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Division of Health Psychology

Welcome to the DHP Blog, please comment on the pieces and if you would like to get involved contact publicengagementdhp@bps.org.uk  with any ideas, we look forward to hearing from you.

Blog

Anneliese Levy, Freelance Health Information Writer and Researcher, with an MSc in Health Psychology

Transition to an adult care system for teenagers with a chronic disease can have a long-term impact on their future physical and psychosocial health. I’ve recently completed a project for the charity Crohn’s and Colitis UK, developing resources aimed at young people with Inflammatory Bowel Disease (IBD). Crohn's Disease and Ulcerative Colitis are the two main forms of IBD, and are lifelong conditions that start in childhood and both cause inflammation of the digestive system, but have broader physical and psychosocial effects.

Around 1000 young people with IBD in the UK per year make the move from the safety of their paediatric team, to the big wide world of adult care. New guidelines from the British Society of Gastroenterology advise that transition should be a gradual process that young people are prepared for. For young people who don’t feel ready for this transition, written information can help them acquire the knowledge and self-management skills they need to thrive in the adult service.

As a health information writer with a health psychology background I feel that good quality health information can be an intervention in itself. The Patient Information Forum back me up - there is evidence that health information can improve wellbeing and contribute to clinical effectiveness, safety and patient experience. Health psychologists can help improve the development of health information by promoting and advising on a participatory, qualitative approach to its development. For example, as a basis for this project I carried out in depth interviews with teenagers.

Harry, aged 16 has Crohn’s Disease, and for him the prospect of moving to the adult care team was daunting:

“I feel a bit sad, because I’ve been with my doctor since I was 10, he knows me and I feel like I have built trust.”

Like Harry, many young people are worried about transition. Unfortunately, some may not yet be ready to thrive in an adult health care system, which relies on independence, autonomy and shared decision making. Themes emerging from the interviews I conducted included fears about medical procedures, differences in communication, and navigating the system. These are therefore directly addressed in the new resource Transition: Moving to adult care.

Guided by research evidence demonstrating that teenagers see distinct value in user-generated health content, a series of blogs were produced as part of the project. Based on the in depth interviews I conducted, these were a different way to make practical use of qualitative research, and tapped into young people’s eagerness for first-hand accounts they can relate to and learn from.

Nick, 22 has ulcerative colitis:

“I’ve come from not really wanting to acknowledge the fact that I’ve got IBD, and not really wanting anyone to know, to being more open about it and researching it myself.”

Health psychologists can help champion a shift that the Patient Information Forum also promotes  - empowering a younger generation of health service users to assert control over their own health, creating patient’s equipped with self-management skills moving into adulthood and beyond. 

Tue, 31/10/2017 - 10:19

Dr Katherine Finlay, Senior Lecturer in Psychology, University of Buckingham https://www.buckingham.ac.uk/research/chr

Knowledge of Health Psychology is growing, but still weak in the general public, often trumped by people’s knowledge and perceptions of counselling psychology or clinical psychology. Therefore there is an urgent need to increase awareness of Health Psychology, what Health Psychology can do and what it is to be a Health Psychologist. We (at the Centre for Health and Relationships research, University of Buckingham) were recently been awarded the DHP public engagement grant for 2017, and having got underway with some of our outreach projects, it is a great time to take stock of what works and what doesn’t when talking to the public. We have run a pop-up Health Psychology lab, taking the lab to large STEM festivals, town centres, schools and community events.

What works:

Create a distinctive brand. Use ‘pop-up lab banners’, wear ‘pop-up lab’ lab coats. It may be stereotypical, but people are drawn to traditional signifiers of science and inquiry. Make the link with health psychology explicit through banners and DHP logos.
Theme your event. If your research strength is in a particular area of Health Psychology, theme your lab and your activities around that research area. For us, this has been pain research – something that is relevant to those with and without health conditions and is easily accessible and understandable for discussions.
Have obvious activities to draw people in, particularly children. For example, we set up a colouring-in stand where people could make and take away ‘brain hats’, with different regions of the brain highlighted and a brain map on the floor to walk through. Activities that took time, without pressure, allowed for creative discussions with all ages. Similarly, a giant connect-four game was very popular and had many health links as we used it to talk about strategic planning, goal setting, habitual behaviours and approach/avoidance behaviours, etc. Set up some interactive activities on the edge of the lab/stand and some in the centre so that you are drawing people in.


