Doctorate in Clinical Psychology Research Portfolio

: 1) Psychological Interventions for Avoidant/Restrictive Food Intake Disorder (ARFID): A Scoping Review; 2) Evaluation of Care Staff Training: Supporting People with Intellectual Disabilities’ Emotional Wellbeing; 3) Cancer-Related Fatigue in Teenage and Young Adult Cancer Patients: Clinicians’ Perspectives, Practice and Challenges.

Abstract

Critical Literature Review
Psychological Interventions for Avoidant/Restrictive Food Intake Disorder (ARFID): A Scoping Review

Background: Avoidant/Restrictive Food Intake Disorder (ARFID) was added to the diagnostic nomenclature in 2013. ARFID refers to avoidant and/or restrictive eating disturbances that do not result from body image or weight concerns. Currently, there are no evidence-based practice guidelines to guide treatment of ARFID. This review aimed to synthesise literature pertaining to psychological interventions in the treatment of ARFID and describe how outcomes are measured.
Method: A scoping review was conducted. A comprehensive search was conducted across Embase, PsycNET and Web of Science Core Collection, yielding 401 unique results. Eligibility criteria applied to the articles resulted in 29 studies included in the review. Data was synthesised to identify what psychological interventions are used in practice and, drawing upon principles of thematic analysis, describe common treatment components across psychological interventions and categorise outcomes measured.
Results Behavioural approaches, Cognitive Behavioural Therapy, and Family Based Therapy were identified as psychological interventions used in practice to treat ARFID.
Eleven of the studies used combinations of these psychological interventions, and one included the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders for Children. Outcomes measured were heterogenous, though can be grouped into themes; physical outcomes and health status, nutritional and dietetic changes, food intake, ARFID diagnostic status, emotional and behavioural change regarding eating, psychological change, idiosyncratic goal-based outcomes, and treatment acceptability.
Conclusion: Whilst various psychological interventions are used in the treatment of ARFID there are commonalities across these approaches, including psychoeducation, food exposures, parental involvement, anxiety management strategies, and treatment generalisation. Research evaluating the effectiveness of psychological interventions for ARFID, across its varied presentation and population, are required. There is urgent need to develop ARFID-specific outcome measures and psychometrically test measures for populations with ARFID. These developments would support fruition of evidenced-based treatment guidelines for ARFID.

Main Research Project
Cancer-Related Fatigue in Teenage and Young Adult Cancer Patients: Clinicians’ Perspectives, Practice and Challenges

Objective Cancer-related fatigue (CRF) is a common and distressing symptom experienced by teenage and young adult cancer patients (TYAs). This study aimed to explore clinicians’ perspectives, practices, and challenges, in supporting TYAs with CRF.
Method Ten clinicians from a TYA multi-disciplinary team (MDT) participated in semi-structured interviews which were thematically analysed.
Results Clinicians perceived CRF as a common, but individual experience, for TYAs, impacting upon multiple domains of TYAs’ development and wellbeing. Clinicians’ practice in supporting TYAs with CRF varied depending on their discipline and role; most clinicians had general conversations around wellbeing and few used structured clinical tools. Clinicians supported TYAs by meeting their health and wellbeing needs, being alongside TYAs experiencing CRF, and adapting their care. Clinicians faced challenges in supporting TYAs with CRF including struggling with knowing how best to manage CRF, managing assumptions and expectations around CRF, and lacking time and TYA-appropriate resources, assessment tools, and community services.
Conclusions Despite clinicians’ good insight into TYAs’ unique experiences of CRF, assessment and management of CRF for TYAs are complicated by numerous challenges. The development of evidence-based interventions and guidelines, clearer pathways of care, and TYA-friendly resources, measures, and programmes, is vital to support clinicians, and TYAs, in managing CRF.

Service Improvement Project
Evaluation of Care Staff Training: Supporting People with Intellectual Disabilities’ Emotional Wellbeing

Background: People with intellectual disabilities have higher prevalence rates of mental health difficulties compared to the general population. Care staff are well placed to support people with intellectual disabilities’ emotional wellbeing. This study evaluated a training day designed for care staff to support people with intellectual disabilities’ emotional wellbeing.
Method: Twenty-eight participants attended a training day at a locality Community Learning Disabilities Team (CLDT), delivered by a Clinical Psychologist. Participants completed bespoke questionnaires to evaluate the training and were followed up at two months.
Results: The content and delivery of the training was rated favourably by most participants. The training significantly increased participants’ knowledge and capabilities, and reduced their worries, in supporting people with intellectual disabilities’ emotional wellbeing. There were few follow-up responses, however, those that did respond reported some changes in practice following the training, such as applying new strategies.
Conclusion: Given largely favourable feedback, the training could be continued. However, recommendations are outlined to improve the training, and continue its evaluation, based upon nuances in feedback and considering limitations of the training and study.

Date of Award	8 Sept 2020
Original language	English
Awarding Institution	University of Bath
Supervisor	Maria Loades (Supervisor) & Paul Chadwick (Supervisor)