Doctorate in Clinical Psychology

Thesis Abstracts 2012

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Clinical and Health Psychology Research

The University of Edinburgh / NHS Scotland Doctorate in Clinical Psychology is funded by NHS Education Scotland to provide professional training in clinical psychology.

Trainees undertake substantial thesis projects in a range of areas as part of this training. These booklets are intended to facilitate dissemination of findings from these projects, which we hope will also be communicated via presentations and publications. Interested readers are encouraged to contact authors of projects for further details.

We would like to congratulate all trainees who completed their thesis projects and wish them well in their chosen careers.

The DClinPsychol Programme Team

Note: Some abstracts presented in this booklet refer to projects concluded in 2011 that had not been included in previous abstract booklets

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Contents

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2011

Dianne J. Beastall Favourable results from predictive testing in Huntington’s Disease: 4 An exploration of the long-term impact on close relationshipsGillian Mackie Nursing staff attitudes to older people and dementia 5Claire Norfolk The neglected parental mental health problem? Borderline personality disorder: 6 a preliminary exploration of borderline mothers’ attributions of children’s behaviour

2012

Lesley A. Allan Insulin Pump Use in children with type 1 diabetes: An exploration of families’ experiences 8Alison C. Barron Attachment in psychological therapy: An exploratory study into patient and therapist 9 attachment patterns and their relationship with early engagement and therapeutic allianceLucy V. Clark An exploration of the role of attachment in the relationship between trauma and distress 10 in psychosisFleur-Michelle M Coiffait Cognitive factors and subjective wellbeing in parents who have children with profound 11 and multiple intellectual disabilityLinda Craig The impact of maternal psychological distress and parental bonding on mother- 12 adolescent agreement about emotional problemsLouisa M. Fraser The Role of Cognitive and Acceptance Components in Predicting Functional and 13 Emotional Adjustment to Chronic PainAnna Graham Psychological health of retirees in rural Scotland 14Leanne Gregory Early Maladaptive Schemas, and associates, in Youth: A quantitative investigation and 15 research portfolioMelissa Hanna Decision-making processes and experiences of older people using the Beating the 16 Blues computerised cognitive behavioural self-help programme: A qualitative studyDavid Huxtable Late-Life Depression: A Systematic Review of Meta-Analyses and a Meta-Analysis of 17 the Effect of Cognitive Behavioural Therapy in Older Adults with Co-Morbid Physical IllnessLucy M Johnson Life after stroke - What may affect recovery 18Joseph Judge The clinical practice of risk assessment of sexual violence 19Victoria Kinnear A review of interventions for informal dementia caregivers 20Renate Kuenssberg The association between the social and communication impairments and 21 repetitive/restricted interests and behaviours of ASD in a clinical sample: Does the triad still fit?Emma Lidstone An exploration of the relationship between interpersonal trauma in childhood and 22 wellbeing in the context of auditory hallucinations: testing for moderating effects of appraisals and coping

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Contents

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Margaret MacKay-Brownless Predictors of coping adaptiveness, and its role as a mediator in relationships 23 between general self-efficacy and mindfulness with psychological wellbeing Joanne MacLeod Computer-assisted cognitive remediation in patients with schizophrenia: effects on 24 symptoms, cognition and psychosocial functioningJenny E. Makinson Early Maladaptive Schemas and their relationship to psychopathology 25 in adolescenceJennifer Marrs Managing the self and other relationships: a father’s role when his partner and baby are 26 hospitalised in a perinatal mental health unit Kirsty Y. Matheson Emotional sequelae during and following hospital admission for diabetic ketoacidosis 27Douglas McConachie The use of an Acceptance and Mindfulness-based Stress Management Workshop 28 Intervention with support staff caring for individuals with intellectual disabilitiesEimear McKay An exploration of explicit and implicit emotion in adult survivors of childhood sexual abuse 29Paul S. McKenzie Chronic low back pain and insomnia: Understanding the experience and attributions 30 made by out-patients about sleeplessness, pain, and their interactionSarah McLaren The Development and Evaluation of a Mindfulness-Based Stress Reduction Self-Help 31 Intervention for Patients with Medically Unexplained SymptomsSuzanne Mills Maternal and infant factors influencing infant feeding - a longitudinal study 32Stuart J. Moulton Childhood trauma and eating psychopathology: A mediating role from dissociation and 33 emotion dysregulation?Kate O’Sullivan Investigating the specificity of neuropsychological performance in bulimic outpatients: 34 a comparison with anxious and depressed outpatientsAmber Saldias Deliberate self-harm in a clinical sample: the impact of schema modes, parental bonding 35 and perceived stressFaye Sullivan Exploring the close relationships of people with learning disabilities: A qualitative study 36Mary Swan Do attachment security, self esteem and emotional distress predict metabolic control and 38 quality of life in adolescents with Type 1 diabetes? Will ‘wellbeing’ text-messaging support improve outcomes?Isabel Traynor Motives for substance use in the presence of Post Traumatic Stress Disorder (PTSD): 40 a research portfolioCharlotte Williams Posttraumatic stress following childbirth and maternal perceptions of the mother-infant bond: 41 the role of attachment experiences and metacognitionSuzanne Wilson Mothers with a learning disability: their experiences of service provision during the 42 postnatal periodSilke L. Ziemen Burnout and Job Engagement in UK Cancer Care Staff: How do they relate to Job 43 Stress and Satisfaction and Turnover Intentions?

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2011

IntroductionHuntington’s Disease (HD) is a chronic neurodegenerative condition caused by a genetic mutation. HD is incurable and affects a person’s cognitive, behavioural, emotional and motor functioning. Symptoms typically develop around 30-45 years old with life expectancy approximately 15-20 years from onset. Children of an affected parent are at 50 percent risk of inheriting the disease, and those individuals who inherit the abnormal gene will eventually be affected by HD. The HD gene was discovered in1993 which resulted in a direct genetic test which could confirm the absence or presence of HD in at-risk individuals. There is a large amount of research into the psychological consequences of predictive testing, with more interest in those individuals who receive unfavourable test results. Less is known about those who receive favourable results and it has been suggested that those individuals do not always experience uncomplicated relief.

Research aimThe study aimed to explore how receiving a favourable result from predictive testing for HD can impact on close relationships in the long-term.

MethodologyA constructivist grounded theory approach was used to meet the aim of the study, generating data through in-depth interviews with 10 people who received favourable results from predictive testing for HD at least five years previously. The interviews were transcribed verbatim and analysed line-by-line using a series of coding procedures.

Favourable results from predictive testing in Huntington’s Disease: An exploration of the long-term impact on close relationships

Dianne J. BeastallClinical supervisor - Fionna Summers, Emma Hepburn Academic supervisor - Ethel Quayle

ResultsThe findings suggest that when people find out they are at risk of HD they face a journey into the unknown and have to try to manage the uncertainty related to living at risk. Making the decision to be tested ends this uncertainty and once people receive a favourable result from predictive testing for HD, they go through a process of trying to distance themselves from HD. Those who have close family members (siblings in particular) with HD or who are at risk of HD can find this process more challenging. Having a sense of duty to family members with HD explains some of the difficulties faced by the participants.

ConclusionsThe findings of this study could help raise awareness of the long-term issues and support needs affecting individuals who receive favourable results from genetic testing. Implications of the findings for clinical practice are discussed, and recommendations for research are made.

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2011

IntroductionDemographic trends indicate that the world’s population is ageing. Given the increased prevalence of chronic illness and dementia with advancing age, the proportion of patients with dementia in general hospital settings is also expected to increase. Research has suggested that nurses in general medical settings can often lack specialist training, both in the care of older people and in the management of patients with dementia, as well as holding negative attitudes towards this patient group, which can impact both on the quality of care provision and the wellbeing of care providers. This study aims to explore whether nursing staff attitudes towards older people with dementia, the illness of dementia and older people differ across psychiatric and general medical settings. Given that increased knowledge and contact can support the development of positive attitudes, it was proposed that psychiatric nursing staff, who tend to have more specialist knowledge about dementia and more frequent contact with this patient group, were likely to hold more positive attitudes than general medical staff.

MethodA qualitative methodology was used and a cross-sectional between-groups design was employed to compare the responses of nursing staff across psychiatric and general medical settings on a series of self-report questionnaires assessing attitudes to older people, older people with dementia, and the illness of dementia. Seventy three completed questionnaire packs were received (45 psychiatric; 28 general medical).

Nursing staff attitudes to older people and dementia

Gillian MackieClinical supervisor - Lindsey Murray Academic supervisor - Ken Laidlaw

ResultsNursing staff across the sample held positive attitudes towards both older people and older people with dementia; however, no significant difference in nursing staff attitudes between the psychiatric and general medical groups was reported. There was a significantly positive correlation between the attitudes nursing staff held about older people and older people with dementia across the whole sample. No significant difference was reported in nursing staff attitudes towards the illness of dementia between groups.

ConclusionsPositive attitudes towards older people and older people with dementia may be considered as reflecting the advent of a downturn in ageist attitudes in some respects; however, more research is needed to explore the manner with which such attitudes translate into practice, as well as the potential barriers to promoting positive views about older people in practice. The role of potential confounding variables in the lack of attitudinal variation between groups, such as the level of training and experience, also merits further investigation.

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The neglected parental mental health problem? Borderline personality disorder: a preliminary exploration of borderline mothers’ attributions of

children’s behaviour

Claire NorfolkClinical supervisor - Matthias Schwannauer Academic supervisor - Jill Cossar

IntroductionDespite the significant interpersonal difficulties experienced by individuals with borderline personality disorder (BPD) and the high family aggregation of BPD, the relationship between borderline parents and their children has been largely neglected. The unstable relationships of borderline individuals are characterised by alternating views of others as alternately ‘malevolent’ and ‘protective’. In experimental studies, the former representation dominates borderline individual’s view of other adults. However the preliminary findings of studies of borderline parents indicate that borderline mothers may view the child from an idealised frame of reference. Parental attributions are proposed to play a critical mediating or moderating role in relation to parents’ affect and behaviour. Exploring the nature of borderline parents’ attributions may, therefore, offer valuable insight into the potential pathways underlying the increased psychiatric risk posed to their children.