Consider including activities that make a noise/commotion. This draws attention from people on the fringes of events. We used joke-shop style electric-shock pain toys, such as electric shock chewing-gum and electric shock pens. These create hilarity and snowball effects as people invite friends to join in, developing a crowd and allowing for discussion of analogous areas of research.
Keep a record of footfall. Use a simple click counter to monitor activity levels, helping you to establish quantitatively at which events you have the widest reach and therefore where you are best investing in the future.

What doesn’t:

Edible freebies. People move in for the sweets and then move away without discussion.
Too many staff on the stand. For us, three was the magic number. More staff than this meant that people became cautious about entering the stand as they felt they would be pushed to take part/have discussions when they were still unsure about whether they were really interested enough to engage.
Static academic posters. People are cautious about reading a poster if they feel they will be forced to talk about it.  Similarly, natural chat is truncated as there is less room for creative thought and enquiry or spontaneous discussion.

For the future:

As we look to expand our lab, we hope to learn from our events, improve our outcomes and promote health psychology even more widely. Here are some things that look promising:

Invite participants from research studies. We work closely with patient populations, recently working with chronic pain support groups and those with spinal cord injury. If they’ve been involved in your research, invite them to take part, to staff and to visit your stand.
Create banners highlighting chronic health conditions/health behaviours. These can be used to encourage people with those conditions or behaviours to enter the stand and discuss their health status. Such conversations can be used to explain Health Psychology further and signpost those who are interested towards Expert Patient Panels and active Patient and Public Involvement groups in current research.
Link with careers in Health Psychology. Many people who visited our lab had an interest in psychology, but little knowledge of health psychology as a career route. Map pathways and provide handouts detailing how to qualify and train in health psychology.

Sat, 30/09/2017 - 22:55

We have all seen this year the rising frustration that has arguably been caused by people being asked to agree to political change one too many times. Within the profession we know that whether working in academia or practice there are very few examples where some sort of organisational change is not always occurring – it often just depends on where you are in the cycle! However, one risk of this is that the constant push for change can cause disengagement and apathy which then leads to changes being agreed without any real checks or balances.

Now change can be a good thing – certainly if there is a clear need for it and the will is there for that change to happen. An example of this is the recent successful outcome of last year’s DHP AGM whereby Professor Marie Johnson put forward a resolution for a review of the requirements for Full Membership of the Division. This need for change was recognised by the DHP Chair and committee, fought for and subsequently agreed by the BPS. But what if that isn’t the case? What if change is being proposed when the need has not been clearly established, and perhaps more importantly, no real consultation or review opportunity is provided?

One possible example that is of direct relevance to DHP members, is the change put forward by DHP Chair Professor Karen Rodham that will lead to the term of the Chair being extended from the current three-year pattern (which was introduced in 2014 with Karen’s own election) to a four-year pattern. With the last change in tenure a consultation with members was undertaken over a period of months. All DHP members were able to vote through the BPS email announcements list on their preference based on a range of models for Chair’s tenure. The current three-year term was voted the most popular and subsequently proposed and ratified by the committee. The consultation was voluntary and this time the DHP committee has followed the BPS procedure which simplifies the process of change and therefore the change in model was proposed by the chair and then voted for and agreed during the May DHP committee meeting.  

But perhaps this could be seen as going against the express wishes obtained only a few years ago of the wider DHP membership? Does this risk individuals feeling frustration not because they have been asked one to many times about organisational change, but because they haven’t? Or are you happy with this simplification and the adoption of the 4-year model? The committee are there to represent you and both Karen and incoming Chair Jo Hart do want to hear your views on this topic. Although this change has been agreed to come in to place, the committee have demonstrated over the last year they will definitely take member views into account and so it is important that members still feel able to put forward their views.

So, what do you want? Are you happy with this most recent change or do you have concerns and want the three-year term to remain? PLEASE let the committee know – the people that work on the committee are hardworking volunteers who are trying to make decisions for the best interests of members, but in order to do that, members do need to let the committee know their views and concerns if they have them.

