Promoting good psychological health and well-being during Covid-19

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By Elizabeth Jenkinson with contributions from Richard Cheston, Christine Ramsey-Wade, Catherine Warner, and Adam Kishtainy

Covid-19 has presented challenges in the maintenance of good psychological health and well-being for all of us. As a consequence, the role of practitioner psychologists and therapeutic professionals in society has never been more vital. The Promoting Psychological Health theme of the Psychological Sciences Research Group here at UWE, Bristol includes Academic and Practitioner psychologists and those in training through our British Psychological society accredited Masters as well as our HCPC accredited Masters and Doctoral training programmes. This includes Health Psychology, Counselling Psychology and Music Therapy. Throughout the pandemic, we have mobilised our community of practice to respond directly to the challenges of Covid-19, applying our psychological knowledge and skills using psychologically informed approaches. Our insights have been applied across research, policy, consultancy and therapeutic practice.

Health Psychology and Covid-19

Our Health Psychology team led by Dr Liz Jenkinson are part of the Health Psychology Exchange project, a collaboration of UK Health Psychologists providing consultancy around COVID-19. The UWE team and Professional Doctoral students such as Natalie Garnett and Ella Guest have been pivotal in three rapid reviews exploring the effectiveness of public health messaging and interventions in driving health behaviours during pandemics, and in the development of guidance to local and national health organisations. Two of these reviews have already been developed into British Psychological Society guidance and are now informing Public Health efforts to communicate effectively with the public, particularly around vaccination. For example, our review examined existing research which measured public responses to health messages encouraging vaccination against infectious diseases in a pandemic or epidemic. We concluded that evidence suggests that in order to be effective messages need to be credible (from trusted official sources), use community-wide outreach and mixed methods, frame risk appropriately (rather than over or understating), be tailored to be personally relevant, short and highlighting the benefits of vaccination to society as a whole rather than to the individual. One key finding was that previous research and practice did not include the voice of those under-represented groups who are often least likely to uptake a vaccine. The review recommends co-production with communities in the design and dissemination of messaging to ensure they are acceptable and accessible. We are pleased to see that recent efforts have been addressing this, and that our work has been reaching a wide audience through initiatives such as Evidence Aid.

Dr Liz Jenkinson is also member of the British Psychological Society Behavioural Science and Disease Prevention Taskforce Health Behaviours Sub-group. Together with a team of Professional Doctorate in Health Psychology trainees including Shanara Abdin and Shenede Coppin, they have played a leading role in the development of guidance for public health officials in supporting health promoting behaviours such as sleep, stopping smoking and limiting alcohol consumption during Covid-19. Details of this work so far is featured on the UWE Covid-19 blog. The success of these roadmaps has led to the team working on a further set with the British Psychological Society  around access to healthcare, adherence to medication and opioid prescribing.

Many of our health psychology trainees are also working on the frontline of the pandemic. From delivering vaccinations, to helping clients stay healthy during lockdown through to working in our local hospitals with clients with health conditions such as diabetes, pain and long term conditions, and now ‘Long Covid’, we are very proud to continue to supervise and support our trainees as they deliver this vital work at this difficult time.

Ageing Well in Older Adulthood

The pandemic has impacted disproportionately on older people with dementia – especially those living in residential care. PSRG members have contributed to building evidence in how best to support this vulnerable group during Covid-19. Prof. Rik Cheston and Emily Dodd carried out a survey of NHS staff to look at how the pandemic had impacted on their ability to deliver the LivDem intervention. This showed that none of the NHS trusts had established plans to reintroduce the course, and that there was widespread interest in developing an online intervention instead. Consequently, they hosted a webinar attended by a dozen clinicians in the UK and Ireland to identify best practice. In January, Emily and Rik hosted two online ‘taster’ sessions for LivDem which were attended by 60 clinicians based in the UK or Ireland. The team plan further introduction sessions for Clinical Psychologists in Yorkshire and Humberside, with intensive LivDem training to be rolled out through 2021 facilitated by Higher Education Innovation funding. Rik also contributed to an ARC West rapid review of the evidence base to identify effective primary preventative and secondary reactive approaches for staff to use when caring for people who walk with intent but are unable to leave residential care.

Counselling Psychology and online therapy

The challenges of the pandemic have presented unprecedented demand for therapeutic psychological support. Our counselling psychology staff and trainees had to swiftly pivot last year to providing some or all their clinical interventions online in line with government restrictions.  This includes members of the teaching team working in private practice, and students working on placements, such as NHS departments and mental health charities such as Nilaari which provide culturally appropriate counselling for clients from the BAME community.  This has created many unforeseen challenges – for example, how best to work with clients remotely. Video calling platforms may provide one solution but staff and students working with adults and young people have found that providing psychological therapy over the telephone can sometimes be more accessible than video calls over the internet, for example, as some clients struggle to access a safe and confidential space in their own home.

Senior Lecturer Christine Ramsey-Wade from the counselling psychology doctorate team has also been finding solutions to the challenges of delivering trauma-focused interventions remotely, such as Eye Movement Desensitisation and Reprocessing.  These interventions are needed now more than ever, so some rapid research is being carried out into how best to translate these more physiological or experiential therapies online with Christine collaborating with EMDR UK on a new externally funded research bid to further investigate the effectiveness and client experience of different forms of EMDR when delivered online.

Music Therapy in education settings

Covid-19 has impacted the mental health and well-being of students at all stages of their journey through education. Adam Kishtainy, lecturer on the music therapy programme and lead for the music therapy clinic at UWE, is supporting two final year Masters students, Laura Wilson and Luke Howell, to run a music and wellbeing group at the UWE Centre for Music led by Kat Branch on the Frenchay campus. The music group makes use of active vocal and instrumental improvisation approaches, directly from music psychotherapy practice, as well as relaxation using music to encourage people to express themselves creatively and reflect on any mental health issues they are experiencing at the moment. Students from any programme can self-refer to this group. This team aim to provide a safe space to address immediate well-being issues through dynamic music making at this difficult time.

Adam is also running an outreach project, as part of the Glenside Clinic, in Bristol Metropolitan Academy and Briarwood Schools, taking in 6 of the Year 1 music therapy trainees on placement and delivering individual music therapy for their students. These schools have limited resources for psychological support and the opportunity to provide additional support for students at such a difficult time has been hugely appreciated.

Conclusion/Summary:

PSRG psychologists and practitioners have risen to the challenge of Covid-19. We mobilised our community of practice to apply our psychological knowledge, skills and therapeutic approaches to promote good psychological health and well-being for our clients, through our research and through policy, consultancy and practice. Further challenges lie ahead, but the contribution of the psychological professions is clear. Psychology is front and centre in responding to the challenge of Covid-19.

A PhD FAQ

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By Miles Thompson and Alex Saunders*

Embarking on a PhD can be one of the most rewarding, frustrating, liberating, challenging and exciting adventures of your professional life. However, it isn’t for everyone and should not be undertaken lightly. If it works for you, it can be incredible. If it doesn’t, it can be painful.