ObjectivesThis study aimed to explore the borderline parents’ child-centred attributions in relation to:

I. The degree of hostile intent attributed to ambiguous and negative child behaviour

II. The perceived balance of control in negative adult-child interactions

MethodNine mothers with a confirmed diagnosis of BPD and nine mothers with mild to moderate mental health difficulties without a diagnosis of BPD completed a parent report questionnaire, which included measures of parental attributions, maternal depression and children’s emotional and behavioural strengths and difficulties. Screening measures for personality disorder and psychological distress were also included, to exclude participants with potential Cluster B personality disorders or severe mental health difficulties from the control group.

ResultsNon-parametric Mann-Whitney U-tests indicated that, relative to mothers in the control group, borderline mothers attributed significantly less hostile intent and considered significantly lower levels of punishment in response to ambiguous or negative child behaviour. No significant differences emerged in relation to maternal attributions of the balance of control in negative adult-child interactions. Exploratory analysis clarified the potential role of maternal depression and emotional and behavioural difficulties of participants’ children in mediating or moderating these findings. All significant results were marked by large effect sizes.

ConclusionsThe findings in the present study are consistent with the picture that emerges from empirical studies of borderline mothers, where maternal behaviour is characterised

2011

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as helpless and frightened as opposed to hostile and frightening. The absence of attributions linked to parental abuse or hostile affect potentially call into question the assumptions of hostile and abusive parenting in borderline parents that dominate clinical texts, and may indicate different pathways to abuse in this population. The findings further pointed to the possibility of a permissive parenting style and an idealised representation of the child in borderline mothers, potentially offering new insights into the possible mechanism underlying the risk to children of borderline parents.

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2012

IntroductionThe management of type 1 diabetes through the use of Continuous Subcutaneous Insulin Infusion (CSII); also known as insulin pump therapy, has become an increasingly popular option for children and adolescents. A systematic review of studies that measured Quality of Life (QoL) in children associated with CSII was conducted. Eighteen studies were reviewed, and the results showed insufficient evidence to conclude that CSII improves QoL in children and adolescents with type 1 diabetes. The current study aimed to address the gap in the literature by exploring children and parents’ perspectives on the use of CSII for managing diabetes.

MethodData were gathered from five children aged 8 – 14 years (and five parents), using one to one semi-structured interviews. Interviews were recorded, transcribed and analysed using Interpretative Phenomenological Analysis (IPA).

ResultsFive super-ordinate themes were identified for parents: ‘Parenting a Child with Diabetes’; ‘Worth the Hard Work’; ‘Strive for Normality’; The Pump as an Enabler’; and ‘An eye on the Future’. Three Super-ordinate themes were identified for children ‘Feeling Different’; Grappling for Control’; and ‘Better…’ which were associated with a central theme of ‘Developing a Relationship with the

Insulin Pump Use in children with type 1 diabetes: An exploration of families’ experiences

Lesley A. AllanClinical supervisor - Vivien Swanson Academic supervisor - Emily Newman

Pump’. Children’s data is presented separately within a journal article format.

DiscussionFindings suggest that parents value the insulin pump, despite acknowledging the challenges, particularly the hard work required to manage it. Children seemed to have an ambivalent but developing relationship with the insulin pump. They experience a number of benefits and drawbacks associated with the use of CSII and it seems to affect their identity and their locus of control.

ConclusionThis research provides a greater insight into the lived experience of CSII for children and their parents. The benefits of CSII seemed to outweigh the challenges involved particularly for parents; and children seemed to be developing a relationship with the pump within the realms of their relationship with diabetes.

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IntroductionRecent research into attachment theory has suggested it provides a useful framework for understanding the psychotherapeutic process. Clinical application of attachment theory has been a recent development in adult mental health research. Previous studies have focused on patient attachment styles and a systematic review of the literature highlights the limited research that explores both patient and clinician attachment patterns. The reported study aims to explore both patient and therapist attachment and the dyadic interaction on the therapeutic process, and, in particular, how attachment influences the early engagement and development of the therapeutic alliance.

MethodsPatient participants and clinician participants completed a self-report measure of attachment prior to commencing a psychological intervention. Early engagement was measured through appointment attendance and independent therapeutic alliance ratings from patient and clinicians were completed after the third appointment. Correlations and regression analysis explored the extent to which patient and clinician attachment predicts early engagement and the therapeutic alliance.

ResultsFifty-five patients and 38 clinicians’ self-report attachment styles indicate greater security among clinicians. Patients presenting to mental health services reported higher

Attachment in psychological therapy: An exploratory study into patient and therapist attachment patterns and their relationship with early engagement

and therapeutic alliance

Alison C. BarronClinical supervisor - Fiona Barry Academic supervisor - Matthias Schwannauer

levels of anxious and avoidant attachment patterns, which were predictive of greater psychological distress. Patient avoidant attachment was associated with poor engagement and both patient anxiety and avoidance attachment were predictive of therapeutic alliance. No relationship was found between therapist attachment and early engagement or therapeutic alliance, and there were no significant interactions between patient and therapist attachment patterns.

ConclusionsFindings from the current study suggest that patient attachment style is predictive of reported psychological distress, early engagement and therapeutic alliance. Applying the principles of attachment theory to clinical practice could therefore provide greater insight into the interpersonal dynamics between patient and therapist and help inform services as to how to improve engagement and alliance with insecure patients. The strengths and weaknesses of the study are discussed, which highlights the need for further research with larger samples to build on the current limited findings.

2012

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2012

An exploration of the role of attachment in the relationship between trauma and distress in psychosis

Lucy V. ClarkClinical supervisor - Amy McArthur Academic supervisor - Matthias Schwannauer

IntroductionAttachment literature indicates attachment status is related to trauma with associations between early trauma and insecure attachment. Links between psychosis and trauma have been established within the literature; however the precise nature of this relationship is still not fully understood. A systematic review was carried out to assess the state of the evidence pertaining to psychosis and attachment. Associations between insecure attachment and psychotic symptoms were identified. Other psychological correlates such as perceived parental care, attachment to services and interpersonal problems were found to relate to insecure attachment status. However due to the early stage of this area of research, small clinical sample sizes and heterogeneity of correlates investigated, firm conclusions cannot currently be drawn.

AimThe aim of this study was to investigate the relationship between trauma, attachment, reflective functioning (RF) and distress for people with psychosis with a view to further understanding these links and the clinical implications.

MethodParticipants with a diagnosis of psychosis were recruited and measures were completed with the principle investigator pertaining to trauma, attachment and distress in psychosis.

ResultsThe majority of the sample reported insecure attachment and low RF and there were high levels of general, and more specifically, interpersonal trauma within the sample. Results indicated that early interpersonal trauma was associated with higher levels of emotional distress. Exploratory mediation analyses implicated anxious attachment in mediating the relationship between interpersonal trauma and distress.

DiscussionThe results indicate the need to consider early trauma histories and specifically interpersonal trauma and attachment in the context of emotional distress for people experiencing psychosis. Incorporating trauma and attachment based therapeutic approaches for people with psychosis is as relevant as it is for other trauma populations, where these approaches may be more routinely drawn on for formulation and treatment. Limitations of the methodological approach are considered along with suggestions for future research.

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2012

AimsThe aims of this thesis were twofold. First, to review the literature on parental locus of control and its role in psychological outcomes for parents who have a child with an intellectual disability (ID). Second, a research study aimed to explore levels of parental subjective wellbeing in a specific group of these parents: those who have a child with profound and multiple intellectual disabilities (PMID), More specifically, whether two different types of parental cognition, parental locus of control and recognition of positive gains of having a child with PMID, were predictive of parental subjective wellbeing.

MethodA systematic review of the literature was conducted to address the first aim. For the research study, a single sample of parents and family caregivers (n=101) completed three quantitative self-report questionnaires as part of a within-participant, cross-sectional survey design. These included the Positive Gain Scale, a modified version of the Parental Locus of Control Scale, and the Warwick-Edinburgh Mental Wellbeing Scale.

ResultsThe systematic review highlighted the influence of parental locus of control and other parental cognitions on parent and family psychological outcomes. The research study revealed that parental subjective wellbeing in this group of parents (N=101) was lower than in the general population. Multiple regression analysis revealed that

Cognitive factors and subjective wellbeing in parents who have children with profound and multiple intellectual disability

Fleur-Michelle M CoiffaitClinical supervisor - Helen Downie Academic supervisor - Karen McKenzie

parental locus of control significantly predicted parental subjective wellbeing (=.279, t (2,99)=9.149, p=.005), accounting for around 8% of the variance in WEMWBS scores, R2=.081, F(2,99)=5.474, p=.006.

Conclusions and ImplicationsAlthough the systematic review and the research study highlighted the importance of parental locus of control for parents with children with ID, the results of the study suggest that other factors are also involved in influencing subjective wellbeing of parents of children with PMID. They also indicate a potential role for psychological intervention for parents and families with a focus on adjusting beliefs and expectations and promoting an internal locus of control. However, further research exploring the emotions and experiences of this group of parents is needed.

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2012

AimsTo explore the impact of parent psychological distress and parental bonding on agreement between informants about adolescent emotional functioning.

MethodsThe study employed an observational design in which 87 pairs of mothers and their adolescent sons and daughters aged 12-17 completed proxy- and self-report ratings on the Strengths and Difficulties Questionnaire. Mothers also completed the Depression, Anxiety and Stress scale as a measure of their own psychological distress, and adolescent completed the Parental Bonding Instrument as a measure of their parenting experience. Moderation analyses using multiple linear regression were used to assess whether the association between maternal psychological distress and mother-adolescent agreement changed as a factor of parental bonding.

ResultsKappa values indicated that mother-adolescent agreement was ‘fair’ for emotional problems. Mothers’ psychological distress and sub-optimal parenting were both associated with greater reporting discrepancies. Maternal psychological distress and perceived maternal distress were unique and combined predictors of reporting discrepancies. Perceived care moderated the relationship between maternal distress and agreement such that when care was rated as low, higher levels of maternal distress predicted poor agreement, but when

The impact of maternal psychological distress and parental bonding on mother-adolescent agreement about emotional problems

Linda CraigAcademic supervisor - Jill Cossar

care was rated as high no significant relationship was found between distress and agreement.

