ERA :: Home

ERA is a digital repository of original research produced at The University of Edinburgh. The archive contains documents written by, or affiliated with, academic authors, or units, based at Edinburgh that have sufficient quality to be collected and preserved by the Library, but which are not controlled by commercial publishers. Holdings include full-text digital doctoral theses, masters dissertations, project reports, briefing papers and out-of-print materials.

Information on current research activity including staff, projects and publications is available via the Edinburgh Research Explorer.

Now showing 1 - 40 of 41

Recent Submissions

Psychological support for post-viral fatigue: evidence from a systematic review and lived experiences of Long COVID using interpretative phenomenological analysis, a portfolio thesis
(The University of Edinburgh, 2026-05-26) Clark, Andrea; Brett, Caroline; Revell, Emily R.
Post-viral fatigue syndromes (PVFS), including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and Long Covid, are persistent conditions associated with substantial functional impairment and no definitive treatments. Psychological support has been one area of interest, but its role has been debated, particularly in relation to Cognitive Behavioural Therapy (CBT). This has led to growing interest in alternative approaches, such as ‘third-wave’ therapies. However, the evidence base for these approaches in PVFS has not previously been systematically reviewed. In addition, while psychological input is increasingly offered to people with Long Covid in the National Health Service (NHS), little is known about how such support is experienced by individuals with lived experience of PVFS. This thesis therefore aimed to advance understanding of psychological approaches to PVFS by: (1) systematically reviewing the evidence for third-wave therapies in this population and (2) qualitatively exploring how people with Long Covid experience one-to-one psychological or other mental health support within the NHS. The systematic review identified ten eligible studies (two randomised controlled trials [RCTs], two quasi-experimental, four pre–post, two case series) investigating interventions including acceptance and commitment therapy (ACT), mindfulness-based cognitive therapy (MBCT), and mindfulness-based stress reduction (MBSR). Findings indicated improvements in fatigue and quality of life in several studies, with large effect sizes in some studies and sustained gains at 3-12 month follow-up. Anxiety outcomes improved across most studies, whereas evidence for depression and mindfulness were less consistent. However, study quality was low to moderate, with small samples, heterogeneous designs and interventions, and limited fidelity checks, such as therapist competence. The review concluded that third wave therapies show preliminary promise but require further high-quality investigation. The empirical study adopted an Interpretative Phenomenological Analysis (IPA) approach to explore the lived experience of adults with Long Covid who had received one-to-one psychological or other mental health support. Semi-structured interviews were conducted with eight participants with a diagnosis of Long Covid. Analysis identified four themes. The first, The Weight of Waiting, described the emotional distress during the waiting period for accessing support. The second, Being Believed and Validated, captured the relief and significance of having symptoms acknowledged and taken seriously within therapeutic encounters. The third, Therapeutic Fit, reflected the importance of relational connection, collaboration, and flexibility in shaping whether support felt helpful or misaligned. The fourth, Grief, Adjustment and Acceptance, outlined how mental health support provided space to process losses associated with the impact of Long Covid on everyday life and to gradually adapt to life with ongoing symptoms. Findings highlighted the importance of responsive, person-centred support for individuals with Long Covid. Taken together, these studies contribute nuanced insights into the role of psychological support for individuals living with PVFS. Findings provide a preliminary indication that acceptance- and mindfulness-based approaches may benefit this population, while the lived experience research underscores the need for person-centred psychological interventions that are collaborative, validating, and responsive to the challenges of living with Long Covid. This thesis portfolio highlights the importance of integrating patient perspectives into service development and points toward clinical recommendations that prioritise evidence based, person-centred care.
Understanding the balance between osteogenesis and bone marrow adipogenesis in the aetiology of bone disease in experimental chronic kidney disease
(The University of Edinburgh. Royal (Dick) School of Veterinary Studies, 2026-05-26) Promruk, Worachet; Farquharson, Colin; Cawthorn, William; Stephen, Louise; Biotechnology and Biological Sciences Research Council (BBSRC); Chulabhorn Royal Academy