Within PSRG at UWE Bristol we are helping to grow the next generation of researchers and academics. As a result, we often have conversations with our students, our graduates and graduates from other universities about the whys and wherefores of PhDs. To help shape these conversations, we’ve put together the following blog as a repository of frequently asked questions and links to other sources of information that might be helpful to those considering embarking on a PhD journey either with us or elsewhere.

So, if you’re thinking about studying for a PhD in the UK (my colleagues from the US tell me things are very different over there), read our blog below for some honest truths and links to even more information about topic areas you should be chewing over. Namely we will cover:

1. Can I do a PhD? Eligibility and Suitability.

Eligibility

In terms of eligibility, on paper the answer is often “yes” for many people. At UWE for example, many PhD programmes only require a 2:1 at undergraduate level or a Masters at merit level or higher (see UWE’s criteria here). If you have undertaken a Masters, this grade will often supersede the importance of your undergraduate degree result (see also here).

But, although you can go straight from your undergraduate degree to a PhD, the step up is a big one. This is why a Masters, or a Masters by Research (which focuses more on research and independent study; read more here) can be a sensible in-between step. There are multiple benefits from both including:

  • gaining more research skills
  • seeing if more independent learning with less structure is for you
  • learning more about building and managing working relationships with a supervisor(s)

While many institutions do not require you to already have a Masters, some funded PhDs include an entire Masters as part of your studies (e.g., the SWDTP). And at many institutions, like UWE, you will take Masters / higher level modules as part of your doctoral studies.

Importantly, if you are considering studying for a PhD without a Masters do carefully compare the differences between undergraduate and PhD study before you begin. Resources like the following can be useful when contemplating which route to take (1 and 2).

Importantly for international students, many institutions require a recognised English language qualification such as the International English Language Testing System test for students that do not have English as their first language. Also, if you are a non-resident of the UK and looking to study a PhD here, you may also require a visa, for which you will have to meet a number of requirements (see here). And please note, these guidelines may change during the Brexit transition period and beyond).

Suitability

Perhaps even more important than thinking about your “eligibility” to study for a PhD, is the question of “suitability.” In short, it is important to ask yourself if you can be self-directed, independent, and focused enough to study one thing for at least 3 years, possibly longer. Do you have the passion and commitment to work on one subject area for that length of time?

A PhD is a big commitment, it can take over large swathes of your life for the duration of study. It will also, inevitably involve some downs as well as ups (see here for more on the “turbulent nature of doctoral research.” So, it is important that you are studying something that you feel committed to and will see through.

It is highly likely that prospective PhD students anywhere will only be accepted onto PhD programmes if they can show that they are: i. likely to complete their PhD and ii. will do so within the time limits of the institution. Further questions to ask yourself can be found here.

2. Funding and what that might mean for what I do or don’t study

Getting funding for your tuition fees and even a stipend to live on is both a very appealing and a very competitive process. In this section, we discuss funding and how being funded or not can influence the focus of your PhD topic.

Tuition fees for standard postgraduate research programmes in the UK are set by “UK Research and Innovation.” They are often lower than taught undergraduate and taught postgraduate programmes, although fees for International students will be higher. More information about PhDs fees at UWE can be found here.

But remember, tuition fees are not your sole expense. Accommodation and other living costs will often end up being much more than the cost of tuition fees alone. As a result, some self-funded students combine working in another job with their PhD studies and complete some or all their PhD on a part-time basis.

If you secure a funded post that has been advertised, it is likely that you will work on a programme of study that has been somewhat pre-determined by your supervisor. And of course, many students are very happy to do this due to the security of the funding and getting a PhD.

If you self-fund, or get a doctoral loan (see below), you should take the opportunity to “shop around” to find a supervisor who is interested in exactly the research topic you wish to study. After all, you are paying to study yourself – so your topic of study should reflect more of your passion.

And, of course, it is also possible that you approach a supervisor – work up a funding proposal together, and then both apply for funding. In terms of this pathway, UWE is part of the South West Doctoral Training Partnership, where exactly this process happens. But again, remember, securing any form of funding is a competitive and demanding process.

Listed below are some of the funding routes available to prospective PhD students:

National Research Councils

Funding for PhDs can be awarded by the different research councils in the UK, each covering a specific academic sector. Research councils post research opportunities on their websites so keep an eye out for research topics and calls that interest you.

Funding from universities

Universities can offer scholarships, studentships and other PhD funding opportunities which can cover tuition fees and stipends. See for example here.

Self-Funding

There are pros and cons to self-funding, even now it is easier to get a doctoral loan (below). Some interesting perspectives from self-funding PhD students can be found here and here.

Doctoral Loans

These loans are provided by the UK Government and can be used to cover both fees and living costs. The amount you get is divided equally across each year of study, and you will not have to start paying it back until your income is over a threshold amount. Eligibility for this loan depends on a number of factors, a list of which can be found here.

Funding for International students

There are several funding options specifically for International students. These can be important as tuition fees for International students are considerably higher than for home students. More information can be found here.

3. Supervisor selection

When deciding on studying a PhD you will likely have strong ideas on what you want to study and even where you want to study – but make sure you also feel very secure with who you are going to be studying with/under. Your supervisor or supervisors (see below) will be among the most significant people in your life during your PhD. They will guide and support you throughout the process, so it is vital that you find people who meet your needs.

Obviously, the process will differ between funded versus a self-funded PhD, but for both, before you commit, try and work out how you will differentiate between:

  1. a supervisor that will really help you get your PhD
  2. a supervisor who may end up hindering your progress

You need to be as sure as you can be that you are a good working match with each other. So do some research around their research passions, check they align with yours. Make sure, before you commit, that you ask some probing questions. You may wish to ask about the amount of contact time you will get or about students they have supervised before and their success rate as a supervisor. You may want to try and speak to their current or past students. If, when you are asking any of these questions, you are not happy with the answers you get, or you feel you already know more about a topic area than your supervisor: that could be a red flag and a sign for you to investigate other options.

Unfortunately, the supervisor-student relationship is not always cohesive and effective and can lead to issues. Unanswered emails, unannounced absences and unsuitable replacement supervisors are just a few examples of how it can go wrong and leave the student feeling confused, losing confidence in their abilities and their research. The following articles delve further into these issues (1 and 2).

The bottom line is simple, your relationship with your PhD supervisor really matters. Make sure you choose someone that will meet your needs both in terms of taking you on and when your studies get into difficulty.

One further thing. As hinted at earlier, generally speaking you will have more than one supervisor. A director of studies (lead / principal supervisor [n.b. different unis use different terms) and a secondary supervisor. The role and structure of secondary supervision can vary from PhD to PhD and place to place. Often secondary supervisors can bring complementary expertise or provide different viewpoints. Read more about their possible roles here. So just to complicate things, you don’t just need to be thinking about one supervisor – you need to be thinking about a supervision team!

Further guidance on how to choose a supervisor and supervision relationships can be found at the following links (1, 2, 3, 4, 5, 6 and 7).

