Evaluating an online self-help intervention for parents of children with food allergies.

BACKGROUND: Parents of children with food allergies (CwFA) experience reduced quality of life (QoL) and may have reduced access to in-person interventions in the COVID-19 pandemic. This trial developed and evaluated an online, self-help, information provision website, aimed at improving QoL in parents of CwFA. METHODS: In a single-blinded, randomised controlled trial (RCT), participants were randomised to either receive access to the website or a waiting-list control. At baseline, post-intervention (week 4) and follow-up (week 8), measures of parental food allergy-related QoL, depression, anxiety, stress, intolerance of uncertainty (IU) and self-efficacy were obtained. RESULTS: A total of 205 participants were randomised; 97% were females, 91% white and 78% educated ≥ degree level, with a mean age of 38.95 years (SD = 6.89). 44.9% (n = 92) were retained at follow-up. The arms did not significantly differ on any outcome at any time point. For a sub-group of participants above the clinical cut-off for depression at baseline, the intervention may have improved QoL. Participants reported the website content as useful and accessible, but accessed it infrequently. In baseline data, IU and self-efficacy were significantly associated with QoL. CONCLUSION: While the COVID-19 pandemic has encouraged greater provision of online interventions, our RCT suggests this particular website is not suitable for this population in general, although future research could examine its efficacy for depressed parents of CwFA, to increase confidence that the sub-group finding was not a Type 1 error. The baseline data suggest IU and self-efficacy remain potential proximal targets for intervention.

Developing and evaluating mental health lived experience practitioner (LXP) roles in an NHS trust.

BACKGROUND: The value of establishing roles for people with lived experience of mental distress within mental health services is increasingly being recognised. However, there is limited information to guide the introduction of these roles into mental health services. AIMS: This study details the development and evaluation of a new mental health peer worker role, the Lived Experience Practitioner (LXP), within an NHS Trust. METHODS: A three-phase exploratory mixed-methods approach was used. Qualitative data were collected and analysed in the first phase. The qualitative findings were then translated into the formal procedures for introducing LXPs into the Trust, with the approach examined quantitatively in the third phase. RESULTS: The qualitative analysis identified five themes; role design, training, piloting, career pathways and communication. These formed the basis for working groups (workstreams) which developed policies and procedures for introducing the LXP role into the Trust. Twenty-eight applicants commenced a training programme with 10 successful completions. Seven LXPs were employed by the Trust and were still in their posts after 2 years. CONCLUSION: In this study, three areas were viewed as important when introducing LXP roles into mental health services; organisational support, the training programme and employment procedures.

Thriving alongside cystic fibrosis: Developing a grounded theory of empowerment in children and young people with cystic fibrosis during key life transitions.

BACKGROUND: Although the importance of patient empowerment is increasingly recognized, little is known about empowerment in children and young people (CYP) with long-term conditions. Empowerment may be particularly important in CYP with cystic fibrosis (CF) due to high treatment burden and limited opportunities for peer support. METHODS: A Grounded Theory method was employed to develop a preliminary theory of empowerment in CYP with CF. Seven CYP with CF, five parents and four professionals were interviewed. RESULTS AND CONCLUSIONS: The emerging model suggests that 'thriving alongside CF' may be supported by interactions between 'having a team' and 'taking charge and having a voice', leading to 'being able to just be a child', that 'concealing self' may get in the way of 'thriving alongside CF' and that these processes occur within wider medical and developmental contexts. Study limitations, clinical and research implications are discussed.

Development of the Guernsey community participation and leisure assessment-Revised (GCPLA-R).

A sufficiently psychometrically robust measure of community and leisure participation of adults with intellectual disabilities was not in existence, despite research identifying this as an important outcome and a key contributor to quality of life. The current study aimed to update the Guernsey Community Participation and Leisure Assessment (GCPLA). Adults with intellectual disabilities, carers and experts were consulted in creating a revised pool of 46 items. These were then tested and data from 326 adults with intellectual disabilities were analysed for their component structure and psychometric properties. Principal component analysis discovered a stable set of components describing seven different clusters. This revised measure (the GCPLA-R) was demonstrated to have satisfactory reliability, and scores were related to challenging behaviour and adaptive behaviour in theoretically consistent ways and were correlated with scores on comparable measures.

Interventions for caregivers of children with food allergy: A systematic review.