Chronic kidney disease–mineral and bone disorder (CKD-MBD) involves irreversible renal impairment that disrupts mineral balance and leads to skeletal complications collectively known as renal osteodystrophy (ROD). Increased bone marrow adipose tissue (BMAT) is a consistent feature in both patients and animal models of CKD, although its regulation remains unclear. Elevated levels of the Wnt signalling inhibitors sclerostin and dickkopf-1 (DKK1) have been implicated, as they suppress osteogenesis while promoting adipogenesis. This study examined the relationship between BMAT accumulation and bone structure in CKD, with a focus on whether disease progression alters bone marrow mesenchymal stromal cell (BMSC) fate commitment to osteogenic or adipogenic precursors and their subsequent differentiation into mature osteoblasts or adipocytes. I further examined the effects of CKD-related factors—including parathyroid hormone (PTH), fibroblast growth factor 23 (FGF23), phosphate, sclerostin, and indoxyl sulfate—on BMSC differentiation. Furthermore, I evaluated whether dual inhibition of sclerostin and DKK1 with a bispecific antibody could prevent bone loss and limit BMAT expansion in a CKD mouse model. Eight-week-old male C57BL/6J mice were fed a 0.2% adenine-supplemented diet for up to 5-weeks to induce CKD, while control mice received the same diet without adenine. CKD onset was confirmed by elevated plasma blood urea nitrogen, creatinine, PTH and FGF23 from week 3. After 5-weeks, trabecular bone mineral density and microarchitecture were significantly reduced, and cortical bone area and thickness declined as early as week 3. BMAT in the proximal tibia increased progressively, showing a significant rise by week 5 and was negatively correlated with trabecular bone volume. In early CKD (weeks 1–2), BMSCs exhibited greater adipogenic capacity, although the proportions of osteogenic and adipogenic progenitors were unchanged. In vitro, low doses of PTH enhanced osteogenesis, while indoxyl sulfate impaired both osteogenic and adipogenic differentiation; FGF23, phosphate, and sclerostin had no direct effects. Treatment with a bispecific antibody targeting sclerostin and DKK1 for 6-weeks improved trabecular and cortical bone parameters and prevented BMAT expansion in CKD mice. In summary, BMAT accumulation during CKD progresses with disease duration and is not driven by early changes in precursor populations. Systemic CKD factors may modulate stromal cell fate over time, and dual inhibition of sclerostin and DKK1 represents a potential therapeutic strategy for the maintenance of bone health in CKD-MBD.
Acknowledging the whole and the spaces in-between: uncovering mental colonialism through integrative holistic psychotherapy in Kuwait
(The University of Edinburgh, 2026-05-26) Al Rayes , Dima; De Andrade, Marisa; Ross, Anna
Psychotherapy has long been criticized for its lack of inclusivity, particularly among minority and marginalized populations, due to its reductionist biomedical methodologies and limited engagement with holistic approaches (Ali-Faisal, 2020; Barona & Santos Barona, 2003). This study explores the experiences of Kuwaiti healthcare practitioners with psychotherapeutic models examining how integrative, holistic practices can enhance inclusivity in therapeutic settings. Grounded in Participatory Action Research (PAR), six Kuwaiti practitioners, three psychotherapists and three yoga therapists, engaged in three iterative workshops that explored the holistic practices of breathwork, meditation, and bodywork, which are pertinent to Yoga Integrative Therapy (YIT). The collaborative workshops revealed significant tensions in participants' previous experiences with the psychotherapeutic paradigm, including its dominant construction of psychological normality and standardized approaches to care. Conversely, holistic practices, integrated through a person-centered, client-driven lens, were found to help develop an inclusive environment, underscoring the potential of integrative approaches to meet diverse needs. The research also uncovered a “silent narrative” that marked the persistent yet unspoken presence of colonialism, driven by epistemic injustice and mental colonization. Through PAR's responsive and fluid framework, the research acknowledged these silences as a form of epistemic presence, rather than absence. The study offers several recommendations for future research, asserting the importance of initiating more inquiries which will integrate decolonial and holistic approaches within psychotherapy with different demographics and contexts; expanding the current conceptualizations surrounding inclusiveness to include more nuanced definitions, perhaps exploring the notions of person-centeredness, client-drivenness, and holistic care; offering recommendations for practice and policy; and exploring the silent narrative of colonialism in relation to inclusive care.
How gender shapes the experience of training and working in Intensive Care Medicine in Scotland
(2026-05-26) Baruah, Rosaleen; Harden, Jeni; Lone, Nazir
Research into workforce planning undertaken by the Faculty of Intensive Care Medicine (FICM) has acknowledged that the United Kingdom (UK) Intensive Care Medicine (ICM) workforce gender balance is misaligned with the gender balance of UK medical graduates. Evidence from the United States of America, Canada and Australia and New Zealand suggest the gender imbalance in ICM may be driven by factors such as lack of work life balance, sexism, limited access to career development opportunities, lack of role models and valorising of stereotypically masculine traits. To date there is no qualitative research from within the UK examining gender and how it may shape the experiences of those working within the specialty. My thesis explores gender and how it shapes the experience of training and working within intensive care medicine in Scotland. For this study, I recruited thirty participants using a purposive recruitment strategy, informed by information power to determine the final number of participants. Eligible participants included specialty trainees in ICM, consultants and non-consultant career grade doctors from the 16 general ICUs in Scotland registered with FICM for