4. Where to study?

This is an interesting topic because there are pros and cons to both staying at an institution you know and moving somewhere else. Some of the pros to staying at a familiar institution include established relationships with staff and processes. It may also be beneficial to stay in the same area if you have family or friends you do not wish to move away from. In some cases, your current institution may also be a leading centre for your research.

However, it might also be the case that the leading centres are somewhere else. Or even though it would be comfortable to stay within a geographical area or institution you know it might be better to look elsewhere. It might, for example, be useful to experience different research cultures and new locations. Some even suggest that staying at the same place for UG, PG and PhD study suggests a lack of willingness to move out of your comfort zone. Just to confuse things even more, some students live in one place but are registered for their part time PhD hundreds of miles away.

In short, you need to weigh up the pros and cons to determine which option is right for you. There are no firmly right or wrong answers. But there are several important points to think through when considering where you should study and live for the next few years of your life.

There is an interesting thread debating both options here. And further advice on where to study here.

5. Life after your PhD

It may sound strange to start thinking about your life after a PhD before you even start your doctoral research – but it is an important subject for now. Ask yourself: “Both, why do you want a PhD AND where do you want it to take you?”

Once you have a PhD there will be many routes open to you: continuing as a researcher, in academia or with a research-based organisations, teaching, or using your PhD skills in a non-research / learning setting. But now is also the time for some truth telling. Just so you have your eyes open from the outset.

“Continuing in academia” is a very natural aspiration for many after completing a PhD. However, for many years now, there have been many more people with PhDs than there are academic jobs in UK universities. The academic job market is both oversaturated and very competitive. That is not to say that academia is no longer an option for PhD students – it is the vital first step. But you might need to prepare yourself for a longer and more uncertain road than you were expecting.

This blog, is a sobering but important read. It notes that 70% of UK PhD holders have left the academic sector 3.5 years after graduating. And, of the 30% still within universities, it is unclear how many are employed on “teaching only” or “fixed term contracts.”. As with elsewhere in the UK workforce, casualisation and precarious working is an issue in academia too.

Of course, many people either always planned to move away from research after their PhD or decide to do so during or after they complete their doctorate. Your PhD gives you many valuable skills for a multitude of roles in many fields. Many doors open with a PhD. An interesting case study of living your values post a PhD can be found here.

Conclusion

We hope that this blog has been a useful read and gives you some more information on issues you were already aware of and some new questions to think through and consider. Importantly, none of the information above is designed to put anyone off studying for a PhD – but is offered instead to enable you to go into this exciting process aware and with your eyes fully open. Indeed, in a 2019 survey, across 50,000 postgraduate researchers at 107 institutions, satisfaction levels were at 81%.

Come and be part of that.

Thanks

This blog was co-written by an amazing graduate student from another university who already had their MRes and was working with members of PSRG to further their research skills. Alex, thank you for all your time and effort in helping put this blog together. And to everyone else, we welcome contact from anyone near or far who wants to work with us and help us with our work. Please contact: PSRG@uwe.ac.uk.

Useful websites for more information:

FindaPhD.com: https://www.findaphd.com

Postgrad.com: https://www.postgrad.com

Prospects: https://www.prospects.ac.uk

PhD Portal: https://www.phdportal.com

Jobs.ac.uk – blogs: https://blog.jobs.ac.uk/

Advance HE – Knowledge Hub: https://www.advance-he.ac.uk/knowledge-hub

Jobs on Toast: http://jobsontoast.com

Learning from the client: The challenges of psychotherapy research and the contribution of qualitative methodologies

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By Eva Fragkiadaki

The implications of nomothetic psychotherapy research

Psychotherapy research has made significant progress in providing strong evidence for process and outcome in favour of specific approaches. However, after many years of research and advanced methodologies, we are still unsure about why psychotherapy works, and how and to what degree these findings can be applied in everyday practice (Kazdin, 2009). Evidence-based approaches do not appear to be effective for everyone, and the mechanisms of change are still investigated with diverse findings. Randomised controlled trials (RCT) and meta-analyses inform policy and guidelines followed by the likes of the National Institute for Health and Care Excellence (NICE). Illustrating this, NICE Guidelines for the treatment of Depression state that “well-defined” depression can be treated with CBT based on its proven efficacy, however “it is not effective for everyone” (NICE, 2009). Clinicians need evidence-based recommendations to inform their work with clients. It is notable though that evidence-based practice is based on nomothetic, quantitative approaches of inquiry but what is actually demanded from practitioners is to apply these theories in an idiographic context and adjust to the needs of the individual who seeks help (Persons, 2008).

One cannot reduce psychotherapy to specific factors and cannot reduce the person to a specific list of symptoms. Added to that, each psychotherapeutic encounter is unique, in terms of transference and real relationship factors. Rigid diagnosis criteria are challenged and culturally sensitive, social models of diagnosis are encouraged in the literature, which question the constant pursuit of functionality, fulfilment and happiness (Kirmayer, Gomez – Carillo & Veissiere, 2017). In reality, clients with the same labels are likely to experience their diagnosis in different ways (Hayes et al, 2019). Moreover, each therapist has inherent biases and internal processes of interpreting each client before deciding which interventions to apply and how (Makhinson, 2012). The therapist’s training, expectations, overgeneralisations and pressure for positive results have a significant impact on the decisions they will make for therapeutic action plans. Lastly, each psychotherapeutic dyad is different, each process that unfolds in this context is a different experience for both parties. Even if the therapist follows the same approach guidelines, they will be different with different clients (Hill, Chui & Baumann, 2013). Each therapeutic encounter forms a new interaction and discussion; a new therapy (Baldwin & Imel, 2020).

Traditional psychotherapy efficacy research struggles to capture the level of complexity therapeutic interactions entail. The findings make inferences about the general population but do not necessarily apply to the individual (Hayes et al., 2019). Another issue is the difficulty in defining each therapeutic modality given the new approaches that appear and their variations in application. Too many approaches are now presented in the literature for too many syndromes which account for too many statistical models, and the number is growing (Hayes et al., 2019). Moreover, there are many confounding factors when trying to measure the effects of psychotherapy, such as the therapist’s subjectivity, training, supervision, the therapist and researcher’s expectations and the clients’ presenting difficulties. The researcher’s subjectivity must also be recognised in the research process even for the most rigorous RCTs. Psychotherapy research entails bias and the effectiveness of psychotherapy can be exaggerated. Moreover, many studies may remain unpublished if results support null or negative hypotheses (Dragioti, Karathanos, Gerdle & Evangelou, 2017).

Going back to case analysis: the idiographic paradigm in psychotherapy research

Psychotherapy is a multi-faceted, complex phenomenon. How can we understand and represent its variability in evidence-based findings? Research is moving away from protocol and approach specific treatments towards a more client-centred way of exploring psychotherapy efficacy; it instead becomes a “personalized treatment” (Zilcha-Mano, 2019, p. 694). The focus is on the implementation of methodologies which can do justice to the complexity and variability of the phenomenon of psychotherapy. Qualitative research allows the exploration of the multidimensional interactions in psychotherapy encounters and the emergence of unexpected results (Hill et al., 2013; McLeod, 2011). By implementing methods such as the Narrative Assessment Interview (Angus, Levitt  & Hardtke, 1999), the  Change Interview (Elliott, Slatick & Urman, 2001) or the Hermeneutic Single-Case Efficacy Design (Elliott et al., 2009), qualitative research is nowadays being used more often in exploring psychotherapeutic processes and effects.

