• Assessing the feasibility of public engagement in a smartphone app to improve well-being through nature connection ( Evaluation of the feasibility of citizen engagement through a smartphone app to improve well-being through connection with nature )

      McEwan, Kirsten; Richardson, Miles; Sheffield, David; Ferguson, Fiona; Brindley, Paul; University of Derby; University of Birmingham; University of Sheffield (Taylor & Francis, 2021-01-08)
      Aside from practical interventions such as providing green infrastructure to improve air quality or water contamination and reduce flooding, wellbeing interventions to increase engagement with the natural environment are one of the fastest growing ways of improving human and environmental health. This feasibility study assessed a novel Smartphone app wellbeing intervention. Over 30 days the app prompted adults, including those seeking help for a common mental health problem, to notice the good things about urban green or built spaces (control condition). Self-referral was successful with 885 people downloading the app, 435 supplying baseline data and 50 supplying post-intervention data. However, the low number of observations (M=6 per participant) indicates that 30 days is too long to remain engaged. There were significant improvements in wellbeing and nature connection, but no difference between green and built space conditions. Limitations, future recommendations regarding improving engagement and marketing to lower socio-economic status groups are discussed.
    • Can compassion-focused imagery be used as an attention bias modification treatment?

      Leboeuf, Isabelle; McEwan, Kirsten; Rusinek, Stéphane; Andreotti, Eva; Antoine, Pascal; Université Lille Nord de France; University of Derby (Springer, 2021-01-06)
      Compassion focused-imagery (CFI), one of the psychological interventions of compassion-focused therapy, is receiving increasing attention. It is a therapeutic tool that targets the process of self-criticism by prompting individuals to imagine themselves as compassionate or to imagine receiving compassion from an ideal compassionate other. This research examines the role of self-criticism in the attentional processing of emotional stimuli, namely, critical and compassionate facial expressions. It is hypothesized that the activation of positive social emotions through CFI plays a role in broadening attention in the processing of emotional stimuli. The McEwan Faces stimulus set, which includes critical, neutral and compassionate faces, was used to create an attentional bias task called the dot probe task. The processing of emotional faces was assessed before and after exposure to either CFI or neutral imagery, controlling for the process of sensory integration (n = 80). A between-subject analysis was used to test the hypothesis. Before the imagery task, participants tended to look away from critical faces, and their level of self-criticism played a role. Both types of imagery significantly reduced the bias away from critical faces when the stimuli were presented for 1200 ms. This effect was reversed in the neutral condition for participants with high levels of self-criticism but not in the CFI condition. Interestingly, self-criticism impacts the attentional treatment of critical faces and the effect of imagery entailing sensory integration on this treatment. CFI seems to preserve this effect for participants with high levels of self-criticism, possibly due to the activation of positive social emotions.
    • Crisis management for people with dementia at home: Mixed‐methods case study research to identify critical factors for successful home treatment

      Hopkinson, Jane; King, Amanda; Young, Lucy; McEwan, Kirsten; Elliot, Fiona; Hydon, Kate; Muthukrishnan, Sabarigirivasan; Tope, Rosie; Veitch, Anne; Howells, Cristie; et al. (Wiley, 2020-08-27)
      Best practice in dementia care is support in the home. Yet, crisis is common and can often result in hospital admission with adverse consequences. The objective of this mixed‐methods case study research was to identify the critical factors for resolving crisis for a person with dementia living at home. The research was an in‐depth investigation of what happens during crisis for people with dementia and how it is managed by a Home Treatment Crisis Team to resolution and outcome at 6 weeks and 6 months. The methods were; observation of crisis management for 15 patients with dementia (max three observations per patient, total 41), interviews with patients with dementia (n = 5), carers (n = 13) and professionals (n = 14, range one to six interviews per person, total 29), focus group (nine professionals), and extraction of demographics and medical history from medical records. Analysis focused on the identification of factors important for crisis resolution and avoidance of hospital admission. Critical factors for the Home Treatment Crisis Team to enable successful crisis resolution were: immediate action to reduce risk of harm, expertise in dementia care and carer education, communication skills to establish trust and promote benefits of home treatment, shared decision‐making, medication management, addressing the needs of carers independently of the person with dementia and, local availability of respite and other community services. The Home Treatment Crisis Team integrated the seven factors to deploy a biopsychosocial systems approach with embedded respect for personhood. This approach enabled crisis resolution for a person with dementia by creating a system of services, treatments, resources and relationships, ‘Safe Dementia Space’, in the community with avoidance of hospital admission in more than 80% of referrals. The identified critical factors for crisis resolution are important considerations in the design and delivery of home treatment services for people with dementia.
    • Developing a whole-school mental health and wellbeing intervention through pragmatic formative process evaluation: A case-study of innovative local practice within the School Health Research Network