BACKGROUND: Studies have identified that food allergy (FA) in children is related to poorer caregiver quality of life (QoL). However, it is unclear which interventions are most effective at improving outcomes for caregivers of children with FA. This review aimed to identify and determine the efficacy, acceptability and quality of interventions for caregivers of children with FA. METHODS: A systematic search of four databases was conducted to identify studies evaluating any intervention that targeted well-being and support of caregivers of children with FA. Studies were not excluded based on design and were rated for quality using the Mixed Methods Appraisal Tool (MMAT) and the Cochrane risk of bias tool for randomized controlled trials (RCTs). RESULTS: Fifteen studies met the inclusion criteria: eight studies used a pre-test/post-test design, four studies used a post-test design, two studies used an RCT design, and one study used a case-control design. Seven studies were educational interventions, five were psychological interventions, and three involved peer/professional support. All interventions had high participant acceptability; some evidence for cognitive behavioural interventions in supporting mothers was observed. Educational interventions tended to be associated with improvements in FA knowledge. With the exception of three studies, most studies were assessed as poor or moderate in terms of quality. CONCLUSION: There is a paucity of high-quality research evaluating interventions to improve outcomes in parents of children with FA. Limited evidence suggests that cognitive behavioural interventions could benefit some mothers, but this has not been tested in other populations. Future research should use methodologically sound designs with validated outcome measures.

Falls self-efficacy and falls incidence in community-dwelling older people: the mediating role of coping.

ABSTRACTBackground:A cognitive behavioral model predicts that coping responses mediate the relationship between falls related psychological concerns and falls incidence, in community-dwelling older people. If empirical support could be found for this pathway then interventions could be developed to reduce falls risk by targeting coping strategies. Therefore, this study aimed to begin the process of testing whether coping responses mediate the association between falls self-efficacy (a principal element of falls related psychological concerns) and falls incidence, in community-dwelling older people. METHOD: In a cross-sectional design, 160 community-dwelling older people (31 male, 129 female; mean age 83.47 years) completed the Falls Efficacy Scale-International, the Revised-Ways of Coping Questionnaire, the Turning to Religion subscale of the COPE, and a falls questionnaire. Data were analyzed via mediation analysis using a bootstrapping approach. RESULTS: Lower falls self-efficacy was associated with higher falls incidence, and more self-controlling coping was found to be a partial mediator of this association, with a confidence interval for the indirect effect of (0.003, 0.021) and an effect size of κ2 = 0.035. The association was not mediated by the other measured coping responses; namely, turning to religion, distancing, seeking social support, accepting responsibility, escape-avoidance, planful problem-solving, and positive reappraisal. CONCLUSIONS: Self-controlling coping may mediate the association between falls self-efficacy and falling. If longitudinal studies confirm this finding then coping could be targeted in interventions to reduce falls.

Building a Grounded Theory of Engagement in Mindfulness-Based Group Therapy for Distressing Voices.

Mindfulness-based group therapy shows promise as a treatment for distressing voice hearing. However, fostering engagement in groups can be challenging, and no theory of engagement in group therapy for distressing voices exists to guide practice or research. This study employed Grounded Theory Method to build a theory of engagement in mindfulness-based groups for distressing voices. Ten service-users and three therapists were interviewed about their experiences of such groups. The model that emerged involves a recursive process of investing in change and continually evaluating its usefulness and safety. Barriers to engagement were often overcome, but sometimes compromised perceived safety, leading to dropout. For others, group participation led to rewards, some of which were integrated beyond group termination. Group engagement can be encouraged by establishing universality around voice hearing early, reducing uncertainty, sharing difficulties with mindfulness practices, and mapping group progress to create a cohering sense of collaboration on therapy tasks.

A "Collective Effort to Make Yourself Feel Better": The Group Process in Mindfulness-Based Interventions.

There is growing interest in mindfulness-based interventions (MBIs) in the management of multiple physical and mental health issues. Although MBIs utilize a group format, research on how this format impacts teaching and learning mindfulness is lacking. This study aimed to develop a detailed theory of MBI group processes utilizing a grounded theory methodology. This article presents our subsequent model, developed from semistructured interviews conducted with MBI students, teachers, and trainers ( N = 12). A core category, the group as a vessel on a shared journey, and three higher-order categories emerged from the data. They illustrate how MBI group processes navigate a characteristic path. Teachers build and steer the group "vessel" in a way that fosters a specific culture and sense of safety. The group is facilitated to share communal experiences that augment learning and enrich mindfulness practice. Limitations and implications for clinicians and researchers are discussed.

Association between maternal childhood trauma and offspring childhood psychopathology: mediation analysis from the ALSPAC cohort.