ConclusionsIncreased mother-adolescent agreement was associated with lower maternal psychological distress and higher ratings of perceived care. The effect of psychological distress on informant agreement varied as a factor of perceived maternal care. Results of this study support the need for multi-informant assessment and suggests that enquiry about mothers’ own psychological functioning could facilitate accurate assessment and intervention for adolescents who present at psychology services.

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2012

IntroductionThe current literature highlights the significant role of psychological factors including cognitive (pain related thoughts and beliefs) and acceptance components (pain willingness, activity engagement, psychological inflexibility) in the management of chronic pain. The research is however in the preliminary stages in terms of investigating the specific relationships that exist between these psychological processes in their ability to predict adjustment to pain. This study aims to extend the current findings by investigating the relationships between several cognitive and acceptance components in their ability to predict emotional and physical adjustment in the context of chronic pain. The hypotheses that cognitive and acceptance components mediate the relationship between pain severity and pain adjustment, and also that acceptance mediates the relationship between cognitive components and pain adjustment will be tested.

MethodThe study employed a cross-sectional survey-based design, including 214 chronic pain patients recruited from an NHS pain clinic. Participants completed a series of self-report questionnaires measuring pain severity, fear of movement beliefs, pain self-efficacy beliefs, pain catastrophising, acceptance and psychological flexibility, pain disability, and depression and anxiety. Structural Equation Modeling was used in order to conduct path analyses, investigating the complex relationships between these variables in predicting physical and emotional adjustment to chronic pain.

The Role of Cognitive and Acceptance Components in Predicting Functional and Emotional Adjustment to Chronic Pain

Louisa M. FraserClinical supervisor - Gill MacLeod Academic supervisors - David Gillanders, Matthias Schwannauer

ResultsThe results from a Confirmatory Factor Analysis indicated that a three factor model comprising pain, cognitive and acceptance components as separate latent variables had a poor fit and therefore could not be used in further analysis. The results of path analyses showed that pain self-efficacy was the only variable to have a strong mediating influence between pain and physical adjustment. Findings also supported a nested path model demonstrating that acceptance, catastrophising and self-efficacy were mediators between pain and emotional adjustment, and that acceptance was also a mediator for pain catastrophising and a partial mediator for pain self-efficacy in their relationship with emotional adjustment.

ConclusionsThe importance of pain self-efficacy specifically in predicting physical adjustment to pain is highlighted. A more complex model however is required to explain emotional adjustment, with acceptance playing a more prominent role in comparison with other variables. The findings also provide support for both Cognitive and Acceptance-based interventions in improving adjustment to living with chronic pain. Given the preliminary nature of these findings, further research employing similar statistical methods are required to provide further support.

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2012

IntroductionIn order to aid effective assessment and detection of psychological health, a clear understanding of the risk factors for disturbance is required. This study was undertaken to test the hypothesis that demographic factors, health factors, social factors, attitudes to ageing, number of life events in the last year and relocation status would each significantly account for, and contribute to, the variance in psychological health.

MethodThe study employed a cross-sectional design in which 1,080 individuals over the age of 55 were randomly drawn from the community health index (CHI) of a rural health board in Scotland and invited to participate in the study. One hundred and ninety six respondents completed the questionnaires assessing psychological health and a range of potential predictors.

ResultsOverall, negative attitudes to ageing were the most prominent predictors of poor psychological health. Psychosocial loss was the only variable found to be a predictor of all seven outcome variables, including anxiety and depression, physical, psychological, social and environmental quality of life, and general psychological and social functioning. Other predictors included a higher number of life events, poor social support from friends, poor self-rated health and not having a spouse/partner.

Psychological health of retirees in rural Scotland

Anna GrahamClinical supervisor - John Higgon Academic supervisor - Ken Laidlaw

ConclusionsAttitudes to ageing appear to play a significant role in the psychological health of older adults. Promoting positive perceptions of ageing in society may potentially pay dividends in prevention of emotional distress in later life. Psychological interventions, such as cognitive behavioural therapy (CBT), may be key to addressing negative attitudes to ageing at an individual level.

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2012

IntroductionThis research investigated Young’s (1994) early maladaptive schemas (EMS) in a non-clinical adolescent population. EMS are self-defeating cognitive and emotional patterns, which are associated with poor outcomes. There are 18 different clinically observed EMS across five thematically different domains according to Young and his colleagues, which are most often researched in adults. The relationship between EMS and various theoretical associates: perceived parenting; neglect; bullying; attachment; and, personality factors was explored.

Systematic ReviewFirstly, a systematic review of the literature related to EMS and these associates in both adult and adolescent non-clinical populations was conducted. The review included 10 studies. Variables related to detrimental parenting, insecure attachment, emotionally unstable personality, and multiple forms of childhood maltreatment were important. Several conclusions were made based on the synthesis of these findings: that observed relationships supported the schema model; that EMS were often the mechanism via which adversity led to poor outcome; that EMS warrant further research, and are highly important treatment targets in clinical settings.

Early Maladaptive Schemas, and associates, in Youth: A quantitative investigation and research portfolio

Leanne GregoryClinical supervisor - Louise Cumbley Academic supervisor - Jill Cossar

Empirical paperThe second part of the research was a cross-sectional study with 181 adolescent participants. A series of regression analyses investigated the impact of perceived parenting, attachment, neglect and personality on total and different sub-domains of EMS. Results indicated that anxious or rejecting parenting, neglect, bullying, insecure attachment and emotional instability were significantly associated with EMS. The experience of bullying was associated with higher levels of EMS. Different domains of EMS were predicted by different combinations of predictor variables.

ConclusionThese findings were in line with Schema Theory and highlighted the importance of further research and clinical emphasis on EMS in youth.

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2012

Introduction Current recommendations by National Institute of Clinical Excellence (Technology Appraisal 51) emphasise the need for future research to examine the effectiveness of CCBT across the age span. Kaltenthaler et al. (2008) recommended future research focuses on acceptability of CCBT through using ‘survey and intensive qualitative methods, include the process of initial engagement, continuation versus drop-out, and in those completing, satisfaction or regret undertaking CCBT’ (p.1528). The pilot study by McMurchie (2011) was the first to explore the acceptability and effectiveness of the CCBT package Beating the Blues (BTB) solely with older people. Using qualitative methodology, the aim of the current study was to explore the experiences of older people who, when participating in the pilot study chose to use BTB compared to those who chose to remain with their treatment as usual (TAU). The current study aimed to gain a deeper understanding of the acceptability of BTB as well as factors that influence decision-making in terms of uptake to BTB and discontinuation from BTB.

MethodIndividual semi-structured interviews were carried out with 20 older people who took part in the pilot study (McMurchie, 2011). Participants were in one of three groups, these were: BTB-completers, BTB-discontinuers and TAU. Transcripts were analysed using Interpretative Phenomenological Analysis (IPA) (Smith et al., 2009).

Decision-making processes and experiences of older people using the Beating the Blues computerised cognitive behavioural self-help

programme: A qualitative study

Melissa HannaClinical supervisors - Fiona Macleod, Kevin Power Academic supervisor - Ken Laidlaw

ResultsFive master themes emerged from the interviews: Beating the Blues as a Process of Change; Relevance of Beating the Blues to Older People; Challenges of Using Beating the Blues; Motivation to Try Something New and Barriers to Beating the Blues at Time of Uptake.

ConclusionsOverall, the master themes reflected the experiences of either “regaining control” or a sense of “hopelessness” when opting whether or not to use BTB in the first instance and to then continue with the treatment. Experiences of using BTB appeared to be linked to the outlook participants had about using a novel treatment with either a sense of hope or impending failure. Participants who chose BTB and had a more positive outlook felt more able to manage perceived challenges and work towards recovery. The sense of impending failure seemed to be linked to participants perceiving more barriers to using BTB and struggling to overcome these challenges, resulting in them either declining BTB or feeling they were not benefiting from BTB and therefore discontinuing it.

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2012

AimsTo examine the efficacy of CBT for late-life depression in older adults with co-morbid physical illness and to review what has been revealed by meta-analytic studies with regards moderators of treatment in psychological approaches for late-life depression.

MethodSystematic literature search and meta-analysis of randomised controlled trials (RCT) evaluating CBT for depression in older adults with co-morbid physical illness and systematic review of meta-analyses examining psychological therapies for late-life depression.

ResultsNine papers met inclusion criteria for meta-analysis. CBT was superior to waiting list and treatment as usual control conditions, showing a statistically significant pooled standardised mean difference (SMD) of 0.63 (95 per cent CI, 0.29 to 0.97, p = 0.0003). This was largely maintained at follow up (SMD 0.5, 95 per cent CI, 0.08 to 0.92). Sensitivity analysis showed individual CBT yielded a large, statistically significant summary effect size of 0.80 (95 per cent CI, 0.45 to 1.16), but that group CBT did not show statistical superiority over controls. Clinician-rated measures of depression yielded larger effect sizes, with a SMD of 1.57 (95 per cent CI, 0.56 to 2.59, p = 0.002) as compared with patient-rated measures: 1.03 (95 per cent CI, 0.75 to 1.31, p = 0.0001).

Late-Life Depression: A Systematic Review of Meta-Analyses and a Meta-Analysis of the Effect of Cognitive Behavioural Therapy in Older

Adults with Co-Morbid Physical Illness

David HuxtableClinical supervisor - Angus Lorimer Academic supervisor - Ken Laidlaw Contributor - Claudia Coelho

Fourteen meta-analyses met inclusion criteria for systematic review. More recent publication was significantly correlated with increased reporting quality and reduced analysis of moderating factors. Duration of treatment, treatment setting and gender of participants showed no moderating impact on outcome.

Depression severity, participant age, treatment modality, and study quality showed no consistent relationship with outcomes. Active or placebo controls were associated with reduced effect sizes when compared with no treatment or waiting list controls. Patient-rated outcome measures were associated with reduced effect sizes as compared with clinician-rated measures.