      Gobat, Nina; Littlecot, Hannah; Williams, Andy; McEwan, Kirsten; Stanton, Helen; Robling, Michael; Rollnick, Stephen; Murphy, Simon; Evans, Rhiannon; University of Oxford; et al. (BMC, 2021-01-18)
      The evidence-base for whole school approaches aimed at improving student mental health and wellbeing remains limited. This may be due to a focus on developing and evaluating de-novo, research led interventions, while neglecting the potential of local, contextually-relevant innovation that has demonstrated acceptability and feasibility. This study reports a novel approach to modelling and refining the theory of a whole-school restorative approach, alongside plans to scale up through a national educational infrastructure in order to support robust scientific evaluation. A pragmatic formative process evaluation was conducted of a routinized whole-school restorative approach aimed at improving student mental health and wellbeing in Wales. The study reports seven phases of the pragmatic formative process evaluation that may be undertaken in the development and evaluation of interventions already in routine practice: 1) identification of innovative local practice; 2) scoping review of evidence-base to identify existing intervention programme theory; outcomes; and contextual characteristics that influence programme theory and implementation; 3) establishment of a Transdisciplinary Action Research (TDAR) group; 4) co-production of an initial intervention logic model with stakeholders; 5) confirmation of logic model with stakeholders; 6) planning for intervention refinement; and 7) planning for feasibility and outcome evaluation. The phases of this model may be iterative and not necessarily sequential. Formative, pragmatic process evaluations support researchers, policy-makers and practitioners in developing a robust scientific evidence-base for acceptable and feasible local innovation that does not have a clear evidence base. The case of a whole-school restorative approach provides a case example of how such an evaluation may be undertaken.
    • Fears of compassion magnify the harmful effects of threat of COVID-19 on mental health and social safeness across 21 countries

      Matos, Marcela; McEwan, Kirsten; Basran, Jaskaran; Gilbert, Paul; University of Derby (Wiley, 2021-04-20)
      The COVID-19 pandemic is a massive global health crisis with damaging consequences to mental health and social relationships. Exploring factors that may heighten or buffer the risk of mental health problems in this context is thus critical. Whilst compassion may be a protective factor, in contrast fears of compassion increase vulnerability to psychosocial distress and may amplify the impact of the pandemic on mental health. This study explores the magnifying effects of fears of compassion on the impact of perceived threat of COVID-19 on depression, anxiety and stress, and social safeness. Adult participants from the general population (N = 4057) were recruited across 21 countries worldwide, and completed self-report measures of perceived threat of COVID-19, fears of compassion (for self, from others, for others), depression, anxiety, stress and social safeness. Perceived threat of COVID-19 predicted increased depression, anxiety and stress. The three flows of fears of compassion predicted higher levels of depression, anxiety and stress and lower social safeness. All fears of compassion moderated (heightened) the impact of perceived threat of COVID-19 on psychological distress. Only fears of compassion from others moderated the effects of likelihood of contracting COVID-19 on social safeness. These effects were consistent across all countries. Fears of compassion have a universal magnifying effect on the damaging impact of the COVID-19 pandemic on mental health and social safeness. Compassion focused interventions and communications could be implemented to reduce resistances to compassion and promote mental wellbeing during and following the pandemic.
    • The good things in urban nature: A thematic framework for optimising urban planning for nature connectedness