So please, do get in touch at: dhp@bps.org.uk

Mon, 14/08/2017 - 10:27

Dr Danijela Serbic, CPsychol, FHEA, Teaching Fellow at Department of Psychology, Royal Holloway, University of London

Low back pain (LBP) is a highly common and disabling condition; it is now recognised as the leading cause of disability in the world. Pain and disability in LBP are associated with a number of psychosocial factors, for example depression, catastrophic thinking and fear of pain. A problem that has been less studied but appears relevant to many LBP patients is diagnostic uncertainty. Many LBP patients report feeling uncertain about their condition, pain and diagnosis. This is because in about 85% of patients a definitive cause for LBP cannot be established. So, it is not surprising that many patients continue searching for the causes of their back pain, instead of focusing on how to better manage their condition and pain. This inevitably results in numerous and unnecessary visits to health professionals. In the absence of a clear cause and diagnosis for their pain problem, many LBP patients report feeling that their pain is not legitimised. Some patients go as far as feeling guilty about being unable to provide a clear diagnosis and concrete evidence for their pain. 

Research has shown that pain-related guilt is a common experience among LBP patients, who also report feeling guilty about being unable to control and manage pain better, failing to engage more in social situations and letting down family and friends. Diagnostic uncertainty and associated feelings of guilt may negatively impact on mood and increase both withdrawal from social engagement and disability-related behaviours. Indeed, recent research evidence has shown that diagnostic uncertainty is associated with depression, anxiety, cognitive biases (e.g., recall bias for negative health stimuli) and disability in LBP. Therefore, there is a need to address diagnostic uncertainty. Health practitioners only partly do this when providing education about LBP; however, more targeted education and reassurance is needed. Some of these issues will be discussed in the next annual meeting of the Society for Back Pain Research, which is taking place on 2nd and 3rd November in Northampton, UK. There will also be a lively debate on the following: ‘This house believes we should target the system not the person with back pain '. This is a great meeting for all involved in chronic (back) pain research including students, clinicians, basic scientists, clinical scientists and psychologists.

We have made many medical advances in the treatment of back pain, but we still do not know how we can effectively reassure patients, without delegitimising their suffering. This question poses a challenge to practitioners and requires further research from health psychologists working in this area

Sun, 30/07/2017 - 23:34

Dr. Francis Quinn, Lecturer in Psychology, Robert Gordon University, Aberdeen

As health psychologists, we understand more than most about health behaviours. Does this give total power over our lifestyle? Well the contents of my kitchen cupboards, and my exercise attendance record, beg to differ. Am I just the world’s worst health psychologist? Maybe, but I think as health psychologists we can still struggle with health behaviours, just like most people in Western societies.

Ours is not the only health profession to face these struggles. Physicians tend to exercise no more than others, not get enough sleep, and nearly half eat less than five portions of fruit and vegetables per day (Wiskar, 2012). Would all health psychologists score more highly?

With our science and techniques, does a lack of perfection make us hypocrites, or human? We live in the same obesogenic environment as our patients and participants (Hill and Peters, 1998). We respond to the same psychological processes: habits, prompts, self-efficacy, negative attitudes, ups and downs of self-regulation, cognitive fatigue, and any others you can name. Many of us face long hours and workplace stress at a university or the NHS.

But maybe our human weakness can be a source of strength. We might be a better model to raise self-efficacy if seen to overcome our own struggles, trying and persevering, rather than seeming as if we don’t have any. Seeing exemplary performance can be discouraging and cause task disengagement (Rogers & Feller, 2016). And work with clients and research participants depends on a good relationship. People seen as highly competent – but not perfect – are more likeable (Aronson, Willerman & Floyd, 1966).

Personal struggles also feed into science. The clinical psychologist Marsha Linehan created dialectical behaviour therapy partly as a result of her own borderline personality disorder (Carey, 2011). It’s now recommended in NICE guidelines. Robert Sternberg’s struggles with love and academic achievement motivated his research in these fields (Sternberg, 2014). Personal struggles can inspire ideas that develop into theory, then are tested in research. At the core of many scientific theories are ideas from everyday experience.

Of course a health psychologist must present a positive role model. But being part of the struggle might help us understand it, by inspiring ideas to test scientifically.  Just as a doctor can become ill, or a clinical psychologist can face ups and downs of well-being, a health psychologist won’t always meet guidelines for exercise or portions of fruit and veg or dental flossing. But our science reminds us of the need to set such goals, that the environment will cause us to lapse and that we must keep trying, insights into why we don’t, and gives us some techniques that can help. Part of being a psychologist is being human, sensitive, and imperfect – just like our clients and participants. Maybe this helps us to create useful scientific knowledge, and to use it to help others.

Wed, 28/06/2017 - 18:19

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