Doctorate in Clinical Psychology: Main Research Portfolio

: 1) : The efficacy of Cognitive Behavioural Therapy for women with depression during pregnancy. A systematic review and metaanalysis; 2) What do LGBTQI+ People Want their Therapist to Know?; 3) Maternal OCD and Depression: The role of beliefs.

Abstract

Critical Review of the Literature: The efficacy of Cognitive Behavioural Therapy for women with depression during pregnancy. A systematic review and meta-analysis

Background: Cognitive Behavioural Therapy is considered to have the strongest empirical base of the psychological therapies and is the NICE recommended treatment of choice for depression in adults. Perinatal (pregnancy and the 12 months postpartum) research has indicated CBT as an efficacious intervention for depression during this period, however previous meta-analyses have not investigated CBT for depression during pregnancy alone.
Method: A systematic review identified 11 randomised controlled trials (RCTs) assessing change in antenatal depression when compared to a control group. Change in depressive symptoms from pre-treatment to post-treatment and pre-treatment and follow up were assessed. Characteristics of included studies were identified and described. Results: A moderate effect size was found for the efficacy of CBT over treatment as usual/ supportive counselling. However, high levels of heterogeneity were also found. Possible sources for this are discussed as well as recommendations for successful adaptation for this population.
Limitations: Many of the included studies were small and underpowered and had key methodological differences which limits the conclusions that can be drawn.
Conclusions: This review provides preliminary evidence for the efficacy of CBT for depression in the antenatal period, particularly individual sessions delivered by a psychologist, however larger powered RCTs are needed in order to draw more firm conclusions.

Service Improvement Project: What do LGBTQI+ People Want their Therapist to Know?

Aim: The aim of this study was to explore what people identifying as LGBTQI+ felt was important for their therapists to know about their lived experiences, and how well their previous therapists had done this. The results were shared with a leading LGBTQI+ therapy provider to inform its training provision for therapists.
Research Methodology: The study has a qualitative exploratory design. Participants were asked to answer a questionnaire comprising closed and open questions about their experience(s) of psychological therapy. The online anonymous survey took 30-60 minutes and was completed by 58 people. Inductive thematic analysis was performed using Braun & Clark’s (2006) seven steps.
Findings: The analysis resulted in three main themes: “Remaining Curious”, “LGBTQI+ knowledge” and “Acceptance”. Participants shared both positive and negative experiences of therapy.
Conclusion: Therapists are advised to remain curious when working with LGBTQI+ communities; by not making assumptions, facilitating exploration of complex sexual and gender identities; committing to gaining specific knowledge of LGBTQI+ identities and sexualities and being reflexive about the effects of their own and society’s
prejudice.

Main Research Project: Maternal OCD and Depression: The role of beliefs

Background: Depression and OCD are both common mental health difficulties during pregnancy and one year postpartum. Although some factors have been linked to perinatal depression, research on perinatal OCD remains in its infancy and more studies are needed to explore why some women develop this debilitating condition when they have a baby. Cognitive theory posits that the dysfunctional beliefs people hold could explain this; women with perinatal depression are more likely to have beliefs linked to judgment and failure, while women with OCD are more likely to have inflated responsibility beliefs.
Method: 90 women who were either pregnant or had given birth within the last two years were recruited via Mental Health charities and completed an online questionnaire comprising a diagnostic questionnaire, measures of symptom severity and measures of general and parenting-specific dysfunctional beliefs.
Results: Women with OCD and Depression shared similar amounts and strength of responsibility and general dysfunctional beliefs. However, women with depression held stronger maternal-specific dysfunctional beliefs. There were no significant differences in parenting-specific beliefs between women with pre-existing OCD and women who developed OCD in the perinatal period. Women with more enduring OCD however engaged in more mental neutralising strategies than women with perinatal OCD or depression. Limitations: The sample was underpowered so results should be interpreted with caution. Women were diagnosed by self-report, an in person diagnostic interview would have been gold standard.
Conclusions: This exploratory study indicates that responsibility beliefs and dysfunctional beliefs are not exclusive to either OCD or Depression, but rather may underlie both presentations during the perinatal period. The advent of responsibility for a vulnerable infant may trigger underlying responsibility beliefs in women previously without OCD, in particular those who have previously experienced depression and anxiety.

Date of Award	8 Sept 2020
Original language	English
Awarding Institution	University of Bath
Supervisor	James Gregory (Supervisor), Catherine Butler (Supervisor) & Josie Millar (Supervisor)