ConclusionsWhen compared with treatment as usual and waiting list controls Individual CBT is effective in reducing depressive symptoms for depressed older adults with an underlying physical illness. Meta-analytic studies of late-life depression show variable results regarding moderators of treatment efficacy. More high quality studies examining the effectiveness of psychological therapies are needed with clinically representative older populations, particularly, the older-old and those with co-morbid physical illnesses.

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2012

AimsThis projects attempts to gain an understanding of the role that perceptions and attitudes to ageing play in the recovery process after stroke.

Systematic ReviewFirstly, a systematic review establishes the current opinion within the literature, and how perceived quality of life and depression interplay during the stroke recovery process. Whilst a relationship is apparent in the literature, the direction of causality remained unclear, in addition to many contributing factors possibly adding the interaction. The reader is introduced to the wider context of stroke, looking at the consequences of stroke and the adjustment process. Whilst older adults add a complexity to formulation and clinical work, they are also the predominant age group who experience stroke. Therefore, the role of the ageing process is introduced, in light of the current literature around stroke and recovery.

Empirical paperA journal article then examines the role of attitudes towards ageing and perceptions of quality of life, in older adults after stroke. The relationship between attitudes and perceptions is explored, in relation to depressive symptoms in the sample recruited; using a questionnaire based cross sectional design. The questionnaires used were the Attitudes to Ageing Questionnaire (AAQ), the World Health Organisation Quality of Life, version for Older adults (WHOQOL-Old) assessment and the

Life after stroke - What may affect recovery

Lucy M JohnsonClinical supervisor - Campbell Culley Academic supervisor - Mick Power

New Multidimensional Depression Scale (NMDS). A correlational analysis revealed that positive attitudes toward ageing were associated with greater levels of perceived quality of life, and that both were negatively associated with depression.

ConclusionsThe findings are discussed in the context of ageing literature and incorporating aspects of loss, in an effort to understand how perceptions and attitudes may be protective factors in the journey of recovery from stroke.

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2012

Introduction Risk assessment of sexual violence involves evidence based evaluation of the risks posed by sexual offenders. It informs risk management; the provision of treatment that reduces the risk of future sexual violence. Previous research has focused on assessment of the predictive accuracy of different risk assessment tools, as well as the identification of risk factors that are associated with recidivism. In contrast, the clinical practice of risk assessment is a research area that has been neglected. The aim of this thesis was to explore the practice of risk assessment in a specialist sex offender liaison service (SOLS). Particular attention was paid to the structured professional judgement method of risk assessment.

MethodA systematic review of the literature identified psychological factors associated with sexual recidivism in adult male offenders. Study 1 employed a cohort quantitative design and aimed to ascertain whether risk judgements made by the SOLS were predicted by factors that were identified by the systematic review (and previously existing meta-analyses) as being evidence based. Ordinal logistic regression and linear regression analyses (N=96) were used to investigate the hypothesised predictive associations between variables. Study 2 utilised a qualitative framework analysis (N=31) and aimed to explore the views of users of SOLS risk assessments with respect to their practical utility.

The clinical practice of risk assessment of sexual violence

Joseph JudgeClinical supervisors - Katherine Russel, Rajan Darjee Academic supervisors - Ethel Quayle, Suzanne O’Rourke

ResultsThe systematic review suggested that psychopathy and sexual deviance were supported as risk factors for sexual recidivism. Inconsistent results were found with respect to denial. Study 1 found that psychopathy, denial, and sexual preoccupation were significantly associated with risk judgement score made by the SOLS, while sexual deviance, and problems with intimate relationships, were not. The best explanatory model accounted for only 40 % of the variance in risk judgement score. Study 2 revealed five major themes: informing risk management; confirming what was known and giving weight; understanding personality; treatment; and the usefulness and limitations of risk assessment.

ConclusionsResults indicated that SOLS risk judgement scores were significantly associated with the evidence based risk factors; psychopathy and sexual preoccupation. However, a substantial proportion of the variance in risk judgement score was unexplained. The SOLS risk assessments were considered by users to be practical and had informed risk management. Strengths and limitations of the research are discussed and implications for clinical practice and future research are suggested.

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2012

AimsThis review evaluates the impact of intervention studies for informal dementia caregivers.

MethodsMeta-analytic methods were used to integrate the findings of 14 intervention studies evaluating cognitive behavioural therapy (CBT) for caregivers. Meta-regression and analysis of variance were used to evaluate the impact of caregiver and intervention characteristics on the outcomes.

ResultsSignificant effect sizes were found for the impact of CBT on depression, burden, and mental health difficulties, g*= -0.55, 95%CI [-0.92, -0.19], g*= -0.37, 95%CI [-0.57, -0.17], and g*=-0.54, 95%CI [-0.78, -0.30], respectively. CBT facilitated more adaptive coping, with significant effects on caregiver adaptive coping and dysfunctional thoughts, g*= 0.48, 95%CI [0.02, 0.24] and g*=-1.33, 95%CI [-2.22, -0.44]. The impact of CBT on caregiver outcomes was associated with the nature of the study control condition, and the intervention delivery, timing and specificity to dementia type. Caregiver ethnicity and gender were not predictive of the CBT outcome.

Victoria Kinnear

A review of interventions for informal dementia caregivers

Academic supervisor - Ken Laidlaw

ImplicationsOverall, caregiver interventions are efficacious in alleviating caregiver distress and facilitating more adaptive coping responses, with prominent effect established for CBT. Future research needs to consider CBT as part of multi-intervention approaches tailored to the needs of caregivers across the disease progression. Further improvements are needed, with greater consideration of the impact of the interventions design in alleviating caregiver distress.

21

IntroductionAutism Spectrum Disorder (ASD) is a behaviourally defined disorder characterised by impairments in three domains of social interaction, communication, and repetitive/restricted interests and behaviours ((DSM-IV-TR; APA, 2000; ICD-10; WHO, 1992). Recent research suggests that this diagnostic triad may no longer fit as the best way to conceptualise ASD. Although not due for publication until 2013, a proposed revision of autistic disorder for DSM-V has merged three domains into two; i) Social/communication deficits and ii) Fixated interests and repetitive behaviours (APA, 2010). The aim of this study was to examine the structure of ASD symptom domains within the Adult Asperger Assessment (AAA; Baron-Cohen et al., 2005) and one of its subscales, the autism-spectrum quotient (AQ; Baron-Cohen et al., 2001; AQ-Short; Hoekstra et al., 2011).

MethodConfirmatory factor analysis was used to examine data from a clinical population of adults diagnosed with Asperger Syndrome (AS) and High Functioning Autism (HFA).

ResultsAnalysis suggested that none of the theoretically-driven models were a good fit on the AAA or AQ data. However, it did highlight high correlations between social and communication factors (r > 0.9) within unmodified models.

The association between the social and communication impairments and repetitive/restricted interests and behaviours of ASD in a clinical sample:

Does the triad still fit?

Renate KuenssbergClinical supervisor - Jill Jones Academic supervisor - Karen McKenzie

DiscussionThe results of the analysis provide tentative support for the move towards considering ASD as a dyad of social-communication impairments and repetitive/restricted interests and behaviours, rather than the traditional triad. The validity of the AAA as a diagnostic tool is discussed, as well as limitations and suggestions for future research.

ConclusionIt seems likely that continuing to rely on the triad of impairments may mean clinicians are assessing the same symptom in social and communication deficits. Within the limitations of this study, support is given for moving towards the proposed DSM-V dyad. Understanding the structure of autism symptoms can improve diagnostic and classification systems, and could also further studies of the genetic and neurobiological bases of ASD.

2012

22

2012

IntroductionThe first aim of this thesis was to systematically review the evidence for the impact of interpersonal trauma in childhood on appraisals of auditory hallucinations in adulthood. Informed by this systematic review and cognitive models of psychosis, potential moderators of the relationship between trauma and distress were proposed.

HypothesesIt was hypothesised that the experience of interpersonal trauma in childhood would predict ‘self blaming’ and ‘danger to self’ appraisals made by voice hearers about their auditory hallucinations. It was predicted that these appraisals would interact with the use of avoidant and non avoidant coping strategies and that this would predict wellbeing.

Method 1 and resultsIn order to measure voice appraisals, the Interpretation of Voices Inventory was adapted. It was completed by one hundred and thirteen voice hearing participants and confirmatory factor analysis was used to test the predicted factors. Most items covaried with their respective factors acceptably. A number of items did not load well and it was recommended that they be removed from the measure. The amended factor structure improved the fit of the measure to an acceptable standard.

An exploration of the relationship between interpersonal trauma in childhood and wellbeing in the context of auditory hallucinations: testing

for moderating effects of appraisals and coping

Emma LidstoneClinical supervisor - Donna Paxton Academic supervisor - Matthias Schwannauer

Method 2 and resultsSixty two participants completed additional measures of interpersonal trauma in childhood and wellbeing. Structural equation modelling provided support for a link between severity of childhood trauma and ‘danger to self’ appraisals. ‘Danger to self’ appraisals predicted the use of acceptance based coping and this predicted wellbeing. Independent of this model, interpersonal coping was shown to predict the use of psychological explanations for the experience of auditory hallucinations. Psychological explanations did not predict acceptance or wellbeing.

DiscussionIt may be clinically helpful to test acceptance based interventions using ‘danger to self’ appraisals as an outcome measure in the future. Possible factors that may have influenced the results were reflected on. The potentially negative impact of insight on wellbeing was discussed. Stigma was highlighted as a potential barrier to non avoidant coping.

23

2012

Predictors of coping adaptiveness, and its role as a mediator in relationships between general self-efficacy and mindfulness with psychological wellbeing

Margaret MacKay-BrownlessClinical supervisor - Anna Wroblewska Academic supervisor - David Gillanders

distress, and positively with psychological wellbeing, and that coping adaptiveness mediates the proposed predictive relationships between general self-efficacy and mindfulness with psychological wellbeing.

MethodIn a cross-sectional design 37 participants from a primary care adult clinical population, experiencing a variety of stress and mood related difficulties (study 1), and 159 undergraduate students and nonclinical associates of the researcher (study2) took part in this study, by completing standardised questionnaires.