BackgroundStudies have shown that a mother's history of childhood maltreatment is associated with her child's experience of internalising and externalising difficulties.AimsTo characterise the mediating pathways that underpin this association.MethodData on a mother's history of childhood maltreatment, depression during pregnancy, postnatal depression, maladaptive parenting practices and her child's experience of maltreatment and internalising and externalising difficulties were analysed in an Avon Longitudinal Study of Parents and Children (ALSPAC) sample of 9397 mother-child dyads followed prospectively from pregnancy to age 13.ResultsMaternal history of childhood maltreatment was significantly associated with offspring internalising and externalising difficulties. Maternal antenatal depression, postnatal depression and offspring child maltreatment were observed to significantly mediate this association independently.ConclusionsPsychological and psychosocial interventions focused around treating maternal depression, particularly during pregnancy, and safeguarding against adverse childhood experiences could be offered to mothers with traumatic childhood histories to help protect against psychopathology in the next generation.

Paediatric gastroesophageal reflux disease and parental mental health: Prevalence and predictors.

OBJECTIVE: The current study aimed to estimate the prevalence of common mental health difficulties in parents who have an infant with Gastroesophageal Reflux Disease (GORD), and to identify psychological predictors of parental anxiety, depression, and well-being, as a platform for subsequent intervention development. METHODS: Parents of infants with GORD (N = 309) completed online psychometric measures of potential predictors (self-compassion, illness appraisals, and illness uncertainty), potential confounders (sleep quality, relationship satisfaction, social support, and infant feeding satisfaction), and mental health outcomes (anxiety, depression, and wellbeing). The outcome measures were repeated eight-weeks later (N = 103). RESULTS: At the first time-point, 66% of participants exceed the clinical cut off for generalised anxiety disorder and 63% exceeded that for a depressive disorder. Both had significantly reduced eights-weeks later. Greater self-compassion predicted lower anxiety and depression, and better well-being, in both cross-sectional and longitudinal data, including when all confounders were controlled for. Illness uncertainty and illness appraisals were less consistent predictors. No robust differences were found between parents of infants with silent GORD and those with GORD with visible regurgitation. CONCLUSIONS: Parents of infants with GORD showed high rates of anxiety and depression, which were elevated compared to those that have been found in perinatal and general population samples. Self-compassion was a consistent predictor of better mental health and has promise as a proximal intervention target. Future research could benefit from examining the efficacy of a compassion-focussed intervention in this population.

Out of control: an associative account of congruency effects in sequence learning.

The demonstration of a sequential congruency effect in sequence learning has been offered as evidence for control processes that act to inhibit automatic response tendencies (Jiménez, Lupiáñez, & Vaquero, 2009) via unconscious conflict monitoring. Here we propose an alternative interpretation of this effect based on the associative learning of chains of sequenced contingencies. This account is supported by simulations with a Simple Recurrent Network, an associative (connectionist) model of sequence learning. We argue that the control- and associative-based accounts differ in their predictions concerning the magnitude of the sequential congruency effect across training. These predictions are tested by reanalysing data from a study by Shanks, Wilkinson, and Channon (2003). The results support the associative learning account which explains the sequential congruency effect without appealing to control processes (either conscious or unconscious).

Facilitators and barriers to empowerment in children and young people with cystic fibrosis: a meta-synthesis of the qualitative literature.

PURPOSE: Patient empowerment may be particularly important in children and young people (CYP) with CF, due to high treatment burden and limited peer support opportunities. This review aimed to meta-synthesize the qualitative literature pertaining to empowerment in CYP with CF. MATERIALS AND METHODS: This work was guided by the ENTREQ framework, with a search strategy based on the SPIDER framework. A systematic search of PsycInfo, Medline, CINAHL and ASSIA databases was conducted. Identified studies were quality assessed and data analysed using thematic synthesis. PROSPERO registration: CRD42019154014. RESULTS: Seventeen studies met inclusion criteria, though none explicitly explored empowerment. Thematic synthesis identified six analytic themes: relational support, information and understanding and feeling heard and respected appeared to facilitate empowerment, while prejudices and assumptions were identified as potential barriers. Mastery and competence and Navigating being different appeared to be components of empowerment. CONCLUSIONS: The findings provide an initial understanding of patient empowerment in CYP with CF. Potential clinical implications include the need for more CYP-friendly information, more shared decision making and more opportunities to experience mastery. The need for further research is highlighted, particularly relating to developmental influences and factors unique to CF, which are not adequately addressed in existing patient empowerment models.Implications for rehabilitationEmpowerment in children and young people with cystic fibrosis can be facilitated by supportive and respectful relationships with family, friends and clinical teams, that enable them to feel heard and understood.It can be further supported by providing developmentally appropriate information and opportunities for children and young people to experience mastery and competency in typical childhood activities.Prejudices and assumptions about the capabilities of children and young people with CF, even when based in good intentions, can act as a barrier to empowerment.Empowerment can shape (and be shaped by) the way the children and young people navigate differences associated with living with CF.

