1. family and parenting
2. children

Thesis Abstracts 2012
Doctorate in
Clinical Psychology
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
1
Contents
Page
2011
Dianne J. Beastall
Gillian Mackie
Claire Norfolk
Favourable results from predictive testing in Huntington’s Disease: An exploration of the long-term impact on close relationships
Nursing staff attitudes to older people and dementia
The neglected parental mental health problem? Borderline personality disorder: a preliminary exploration of borderline mothers’ attributions of children’s behaviour
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5
6
2012
Lesley A. Allan
Alison C. Barron
Lucy V. Clark
Fleur-Michelle M Coiffait
Linda Craig
Louisa M. Fraser
Anna Graham
Leanne Gregory
Melissa Hanna
David Huxtable
Lucy M Johnson
Joseph Judge
Victoria Kinnear
Renate Kuenssberg
Emma Lidstone
2
Insulin Pump Use in children with type 1 diabetes: An exploration of families’ experiences
Attachment in psychological therapy: An exploratory study into patient and therapist attachment patterns and their relationship with early engagement and therapeutic alliance
An exploration of the role of attachment in the relationship between trauma and distress in psychosis
Cognitive factors and subjective wellbeing in parents who have children with profound and multiple intellectual disability
The impact of maternal psychological distress and parental bonding on mother-
adolescent agreement about emotional problems
The Role of Cognitive and Acceptance Components in Predicting Functional and Emotional Adjustment to Chronic Pain
Psychological health of retirees in rural Scotland
Early Maladaptive Schemas, and associates, in Youth: A quantitative investigation and research portfolio
Decision-making processes and experiences of older people using the Beating the Blues computerised cognitive behavioural self-help programme: A qualitative study
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
Life after stroke - What may affect recovery The clinical practice of risk assessment of sexual violence
A review of interventions for informal dementia caregivers
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?
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
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Contents
Margaret MacKay-Brownless
Joanne MacLeod
Jenny E. Makinson
Jennifer Marrs
Kirsty Y. Matheson
Douglas McConachie
Eimear McKay
Paul S. McKenzie
Sarah McLaren
Suzanne Mills
Stuart J. Moulton
Kate O’Sullivan
Amber Saldias
Faye Sullivan
Mary Swan
Isabel Traynor
Charlotte Williams
Suzanne Wilson
Silke L. Ziemen
Page
Predictors of coping adaptiveness, and its role as a mediator in relationships 23
between general self-efficacy and mindfulness with psychological wellbeing
Computer-assisted cognitive remediation in patients with schizophrenia: effects on 24
symptoms, cognition and psychosocial functioning
Early Maladaptive Schemas and their relationship to psychopathology
25
in adolescence
Managing the self and other relationships: a father’s role when his partner and baby are 26
hospitalised in a perinatal mental health unit
Emotional sequelae during and following hospital admission for diabetic ketoacidosis
27
The use of an Acceptance and Mindfulness-based Stress Management Workshop
28
Intervention with support staff caring for individuals with intellectual disabilities
An exploration of explicit and implicit emotion in adult survivors of childhood sexual abuse 29
Chronic low back pain and insomnia: Understanding the experience and attributions 30
made by out-patients about sleeplessness, pain, and their interaction
The Development and Evaluation of a Mindfulness-Based Stress Reduction Self-Help 31
Intervention for Patients with Medically Unexplained Symptoms
Maternal and infant factors influencing infant feeding - a longitudinal study
32
Childhood trauma and eating psychopathology: A mediating role from dissociation and 33
emotion dysregulation?
Investigating the specificity of neuropsychological performance in bulimic outpatients: 34
a comparison with anxious and depressed outpatients
Deliberate self-harm in a clinical sample: the impact of schema modes, parental bonding 35
and perceived stress
Exploring the close relationships of people with learning disabilities: A qualitative study 36
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?