As psychotherapy researchers, we need to pursue a route that is different to “protocol-to-syndrome.” We are moving away from labels and therapy “brands” (Hofman, 2020, pp. 297 – 298) towards elaborate descriptions of people and therapies, focusing on what works, why and how, for both specific individuals or groups that share common characteristics. The suggestion is to distance ourselves from theory-driven process and outcome studies, from measurable and quantifiable behavioural changes (Hill et al., 2013) and instead to approach the client’s perspective in an open and explorative way; to enable learning and knowledge derived from the clients’ experience of psychotherapy efficacy. In particular, idiographic qualitative phenomenological research offers the means to explore intrapsychic change. A well-designed case study provides detailed, in-depth knowledge which is readily applicable to everyday clinical practice (Persons & Boswell, 2019).

Interpretative Phenomenological Analysis (IPA) is a qualitative methodology that focuses on the individual’s unique experiences of the situation studied. IPA can make a significant contribution by enabling researchers and practitioners to gain insights into client’s experiences of therapeutic processes. The philosophical, epistemological, and methodological underpinnings and guidelines of IPA allow for an in-depth exploration of the client’s experience, leading to significant conceptualisations on how therapeutic approaches work (Larkin & Thompson, 2012). It is based on the phenomenological paradigm as outlined by Husserl, Heidegger, and Merlau-Ponty (Smith, 1996; Smith, Flowers, & Larkin, 2009). It provides the framework to place the therapeutic encounter in context and analyse it; to go back to the phenomenon of psychotherapy “on its own terms.” The focus is on individuals, their subjective accounts and perceptions, bracketing the understanding of preconceived ideas, beliefs, and expectations.  IPA methodology views persons in-context as they expound on embodied, dynamic, and interactive experiences. Interpretation in IPA implies moving away from the obvious, focusing on the meaning participants attribute to their experience, engaging in a dialogue with the data, and illuminating sense-making (Smith, 1996; Smith et al., 2009). 

Adhering to an existential framework, IPA methodology does not rely on psychological theories for the collection and analysis of data. It is data-driven, emphasizing personal experience (Smith, 2017). It is deemed a useful method for psychotherapy process exploration as it frees the researcher from the compounds of psychotherapy theory and gives voice to the clients’ unique experience and intersubjective meaning-making processes (Larking & Thompson, 2012). Phenomenological methods have been applied to the exploration of adults’ experiences of psychotherapy during their childhood have changed their live, clients’ experience of positive change and to psychotherapy outcome studies (Binder et al., 2010; Midgley, Target, & Smith, 2006; Olofsson et al., 2019; Wilmots et al., 2019). IPA applied to psychotherapy research allows for the exploration of the clients’ perspective, the meaning they attribute to seeking and receiving help and how they conceptualise the psychotherapy process rendering the results useful for incorporation into everyday clinical practice (Binder et al., 2010; McLeod, 2011; Midgley et al., 2014). IPA guidelines help researchers keep the focus on the participants’ experiences and meaning-making processes, and can further bolster and clarify the knowledge of psychotherapy effects from the clients’ perspective.

Conclusions

Nomothetic approaches to research claim that there is one absolute truth outside of us to be discovered (Ponterotto, 2005). As psychotherapy researchers, the phenomenological perception of truth helps us view psychotherapy as real however it is the individual’ consciousness that determines its reality. IPA exploration of psychotherapy brings research back to the clients, to their experience of change, from which we can acquire significant insight on how and why psychotherapy works. We go back to the individual case and understand the psychotherapy processes from their perspective. Thus, the findings are closely linked to practice. Inventories and questionnaires may capture a small proportion of this variability in psychotherapy change procedures, but they are restricted to overt behaviours and symptoms whilst the questions might not be applicable to the person’s issues. The use of qualitative research methods in psychotherapy effectiveness and outcome research adds to our efforts to comprehend when and how psychotherapy works in an explorative and descriptive manner.

Qualitative psychotherapy research allows for the client’s voice to be heard. Their perceptions and interpretations of psychotherapy process and change may guide research conclusions, theory advancements and policies. Hence, psychotherapy is adjusted to the clients and the service users, and not the other way around. In recent literature, a more pluralistic method of inquiry is now considered in an effort to address the diversity of psychotherapy processes, encouraging researchers’ reflexivity on the aspect of psychotherapy they choose to explore (Rieken & Gelo, 2015). Various methodologies and epistemologies are now employed in the search for an answer to why psychotherapy works. Qualitative methodologies, and especially IPA, places the client in–context considering psychological, physical and social aspects of their experience of psychotherapy. Like clinicians who tailor their use of techniques to the specific client in the specific therapeutic relationship, researchers should consider individual needs, culture and social context, tailoring research methods to specific aspects of psychotherapy process and change.

References

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Baldwin, S. A., & Imel, Z. E. (2020). Studying specificity in psychotherapy with meta-analysis is hard. Psychotherapy Research, 30(3), 294–296. https://doi.org/10.1080/10503307.2019.1679403

Binder, P.-E., Holgersen, H., & Gier Høstmark, N. (2010). What is a “good outcome” in psychotherapy? A qualitative exploration of former patients’ point of view. Psychotherapy Research, 20(3), 285 – 294. doi: 10.1080/10503300903376338

Dragioti, E., Karathanos, V., Gerdle, B., & Evangelou, E. (2017). Does psychotherapy work? An umbrella review of meta-analyses of randomized controlled trials. Acta Psychiatrica Scandinavica, 136(3), 236–246. https://doi.org/10.1111/acps.12713

Elliott, R., Partyka, R., Alperin, R., Dobrenski, R., Wagner, J., Messer, S. B., . . . Castonguay, L. G. (2009). An adjudicated hermeneutic single-case efficacy design study of experiential therapy for panic/ phobia. Psychotherapy Research, 19, 543–557. doi:10.1080/
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Hayes, S. C., Hofmann, S. G., Stanton, C. E., Carpenter, J. K., Sanford, B. T., Curtiss, J. E., & Ciarrochi, J. (2019). The role of the individual in the coming era of process-based therapy. Behaviour Research and Therapy, 117(October 2018), 40–53. https://doi.org/10.1016/j.brat.2018.10.005

Hill, C. E., Chui, H., & Baumann, E. (2013). Revisiting and reenvisioning the outcome problem in psychotherapy: an argument to include individualized and qualitative measurement. Psychotherapy, 50(1), 68 – 76. doi: 10.1037/a0030571

Hofmann, S. G. (2020). Imagine there are no therapy brands, it isn’t hard to do. Psychotherapy Research, 30(3), 297–299. https://doi.org/10.1080/10503307.2019.1630781

Kazdin, A. E. (2009). Understanding how and why psychotherapy leads to change. Psychotherapy Research, 19(4–5), 418–428. https://doi.org/10.1080/10503300802448899

Kirmayer, L. J., Gomez-Carrillo, A., & Veissière, S. (2017). Culture and depression in global mental health: An ecosocial approach to the phenomenology of psychiatric disorders. Social Science and Medicine, 183, 163–168. https://doi.org/10.1016/j.socscimed.2017.04.034

Larkin, M. & Thompson, A. (2012). Interpretative phenomenological analysis. In Thompson, A. & Harper, D. (eds), Qualitative research methods in mental health and psychotherapy: a guide for students and practitioners. John Wiley & Sons: Oxford, pp. 99-116.

