Critical Review of the Literature
The consequences of childhood maltreatment are pervasive and implicated in the development of a range of mental health difficulties, including eating disorders. However, the mechanisms which mediate the link between childhood maltreatment and eating disorders are unknown. This has important implications for effective intervention, as eating disorders are notoriously difficult to treat. There are numerous factors which predict poor therapy outcome that overlap with mediators between childhood maltreatment and disordered eating behaviours in non-clinical samples. This may suggest people with a history of maltreatment could be at greater risk of developing an eating disorder which does not respond to currently available interventions. This review aimed to identify the mediating variables between childhood maltreatment and eating disorders. Studies which tested mediators of the relationship between childhood maltreatment and eating disorders were systematically reviewed and a narrative synthesis of the findings reported. The findings suggested mediators of the relationship between childhood maltreatment and eating disorders could be mapped onto cognitive-emotional-behavioural and affective models of eating disorders. Limitations of the reviewed studies and clinical implications are discussed.
Service Improvement Project
Formulation, in the context of clinical psychology, involves integrating a breadth of knowledge to create a tentative hypothesis to describe the difficulties service users may experience. Team formulations, created by a multi-disciplinary team to construct a shared understanding of a service user’s experiences, can facilitate a more consistent and collaborative approach within a team and lead to a more holistic, psychosocial understanding of a person’s difficulties. This project was carried out in two recovery teams in a locality within an NHS trust in which staff had been trained to use the 5 Ps model of formulation (Weerasekera, 1995). The project aimed to establish whether staff were using 5 Ps formulations in their work, whether these were experienced as useful, what supports staff to use a 5 Ps formulation, and what staff feel the barriers to using a 5 Ps formulation are. A questionnaire and two focus groups were used and analysed using descriptive statistics and thematic analysis. The results suggested staff used the model to inform their clinical thinking, in consultation with therapist colleagues, and in group reflective practise. Overall, the 5 Ps model was well received. The model appeared to support staff both with their clinical work and to be more reflective and holistic in their approach. However, staff did raise some drawbacks with the model and difficulties with integrating it consistently into their clinical practise. Service recommendations include areas for continued practise, areas for development and change, and areas for further service evaluation and potential research opportunities.
Main Research Paper
The ‘Common Sense Model’ (CSM; Leventhal, Meyer, & Nerenz, 1980) aims to explain how psychological factors influence long-term health condition (LTC) management. Research has shown the CSM applies to children and young people (CYP) as well as adults. However, the model does not incorporate systemic factors, which are especially relevant for CYP, for whom families hold more illness management responsibilities. Caregiver perceptions of an illness have been linked with outcomes for the person with the health condition. Other factors which have been shown to affect illness perceptions include the LTC itself. This pilot study examines differences in illness perceptions between two groups of parents: those whose children had type 1 diabetes, and parents of children with juvenile idiopathic arthritis. This study also examined mood, anxiety and time since the child’s diagnosis as predictors of parental illness perceptions. It was found that having a child with type 1 diabetes was predictive of anticipating longer illness duration and perceiving greater control over the condition. Additionally, having greater levels of anxiety was predictive of more perceived control, which may be associated with condition monitoring behaviours in type 1 diabetes. Finally, scores indicating lower mood predicted perceiving the consequences of the condition as more severe and lower levels of perceived control over the condition. Future research directions and clinical implications are discussed.
|Date of Award||23 Aug 2018|
|Supervisor||James Gregory (Supervisor)|