Motives for substance use in the presence of Post Traumatic Stress Disorder (PTSD): 40
a research portfolio
Posttraumatic stress following childbirth and maternal perceptions of the mother-infant bond: 41
the role of attachment experiences and metacognition
Mothers with a learning disability: their experiences of service provision during the 42
postnatal period
Burnout and Job Engagement in UK Cancer Care Staff: How do they relate to Job 43
Stress and Satisfaction and Turnover Intentions?
3
2011
Favourable results from predictive testing in Huntington’s Disease:
An exploration of the long-term impact on close relationships
Dianne J. Beastall
Clinical supervisor - Fionna Summers, Emma Hepburn
Introduction
Huntington’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 aim
The study aimed to explore how receiving a favourable
result from predictive testing for HD can impact on close
relationships in the long-term.
Methodology
A constructivist grounded theory approach was used to
meet the aim of the study, generating data through indepth 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.
4
Academic supervisor - Ethel Quayle
Results
The 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.
Conclusions
The 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.
2011
Nursing staff attitudes to older people and dementia
Gillian Mackie
Clinical supervisor - Lindsey Murray
Introduction
Demographic 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.
Method
Academic supervisor - Ken Laidlaw
Results
Nursing 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.
Conclusions
Positive 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.
A qualitative methodology was used and a crosssectional 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).
5
2011
The neglected parental mental health problem? Borderline personality disorder:
a preliminary exploration of borderline mothers’ attributions of
children’s behaviour
Claire Norfolk
Clinical supervisor - Matthias Schwannauer
Introduction
Despite 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.
Objectives
This study aimed to explore the borderline parents’ childcentred 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 adultchild interactions
6
Academic supervisor - Jill Cossar
Method
Nine 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.
Results
Non-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 adultchild 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.
Conclusions
The findings in the present study are consistent with the
picture that emerges from empirical studies of borderline
mothers, where maternal behaviour is characterised
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.
7
2012
Insulin Pump Use in children with type 1 diabetes: An exploration of
families’ experiences
Lesley A. Allan
Clinical supervisor - Vivien Swanson
Introduction
The 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.
Method
Data 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).
Results
Five 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
8
Academic supervisor - Emily Newman
Pump’. Children’s data is presented separately within a
journal article format.
Discussion
Findings 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.
Conclusion
This 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.
2012
Attachment in psychological therapy: An exploratory study into patient and
therapist attachment patterns and their relationship with early engagement
and therapeutic alliance
Alison C. Barron
Clinical supervisor - Fiona Barry
Academic supervisor - Matthias Schwannauer
Introduction
Recent 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.
Methods
Patient 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.
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.
Conclusions
Findings 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.
Results
Fifty-five patients and 38 clinicians’ self-report attachment
styles indicate greater security among clinicians. Patients
presenting to mental health services reported higher
9
2012
An exploration of the role of attachment in the relationship between
trauma and distress in psychosis
Lucy V. Clark
Clinical supervisor - Amy McArthur
Academic supervisor - Matthias Schwannauer
Introduction
Attachment 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.
Aim
The 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.
Method
Participants with a diagnosis of psychosis were recruited
and measures were completed with the principle
investigator pertaining to trauma, attachment and distress
in psychosis.
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Results
The 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.
Discussion
The 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.
2012
Cognitive factors and subjective wellbeing in parents who have children
with profound and multiple intellectual disability
Fleur-Michelle M Coiffait
Clinical supervisor - Helen Downie
Aims
The 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.
Method
A 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.
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 Implications
Although 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.
Results
The 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
11
2012
The impact of maternal psychological distress and parental bonding on
mother-adolescent agreement about emotional problems
Linda Craig
Academic supervisor - Jill Cossar
Aims
To explore the impact of parent psychological distress
and parental bonding on agreement between informants
about adolescent emotional functioning.
Methods
The 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.
Results
Kappa 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
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care was rated as high no significant relationship was
found between distress and agreement.
Conclusions
Increased 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.
2012
The Role of Cognitive and Acceptance Components in Predicting Functional
and Emotional Adjustment to Chronic Pain
Louisa M. Fraser
Clinical supervisor - Gill MacLeod
Academic supervisors - David Gillanders, Matthias Schwannauer
Introduction
The 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.