Makhinson, M. (2012). Biases in the evaluation of psychiatric clinical evidence. Journal of Nervous and Mental Disease, 200(1), 76–82. https://doi.org/10.1097/NMD.0b013e31823e62cd

McLeod, J. (2011). Qualitative research in counselling and psychotherapy. London: Sage.

Midgley, N., Ansaldo, F., & Target, M. (2014). The meaningful assessment of therapy outcomes: Incorporating a qualitative study into a randomized controlled trial evaluating the treatment of adolescent depression. Psychotherapy, 51(1), 128 – 137. doi: 10.1037/a0034179

National Institute for Health and Care Excellence. (2009). Depression in adults: Recognition and management (NICE Clinical Guideline CG 90). Retrieved from https://www.nice.org.uk/guidance/cg90

Olofsson, M. E., Oddli, H. W., Hoffart, A., Eielsen, H. P., & Vrabel, K. R. (2019). Change processes related to long-term outcomes in eating disorders with childhood trauma: An explorative qualitative study. Journal of Counseling Psychology, advanced online publication. doi: 10.1037/cou0000375

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Persons, J. B., & Boswell, J. F. (2019). Single case and idiographic research: Introduction to the special issue. Behaviour Research and Therapy, 117(March), 1–2. https://doi.org/10.1016/j.brat.2019.03.007

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Wilmots, E., Midgley, N., Thackeray, L., Reynolds, S. & Loades, M., (2019). The therapeutic relationship in Cognitive Behaviour Therapy with depressed adolescents: A qualitative study of good-outcome cases. Psychology and Psychotherapy: Theory, Research and Practice. doi: 10.1111/papt.12232

Zilcha-Mano, S. (2019). Major developments in methods addressing for whom psychotherapy may work and why. Psychotherapy Research, 29(6), 693–708. https://doi.org/10.1080/10503307.2018.1429691

Maintaining the “entente cordiale” in the era of Brexit

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By Tony Ward

If you read the higher education press, you will be aware of the concerns of many British academics and universities following the 2016 referendum and the vote in favour of leaving Europe. How the UK leaves the European Union could have many important consequences for British universities.  It may become impossible for British researchers to access European research funds, which in the past have been a major source of funding.  Access to staff and student mobility schemes may cease, making it harder for people to travel abroad to study and collaborate.  Academic staff from Europe may no longer find the UK an attractive place to come and work, and vice versa.

As an academic that has had strong links with our nearest European neighbour for some time, the referendum decision has been personally painful, and the ensuing months and years since torturous. However, I am determined to do my bit in maintaining close working relationships with our continental colleagues, however the Brexit project turns out. So I thought I would use my PSRG blog entry to tell you a bit about French psychology, and the rewards of international collaboration.

This story really started for me in the winter of 2013, when I decided it might be useful to travel abroad to find out how other institutions were delivering online learning in post-graduate psychology. Having set up a distance-based MSc in the early 2000s, and by 2013 being the programme lead for the doctorate in counselling psychology at UWE, I was keen to see how professional courses could be delivered online. I duly wrote and submitted a travel grant application to the Higher Education Academy (HEA), with a view to visiting the Fielding Institute in California and Paris 8 University in France, both of which run distance courses in clinical psychology (if you are an undergraduate psychology student that speaks good French you might consider the Paris 8 Masters – though using this to get HCPC registered might be less straight forward after Brexit!). Unfortunately, the HEA hit a period of financial turbulence, and the travel grants were axed. As a result, the USA part of the plan had to go, but Paris 8 was possible with some university funding.

So in 2014 I spent a week at Paris 8 University, talking to staff and students, and finding out how their online MSc in clinical psychology was run. In France currently, access to the profession of clinical psychology is via a two year MSc, as it used to be in the UK (before Plymouth University pioneered professional doctorates in the 1990s, and everyone else followed suit). I soon discovered that an interesting aspect of clinical psychology at Paris 8 is that it quite closely resembles our counselling psychology course at UWE, in that students study both humanistic and psychodynamic foundations of therapy, as well as the ubiquitous cognitive behaviour therapy.

Paris 8 University is well known in France as the experimental university which was founded after the student led riots of 1968. Well known academics have included Foucault and Deleuze. Amongst the current psychology staff is Professor Arnaud Plagnol, who like me has interests in the application of cognitive science to understanding and working with client issues in therapy. Following my 2014 visit, Arnaud and I have collaborated on a number of projects.  The picture shown here is a poster we did on neuroscience and depression, at the DCoP conference in Harrogate in 2015. More recently we have written a book together called Cognitive Psychodynamics, which illustrates how psychodynamic insights into phenomena such as the unconscious and transference can be understood and further developed in therapy through a cognitive framework.

Since 2014 I have done a small amount of teaching on the Paris 8 MSc.  To help me communicate better with my French colleagues and students, I have attended a number of the annual conferences of the French Psychological Society. This year’s was in Poitiers, and the picture shown here is of the Hotel Fumé, which as the name suggests was built as a hotel by the  Fumé family in the 15th century. It became part of the University of Poitiers’ Faculty of Human Sciences in 1922. The University of Poitiers is one of the oldest in France, often seen as the number 2 after Paris (so the French equivalent of Oxford ;).  I was pleased to be able to present at the conference the excellent research carried out by one of my professional doctorate students, Sara Dowsett, on the utility of schema theory in understanding mental health issues in higher education students.  The great thing about attending this conference is also the opportunity to catch up on some of the research being done by our colleagues in the Francophone world. For example, I listened to an extremely interesting paper by Geoffrey Gauvin, who along with colleagues in Montreal has been looking at the utility of self-help groups for clients with depression.  It struck me that the holistic perspective being used with clients in these groups is something we might well benefit from here in the UK.

One of the highlights, as you would expect for a conference in France, was the conference dinner. I felt privileged to be seated opposite the president of the French Society, Rene Clarisse. In talking to Rene, one of the interesting things I learned was psychologists in France are pushing the government to extend psychology training courses by an extra year, which may well give rise to the development of professional doctorates in France.  Ironically, the similarities between British and French psychology may well therefore increase even further after Brexit, just as the possibility of professional mobility may well get harder.

I hope my blog entry encourages you all to reach out to our continental psychology colleagues and overcome the linguistic barriers, whatever language your rusty GCSE happens to be in.

Introducing our new lecturer, Dr Eva Fragkiadaki!

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By Eva Fragkiadaki

My name is Eva Fragkiadaki, and I have recently joined the UWE Department of Health and Social Sciences as a Senior Lecturer in Counselling Psychology.

