AbstractMain Research ProjectObjectives: Chronic Fatigue Syndrome/ME (CFS/ME) and Irritable Bowel Syndrome (IBS) are known to be associated with poor quality of life and impaired functioning. Similar psychological drivers have been identified in these conditions, such as beliefs about symptoms (cause, consequence and management) and behavioural responses (withdrawal, avoidance and safety- seeking). The aim of this study was to compare CFS/ME and IBS groups regarding these factors to establish the extent to which they are similar (transdiagnostic) and different (disorder-specific). Method: Using a cross- sectional design, CFS/ME participants (n= 21), IBS participants (n=40), participants with co-morbid CFS/ME and IBS (n= 17) and healthy controls (n=65) were compared on a range of self-report questionnaires. This included measures of general psychological well-being (depression, anxiety, mental defeat, functioning). Novel measures were also developed to measure transdiagnostic and disorder-specific beliefs and behaviours, all of which were found to have good internal consistency. Results: Compared to the controls, the clinical groups reported poorer psychological wellbeing and endorsed more negative transdiagnostic beliefs and behaviours than healthy controls. The CFS/ME and co-morbid groups also scored significantly higher than the IBS group. Additionally, the CFS/ME group endorsed more disorder-specific beliefs and behaviours related to fatigue, while the IBS group scored higher on disorder-specific characteristics relevant to gastrointestinal symptoms. The co- morbid group showed characteristics of both CFS/ME and IBS. Conclusions: These study found similarities and differences between CFS/ME and IBS participants, regarding their beliefs about symptoms and behavioural responses to symptoms. This indicates that it may be appropriate to use a modular transdiagnostic cognitive-behavioural approach for these problems, whereby therapy would start by addressing their common features and become more tailored to disorder-specific features as therapy progresses. For patients with CFS/ME, potentially unhelpful fatigue-related beliefs and behaviours should be addressed. Similarly, IBS patients may benefit from a focus on relevant gastrointestinal beliefs and behaviours. Implications for future research are discussed. Service Improvement ProjectPeople with mental health problems in general and Obsessive Compulsive Disorder (OCD) in particular often delay seeking help and lack information about evidence-based treatment. Provision of such information has increasingly become a task led by third sector organisations. OCD-UK is a charity, led by people with personal experience of OCD that runs an annual conference to address these issues. It primarily aims to promote understanding of OCD and its treatment, and increase optimism regarding the ability to overcome OCD. It also aims to highlight the need for psychological treatment, specifically Cognitive Behavioural Therapy. The present study undertook a systematic evaluation of OCD-UK’s 2014 conference. Sufferers (n=50) and carers (n=41) completed questionnaires pre- and post-conference. Changes in their scores showed that the conference was successful in increasing attendees’ confidence in their understanding of OCD and knowledge of treatment options. Additionally, the following beliefs weakened: pessimism about the ability to overcome OCD and perception of OCD as a biological illness. Beliefs about perceived need for psychological therapy to overcome OCD strengthened. Generally, sufferers and carers did not differ in terms of the impact of the conference. The findings illustrate the value of third-sector organisations, like OCD-UK, in providing information and addressing beliefs that are considered barriers to accessing treatment. The implications of these findings are discussed, along with recommendations for future research. Critical Review of the LiteraturePurpose: Solution-Focused Brief Therapy (SFBT) has a growing evidence base for the general population. Several authors have recognised the advantages of applying this short-term, goal-focused and client-directed approach in intellectual disabilities (ID) and its evidence-base in this context is growing. However, it has not been critically evaluated. The purpose of this review is to summarise and critique the literature that has used solution-focused (SF) approaches in ID, and consider the implications for future research and clinical practice. Methodology and findings: A narrative literature review identified 12 studies that described or evaluated the application of solution- focused approaches; six used SFBT with individuals with IDs and six used Solution Focused Counselling (SFC) with staff and families. Research implications: The evidence-base primarily consists of case studies, and while they were generally of good quality, this limits the conclusions that can be drawn regarding the effectiveness of SF approaches in this context. There is a need for further controlled studies, with valid and reliable outcome measures, larger samples and longer follow-ups. Practical implications: Overall the reviewed studies offered preliminary evidence for the effectiveness of SFBT for individuals with mild ID and SFC for care staff working with individuals with moderate and severe ID, in particular in cases where clients’ behaviour challenges. ID services should consider offering SF approaches on this basis. For individuals with ID, SF techniques should be modified to accommodate for their cognitive abilities and carers should be involved in sessions where possible. The ‘miracle question’ technique was consistently considered too abstract and unhelpful, regardless of whether it was used for individuals with ID or their family and carers. Hence, it should be re-phrased so that it is more concrete and focused on coping, strengths & competencies.
|Date of Award||14 Sep 2016|
|Supervisor||Paul Salkovskis (Supervisor), Cathy Randle-Phillips (Supervisor) & Josie Millar (Supervisor)|
Research Portfolio Submitted in Part Fulfilment of the requirements for the Degree of Doctorate in Clinical Psychology
Carrick, H. (Author). 14 Sep 2016
Student thesis: Doctoral Thesis › Doctor of Clinical Psychology (DClinPsy)