Abstract
Critical Review of the LiteratureObjectives: Non-suicidal self-injury (NSSI) is associated with several physical and social harmful consequences and has been found to be comorbid with other clinical presentations, including eating disorders. Models have been developed to understand the functions and risk factors of NSSI only, but it is unknown whether they apply to NSSI in the context of people with eating disorders.
Methods: To investigate the risk factors and functions of NSSI in eating disorders, a systematic search was conducted leading to the identification of two longitudinal papers related to risk and six papers related to function, across 666 unique participants.
Results: Affective lability and variation in affective activation were identified as risk factors. NSSI primarily served the functions of emotion regulation, self-punishment, identity formation and self-criticism arising from perceived parental criticism and the failure to meet high standards based on perfectionist traits.
Conclusions: These risk factors and functions fit well with the intrapersonal and interpersonal vulnerability factors identified for NSSI and highlighted other factors, including perfectionism and identity confusion. These may interact with the reinforcing functions of NSSI and lead to the engagement of NSSI alongside ED behaviours.
Service Improvement Project
Objectives: Dialectical behavioural therapy (DBT) is an effective treatment for people with borderline personality disorder (BPD) to help with difficulties they may experience in affect, behaviour and interpersonal relationships. This study aimed to expand upon previous literature by exploring both client and staff perspectives of DBT, of a dual diagnosis DBT service that takes an integrated approach to concurrently treat both the symptoms of BPD and comorbid substance misuse.
Methods: Questionnaires and individual interviews were completed by four clients. Questionnaires were completed by six team members and five of those also completed individual interviews.
Results: For clients, results showed that they rated having a high level of satisfaction with the service and thematic analysis identified three main themes: ‘Building a life worth living’, ‘Challenging aspects of DBT’ and ‘The therapeutic environment’. Team members rated their delivery of DBT to be of good quality and felt that clients appeared to be satisfied. Thematic analysis identified two superordinate themes: ‘Not a dedicated DBT service’ and ‘Provision of DBT’.
Conclusions: Recommendations made to the service included improving phone support and the presentation of skills to clients. Additional recommendations made included improving the measurement of outcomes and bringing structure to consultation meetings.
Main Research Project
Objective: Negative subjective interpretations about the cause and consequences of physical symptoms is linked to psychological distress amongst cancer survivors. The present study aimed to extend upon previous literature by examining the role of mental defeat, fear of cancer recurrence (FCR) and health-related beliefs on psychological distress and quality of life, in cancer survivors who experience cancer pain and/or cancer related fatigue (CRF).
Method: The first stage involved 117 cancer survivors completing a brief screening tool evaluating fatigue, pain, depression and anxiety. The second stage comprised 33 participants who had completed the screening tool. Group comparisons were conducted between those experiencing higher levels of cancer pain and/or CRF interference and those with lower levels of cancer pain and CRF, on levels of distress, quality of life, FCR, mental defeat and health-related beliefs.
Results: The screening tool was effective at identifying physical and psychological symptoms known to be present amongst many cancer survivors and was useful in prospectively predicting quality of life and FCR. In the second stage, participants experiencing higher levels of cancer pain and/or CRF interference had significantly higher levels of psychological distress and poorer quality of life, in comparison to those with lower levels of cancer pain and CRF interference. There were no significant group differences on any of the other measures. Mental defeat was a significant predictor of psychological distress and quality of life.
Conclusions: These results highlight the detrimental impact that the experience of physical symptoms can have on cancer survivors. Findings suggest that the brief screening tool could be used clinically to provide earlier detection of cancer survivors who may be in need of psychological support.
| Date of Award | 15 Sept 2017 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Paul Salkovskis (Supervisor), Ailsa Russell (Supervisor) & Emma Griffith (Supervisor) |
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