      McEwan, Kirsten; Ferguson, Fiona J; Richardson, Miles; Cameron, Ross; University of Derby (2019-11-06)
      Green interventions which connect people with nature to improve wellbeing are increasingly being applied to tackle the current crisis in mental health. A novel Smartphone app intervention was evaluated amongst adults (n = 228) including (n = 53) adults with common mental health problems, with the aim to improve wellbeing through noticing the good things about urban nature. The app prompted participants once a day over 7 days to write notes about the good things they noticed in urban green spaces. Notes were thematically analysed and ten themes emerged. The three themes with the greatest representation were: i) wonder at encountering wildlife in day-to-day urban settings; ii) appreciation of street trees; and iii) awe at colourful, expansive, dramatic skies and views. Through combining the above themes with the pathways to nature connectedness this paper provides an extended framework of activities to inform activity programming, nature engagement media content, and ‘green health’ interventions. Moreover, the findings have strong implications for optimising city planning, design and management for the wellbeing of both humans and wildlife.
    • The magic of the mundane: the vulnerable web of connections between urban nature and wellbeing

      Dobson, Julian; Brindley, Paul; Birch, Jo; Henneberry, John; McEwan, Kirsten; Mears, Meagan; Richardson, Miles; Sheffield Hallam University; University of Sheffield; University of Derby (Elsevier, 2020-10-23)
      Cities are sites of human, ecological and institutional stress. The elements that make up the city – its people, landscapes and processes – are engaged in constant assemblage and disassembly, joining and pulling apart. Reporting the findings of a three-year multi-disciplinary deep case study, this paper examines the role of urban nature in mediating the relationship between stressed humans and stressed places. It applies assemblage theory to show how such relationships can be understood in contexts of multiple pressures. From empirical findings it shows how urban nature contributes to mental wellbeing, but also how institutional stresses linked to austerity policies shape efforts to reconnect humans and nature. Across five strands of research, this article foregrounds the importance of multiple everyday experiences of urban nature and practices of care and maintenance. It calls on researchers, policymakers, planners and practitioners to pay closer attention to the ‘magic of the mundane’ in supporting human wellbeing; in caring for spaces and places; and in providing the services that link people and the natural environment.
    • A pragmatic controlled trial of forest bathing compared with compassionate mind training in the UK: impacts on self- reported wellbeing and heart rate variability

      McEwan, Kirsten; Giles, David; Clarke, Fiona; Kotera, Yasuhiro; Evans, Gary; Terebenina, Olga; Minou, Lina; Teeling, Claire; Basran, Jaskaran; Wood, Wendy; et al. (MDPI, 2021-01-28)
      Forest Bathing, where individuals use mindfulness to engage with nature, has been re-ported to increase heart rate variability and benefit wellbeing. To date, most Forest Bathing studies have been conducted in Asia. Accordingly, this paper reports the first pragmatic controlled trial of Forest Bathing in the United Kingdom, comparing Forest Bathing with a control comprising an es-tablished wellbeing intervention also known to increase heart rate variability called Compassion-ate Mind Training. Sixty-one university staff and students (50 females, 11 males) were allocated to (i) Forest Bathing, (ii) Compassionate Mind Training or (iii) Forest Bathing combined with Com-passionate Mind Training. Wellbeing and heart rate variability were measured at baseline, post-intervention and three-months follow-up. There were improvements in positive emotions, mood disturbance, rumination, nature connection and compassion and 57% of participants showed an increase in heart rate variability (RMSSD -parasympathetic activity). There were no significant differences between conditions, showing that Forest Bathing had an equivalence with an established wellbeing intervention. The findings will help healthcare providers and policy makers to understand the effects of Forest Bathing and implement it as a feasible social prescription to improve wellbeing. Future research needs to involve clinical populations and to assess the effects of Forest Bathing in a fully powered randomised controlled trial (RCT) .
    • The relationship between nature connectedness and eudaimonic well-being: A meta-analysis