training. I recruited a total of 15 consultants (six female) and 15 trainees (ten female). I conducted online one-to-one semi-structured interviews. Using reflexive thematic analysis, I iteratively analysed data from interview transcripts using an inductive approach guided by a subtle realist epistemology and ontology, informed by feminist research methods. I generated five themes and one subtheme from my data: Intensivists are super-heroic high achievers (but at a cost); The culture of ICM equates struggle with strength (with its subtheme A ‘New School’ culture could humanise ICM); Invisible barriers make the playing field look level; Women in ICM face a confidence and credibility deficit and Female intensivists have a hidden care burden. The overarching linking concept between all themes involves the archetype of the Old School intensivist, a personification of the masculine culture within ICM. Veneration of this archetype leads to the persistence of masculine medical hegemonic practices within ICM, including status homophily and banter culture favouring male career progression; testimonial injustice; gendered microaggressions in the form of microinvalidations and microinsults; benevolent sexism; and the need to engage in unseen emotional and cognitive labour, being experienced by women. Participant accounts described ways in which masculine medical hegemonic practices within ICM led to formation of a male ingroup and female outgroup. Female participants were subjected to frequent covert workplace discrimination but appeared unaware of the presence or nature of this discrimination, frequently attributing negative workplace experiences to personal or professional inadequacy. Male participants described being subject to rigorous policing of their emotional state, and felt unable to express personal or professional vulnerability by asking for help or admitting gaps in knowledge. The persistence of these hegemonic practices perpetuated the masculine culture of ICM, which in turn promoted the persistence of the hegemonic practices. An alternative New School archetype described by participants personified a culture less masculine than Old School culture. This archetype and the culture associated with it appeared close to participants own personal values, but was perceived to involve loss of status for the specialty and therefore likely to be resisted. I discuss the concepts of hermeneutical injustice and stigma as potential contributors to this resistance to cultural change. Initiatives at national and international level promoting recruitment and retention of female intensivists already exist. My findings suggest that an increase in the number of women entering ICM may not result in culture change. In order to promote positive culture change within ICM, a deeper understanding of the gendered culture of the specialty, the practices perpetuating this culture and the ways this impacts the experience of intensivists is needed. I propose formation of ‘Men in ICM’ initiatives alongside Women in ICM initiatives to give male intensivists knowledge and space to reflect on gender and how it shapes their experience of training and working in ICM. Setting up of such groups will require further exploratory work to assess the most effective ways of delivering such interventions.
Understanding self-control: the role of metacognitive beliefs and strategy use
(The University of Edinburgh. College of Humanities and Social Sciences, 2026-05-26) Bwalya, Anssi; Chevalier, Nicolas; Rabagliati, Hugh; School of Philosophy, Psychology, and Language Sciences (PPLS), University of Edinburgh: Doctoral College Scholarship
Self-control allows people to align their behaviour with intention in the face of a motivational conflict. Successful self-control predicts positive long-term outcomes in terms of career, health, and social relationships. Recent research highlights the role of metacognition in self-control performance. This dissertation examines people’s metacognitive beliefs about self-control, how these beliefs vary depending on individual characteristics, and how they relate to strategy use in everyday self-control situations and at the level of executive function (EF). In the first two studies, we find evidence that beliefs about the short-term limitedness versus long-term malleability of self-control are relatively independent of each other. Moreover, limitedness beliefs vary depending on the self-control domain. Our results thus support a multidimensional and domain-specific approach for measuring self-control beliefs. Next, we demonstrate that people’s beliefs about self-control depend on whose self-control they are thinking about. If people are told that a person has ADHD, they are more likely to view this person’s self-control is a limited resource and a fixed trait. Moreover, people with strong ADHD traits appear to view their own self-control as more limited and fixed. By contrast, we find no consistent association between people's self-control beliefs and their knowledge and use of different self-control strategies. In the last two studies, we further investigate metacognition and strategy use, focusing on specific EF subprocesses. Our findings suggest that the benefits of verbal strategies are not limited to information maintenance: verbal representations may also support the efficient updating of task-relevant information. However, contrary to our hypothesis, self-control beliefs were not associated with performance in an EF task. These results are discussed in relation to existing literature to propose an integrative framework of how metacognitive beliefs, EF, and strategy use interact to enable self-control.