ResultsThe results of correlational analysis broadly supported associations in the theoretically predicted directions, and meditational analysis in study 2 suggested a significant mediation effect of coping adaptiveness in the relationship between mindfulness and psychological wellbeing, and general self-efficacy and psychological wellbeing in the nonclinical sample.

ConclusionResults from both studies are discussed in relation to methodological, theoretical and clinical implications.

IntroductionThe ways in which individuals cope with stress has been the subject of much psychological research. Traditionally, coping has been understood as either a disposition, implying stability of individual coping style across situations, or as a process involving individual appraisal of situations and resources, leading to use of a variety of coping strategies. There is considerable evidence of maladaptive psychological and physical health outcomes in relation to different coping styles. More recent research suggests that flexibility in choice of coping responses may be more adaptive than any particular style or strategy. The concept of coping adaptiveness, as measured by the Personal Functioning Inventory (PFI), is a relatively recent addition to the stress and coping literature. It emphasises the importance of accurate judgement of the controllability of the stressor in the coping process, as well as sufficient determination and self-control to ensure the most adaptive coping response when faced with obstacles or pressures to respond otherwise. The concept of discriminative facility has been shown to be a useful predictor of individual appraisal of controllability, and in the absence of scales designed specifically to measure determination and self-control, it is proposed in the present study that discriminative facility, general self-efficacy (which may be similar or related to determination), and mindfulness (which may help an individual have greater control over their responses), may be related to coping adaptiveness. Further predictions are that coping adaptiveness is negatively related to psychological

24

2012

IntroductionCognitive remediation is a behavioural intervention that aims to improve cognitive functioning with the goal of durability and generalisation. Although evidence suggests that computer-assisted cognitive remediation (CACR) improves cognitive functioning in individuals with schizophrenia, it remains unclear whether these effects generalise and lead to improvements in clinical symptoms and psychosocial functioning. The current study aimed to investigate the effects of CACR on clinical symptoms, cognitive functioning and psychosocial functioning in individuals with schizophrenia or schizoaffective disorder.

MethodA systematic review was performed using the quality assessment criteria defined by the Scottish Intercollegiate Guidelines Network (SIGN 50) to investigate the effects of CACR on clinical symptoms in individuals with a diagnosis of schizophrenia or schizoaffective disorder. Additionally, a within subjects repeated measures design was used to investigate the effects of CACR on cognitive functioning, functional capacity and everyday social functioning.

ResultsThere was some evidence to suggest that CACR improves clinical symptoms, but the majority of studies reviewed did not report a significant effect, and a number of methodological weaknesses were identified in the literature. Results of the experimental study revealed improvements in speed of processing, reasoning and

Clinical supervisor - Tim Delahunty Academic supervisor - Suzanne O’Rourke

Joanne MacLeod

Computer-assisted cognitive remediation in patients with schizophrenia: effects on symptoms, cognition and psychosocial functioning

problem solving and the overall composite score for cognition, but these improvements could not be attributed solely to the CACR intervention. No improvements in functional capacity or everyday social functioning were observed.

ConclusionsFurther, more rigorous research is required to develop a clearer understanding of the effects of CACR on clinical symptoms. The results of the experimental study support previous literature which has identified that a pure CACR intervention does not improve psychosocial functioning. The results are discussed in relation to the relevant literature.

25

2012

IntroductionSchema therapy was developed by Jeffrey Young to treat adults with personality disorders, and has been evidenced to be effective in treating both Axis I and Axis II disorders. While Young stipulates that schemas are likely to be in place by adolescence, there is currently little agreement over the appropriateness of schema theory and therapy in understanding and treating psychopathology in adolescence. This thesis aims to explore the evidence-base and potential utility of applying schema theory to adolescent psychopathology, and consists of a systematic review and research article.

Systematic ReviewThe review included published studies measuring Early Maladaptive Schemas (EMS) in 12 to 18 year olds, including those exploring relationships between EMS and psychopathology. The search (1990 to 2012) yielded 19 articles for review, which were then subjected to assessment of methodological quality. Most studies were assessed as ‘moderate’ in quality. Good quality evidence was found for the detection of higher rates of EMS in clinical or referred adolescent populations compared to non-clinical populations, as well as some evidence for effects of age and gender on EMS. Less consistent evidence was found for specific associations between individual EMS or domains and particular types of psychopathology or problem behaviour. Common limitations of the articles reviewed included poor control of confounding variables and little testing of EMS alongside contextual constructs to provide validation of findings.

Early Maladaptive Schemas and their relationship to psychopathology in adolescence

Jenny E. MakinsonClinical supervisor - Rachael Smith Academic supervisor - Matthias Schwannauer

Empirical paperA quantitative, questionnaire-based cross-sectional design was used to test the dimensionality of the schema concept in a population of 12 to 18 year-olds, comparing levels of EMS between a referred and a non-referred group. EMS were measured alongside attachment and interpersonal behaviours to test their unique predictive effect on psychopathology. Specific relationships between individual groups of EMS and type of psychopathology were also explored. Results showed that the referred group scored significantly higher than the non-referred group on overall schema score. Schemas were found to significantly predict level of psychopathology, over and above prediction by attachment or interpersonal behaviour scores. There was also evidence for the specific prediction of internalising and externalising problem behaviour, affective, anxiety, oppositional-defiant and conduct problems by clusters of EMS.

ConclusionEMS appears to be a valid concept in predicting and understanding psychopathology in adolescence. A conceptual model is suggested for future research to explore the adaptation of schema theory more fully within developmental psychopathology. It is hoped that future research will test other aspects of schema theory in adolescents such as coping styles and modes. It is proposed that, following further validating evidence, this may result in the development of improved interventions for a range of presenting problems in adolescence.

26

2012

AimsTo examine the father’s role when his partner and child are admitted to a perinatal mental health unit.

IntroductionEstablishing attachment in the first months of life is crucial for infant mental health. Parental mental health and separation can interrupt the formation of attachment. Maternal postnatal mental health is known to affect the father’s well-being and mental health. A systematic review conducted found paternal depression in the first year after birth affects child behavioural and emotional difficulties. One previous study has gathered limited evidence of fathers experiences of a perinatal mental health unit.

MethodEight interviews were conducted with fathers whose partner was a current or former inpatient in a perinatal psychiatric unit in Scotland. Grounded Theory was utilised in the collection and analysis of data. No participants reported symptoms of Depression, Anxiety, or Stress at time of interview. Transcripts were coded by the researcher and supervisors and categories were compared. Additionally, results were validated by a participant before completing analysis.

Managing the self and other relationships: a father’s role when his partner and baby are hospitalised in a perinatal mental health unit

Jennifer MarrsClinical supervisor - Anna Wroblewska Academic supervisor - Jill Cossar

ResultsMaternal postnatal mental illness and hospitalisation was challenging. Long admissions with infrequent visits were most difficult. The overarching category ‘managing the self and other relationships’ captured the father’s experience and how he tried to understand and manage, whilst making and maintaining family bonds. Five subcategories were Bonding with Baby, Keeping the Family Together, Feeling Contained, Feeling Overwhelmed, and Experiencing Uncertainty. Fathers had concerns about bonding and regarded the mother-baby bond as vital. Relationships were strained. Fathers experienced anxiety regarding illness and felt relief on admission. Fathers experienced demands such as work and travel. They tried to retain normality, take each day as it comes, and use family support to cope. Fathers were uncertain about illness and treatment and desired improved communication with professionals.

ConclusionSevere maternal postnatal mental illness and inpatient admission affects fathers. Fathers have multiple demands which impact on participation in the unit. Father-infant bonding was affected by father availability. Recognition of the father’s experience and increasing father’s knowledge of illness and skills in caregiving is likely to improve the father’s experience and benefit the family.

27

2012

IntroductionIncreasingly patients are surviving admission to intensive care units (ICUs) with life-threatening, critical illness. There is a growing interest in long-term patient outcomes like psychological health. In this thesis 1) a systematic review of research evaluated emotional outcomes between 3 and 12 months post-ICU discharge, and 2) a longitudinal co-hort study investigated emotional sequelae among adults with Type 1 diabetes during and following admission for diabetic ketoacidosis (DKA).

Systematic reviewSeven studies that met inclusion criteria were identified, and highlighted weaknesses in the existing literature. From the available evidence there appears to be elevated rates of clinically significant depression (11%), anxiety (15%) and post-traumatic stress disorder (PTSD symp-toms (23%) 3 months after discharge, and these remain high 9 months later (12%; 18%; and 27%, respectively).

Empirical paperThe prospective study of DKA admissions indicated substantial rates of clinically relevant depression (25%); anxiety (37.5%), and PTSD symptoms (37.5%) prior to discharge. However, 3 months later the rates of depres-sion and PTSD had substantially attenuated (both 8.3%) although rates of anxiety (37.5%) remained higher than that found in the general population (7%) and the local Type 1 diabetes clinical community (11.9%). Those admit-ted with DKA had significantly poorer HbA1c compared

Emotional sequelae during and following hospital admission for diabetic ketoacidosis

Kirsty Y. MathesonClinical supervisor - Andrew Keen Academic supervisor - David Gillanders

to the overall Type 1 clinic population (10.9% vs. 8.9%; p<0.0001), which indicates substantial difficulties in self managing their condition.

Discussion It appears that psychological problems are elevated over time following ICU discharge. PTSD is notably high and enduring in general ICU survivors, whereas was observed to fall away in the DKA sample. Anxiety seems to be elevated and this persists over time following DKA; this is pertinent given the dearth of research on the role of anxi-ety in the efforts of people with Type 1 diabetes to manage their condition. In this novel study clear significant psycho-logical issues post DKA discharge were highlighted that will likely impact on staff efforts to provide ward-based care aimed at improving post-discharge diabetes control, and on the future efforts of those admitted for DKA to self-manage a complex condition. A greater awareness among health professionals about the ways emotional distress can impact on self-management is needed, as well as a greater understanding of how best to communi-cate information and educational material in light of pos-sible information processing deficits. Larger, multi-centre, higher quality studies are required in both general ICU settings and looking at specific disease complications (such as DKA). Psychological screening for ICU survivors and implementation of a care pathway to allow access to services post-ICU may be a useful development.