Living in a World With God: An Interpretative Phenomenological Exploration of the Religious Experiences of Five Baptists in Britain.

Religious and spiritual experiences often form significant elements of people's narratives about their faith and lives, but the impact of these experiences is often neglected in academic studies. This study investigated the connections between perceived experiences of God and beliefs in the lives of five members of a Baptist church in Britain, using data from semi-structured interviews. Interpretative phenomenological analysis (IPA) was used to explore the data and develop 11 recurrent sub-themes, organized into two super-ordinate themes: "Knowing God" and "Living in the World." There were idiosyncratic differences between the experiences of the participants, but they all perceived God communicating with them and attributed certain events to God's influence. These experiences developed real and meaningful relationships with God, and the participants' faith affected every aspect of their lives, shaping their actions, beliefs and daily lived experiences. The participants' diverse experiences and beliefs created mutually supporting meaning systems (or worldviews) that were much stronger than the individual elements that contributed to them. God was an intrinsic part of the participants' social reality, and their lived experiences cannot be adequately understood without appreciating the influence of this central aspect of their lives. These findings show the importance of taking a holistic and idiographic perspective when studying religiosity and spirituality. The study also demonstrates IPA is a useful and effective tool for studying lived experiences of religiosity and spirituality and supports its broader use to investigate such phenomena.

Singing and music making: physiological responses across early to later stages of dementia.

Background: Music based interventions have been found to improve wellbeing for people with dementia. More recently there has been interest in physiological measures to provide additional information about how music and singing impact this population. Methods: This multiple-case study design explored physiological responses (heart rate-HR, electrodermal activity-EDA, movement, and skin temperature-ST) of nine people with mild-to-moderate using simulation modelling analysis.             Results: In study 1,  the singing group showed an increase in EDA (p < 0.01 for 8/9 participants) and HR (p < 0.01 for 5/9 participants) as the session began. HR (p < 0.0001 for 5/9 participants) and ST (p < 0.0001 for 6/9 participants) increased during faster tempos. EDA (p < 0.01 all), movement (p < 0.01 for 8/9 participants) and engagement were higher during singing compared to a baseline control. In study 2 EDA (p < 0.0001 for 14/18 data points [3 music conditions across 6 participants]) and ST (p < 0.001 for 10/18 data points) increased and in contrast to the responses during singing, HR decreased as the sessions began (p < 0.002 for 9/18 data points). EDA was higher during slower music (p < 0.0001 for 13/18 data points), however this was less consistent in more interactive sessions than the control. There were no consistent changes in HR and movement responses during different music genre.   Conclusions: Physiological measures provide valuable information about the experiences of people with dementia participating in musical activities, particularly for those with verbal communication difficulties. Future research should consider using physiological measures. video-analysis and observational measures to explore further how engagement in specific activities, wellbeing and physiology interact.

When one childhood meets another - maternal childhood trauma and offspring child psychopathology: A systematic review.

BACKGROUND: Child maltreatment can have a long-term impact on mental health. Less is known about the consequences of child maltreatment on the next generation's psychological wellbeing. AIM: This systematic review aimed to synthesise the existing empirical literature on the association between a mother's history of maltreatment in her own childhood and her children's experiences of psychopathology, and to characterise potential mediating pathways. METHOD: Electronic database and hand searches yielded 12 studies, with a combined sample size of 45,723 mother-child dyads, which met criteria for inclusion in the review. RESULTS: There was evidence of an overall positive association between a mother's history of child maltreatment and her child's experience of emotional and behavioural difficulties across childhood and adolescence. Maternal psychological distress and poorer parenting practices were found to be key mediating pathways of this association. CONCLUSION: Children of mothers who were exposed to maltreatment in childhood appear to be at an increased risk for psychopathology. Mothers with traumatic childhood experiences should be offered improved access to psychological therapies and parenting programmes to help mitigate the potential impact of child maltreatment on future generations.

Understanding the concept of resilience in relation to looked after children: A Delphi survey of perceptions from education, social care and foster care.