Method
The 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.
Results
The 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 selfefficacy in their relationship with emotional adjustment.
Conclusions
The 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.
13
2012
Psychological health of retirees in rural Scotland
Anna Graham
Clinical supervisor - John Higgon
Introduction
In 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.
Method
The 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.
Results
Overall, 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.
14
Academic supervisor - Ken Laidlaw
Conclusions
Attitudes 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.
2012
Early Maladaptive Schemas, and associates, in Youth: A quantitative
investigation and research portfolio
Leanne Gregory
Clinical supervisor - Louise Cumbley
Introduction
This 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 Review
Firstly, a systematic review of the literature related to EMS
and these associates in both adult and adolescent nonclinical 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.
Academic supervisor - Jill Cossar
Empirical paper
The 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.
Conclusion
These findings were in line with Schema Theory and
highlighted the importance of further research and clinical
emphasis on EMS in youth.
15
2012
Decision-making processes and experiences of older people using
the Beating the Blues computerised cognitive behavioural self-help
programme: A qualitative study
Melissa Hanna
Clinical supervisors - Fiona Macleod, Kevin Power
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.
Method
Individual 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).
16
Academic supervisor - Ken Laidlaw
Results
Five 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.
Conclusions
Overall, 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.
2012
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 Huxtable
Clinical supervisor - Angus Lorimer
Academic supervisor - Ken Laidlaw
Aims
To 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.
Method
Systematic 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.
Results
Nine 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).
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.
Conclusions
When 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.
17
2012
Life after stroke - What may affect recovery
Lucy M Johnson
Clinical supervisor - Campbell Culley
Aims
This projects attempts to gain an understanding of the
role that perceptions and attitudes to ageing play in the
recovery process after stroke.
Systematic Review
Firstly, 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 paper
A 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
18
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.
Conclusions
The 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.
2012
The clinical practice of risk assessment of sexual violence
Joseph Judge
Clinical supervisors - Katherine Russel, Rajan Darjee
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.
Method
A 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 metaanalyses) 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.
Academic supervisors - Ethel Quayle, Suzanne O’Rourke
Results
The 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.
Conclusions
Results 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.
19
2012
A review of interventions for informal dementia caregivers
Victoria Kinnear
Academic supervisor - Ken Laidlaw
Aims
This review evaluates the impact of intervention studies for
informal dementia caregivers.
Methods
Meta-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.
Results
Significant 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.
20
Implications
Overall, 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.
2012
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 Kuenssberg
Clinical supervisor - Jill Jones
Introduction
Autism 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-IVTR; 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).
Academic supervisor - Karen McKenzie
Discussion
The results of the analysis provide tentative support for
the move towards considering ASD as a dyad of socialcommunication 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.
Conclusion
It 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.
Method
Confirmatory factor analysis was used to examine data
from a clinical population of adults diagnosed with
Asperger Syndrome (AS) and High Functioning Autism
(HFA).
Results
Analysis 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.
21
2012
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 Lidstone
Clinical supervisor - Donna Paxton
Academic supervisor - Matthias Schwannauer
Introduction
The 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. Hypotheses
It 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 results
In 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.
22
Method 2 and results
Sixty 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.
Discussion
It 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. 2012
Predictors of coping adaptiveness, and its role as a mediator in relationships
between general self-efficacy and mindfulness with psychological wellbeing
Margaret MacKay-Brownless
Clinical supervisor - Anna Wroblewska
Introduction
The 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 selfefficacy (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
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.
Method
In 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.
Results
The 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.
Conclusion
Results from both studies are discussed in relation to
methodological, theoretical and clinical implications.
23
2012
Computer-assisted cognitive remediation in patients with schizophrenia:
effects on symptoms, cognition and psychosocial functioning
Joanne MacLeod
Clinical supervisor - Tim Delahunty
Introduction
Cognitive 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.