28

2012

IntroductionSupport staff working with individuals with intellectual disability (ID) and challenging behaviour experience high levels of work-related stress. Preliminary theoretical and experimental research has highlighted the potential suitability of acceptance and mindfulness approaches for addressing support staff stress. This study examines the effectiveness of an acceptance and mindfulness-based stress management workshop on the levels of psychological distress and well-being of support staff working with individuals with ID and challenging behaviour.

MethodSupport staff (n=120) were randomly assigned to a workshop intervention condition (n=66) or to a waiting list control condition (n=54). Measurements were completed at three time points (pre-, post and six week follow-up) for: psychological distress, well-being, perceived work stressors, thought suppression, emotional avoidance/psychological inflexibility.

ResultsThe results showed that for psychological distress there was a significant interaction effect in favour of the workshop. Thought suppression was found to reduce significantly in the intervention group post to follow-up, although no significant change was found in well-being or experiential avoidance/psychological inflexibility. For individuals with higher levels of psychological distress

The use of an Acceptance and Mindfulness-based Stress Management Workshop Intervention with support staff caring for individuals with

intellectual disabilities

Douglas McConachieClinical supervisor - Bob Walley Academic supervisors - Karen Mckenzie, Paul Morris

at pre-intervention (GHQ>11), larger effect sizes for the interaction were found, suggesting a greater impact of the workshops on the most distressed.

ConclusionOverall, results demonstrated support for the effectiveness of an acceptance and mindfulness-based intervention in reducing distress.

29

IntroductionChildhood sexual abuse (CSA) has the potential to compromise the socio-emotional development of the victim resulting in an increased vulnerability to difficulties regulating emotions and one’s sense of self. Emotion is thought to play a key part in a number of psychological disorders which CSA survivors are at increased risk of developing. A better understanding of the basic emotions experienced in this population and emotion regulation will inform current treatment.

AimsThis research aimed to develop a better understanding of the emotions experienced by survivors of CSA and the relationship between “implicit” and explicit emotions and psychopathology.

MethodTwo empirical studies were conducted. Study 1 employed a cross-sectional consecutive case series design involving 109 survivors of CSA. Participants completed a set of measures relating to basic emotions, emotion regulation and symptoms. Exploratory factor analyses were conducted on the Basic Emotions scale (BES). Regression analyses were used to explore the relationship between emotions experienced, emotion regulation strategies and psychological symptoms. Study 2 examined basic emotions, “implicit disgust self-concept” and psychopathology in a population of CSA survivors (n=26) and a group of individuals currently receiving

An exploration of explicit and implicit emotion in adult survivors of childhood sexual abuse

Eimear McKayClinical supervisors - Andy Summers, Thanos Karatzias Academic supervisor - Mick Power

psychological therapy who reported that they had not experienced childhood trauma (n=25). Participants completed self-report measures pertaining to emotion, emotion regulation, symptoms and cognitive fusion. Participants also completed an implicit association test.

ResultsExploratory factor analyses supported the structure of three versions of the BES-Weekly, General, and Coping in a sample of survivors of childhood sexual abuse. In all three versions of the scale, disgust explained the largest proportion of variance. The basic emotions of sadness, fear and disgust as well as external dysfunctional coping strategies appear to predict PTSD symptomatology in this sample. The results of Study 2 also support the finding that self-reported disgust is prominent in the emotion profile of CSA survivors. Implicit disgust self-concept was not significantly correlated with other emotions or psychopathology. However, implicit disgust self-concept was found to be significantly associated with cognitive fusion.

DiscussionPsychotherapeutic approaches for survivors of childhood sexual abuse should address the emotional experience of this population. In particular, these findings suggest that sadness and disgust should be targeted in therapy.

2012

30

2012

AimsChronic low back pain (CLBP) is a common form of chronic pain that affects a large population each year. Chronic pain and insomnia are highly co-morbid conditions, yet knowledge about how patients perceive their interaction is limited. This qualitative study aims to inform our understanding of the patient experience with particular reference to beliefs and attributions surrounding pain, poor sleep and their interaction.

MethodsEleven outpatients from a chronic pain clinic were recruited who suffered CLBP as their main symptom, and who had subsequently developed insomnia as a result. Data were analysed using Interpretative Phenomenological Analysis (IPA).

ResultsQualitative analysis produced 5 supra-ordinate themes: 1) the privacy of pain and solitude of sleep; 2) sleep/pain interaction; 3) night-time thinking; 4) adjustment and acceptance; and 5) self-management.

DiscussionThe first 3 themes combine to create the individual experience of CLBP: the visceral, emotional experience; the pre-existing and shifting beliefs; and the thought content. Once this is in place, the individual can reflect on what this means to them, and through acceptance,

Chronic low back pain and insomnia: Understanding the experience and attributions made by out-patients about sleeplessness, pain, and

their interaction

Paul S. McKenzieClinical supervisor - Kevin Power Academic supervisor - David Gillanders

move through adjustment. The individual accepts elements of their current experience, but where they see the opportunity to take control, these adjustments are translated into actions relating to self-management. These themes suggest CBT-I should be adapted to include pain specific beliefs to form a CBT fro Insomnia and Chronic Pain (‘CBT-CPI’).

31

2012

IntroductionAlongside experiencing physical symptoms with no identifiable organic cause, patients with MUS commonly experience comorbid anxiety and depression. They also have high health utilisation costs, which has implications for the health service. Interventions which target these symptoms in a cost effective way need to be developed and evaluated.

AimsTo develop and evaluate a self-help mindfulness-based stress reduction (MBSR) intervention for patients with medically unexplained symptoms (MUS).

MethodsA systematic review of the literature was carried out to evaluate the effectiveness of MBSR for reducing psychological distress in people with MUS. Study 1 developed and evaluated a self-help MBSR intervention in a clinical setting. Fifteen participants were recruited from eight practice, however only five completed post-intervention measures. A combination of t-tests and descriptive statistics were used to compare changes in levels of psychological distress, quality of life, symptoms and mindfulness at post-intervention. Pearson’s correlations were used to identify relationships between improvements in mindfulness and improvements in outcomes. Study 2, exploring the reasons for the difficulties recruiting participants to Study 1, was then carried out through questionnaires to GPs.

The Development and Evaluation of a Mindfulness-Based Stress Reduction Self-Help Intervention for Patients with Medically Unexplained Symptoms

Sarah McLarenClinical supervisor - April Quigley Academic supervisor - Paul Morris

ResultsThough more evidence is needed, the systematic review found MBSR to have moderate effects on psychological distress, which are largely maintained or improved at follow-up. Study 1 found symptom frequency and levels of acceptance to have improved at post-intervention. Study 2 found that the main reasons for GPs not recruiting participants was that they were busy and found it difficult to prioritise given other demands.

ConclusionsEvidence to date suggests that MBSR is an effective intervention for patients with MUS. Future studies may benefit from recruiting participants from relevant organisations or using alternative methods such as database searches. No firm conclusions can be made about the self-help MBSR intervention’s efficacy due to the study’s limitations, however changes seen in the completer group suggest that further research would be warranted.

32

2012

IntroductionThere has been a lack of longitudinal studies on maternal and infant factors associated with feeding difficulties. Feeding difficulties are common, cause much anxiety for parents, and are associated with a range of child health and behavioural outcomes. This study aims to gain an understanding of the prevalence and type of feeding difficulties found in a community sample, the prevalence of maternal mental ill-health and identify maternal and infant factors predictive of feeding difficulties. A final aim is to identify factors associated with successful and unsuccessful feeding experiences from a maternal perspective.

MethodA short questionnaire with questions about support and help-seeking was compiled, and several standardised measures were included in the pack; a measure of maternal mood (DASS-21), social support (SOS-S), and eating disorder symptomatology (EAT-26). Questionnaires were given to mothers in pregnancy, and again when infants were around 3 and 7 months old. An adapted version of the Child Feeding Assessment Questionnaire, and the food fussiness subscale from the Children’s Eating Behaviour Questionnaire examined feeding behaviour and maternal response. The Infant Temperament Questionnaire examined maternal perception of infant temperament. Content analysis was used to identify themes in mother’s narrative about factors which help feeding and barriers to

Maternal and infant factors influencing infant feeding - a longitudinal study

Suzanne MillsClinical supervisors - Caroline Howe, Helen Prior Academic supervisors - Suzanne O’Rourke, Emily Newman

a successful feeding experience. A within subjects design was employed to examine predictors of infant feeding difficulties.

Results23% of mothers of 3 to 5 month old infants, and 13% of mothers of 7 to 10 month olds reported their child as having one or more feeding difficulties. Levels of stress remained stable across the length of the study, but prevalence of maternal anxiety and depression reduced. 47% of those mothers who breast fed found breast feeding difficult or very difficult. Maternally identified barriers to successful feeding with feeding were child illness, and painful or difficult breastfeeding. Mothers wanted an improvement in support and knowledge of health professionals, and a reduction in pressure from health professionals in relation to feeding method. Maternal depression and stress were correlated with severity of food refusal in infants, as well as maternal anxiety and food fussiness, prior to post-hoc analyses. Following post-hoc analyses these relationships were no longer significant.

DiscussionRelationships between infant behaviour, maternal health and feeding difficulties are explored. The low prevalence of feeding difficulties and reasons for negative findings in relation to predictors of feeding difficulties are discussed. Implications for health services are presented in the light of maternal views about support and barriers to successfully feeding their child.

33

2012

AimsThis thesis investigated whether a history of childhood trauma (CT) was indirectly associated with eating psychopathology (EP) through mediation by dissociation (DISS) and/or emotion dysregulation (EDys).

MethodA systematic review was conducted to investigate the evidence within the literature supporting DISS as a potential mediator. Only studies that assessed the variables of CT, DISS and EP within a single study were reviewed. A cross-sectional study was conducted to investigate a multiple mediation model of the association between CT and EP with DISS and EDys as potential mediators. Undergraduate Psychology students (N=165) took part in this study and completed measures of CT, EP, DISS and EDys. Experiences of multiple forms of CT were assessed, including emotional abuse (CEA), physical abuse (CPA), sexual abuse (CSA), emotional neglect (CEN) and physical neglect (CPN).

