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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 [email protected]  with any ideas, we look forward to hearing from you.

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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: [email protected]

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

Sarah Golding, PhD student and trainee Health Psychologist (University of Surrey)

How does a trainee health psychologist end up researching livestock farming? By starting with a keen but unspecified interest in a big topic, by being brave enough to approach a potential supervisor to talk through those early, vague ideas, and by being open to where those conversations might lead!

That big topic was antibiotic resistance (when the drugs no longer harm the bugs) and I’d assumed I’d do a typical health psychology PhD: explore GP-patient communication and decision-making, then design an intervention to reduce antibiotic prescriptions. Simple. But then I discovered such work was already well underway, and I realised I needed another angle. I was going nowhere fast, trying to think up alternative projects with GPs, and then my would-be supervisor asked the magic question…who else uses antibiotics? Well, I said. Hospital doctors? Pharmacists? Vets? Vets, she said. I know a vet who is interested in psychology…maybe we could do something with vets?

And so we did, and it’s really good fun, but I’m often asked what psychology has to do with veterinary medicine (including by my participants!). Well, vets are healthcare professionals, who are often highly autonomous practitioners, and they have client relationships to nurture, protect, and negotiate. Farmers are time-pressured people, busy running businesses, managing staff, and making countless decisions that affect their animal husbandry practices. Whichever way you look at it, vets and farmers are people too; they are driven by beliefs, emotions, and biases, just the same as doctors, nurses, and patients are. The same applies to those of us who are pet owners. Ultimately, human psychology is a factor in animal health outcomes. And in the case of antibiotic resistance, that means the psychology of vets, farmers, and pet owners influences human health outcomes too.

There is much debate about the extent to which inappropriate antibiotic use in farming causes antibiotic resistance in human bacteria. There are high profile cases of resistance genes emerging in bacteria carried by livestock, and of these resistant bacteria being passed to humans. But there are also (less well publicised) examples where the resistance has gone the other way, from human to animal bacteria. In reality, genetic mapping studies are complex and hard, and mostly, we just lack the data to say for sure. Ultimately, however, we all share one global microbiome. We therefore need to tackle inappropriate antibiotic use in both humans and animals, as the public (and animal) health risks from resistant infections are real and increasing. Bacteria are not worried about borders, and many are not fussy about which species they live in or on.

Health psychology has an important role to play in tackling this issue – in both humans and animals. Antibiotic resistance threatens both current medical practice and our future food security. My research will provide insight into factors that drive inappropriate antibiotic use in farming, and should inform future interventions to reduce unnecessary prescriptions. Talking to vets and farmers is fascinating. Farming is a whole new world to me, and I’m learning so much. But can I advise on the behaviour of a moo-dy cow? Not a chance!

 

Fri, 16/06/2017 - 13:12

Sam Cockle, PhD Researcher & Trainee Health Psychologist (University of Surrey)

I think most psychology researchers will identify with the challenges involved in recruiting research participants.  However, recruiting participants when the research topic is sensitive poses particular challenges. My own research explores expectations of cancer treatment where there is a real need to balance the need for advert visibility and recruiting participants, with the ethical and moral duty to act with compassion and tact. I need at least 200 participants to validate my newly developed measure of the expectations of cancer treatment.  I’m an optimist, so I thought to myself that although it would be a challenge, I just needed to work at it and I would get the numbers I needed.  The NHS oncology centre staff I had been working with acknowledged that was a lot of participants, but thought that it should be viable. So far so good.

I embarked with positivity through what was a lengthy ethics processes (that’s another story!) until months later I finally had all the necessary approvals. By this point I had been constrained by what staff at the clinic and the ethics committee thought would be appropriate; as an outsider to the oncology centre and to patients’ usual care team, I wouldn’t be allowed to approach patients directly since patients are already encountering lots of new people where another face amongst the many may not be appropriate.  Furthermore, management staff had concerns about the additional workload placed on an already pressured NHS teams to advertise the study.

This has meant taking a very passive approach to advertising my study through adverts and posters in the oncology centre.  As such, there has been little engagement with the study with only one participant recruited since December. So, I took to Plan B, which is to advertise on social media (shameless plug to my research here. Please share!).  This is perhaps not the most ideal method since cancer is more common in older people who may be less likely to use social media.  Recruitment is going far better than in the oncology centre but it is still slower than expected; big pictures and catchy adverts may be good at getting people’s attention on social media but might not be appropriate given the sensitive subject matter.

Although I completely understand some of the ethical concerns in recruiting NHS patients for research purposes, I feel that if recruitment is restricted so much that research becomes unviable, we could be limiting how good best practice is. Where are we left as researchers in health psychology if we cannot recruit effectively? I would be really interested to hear about other people’s experiences of recruiting in this area, or any other where there may be greater sensitivity involved. If anyone has advice I’d be glad to hear it!

Tue, 30/05/2017 - 11:53

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