      Pritchard, Alison; Richardson, Miles; Sheffield, David; McEwan, Kirsten; University of Derby (Elsevier, 2019-04-30)
      Nature connectedness relates to an individual’s subjective sense of their relationship with the natural world. A recent meta-analysis has found that people who are more connected to nature also tend to have higher levels of self-reported hedonic well-being; however, no reviews have focussed on nature connection and eudaimonic well-being. This meta-analysis was undertaken to explore the relationship of nature connection with eudaimonic well-being and to test the hypothesis that this relationship is stronger than that of nature connection and hedonic well-being. From 20 samples (n = 4758), a small significant effect size was found for the relationship of nature connection and eudaimonic well-being (r = 0.24); there was no significant difference between this and the effect size (from 30 samples n = 11638) for hedonic well-being (r = 0.20). Of the eudaimonic well-being subscales, personal growth had a moderate effect size which was significantly larger than the effect sizes for autonomy, purpose in life/meaning, self-acceptance, positive relations with others and environmental mastery, but not vitality. Thus, individuals who are more connected to nature tend to have greater eudaimonic well-being, and in particular have higher levels of self-reported personal growth.
    • The schwartz center rounds: supporting mental health workers with the emotional impact of their work.

      Allen, Deborah; Spencer, Graham; McEwan, Kirsten; Catarino, Francisca; Evans, Rachael; Crooks, Sarah; Gilbert, Paul; University Hospitals Derby & Burton NHS; Derbyshire Healthcare NHS Foundation Trust; University of Derby (Wiley, 2020-05-15)
      In healthcare settings there is an emotional cost to caring which can result in compassion-fatigue, burnout, secondary trauma and compromised patient care. Innovative workplace interventions such as the Schwartz Rounds offer a group reflective practice forum for clinical and non-clinical professionals to reflect on the emotional aspects of working in healthcare. Whilst the Rounds are established in medical health practice, this study presents an evaluation of the Rounds offered to mental health services. The Rounds were piloted amongst 150 mental health professionals for 6 months and evaluated using a mixed-methods approach with standardised evaluation forms completed after each Round and a focus group (n=9) at one-month follow-up. This paper also offers a unique six-year follow-up of the evaluation of the Rounds. Rounds were rated as helpful, insightful, relevant and at six years follow-up Rounds were still rated as valuable and viewed as embedded. Focus groups indicated that Rounds were valued because of the opportunity to express emotions (in particular negative emotions towards patients that conflict with the professional care-role), share experiences, and feel validated and supported by colleagues. The findings indicate that Schwartz Rounds offer a positive application in mental healthcare settings. The study supports the use of interventions which provide an ongoing forum in which to discuss emotions, develop emotional literacy, provide peer-support and set an intention for becoming a more compassionate organisation in which to work.
    • Searching compassion in a crowd: Evaluation of a novel compassion visual search task to reduce self-criticism

      McEwan, Kirsten; Dandeneau, Stephane; Gilbert, Paul; Maratos, Frances; Andrew, Lucy; Chotai, Shivani; Elander, James; University of Derby (ECronicon Open Access, 2019-04-15)
      Background: The ability to appropriately process social stimuli such as facial expressions is crucial to emotion regulation and the maintenance of supportive interpersonal relationships. Cognitive Bias Modification Tasks (CBMTs) are being investigated as potential interventions for those who struggle to appropriately process social stimuli. Aims: Two studies aimed to assess the effectiveness of a novel computerised ‘Compassion Game’ CBMT compared with a validated ‘Self-Esteem Game’ (Study 1, n=66) and a Neutral Control Game (Study 2, n=59). Method: In each study, baseline, post-task, and one-month follow-up measures of 3 self-reported forms of self-criticism (inadequate self, hated self, and self-reassurance) were used to examine the benefits of two weeks’ attentional training. Results: Analyses show that the novel Compassion Game significantly reduced inadequate self-criticism at post and one-month follow-up (Studies 1 and 2) and increased self-reassurance (Study 1). Results also show that the Self-Esteem (Study 1) and the Neutral Control Game (Study 2), which also used social stimuli, produced reductions in inadequate self-criticism. Conclusions: Results suggest that training one’s attention toward social stimuli can improve inadequate self-criticism. Implications for the use of compassionate stimuli in such CBMTs are discussed.
    • Shmapped: development of an app to record and promote the well-being benefits of noticing urban nature