I received my undergraduate degree in Psychology from University of Crete in Greece. I then moved to London where I completed my Master of Science in Counselling Psychology as well as my Professional Doctorate (PsyD) in Counselling Psychology at City University of London. Prior to joining UWE, I worked as an Assistant Professor and Director of the Psychology Division at Hellenic American University (Athens, Greece) for three years.

At UWE, I will be primarily teaching at the Professional Doctorate in Counselling Psychology programme, and I will also be involved in the roles of Placement Coordinator, Director of Studies as well as supervisor of undergraduate dissertations.

I am a qualitative researcher and my projects have been based on constructionist methodologies like Grounded Theory and Narrative Analysis, but recently I have engaged more into phenomenological paradigms and Interpretative Phenomenological Analysis in particular. My scholarly interests initially involved the exploration of psychotherapy termination, trainees’ professional development, mental health practice and the impact of financial crisis on people and services. Over the last years, my research focuses on the investigation of psychotherapy process, change and outcome, developing longitudinal, mixed method and qualitative study designs. I have collaborated with academics and researchers from Greece, UK, Netherlands, and USA, and I have published academic articles and peer-reviewed chapters based on my research activities. Given my expertise in qualitative methodologies, I have been invited to facilitate seminars and also consult on projects by a number of institutions. Moreover, I have been the organizer of five qualitative research panels in national and international conferences and I have been invited to participate in numerous discussions as a presenter. Recently, I was invited to be the keynote speaker in an international conference of the American Counseling Association.

I am a trained psychotherapist, adhering primarily to the psychodynamic and psychoanalytic model of formulation and practice but I have also been trained in Cognitive Behavioural approach. I have worked on short and long term therapeutic basis with a variety of clinical cases (depression, anxiety disorders, personality disorders, psychosis etc.) and ages (adults, adolescents, children and families). I have collaborated with social workers, play therapists, psychiatrists, teachers and other professionals in the fields of mental health and education. I adhere to the scientist – practitioner model based on my academic and clinical training and practice. As a researcher and a psychotherapist I believe the two domains interact and inform each other. I try to encourage this model to my students and trainees.

A dormouse, a t-shirt made from bin liners and a jar of Nutella: Applying creative methodologies to understand athletes’ experiences of overtraining syndrome

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By Lindsay Woodford

Exceptional physical features, together with high commitment and motivation, are important attributes of high-performance athletes. However, when faced with frustrating setbacks, the same qualities of commitment and motivation that have elevated athletes above the pressures of competition can be their own worst enemies. It is not uncommon for elite athletes, especially young athletes to push themselves too far, to overreach and experience extreme tiredness on a regular basis and never reach their full potential because of excessive training load and insufficient recovery.

Unexplained underperformance and persistent fatigue – Exploring overtraining syndrome

Overtraining syndrome has been described as persistent fatigue and underperformance, which occurs following hard training and competition. The symptoms do not improve following two weeks rest and there is no other identifiable cause. It can be a devastating condition, as highly motivated athletes have to cope with the frustration of reduced performance and taking extended periods off training and competition to recover. Monitoring and treating a persistently fatigued athlete can be challenging, as the root cause of the fatigue is often not recognised until months of poor performance have passed. Accurate diagnosis is difficult as there are often numerous other medical and psychological conditions that present with similar symptoms. 

There is much debate in the sport science literature regarding the aetiology of overtraining syndrome. Various physiological mechanisms have been proposed to influence an athlete’s vulnerability to the overtraining state. These include low muscle glycogen, decreased glutamine, central fatigue, oxidative stress, an imbalance in the autonomic nervous system, hypothalamic dysfunction and elevated cytokine levels. However, no single marker can be taken as an indicator of impending overtraining syndrome. Until a definitive diagnostic tool for overtraining syndrome is developed, regular monitoring of a combination of performance, physiological, biochemical, immunological and psychological variables seem to be the best strategy to help identify athletes who are failing to recover properly.

Making the familiar unfamiliar – Using visual methods in applied psychological research

My passion for conducting research in the area of overtraining syndrome was inspired by my personal experience of the condition when I was competing as a national level lightweight rower. I understood first-hand what a debilitating condition it can be and the devastating impact it can have on an athletes’ career. I desperately wanted to help further our understanding of the condition so that sport science and medical practitioners could better support athletes like myself. There is a wealth of research that has examined the pathology of the overtraining syndrome, but no comprehensive understanding of the subjective experiences.

When I started my research, I was excited to conduct my first interview with a triathlete who had suffered with the condition for the last five years. I thought long and hard about the questions I was going to ask, and I was eager to hear his responses. But at the end of the interview I felt bitterly disappointed that the answers I received told me nothing I didn’t already know. I could not understand why. Perhaps he had difficulty accessing and communicating his experiences, maybe he was offering a rehearsed narrative, or was it that I was asking the wrong questions? 

I attended a seminar organised by my colleagues Victoria Clarke, Nicola Holt and Elizabeth Jenkinson from the psychology department at the University of the West of England, in collaboration with Cathy Randle Phillips and Catherine Butler. The seminar focused on exploring the potential for creative and arts-based methods for applied psychological research. Whilst feeling demotivated and dejected about my research it was following this seminar that I experienced what can only be described as an epiphany. I realised that the problem was that I was asking questions I already knew the answers to; overtraining syndrome had become too familiar – I needed to make it unfamiliar.

It has been suggested that by introducing a visual element to the process of data collection we can potentially provide different ways of knowing and understanding. Art can address atomization by forcing us to slow down our perception, to encourage us to linger for a while and to notice new things. Perhaps if I utilised visual methods in my research I could disrupt the athletes’ narratives and allow the unsayable to reveal itself? If I asked my participants to play with Lego, paint and take photographs would it provide a platform for exploring their world in more reflexive depth? 

The Dormouse – Recollections of a lightweight rower with overtraining syndrome

In my role as a practitioner I have been humbled and privileged to hear the stories of athletes I work with. I have shared in their joy and their sorrow, I have played a part in their journey of self-exploration – my role has been so much more than enhancing athletic performance. Yet in my research, to date, I have not allowed my participants to tell their stories. So, like all mad scientists I conducted a little experiment on myself! I got my camera out and started taking photographs of what overtraining syndrome meant to me. These are the images that represented my experience of living with the condition and some extracts from the story they inspired, told as part of The British Journal of Sports Medicine’s Patient Voices series this month.

Making weight was a challenge for me and my crew, the extreme and frankly ridiculous weight loss strategies we employed in the days leading up to the National Championships in 2000 seem incomprehensible now. I was not at race weight the night before the finals, so I severely restricted my food and drink intake, to the point of dehydration. I remember feeling so thirsty it was uncomfortable to swallow. The blissful sensation of sucking the moisture out of my toothbrush – I savoured that moment when the cool, minty water slid down my throat, it could have been champagne! It was July and I had set the central heating in the house to full blast, I had put on as many layers of clothing as I could, and I slept motionless, restrained from the weight of the blankets pinning me down. Despite subjecting my housemates to a night in a sauna, the next morning I was still 500g over race weight. In a last ditch attempt to be able to compete, I fashioned a t-shirt out of a bin liner, layered all my cold weather kit on top and ran a few laps round the housing estate. I remember darting behind a dustbin when I saw my coach drive past, I did not want him to know the shameful extent of my weight loss strategies. But to me it was normal, it was just part of being a lightweight rower, we all did it, I think our coach did know but he chose to ignore it. 

