index. Regression analysis was used to identify unique predictors. Boundary violation propensity was associated with nurturant interpersonal styles...
The term ‘wounded healer’ is sometimes used to describe people with a personal experience of adve... more The term ‘wounded healer’ is sometimes used to describe people with a personal experience of adversity who enter a helping profession. Wounded healers have been thought to be both especially suited to counselling - perhaps through greater empathy for those in need - and at increased risk of making poor decisions due to the influence of their own psychopathology. Undergraduate students in psychology and social work (N=112) completed online questionnaires measuring childhood adversity, parentification, empathy, psychological inflexibility and a measure developed for this study of propensity to violate professional boundaries. Despite a high prevalence of childhood adversity among respondents, neither childhood adversity nor parentification were associated with empathy or willingness to violate boundaries. Instead, higher psychological inflexibility was associated with greater propensity to violate boundaries and more personal distress in response to others’ suffering. Notwithstanding ...
This study aimed to examine the factor structure, reliability, inter-rater agreement and converge... more This study aimed to examine the factor structure, reliability, inter-rater agreement and convergent validity of the child and parent Italian versions of the paediatric quality of life inventory multidimensional fatigue scale (PedsQL-MFS) in paediatric inpatients with obesity and one of their parents. 100 pairs of children/adolescents (64% female, mean age = 15.34) with obesity and one of their parents completed the PedsQL-MFS and the Child Behaviour Checklist (CBCL) or the Youth Self Report. Confirmatory Factor Analysis indicated that the three correlated first-order factors model corresponding to the published subscales demonstrated acceptable fit and achieved strict invariance across parent and child informants. Bifactor Analysis supported the multidimensionality and the reliability of the total and subscale scores as multidimensional composites. Parent–child agreement was low with latent means higher for parent reports. PedsQL-MFS total scores were strongly correlated with Somati...
BACKGROUND Acceptance and commitment therapy (ACT) focuses on helping patients to behave more con... more BACKGROUND Acceptance and commitment therapy (ACT) focuses on helping patients to behave more consistently with their own values and apply mindfulness and acceptance skills to their responses to uncontrollable experiences. OBJECTIVE This article presents an overview of ACT, its evidence base and how general practitioners can apply ACT consistent practice in the primary care setting. It describes pathways for general practitioners to develop further expertise in the approach. DISCUSSION Acceptance and commitment therapy has been associated with improved outcomes in patients with chronic pain (comparable to cognitive behaviour therapy) and several studies suggest that it may be useful in patients with mild to moderate depression. Preliminary evidence of benefit has also been shown in the setting of obsessive-compulsive disorder, psychosis, smoking, tinnitus, epilepsy and emotionally disordered eating after gastric band surgery. Acceptance and commitment therapy starts with a discussio...
Although it is well established that emotion-focused coping is associated with burnout, the schem... more Although it is well established that emotion-focused coping is associated with burnout, the schema therapy model may improve the prediction of who is most vulnerable to using emotion-focused coping and what kinds of emotion-focused coping carry the greatest risk of burnout. It is also unknown the extent to which resilience might buffer against maladaptive coping in protecting against burnout. The present study investigated whether maladaptive coping modes would incrementally predict emotional exhaustion (EE) adjusting for resilience and whether resilience might moderate the effect of maladaptive coping on EE. The possible role of maladaptive coping as a mediator of job demands on EE was also explored. Four hundred and forty-three clinical and counselling psychologists completed on-line measures of job demands, EE, resilience and maladaptive coping modes. The Detached Protector mode was associated with greater EE after adjusting for resilience. Bully and Attack mode was associated with greater EE when considered separately from other coping modes, but associated with decreased EE when considered together. Resilience did not moderate the effect of job demands on EE, or the effect of coping modes on EE, except for Compliant Surrenderer. Coping modes only partially mediated the effect of job demands on EE accounting for 20% or less of its effect. Maladaptive coping modes appear to make independent contributions to the risk of EE and efforts to reduce burnout in psychologists should focus dually on increasing resilience-building practices and decreasing maladaptive coping.
ObjectiveTo assess whether physically active yoga is superior to waitlist control, treatment as u... more ObjectiveTo assess whether physically active yoga is superior to waitlist control, treatment as usual and attention control in alleviating depressive symptoms in people with a diagnosed mental disorder recognised by the Diagnostic and Statistical Manual of Mental Disorders (DSM).DesignSystematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Data sourcesData were obtained from online databases (MEDLINE, EMBASE, PsychINFO, CENTRAL, EMCARE, PEDro). The search and collection of eligible studies was conducted up to 14 May 2019 (PROSPERO registration No CRD42018090441).Eligibility criteria for selecting studiesWe included randomised controlled trials with a yoga intervention comprising ≥50% physical activity in adults with a recognised diagnosed mental disorder according to DSM-3, 4 or 5.Results19 studies were included in the review (1080 participants) and 13 studies were included in the meta-analysis (632 par...
BACKGROUND Methamphetamine use is of deep concern to Aboriginal and Torres Strait Islander commun... more BACKGROUND Methamphetamine use is of deep concern to Aboriginal and Torres Strait Islander communities, but access to culturally appropriate treatment resources and services is limited. Web-based programs have potential as flexible and cost-effective additions to the range of treatment options available to Aboriginal people. The We Can Do This web-based therapeutic program (WBTP) is designed to incorporate evidence-based therapies in a culturally-relevant format using narratives from Aboriginal people to contextualise the therapeutic content. OBJECTIVE The effectiveness of the WBTP will be tested in a wait-list control, randomised trial across multiple sites in urban, regional and remote locations. METHODS Recruitment will commence in May 2019, and results are expected in early 2021. RESULTS Participants will be Aboriginal and Torres Strait Islander people aged 16 or over who have used methamphetamine at least weekly for the previous three months. They will be recruited online and v...
Psychologists are subject to multiple competing emotional demands that increase the risk of burno... more Psychologists are subject to multiple competing emotional demands that increase the risk of burnout. Research has demonstrated that burnout arises from both organizational and personal factors, including psychologists' personal beliefs and coping. Preliminary research indicates that early maladaptive schemas (EMS) are associated with high burnout, yet, to date, the role of EMS and associated coping responses (maladaptive coping modes [MCM]) in predicting high burnout amongst psychologists has not been investigated. Four hundred forty-three psychologists completed a self-report online questionnaire comprising the Maslach Burnout Inventory-emotional exhaustion scale (EE), Young Schema Questionnaire, and Schema Mode Inventory. The two most common EMS amongst psychologists were unrelenting standards and self-sacrifice. There was substantial indication of burnout, with 18.3% in the high range and 29.6% in the moderate range of EE. The most common MCM were detached protector and detac...
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Papers by Matthew Smout