Method
A 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.
Results
There 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
24
Academic supervisor - Suzanne O’Rourke
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.
Conclusions
Further, 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.
2012
Early Maladaptive Schemas and their relationship to psychopathology
in adolescence
Jenny E. Makinson
Clinical supervisor - Rachael Smith
Academic supervisor - Matthias Schwannauer
Introduction
Schema 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 evidencebase and potential utility of applying schema theory
to adolescent psychopathology, and consists of a
systematic review and research article.
Systematic Review
The 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.
Empirical paper
A 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.
Conclusion
EMS 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.
25
2012
Managing the self and other relationships: a father’s role when his partner
and baby are hospitalised in a perinatal mental health unit
Jennifer Marrs
Clinical supervisor - Anna Wroblewska
Aims
To examine the father’s role when his partner and child are
admitted to a perinatal mental health unit.
Introduction
Establishing 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.
Method
Eight 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.
26
Academic supervisor - Jill Cossar
Results
Maternal 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 motherbaby 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.
Conclusion
Severe 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.
2012
Emotional sequelae during and following hospital admission
for diabetic ketoacidosis
Kirsty Y. Matheson
Clinical supervisor - Andrew Keen
Introduction
Increasingly 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 cohort study investigated emotional sequelae among adults
with Type 1 diabetes during and following admission for
diabetic ketoacidosis (DKA).
Systematic review
Seven 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 symptoms (23%) 3 months after discharge, and these remain
high 9 months later (12%; 18%; and 27%, respectively).
Empirical paper
The 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 depression 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 admitted with DKA had significantly poorer HbA1c compared
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 anxiety in the efforts of people with Type 1 diabetes to manage
their condition. In this novel study clear significant psychological 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 communicate information and educational material in light of possible 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.
27
2012
The use of an Acceptance and Mindfulness-based Stress Management
Workshop Intervention with support staff caring for individuals with
intellectual disabilities
Douglas McConachie
Clinical supervisor - Bob Walley
Academic supervisors - Karen Mckenzie, Paul Morris
Introduction
Support 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 mindfulnessbased stress management workshop on the levels
of psychological distress and well-being of support
staff working with individuals with ID and challenging
behaviour.
Method
Support 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.
Results
The 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
28
at pre-intervention (GHQ>11), larger effect sizes for the
interaction were found, suggesting a greater impact of the
workshops on the most distressed.
Conclusion
Overall, results demonstrated support for the
effectiveness of an acceptance and mindfulness-based
intervention in reducing distress.
2012
An exploration of explicit and implicit emotion in adult survivors of
childhood sexual abuse
Eimear McKay
Clinical supervisors - Andy Summers, Thanos Karatzias
Introduction
Childhood 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.
Aims
This 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.
Method
Two 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
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.
Results
Exploratory 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.
Discussion
Psychotherapeutic 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.
29
2012
Chronic low back pain and insomnia: Understanding the experience
and attributions made by out-patients about sleeplessness, pain, and
their interaction
Paul S. McKenzie
Clinical supervisor - Kevin Power
Aims
Chronic 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.
Methods
Eleven 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).
Results
Qualitative 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.
Discussion
The 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,
30
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’).
2012
The Development and Evaluation of a Mindfulness-Based Stress Reduction
Self-Help Intervention for Patients with Medically Unexplained Symptoms
Sarah McLaren
Clinical supervisor - April Quigley
Introduction
Alongside 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.
Aims
To develop and evaluate a self-help mindfulness-based
stress reduction (MBSR) intervention for patients with
medically unexplained symptoms (MUS).
Methods
A 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 postintervention 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.
Academic supervisor - Paul Morris
Results
Though 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.
Conclusions
Evidence 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.
31
2012
Maternal and infant factors influencing infant feeding - a longitudinal study
Suzanne Mills
Clinical supervisors - Caroline Howe, Helen Prior
Academic supervisors - Suzanne O’Rourke, Emily Newman
Introduction
There 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.