These strategies proved effective as I won a bronze medal at the Nationals, and later a coveted place on the England lightweight women’s rowing squad for the 2002 Commonwealth Games.Everything was going to plan, when one morning at 5.30am as I reached over to turn my alarm off, I felt my head begin to spin, my heart was pounding, and I felt violently sick. I threw up to ease the nausea, sipped some water, put on my kit and drove to the rowing club. I managed to complete the training session, but my legs felt like lead and my heart was racing. This was the start of a progressive decline in performance.

One of the most debilitating symptoms I experienced was the need to sleep. I became affectionally known as “The Dormouse” because I slept over 10 hours a night and during the day. When I stood up my heart rate would go through the roof and my blood pressure would drop, I felt constantly dizzy and sick. I caught cold after cold and I felt like I had a pair of golf balls permanently lodged in my throat. Despite these debilitating physiological symptoms, I was more motivated than ever to represent my country. 

It took me two years until I was well enough to do a full training session on the water with the rest of the squad. I had various relapses along the way, but none as severe as the first one. By the time I was fit enough to trial for the national team again I was completely burnt out. The sport that I loved more than anything else in the world, became something I despised and not long afterwards I quit (Woodford, 2019).

My current research has embraced some of the methods offered by the creative arts and has empowered my participants to shape its direction. I am excited about how this new approach can further our understanding of this debilitating condition and help us develop strategies to support those athletes with overtraining syndrome. 

Intergenerational Contact: Connecting Generations and Connecting the Research

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By Jennie Ferrell

Intergenerational activities and programmes have become a popular topic in the United Kingdom recently with the success of projects involving older adults and children as portrayed in television programmes such as Old People’s Home for 4 Year Olds and The Toddlers Who Took on Dementia, through media attention of innovative projects including the Apples and Honey Nightingale co-located nursery-care home, as well as from societal issues of media-grabbing headlines of tensions between ‘baby boomers’ and ‘millennials’ and generational differences in political attitudes such as toward Brexit. As society becomes more age-segregated and resources become stretched, intergenerational activities have become a necessity beyond the feel-good aspects of such projects, a point argued by many who promote the need for intergenerational contact in society, such as Nancy Henkin, founder of Temple University’s Center for Intergenerational Learning, and Stephen Burke, founder of United for All Ages. In addition to the initiation of such projects, it’s vital to also consider the evidence base in this area as well as ways to evaluate such programmes and increase the accessibility of this information to those interested in running intergenerational programmes.

Why Intergenerational Contact is Important

There’s an interesting phenomenon when it comes to psychological research; as much as we often characterise scientific research as being objective and neutral, like many researchers, our own personal experiences often guide us and inform us through our exploration of research areas. I am an immigrant raising my daughter in a different country than her grandparents. I was thrust into a new lifestyle of motherhood 3 years ago and had to re-evaluate my identity, my purpose and how I fit into society. As my maternity leave ended and I came back to the world of academic life, I became involved with Acorns ‘n’ Oaks Playgroups, a new organisation which was organising playgroups in care homes across the Bristol area, as a parent participant, a group leader and the research coordinator. I could immediately see the benefits of activities such as these playgroups to not just the older people and the children, but the parents, grandparents, caregivers, student volunteers and staff as well. 

We are currently experiencing a crisis of providing mental health support and reducing feelings of isolation and loneliness in our society, whether it’s for older adultsnew mothers, or university students, three groups vulnerable to these issues as they experience life transitions. Intergenerational activities have been proposed as a way to prevent and alleviate some of these issues, providing the connections and relationships that allow for improvements in mental and physical health, changes in ageist attitudes, learning opportunities, and stronger communities. 

Why is Research Important?

Key to any programme or intervention is the research; activities should be evidence-based and evaluated. For decades, researchers have been investigating the effects of intergenerational contact on its participants, particularly the physical and mental wellbeing of the older participants and the attitudes and social development of the younger participants, finding overall positive consequences from intergenerational experiences. Constructing a coherent picture of intergenerational benefits has been tricky, however. The nature of evaluating programmes that have not been set up as controlled experimental studies means that research often suffers from issues such as small sample size, lack of control groups or control activities, and variation of participants and structure both within and across studies. 

Research on intergenerational contact, however, has also been useful to identify what qualities can make a programme more or less successful. Focussing on programmes that aim to reduce negative attitudes toward ageing and stereotypes of older adults, publications such as a recent report for Age UK by Drury et al. (2018) and a review article by Christian et al. (2014) give a thorough review of intergenerational programmes and research findings to highlight, backed by social psychology theory, recommendations for planning and structuring successful intergenerational activities.

Intergenerational Contact and Research: The Next Steps

Research can be greatly beneficial to any organisation interested in setting up and evaluating an intergenerational activity. Although it’s positive that so many nurseries, care homes, community organisations and councils are interested in developing intergenerational activities, the fact that so many of these projects are initiated from the ‘bottom-up’ means they aren’t able to benefit from a top-down structure or organisation that can provide the evidence for planning, the evaluation tools, the practical guidelines such as risk assessments and data protection and funding opportunities. There are, however, some excellent resources, for example the United for All Ages’ webpage which includes tips for planning parent and toddler groups in care homesSt Monica’s Trust’s guide for intergenerational activity, and the Together Young and Old Programme, which provides a number of resources and training opportunities, a toolkit for training people in intergenerational activities and an online course. The more a network of those interested and working in intergenerational activities and research can be developed, the stronger this area will become. Currently I am part of an interdisciplinary intergenerational research group that has recently been awarded funding from the NIHR to do a systematic review on intergenerational programmes and research. This research group grew out of last year’s Innovation in Care: Stories of Intergenerational Action conference, which was a very informative gathering of those working in the area ranging from one-off and pilot projects to regular activities to co-located facilities.

I am currently working with Acorns ‘n’ Oaks to evaluate their playgroup experiences, looking at some of the motivations and perceived effects of participating in the playgroups from the perspectives of the older adults, those that bring children to the group and the staff involved. Psychology students researching this area for their final year undergraduate dissertation have been key in this data collection. Findings will be presented later this year at the 11thInternational Social Innovation Research Conference in Glasgow. I have also been working with BS3 Community in South Bristol, who have run a number of successful intergenerational programmes, including linking their nursery with a local care home, Tech and Talk and their current pilot Grandparent-Toddler playgroup, which will feature as a case study in Children’s Centre Leader magazine later this year. We also have a fantastic opportunity now with the new ExtraCare Stoke Gifford Retirement Village situated next to UWE Frenchay Campus for intergenerational connections to be made with university students, as well as special projects with the local community. Psychology students have been instrumental in working with the new village to develop and run an intergenerational playgroup, funded by a UWE Community Fund and Quartet, and we’re working with ExtraCare to help keep their intergenerational programmes sustainable with a general plan for intergenerational activities across their facilities. 