There has been a surge of interest regarding the application of resilience theory in childcare practice and how resilience can be promoted among vulnerable children, in particular, looked after children. However, little is known about how people working with looked after children understand the concept of resilience. This study aimed to explore how social workers, teachers and foster carers, working with looked after children, understand resilience and whether there is consensus as to what constitutes resilience. The study also sought to explore whether there are differences in how resilience is constructed across these groups. In total, 106 participants took part in a Delphi survey (34 teachers, 36 foster carers, 36 social workers). There was moderate consensus that resilience related to survival, coping and a sense of self-worth. Resilience was not considered a panacea but a concept that also had limitations. Participants understood resilience in ways that were both similar and different to existing conceptualisations within the literature. However, there were many aspects of resilience for which there was no consensus or significant difference of opinion between the participant groups. The need for further training and research is discussed, in order to support attempts to promote resilience among looked after children.

The role of working memory and verbal fluency in autobiographical memory in early Alzheimer's disease and matched controls.

Retrieval of autobiographical memories (AMs) is important for "sense of self". Previous research and theoretical accounts suggest that working memory (WM) and semantic and phonemic fluency abilities facilitate the hierarchical search for, and reliving of past, personal events in the mind's eye. However, there remains a lack of consensus as to the nature of the relationships between these cognitive functions and the truly episodic aspects of AM. The present study therefore aimed to explore the associations between these variables in a sample with a wide range of cognitive abilities. The study incorporated a between-groups component, and a correlational component with multiple regression. Participants with Alzheimer's disease (n=10) and matched healthy controls (n=10) were assessed on measures of semantic and episodic AM search and retrieval, auditory and spatial WM, and semantic and phonemic fluency. The AD group produced less episodic AM content compared to controls. Semantic fluency predicted episodic AM retrieval independent of age effects but there were no significant relationships between measures of phonemic fluency, WM and episodic AM. The results suggest that the ability to maintain hierarchical search of the semantic knowledge-base is important for truly episodic reliving, and interventions for people with AM impairment might therefore benefit from incorporating structured, individualised external memory-aids to facilitate AM search and retrieval.

State-trace analysis: dissociable processes in a connectionist network?

Some argue the common practice of inferring multiple processes or systems from a dissociation is flawed (Dunn, 2003). One proposed solution is state-trace analysis (Bamber, 1979), which involves plotting, across two or more conditions of interest, performance measured by either two dependent variables, or two conditions of the same dependent measure. The resulting analysis is considered to provide evidence that either (a) a single process underlies performance (one function is produced) or (b) there is evidence for more than one process (more than one function is produced). This article reports simulations using the simple recurrent network (SRN; Elman, 1990) in which changes to the learning rate produced state-trace plots with multiple functions. We also report simulations using a single-layer error-correcting network that generate plots with a single function. We argue that the presence of different functions on a state-trace plot does not necessarily support a dual-system account, at least as typically defined (e.g. two separate autonomous systems competing to control responding); it can also indicate variation in a single parameter within theories generally considered to be single-system accounts.

The experiences and coping strategies of United Kingdom-based African women following an HIV diagnosis during pregnancy.

A qualitative investigation was conducted to explore the experience of African women living in the United Kingdom after being diagnosed with HIV during pregnancy. Participants (N = 12) completed a demographic questionnaire and participated in one-to-one semi-structured interviews. The interview addressed multiple personal, interpersonal, and systemic issues related to HIV, as well as HIV in the context of motherhood. Data were analyzed using interpretative phenomenological analysis. Themes that emerged included: (a) HIV being part of one's wider tapestry, (b) community and systemic influences and responses to HIV, (c) experiencing a different story of HIV, and (d) the mother-child relationship. Strikingly, the aspect of HIV these women reported finding most distressing was their inability to breastfeed, which seemed central to their cultural identity as mothers. Clinical recommendations and implications are made.

Perceived social stigma and attitudes towards seeking therapy in training: a cross-national study.

Given the potential value of undergoing psychological therapy when training as a therapist, it is important to understand what influences students' decisions regarding seeking therapy. The study examined the relationship between clinical psychology students' perception of the social stigma attached to receiving therapy and their attitudes toward seeking therapy. Students from Argentina (n = 121), England (n = 211), and the United States (n = 130) completed measures of demographic characteristics, perceived social stigma, attitudes, and other variables associated with therapy-seeking. The results revealed significant cross-national differences, with Argentinean students showing the lowest levels of perceived social stigma for receiving therapy, followed by English and Americans. English students showed relatively less positive attitudes toward seeking therapy than their Argentinean and American counterparts. Social stigma predicted students' attitudes toward seeking therapy among English and American but not Argentinean students. The relationship between perceived social stigma and attitudes was moderated by nationality. Implications for training are discussed, including English and American clinical psychology courses encouraging their students to reflect on the effect of perceived social stigma on their decision-making.