Method
A 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
32
a successful feeding experience. A within subjects design
was employed to examine predictors of infant feeding
difficulties.
Results
23% 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.
Discussion
Relationships 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.
2012
Childhood trauma and eating psychopathology: A mediating role from
dissociation and emotion dysregulation?
Stuart J. Moulton
Clinical supervisor - Kevin Power
Aims
This 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).
Method
A 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).
Results
The 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
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.
Conclusions
The 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.
33
2012
Investigating the specificity of neuropsychological performance in bulimic
outpatients: a comparison with anxious and depressed outpatients
Kate O’Sullivan
Clinical supervisors - Kevin Power, Allison Livingstone, Paula Collins
Introduction
Eating 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.
Methods
A 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
34
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.
Results
The 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.
Conclusion
These 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.
2012
Deliberate self-harm in a clinical sample: the impact of schema modes,
parental bonding and perceived stress
Amber Saldias
Clinical supervisor - Kevin Power
Introduction
Deliberate 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 Review
Despite 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.
Academic supervisor - David Gillanders
Empirical Study
ST 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.
Conclusion
Results 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.
35
2012
Exploring the close relationships of people with learning disabilities:
A qualitative study
Faye Sullivan
Clinical supervisor - Keith Bowden
Academic supervisors - Karen McKenzie, Ethel Quayle
Introduction
Interpersonal 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.
Method
Data were gathered from ten PWLD using one to
one semi-structured interviews. Interviews were
36
recorded, transcribed and analysed using Interpretive
Phenomenological Analysis.
Results
Five 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.
Discussion
The 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
up communication regarding this area, which could
indirectly promote PWLD ability to express their emotions
regarding relationships.
Conclusions
The 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.
37
2012
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 Swan
Clinical supervisor - Vicki Dunbar
Aims
Systematic 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.
Method
Systematic 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
38
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.
Results
Systematic 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.
Conclusion
Systematic 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.
39
2012
Motives for substance use in the presence of Post Traumatic Stress
Disorder (PTSD): a research portfolio
Isabel Traynor
Clinical supervisors - Andrew Summers, Zoe Hughes
Introduction
Post 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.
Methods
Firstly, 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.
Results
Results 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.
40
Academic supervisor - Mick Power
Conclusions
Findings 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.
2012
Posttraumatic stress following childbirth and maternal perceptions of the
mother-infant bond: the role of attachment experiences and metacognition
Charlotte Williams
Clinical supervisor - Rachel Smith
Academic supervisors - Emily Taylor, Matthias Schwannaeur
Introduction
Some 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.
Conclusions
Metacognition 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.
Methods
An 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.
Results
The 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.
41
2012
Mothers with a learning disability: their experiences of service provision
during the postnatal period
Suzanne Wilson
Clinical supervisor - George Murray
Academic supervisor - Karen McKenzie, Ethel Quayle
Introduction
There 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.
Method
Semi-structured interviews were carried out with six
mothers with learning disabilities. The data were collected
and analysed using Interpretative Phenomenological
Analysis.
Results
Mothers‟ 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.
42
Discussion
The 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.
Conclusion
The 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.
2012
Burnout and Job Engagement in UK Cancer Care Staff: How do they relate
to Job Stress and Satisfaction and Turnover Intentions?
Silke L. Ziemen
Clinical supervisor - Belinda Hacking
Academic supervisor - Emily Newman
Introduction
Health 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 wellbeing of health care professionals and their ability to care
for patients can be improved.
Systematic review
A 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.
Aims
A 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 procedure
150 cancer care workers completed a cross-sectional
Contributor - Gerry Humphris
questionnaire entailing the Maslach Burnout Inventory,
the Engagement Indicator, measures of job satisfaction,
stress, turnover intentions and demographics.
Results
Mean 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.
Implications
It 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.
Conclusions
Work 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.
43
Contacts
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 Kelly
Clinical & Health Psychology
University of Edinburgh
Teviot Place Quad
Edinburgh EH8 9AG
(0131) 651 3972
44
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