ResultsThe results of the systematic review were inconclusive regarding the potential role of DISS as a mediator in the relationship between CT and eating EP. Findings within the reviewed studies generally offered more support for associations between CT and DISS; and DISS and EP. Studies reported more inconsistent findings regarding the association between CT and EP. The results from the empirical study indicated that CEA and CEN were both

Stuart J. Moulton

Childhood trauma and eating psychopathology: A mediating role from dissociation and emotion dysregulation?

Clinical supervisor - Kevin Power Academic supervisor - Emily Newman

significantly associated with increased EP within the whole sample. These relationships were significantly mediated by both DISS and EDys. A separate analysis with female participants only, indicated that CPA and CPN in addition to CEA and CEN were significantly associated with increased EP. The associations between CEA, CEN, CPN and EP were all significantly mediated by both DISS and EDys. DISS and EDys did not mediate the association between CPA and EP.

ConclusionsThe studies included within the systematic review offered tentative support for an indirect relationship between CT and EP through DISS. Firm conclusions were limited, however, due to a number of methodological shortcomings identified within the included studies. The main methodological shortcomings concerned the definition and measurement of CT and the failure of a number of studies to address theoretical models within their research design. Addressing both these methodological limitations, the results of the empirical study provided support for the growing consensus that emotional maltreatment may be an important risk factor for the development of EP. Further, the results of this study indicate that CT impacts indirectly on EP through an enduring effect on both dissociative and emotion regulation processes.

34

2012

IntroductionEating Disorder research has highlighted the role of neuropsychological functioning, informing the treatment of Anorexia Nervosa. There is ambiguity in the data relating to cognitive impairment in Bulimia Nervosa (BN), with the latest review providing inconclusive results. Executive function impairments in the area of set shifting and inhibition reported in BN are proposed to relate to traits of compulsivity and impulsivity. Other psychological disorders have also demonstrated executive function impairments. Among anxiety disorders, only PTSD and OCD have strong evidence of executive function deficits while a number of studies point towards executive function deficits in depression. This thesis aims to investigate the specificity of cognitive impairments seen in a group of female outpatients with BN, using a clinical comparison group of anxious and/or depressed female outpatients.

MethodsA systematic review was conducted to address a gap in the anxiety disorder literature and assess the neuropsychological profile of panic disorder. In order to address the main study aims, a comparison between a group of patients with BN and an anxious depressed group was conducted on neuropsychological measures of the Trail Making Test, Wisconsin Card Sorting Test, Hayling and Brixton tasks, Stroop and Verbal Fluency. In addition, psychological symptoms were assessed using SCL-90-R, Yale-Brown Obsessive Compulsive Scale and

Kate O’Sullivan

Investigating the specificity of neuropsychological performance in bulimic outpatients: a comparison with anxious and depressed outpatients

Clinical supervisors - Kevin Power, Allison Livingstone, Paula Collins Academic supervisor - Emily Newman

the Self-liking Self Competence scale. Social problems solving skills were assessed as a potential real world effect of executive function difficulties associated with eating disorders. The relationships between psychological and neuropsychological variables were investigated.

ResultsThe systematic review concluded that there was limited evidence of specific impairment in short-term memory in panic disorder.The empirical study indicated no group differences on the above neuropsychological measures. Groups also did not differ on NART estimated IQ or self reported psychological symptoms. No relationships were found between psychological symptoms and neuropsychological measures. Few individual participants were found to be impaired on neuropsychological measures in either group. However, those impaired in the BN group were exclusively impaired on the non-pervasive errors and categories completed variables of the WCST, which is thought to be related to impulsivity.

ConclusionThese findings suggest that the neuropsychological profile of bulimia is broadly similar to that of an anxious and/or depressed clinical group on measures of set shifting and inhibition. Although there was evidence of a deficit in inhibition among patients with bulimia further investigation is required.

35

2012

IntroductionDeliberate self-harm (DSH) is being increasingly recognised as a behaviour with significant clinical importance. Yet, there remains uncertainty regarding which forms of psychological therapy are most effective for its treatment. Schema Therapy (ST) is an integrative psychotherapy blending elements of cognitive behaviour therapy, object relations and gestalt therapy into a unified approach for the treatment of individuals with complex and chronic psychological conditions. The current thesis aimed to provide a better understanding of the ST model and its association with DSH.

Systematic ReviewDespite the increasing evidence base for the efficacy of ST, less is known about the evidence for its theoretical underpinnings. To address this gap in the literature a systematic review was undertaken to explore the following question: How empirically supported is the theoretical underpinning of ST? In a systematic search of the literature conducted until 01 June 2012, studies based on cross-sectional, longitudinal, intervention, mediational and experimental designs were considered. These studies underwent detailed quality analysis culminating in 19 articles being included in the current review. Overall these studies indicate that many of the key theoretical assumptions in ST are supported by the literature.

Deliberate self-harm in a clinical sample: the impact of schema modes, parental bonding and perceived stress

Amber SaldiasClinical supervisor - Kevin Power Academic supervisor - David Gillanders

Empirical StudyST has recently been expanded to include the ‘schema mode’ concept, with a number of researchers highlighting an association between particular schema modes and a number of chronic psychological conditions. Although the schema mode model allows a method for understanding moment-to-moment emotional states it has not previously been explored in relation to DSH. The current project aimed to explore the relationship between these variables and their association with early experiences of parental bonding and current levels of perceived stress. 70 psychiatric outpatients with a history of DSH completed a number of measures including the DSH Inventory, Schema Mode Inventory, Parental Bonding Instrument and Perceived Stress Scale. Results revealed significant associations between DSH, maladaptive schema modes, perceived stress and patterns of parental care. Maladaptive schema modes significantly mediated the relationship between parental care and DSH. The Punitive Parent and Angry Child modes were significant mediators in this relationship.

ConclusionResults from the systematic review support the notion that ST has a good theoretical underpinning. The empirical study also supports ST by highlighting the mediational role of maladaptive schema modes in the relationship between low parental care in childhood and DSH in adulthood. These findings provide further support for the ST model and suggest that individuals with DSH may benefit from this treatment.

36

2012

IntroductionInterpersonal relationships are beneficial for people with a learning disability (PWLD), acting as a protective barrier against transition difficulties, social stigma and negative outcomes such as physical and mental health problems. The social networks of PWLD are, however, often more restricted than those of the general population. There has been very little research which has explored the views and experiences of PWLD about their social and sexual relationships. A systematic review of the qualitative research surrounding the sexual relationships of PWLD was conducted. Eleven studies were reviewed, which revealed five themes: ‘A lack of knowledge regarding sexual relationships’, ‘Sexual relationships as restricted and regulated’, ‘Sexual relationships perceived as wrong’, ‘Sexual relationships being desired’, and ‘Sex as a negative experience’. Positive developments in the attitudes of others and supports were described, but the impact and influence of stigma, assumption, ignorance and a lack of autonomy regarding sexual relationships were dominantly reported. However, the findings of the reviewed studies must be considered with caution due to methodological limitations. The current study aimed to build on the existing qualitative research by exploring the experiences and perceptions of both sexual and close relationships for PWLD.

MethodData were gathered from ten PWLD using one to one semi-structured interviews. Interviews were

Faye SullivanClinical supervisor - Keith Bowden Academic supervisors - Karen McKenzie, Ethel Quayle

Exploring the close relationships of people with learning disabilities: A qualitative study

recorded, transcribed and analysed using Interpretive Phenomenological Analysis.

ResultsFive super-ordinate themes were identified; ‘Relationships feeling safe and being useful’, ‘Who’s in charge?’, ‘Struggling for an ordinary life’, ‘Touching people in relationships’ and ‘Hidden feelings’. The findings were shared with participants who confirmed their relevance in the lives of PWLD. ‘Touching people in relationships’ is presented separately within a journal article format.

DiscussionThe findings suggest that fundamental components of close relationships were feeling safe and receiving some form of positive gain. The lack of agency participants experienced limited the development of these aspects, whilst also preventing the ability to live an ‘ordinary existence’, which included physically intimate relationships for many individuals. Finally, participant’s feelings were generally unclear, which could be related to being interviewed by a relative stranger or emotional expression difficulties. Based upon these findings it is considered that those who support PWLD should focus their assistance on addressing negative attitudes and redressing the power imbalance to facilitate an ‘ordinary existence’ for these individuals, which may indirectly enable them to naturally develop safe and useful relationships. It is also possible that reducing the barriers and stigma surrounding close relationships would open

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up communication regarding this area, which could indirectly promote PWLD ability to express their emotions regarding relationships.

ConclusionsThe research provides a greater insight into the lived experience of close relationships for PWLD. Participants valued close relationships that were safe and useful, but their ability to develop and maintain these was described as being restricted by other people and service rules. It is proposed that those supporting PWLD need to balance protective action against the freedom and choice required to develop and maintain close relationships, as restricting the already limited social networks of this population will negatively impact upon their quality of life.

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2012

AimsSystematic Review: This article presents a systematic review of studies evaluating the evidence for mobile phone-based interventions with adolescents who have Type 1 diabetes. Studies were critically appraised and findings synthesised with the aim of answering the question: do mobile phone technologies facilitate improved outcomes in adolescents who have type 1 diabetes?

Empirical Study: Diabetes research has indicated an association between attachment security and metabolic control as well as increased prevalence of mental health difficulties in diabetes populations. There is limited research with an adolescent Type 1 diabetes population. The current study aimed to examine attachment, emotional distress and self esteem in an adolescent Type 1 diabetes population in relation to metabolic control and quality of life. The current study also aimed to evaluate the impact of ‘wellbeing text-messaging support’ with the same population.

MethodSystematic Review: A systematic search strategy was employed to identify relevant studies. An electronic database search, combined with a hand search of key journals and reference sections of key papers, was undertaken. Methodological quality was determined using an idiosyncratic measure including information relating to study design, sample size, interventions and statistical

Do attachment security, self esteem and emotional distress predict metabolic control and quality of life in adolescents with Type 1 diabetes?