      McEwan, Kirsten; Richardson, Miles; Brindley, Paul; Sheffield, David; Tait, Crawford; Johnson, Steve; Sutch, Hana; Ferguson, Fiona; University of Derby; University of Debry (Oxford Academic, 2019-03-05)
      The majority of research to date on the links between well-being and green spaces comes from cross-sectional studies. Shmapped is an app that allows for the collection of well-being and location data live in the field and acts as a novel dual data collection tool and well-being intervention, which prompts users to notice the good things about their surroundings. We describe the process of developing Shmapped from storyboarding, budgeting, and timescales; selecting a developer; drawing up data protection plans; and collaborating with developers and end-user testers to ultimately publishing Shmapped. The development process and end-user testing resulted in a highly functional app. Limitations and future uses of such novel dual data collection and intervention apps are discussed and recommendations are made for prospective developers and researchers.
    • A smartphone app for improving mental health through connecting with urban nature

      McEwan, Kirsten; Richardson, Miles; Sheffield, David; Ferguson, Fiona; Brindley, Paul; University of Sheffield; University of Derby (MDPI, 2019-09-12)
      In an increasingly urbanised world where mental health is currently in crisis, interventions to increase human engagement and connection with the natural environment are one of the fastest growing, most widely accessible, and cost-effective ways of improving human wellbeing. This study aimed to provide an evaluation of a smartphone app-based wellbeing intervention. In a randomised controlled trial study design, the app prompted 582 adults, including a subgroup of adults classified by baseline scores on the Recovering Quality of Life scale as having a common mental health problem (n = 148), to notice the good things about urban nature (intervention condition) or built spaces (active control). There were statistically significant and sustained improvements in wellbeing at one-month follow-up. Importantly, in the noticing urban nature condition, compared to a built space control, improvements in quality of life reached statistical significance for all adults and clinical significance for those classified as having a mental health difficulty. This improvement in wellbeing was partly explained by significant increases in nature connectedness and positive affect. This study provides the first controlled experimental evidence that noticing the good things about urban nature has strong clinical potential as a wellbeing intervention and social prescription.
    • Where the wild things are! Do urban green spaces with greater avian biodiversity promote more positive emotions in humans?

      Cameron, Ross; Brindley, Paul; Mears, Meagan; McEwan, Kirsten; Ferguson, Fiona; Sheffield, David; Jorgensen, Anna; Riley, J; Goodwick, J; Ballard, L; et al. (Elsevier, 2020-01-22)
      Urban green space can help mitigate the negative impacts of urban living and provide positive effects on citizens’ mood, health and well-being. Questions remain, however, as to whether all types of green space are equally beneficial, and if not, what landscape forms or key features optimise the desired benefits. For example, it has been cited that urban landscapes rich in wildlife (high biodiversity) may promote more positive emotions and enhance well-being. This research utilised a mobile phone App, employed to assess people’s emotions when they entered any one of 945 green spaces within the city of Sheffield, UK. Emotional responses were correlated to key traits of the individual green spaces, including levels of biodiversity the participant perceived around them. For a subsample of these green spaces, actual levels of biodiversity were assessed through avian and habitat surveys. Results demonstrated strong correlations between levels of avian biodiversity within a green space and human emotional response to that space. Respondents reported being happier in sites with greater avian biodiversity (p < 0.01, r = 0.78) and a greater variety of habitats (p < 0.02, r = 0.72). Relationships were strengthened when emotions were linked to perceptions of overall biodiversity (p < 0.001, r = 0.89). So, when participants thought the site was wildlife rich, they reported more positive emotions, even when actual avian biodiversity levels were not necessarily enhanced. The data strengthens the arguments that nature enhances well-being through positive affect, and that increased ‘engagement with nature’ may help support human health within urban environments. The results have strong implications for city planning with respect to the design, management and use of city green spaces.