Will ‘wellbeing’ text-messaging support improve outcomes?

Mary SwanClinical supervisor - Vicki Dunbar Academic supervisor - Mick Power

analyses. A narrative synthesis was performed due to the heterogeneity of the sample.

Empirical Study: Sixty participants aged between 12-18 years old who had a diagnosis of Type 1 diabetes for over 12months took part. A longitudinal questionnaire design was used to collect data using five validated psychological measures. HbA1c was used as a measure of metabolic control. Text-messaging comprised a wellbeing module being delivered daily over a three-week period.

ResultsSystematic Review: Twelve eligible studies were identified. One achieved a rating of ‘very good’, two a rating of ‘good’ and the remaining nine were pilot and/or feasibility studies, of whom four received a rating of ‘fair’ and five received a rating of ‘poor’ methodological quality. Results indicated limited good quality evidence which included improved adherence and self-efficacy and mixed results in relation to metabolic control. Limitations identified included the use of small, convenience samples and short study duration.

Empirical Study: High levels of fearful attachment security predicted poorer quality of life, and high levels of emotional distress predicted poorer quality of life. ‘Wellbeing text-messaging support’ resulted in significantly improved quality of life.

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ConclusionSystematic Review: There is limited evidence that mobile phone technology has consistently improved outcomes in adolescents with Type 1 diabetes. Due to the number of pilot or feasibility studies and predominantly poor/fair quality of the current literature, and the heterogeneity of the sample, only tentative conclusions can be drawn, thus highlighting the need for further research.

Empirical Study: Adolescent attachment style and emotional distress may be assessed as part of routine diabetes care in order to identify individuals who are potentially most at risk of failing to engage with diabetes health care. This can subsequently impact negatively on metabolic control and/or quality of life. These findings highlight the importance of clinical psychology input in paediatric diabetes teams. Further research in relation to text-messaging support was recommended.

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2012

IntroductionPost Traumatic Stress Disorder (PTSD) is frequently linked with substance use disorder (SUD). However, the nature of this association remains unclear. A clearer understanding of the dynamic associations between PTSD and SUD may shed light on the course of these two disorders thereby, identifying areas for intervention, which may potentially reduce some of the associated costly and harmful outcomes.

MethodsFirstly, a systematic review was conducted to investigate the evidence base regarding the relationship between PTSD and SUD. Secondly, an empirical project was undertaken to explore functional associations between PTSD and SUD. This was achieved by comparing, motives for substance use, anxiety and depression symptoms, and SUD symptom severity amongst treatment-seeking adults with and without PTSD.

ResultsResults from the systematic review suggest that individuals with co-morbid PTSD and SUD have more severe clinical profiles compared to individuals with a SUD alone. The results from the empirical study indicate that those with PTSD endorse coping-related motives for substance use significantly more than those without PTSD. Furthermore, those with PTSD had significantly elevated SUD severity ratings and higher anxiety and depression scores.

Isabel Traynor

Motives for substance use in the presence of Post Traumatic Stress Disorder (PTSD): a research portfolio

Clinical supervisors - Andrew Summers, Zoe Hughes Academic supervisor - Mick Power

ConclusionsFindings suggest that individuals with co-morbid PTSD and SUD are motivated to use substances to cope with negative affect. The clinical implications of this are discussed.

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2012

IntroductionSome women develop symptoms of posttraumatic stress following childbirth. There is preliminary evidence that cognitive variables may be associated with the development or maintenance of these symptoms. Research indicates that symptoms of posttraumatic stress following childbirth may have negative consequences for mother-infant relationship outcomes. However, these may be attributable to comorbid symptoms of depression. Further evidence is required regarding the nature of the relationships between these variables.

MethodsAn internet based cross-sectional questionnaire design was employed to test hypothesised relationships between maternal attachment experiences, metacognition, symptoms of PTSD and depression and perceptions of the mother-infant bond, in an analogue sample of new mothers. Structural equation modelling was employed for the principal analysis.

ResultsThe final structural model demonstrated a good fit to sample data. Metacognition fully mediated the relationship between attachment experiences and postnatal psychological outcomes. The association between posttraumatic stress and maternal perceptions of the mother-infant bond was fully mediated by depression.

Charlotte Williams

Posttraumatic stress following childbirth and maternal perceptions of the mother-infant bond: the role of attachment experiences and metacognition

Clinical supervisor - Rachel Smith Academic supervisors - Emily Taylor, Matthias Schwannaeur

ConclusionsMetacognition may have a key role in the development and maintenance of postnatal psychological distress. If clinically significant postnatal depression is identified, screening for posttraumatic stress is strongly indicated.

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2012

IntroductionThere is growing evidence that many parents with learning disabilities, when given adequate support, can parent successfully. Childbirth is a significant life event that marks a woman’s transition to motherhood and is a time when parents first learn to nurture their children. Postnatal care aims to facilitate this learning experience as well as promote the emotional and physical well-being of both infant and mother. To date, no research has explored the support mothers with learning disabilities receive during the postnatal period. To fill this gap in the research and help inform service provision, this study aims to explore how mothers with learning disabilities experience postnatal care.

MethodSemi-structured interviews were carried out with six mothers with learning disabilities. The data were collected and analysed using Interpretative Phenomenological Analysis.

ResultsMothers‟ experiences of postnatal care were conceptualised within four superordinate themes: challenges of providing support, how support was delivered , learning to cope and challenges to building trust. All of these had accompanying subthemes.

Mothers with a learning disability: their experiences of service provision during the postnatal period

Suzanne WilsonClinical supervisor - George Murray Academic supervisor - Karen McKenzie, Ethel Quayle

DiscussionThe results are discussed in the context of relevant literature. Consistent with previous research which has been carried out with parents with learning disabilities, participants were found to be highly dependent on informal support. The participants acknowledged the value of professional input and their perceptions of how this support was delivered had important implications. Learning how to cope with the demands of their new role raised issues not dissimilar to those of parents without learning disabilities. Challenges, however, were faced in establishing trusting relationships with professionals. The findings were found to have implications for clinical practice which are described and suggestions for future research made.

ConclusionThe findings suggest that participants‟ informal supports play a key role during the initial stages of parenthood particularly with providing practical support in areas which present challenges. Professional input was valued when delivered according to the typical pathway of care post-birth. It is recommended that consideration is given to how the support is delivered to participants. This should essentially seek to empower parents rather than undermine them as how support was perceived by parents impacted on their subsequent engagement with professionals.

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IntroductionHealth care professionals are at risk of developing burnout due to the inherently stressful nature of their work. Burnout has been found to compromise the wellbeing of health care professionals and their ability to provide optimal patient care. Job engagement is proposed to be the antipode of burnout and is concerned with occupational well-being. It is hoped that through a better understanding of factors related to job engagement and burnout, occupational well-being of health care professionals and their ability to care for patients can be improved.

Systematic reviewA systematic review of the literature on burnout and job engagement in physicians and nurses since 2002 identified seven studies. Findings suggest that burnout and job engagement are independent constructs, albeit negatively related. These findings contribute to the current knowledge about the relationships between burnout and engagement dimensions and provide a framework for interventions aimed at increasing occupational well-being among front line medical professionals.

AimsA study was conducted to assess levels of job engagement and burnout and their relationship with turnover intentions and job satisfaction and stress in the entire workforce of a Cancer Centre in the United Kingdom.

Participants and procedure150 cancer care workers completed a cross-sectional

Burnout and Job Engagement in UK Cancer Care Staff: How do they relate to Job Stress and Satisfaction and Turnover Intentions?

Silke L. ZiemenClinical supervisor - Belinda Hacking Academic supervisor - Emily Newman Contributor - Gerry Humphris

questionnaire entailing the Maslach Burnout Inventory, the Engagement Indicator, measures of job satisfaction, stress, turnover intentions and demographics.

ResultsMean scores of emotional exhaustion did not differ from normative data, while lower levels of depersonalisation and lack of accomplishment were found. Furthermore, engagement scores were significantly higher than in the normative sample and the majority reported high levels of job satisfaction and indicated no turnover intentions. Path analysis provided preliminary support for an exploratory model indicating that engagement mediates the relationship between job stress, burnout and job satisfaction and turnover intentions.

ImplicationsIt is important that, despite increasing pressure to reduce costs, service planning is mindful of the continuous and long-term process required to maintain and facilitate engagement and job satisfaction, which appear important to the long term retention of staff.

ConclusionsWork overload and a perception of being poorly managed and resourced appear to be risk factors for burnout. However, engaged employees with high levels of personal accomplishment may experience job satisfaction and desire to stay in their jobs despite high levels of occupational stress. Further research is required to identify factors predictive of personal accomplishment and job engagement in oncology services.

2012

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To find out further information about any of these projects, please contact either the main author or one of their supervisors. E-mail contact details for the academic supervisors are:

Jill Cossar jill.cossar@ed.ac.uk

David Gillanders dgilland@staffmail.ed.ac.uk

Ken Laidlaw K.Laidlaw@ed.ac.uk

Karen McKenzie kmckenzie@staffmail.ed.ac.uk

Paul Graham Morris p.g.morris@ed.ac.uk

Emily Newman emily.newman@ed.ac.uk

Suzanne O’Rourke sorourke@staffmail.ed.ac.uk

Dave Peck david.peck@ed.ac.uk

Mick Power mjpower@staffmail.ed.ac.uk

Ethel Quayle Ethel.Quayle@ed.ac.uk

Matthias Schwannauer m.schwannauer@ed.ac.uk

Emily Taylor etaylor5@staffmail.ed.ac.uk

Alternatively, please contact Evelyn Kelly who will be able to put you in contact with the authors:

Evelyn KellyClinical & Health PsychologyUniversity of EdinburghTeviot Place QuadEdinburgh EH8 9AG

(0131) 651 3972

Contacts

If you require this document in an alternative format e.g. large print please contact: Evelyn Kelly - telephone 0131 651 3972 or email - Evelyn.A.Kelly@ed.ac.uk

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