I’m very interested to grow a local Bristol/Southwest network of those involved in intergenerational activities and help provide resources and workshops to those interested in starting and evaluating programmes. If you’d like more information, please contact me at jennie.ferrell@uwe.ac.uk.

 

Who is sport psychology for?

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By James Byron-Daniel and Manuela Teti (UWE MSc Sport and Exercise Psychology graduate)

What is sport psychology? 

Sport psychology is a broad subject, covering such things as the enhancement of athlete performance, dealing with pressure, enhancing focus, working with addiction and an infinite number of other issues. In terms of these services there has traditionally been a focus on athletes at the professional end of the sporting continuum, and there is a wealth of research which has shown very convincingly the efficacy and worth of these services for this group of athletes. All sport psychologists who work in practice have a smorgasbord of techniques they can bring to any given athlete or team, from psychological skills training (goal setting, visualization, relaxation techniques and self-talk) to more intensive therapeutic techniques (mindfulness, cognitive restructuring, REBT), all of which can be adapted and used collectively to address the issue or issues we face in applied sport psychology work.  

We can also say from our own experience, both from an applied sport psychology perspective and as a professional coach, that athletes and teams almost all believe in the importance of the mental side of their sport, regardless of what that sport is, and that despite an emphasis on the importance of this side of their training and performance in competition situations they do very little, and often feel they don’t have the opportunity, to enhance the psychological side of their game. 

Sport psychology, in an applied sense, therefore fills this gap. Indeed the discipline as a whole has been developed and continues to evolve in order to provide a way to enhance and support athletes to be the best they can be. So, taking both the focus of sport psychology and the need and enthusiasm for it in sports in general then it seems rationale to assume sport psychology is widely available to all and that sport psychology services are integrated across all levels of all sports. This unfortunately isn’t necessarily the case. 

Who uses sport psychology? 

Sport psychology services (SPS) have traditionally been directed at professional athletes, perhaps not exclusively, however when one looks at any number of sport psych textbooks there tends to be a skew to this group, or at the very least when describing and discussing applied techniques the assumption often is that who you are working with has significant access to sport psychology and other resources. This may well be the case for professional or semi-pro athletes however this is almost universally not the case for the hundreds of thousands of us that play and compete outside this professional group. If one were to look at a current issue of a popular sport psychology academic journal (for example Journal of Applied sport psychology; The Sport Psychologist; Psychology of Sport and Exercise), there is a trend toward elite and professional levels of sport in academic research as well (not exclusive but certainly the focus tends to be on semi professional and professional sports women and men). There are undoubtedly many reasons for this focus however this shouldn’t lead us to conclude that sport psychology services have no place in amateur sport, be that competitive or non-competitive amateur sport. It is in the authors experience that far from not having a place there is in fact just as much demand for sport psychology support and that sport psychology interventions and support at this level can be just as effective. There is however a sub group of this already unrepresented group that have even less access to sport psychology services and are further under researched, and that is young (non-adult) non-elite athletes.

Sport psychology support for young amateur athletes 

Even less research and applied work has been dedicated to youth non-elite athletes, with a lack of guidance for Sport Psychologists working with young athletes which in recent years has sparked streams of research aimed at generating developmental frameworks and attempts at understanding young athletes’ progression in sport, from childhood to adolescence and into adulthood.  

Authors of the ‘International Olympic Committee (IOC) Consensus Statement on Youth Athletic Development’, reported an “urgency to address the culture of specific sports and youth sport in general, which have become disproportionately both adult and media centered”. The IOC recommendations advise on the need for widening the definition of success in youth sport, focusing on the development of young athletes in their whole and as “persons”, and committing to their psychological growth. The historical paucity of literature on developmental sport psychology is even more surprising when considering that young athletes are placed at the “ideal window of opportunity” for developing mental qualities and competencies. 

Many researchers agree on the need for developing comprehensive and holistic models and programs to support young athletes at a vital transitional period of physical and psychological development.  This is of course challenging for all sorts of reasons, perhaps one of the most important being the already existing challenges for young people, be they pre-adolescent or be they 12-18 years of age.  

Due to the high demands of competitive sport and more general life demands, young athletes are faced with the need to take ownership of their psychological growth: this often leads them to intuitively (through experience) and/or informally (taught by significant others) acquire a repertoire of mental skills necessary to cope with the pressures their sport places upon them. Consequently, young athletes may gain an implicit understanding of a range of psychological skills, albeit at various levels of awareness

Furthermore, the lack of easy-to-access sport psychology services to young athletes might drive them to spontaneously seek information, gain understanding and share experiences. In this context, in addition to relying on members of their support network, they might explore the internet and access online communication tools, such as social media platforms etc. However, a lot of this is assumed as so little work is done at this group, and it is in this context that we have conducted an initial investigation into sport psychology in youth amateur sport.  

Our research into sport psychology and young athletes 

The main purpose of our research was to investigate non-elite young athletes experiences by giving young athletes voice and an opportunity to express feelings and communicate thoughts in relation to their sporting engagement. The study revolved around three main research questions:  

  • What are young athletes’ perceptions of psychological needs and experiences of challenges?  
  • What is their understanding of the psychological dimensions of sport?  
  • What spontaneous ways do they resort to when seeking psychological support? 

An online survey, including quantitative and qualitative data collection and qualitative semi-structured interviews were conducted in a sample of 13-19 year old girls and boys who regularly engaged in extracurricular sporting activities (outside of school and within clubs, associations, organisations), involved in a number of sports (including multi-sport engagements), at any level of training and competition, but not included in any talent development programs or professional level sport structures.  

Through these interviews what the participants said clearly showed the discrepancies between young athletes’ needs and their sporting realities. The young athletes’ all desired sport psychology support, specifically access to independent sport psychology professionals and availability of ‘in-house’ and ‘easy-to-access’ services consistently integrated in their ‘ideal sporting world’. Participants sometimes resorted to Screen-Based Media (SBM) as a spontaneous way to seek psychological support: however, the young athletes were favourable to online communication technology to get that support as well as face to face support with a sport psychology specialist. (This work is currently being prepared for publication, as well as a follow-on study to this initial work.) 

So what does this mean and where do we go from here? 

In summary, it certainly seems that there is a need for a greater understanding of how sport psychology services could be used to benefit young athletes, and that irrespective of level of athlete this support is desired and sought out. Our work with these young athletes clearly shows that demand and perhaps points to a way we can get sport psychology into amateur club and team settings (through screen-based media and social media being one possibility). The lack of research into this group also needs to be addressed, specifically deepening our understanding of how sport psychology can be integrated within a young athletes life, and what the subsequent benefit for future engagement and performance might be. We believe that integrating sport psychology into youth sport has the potential to reap huge benefits for youth sport and the sport psychology profession in general, and we hope in the years to come a greater focus on this group of athletes will lead to not only to the next generation of elite levels sports women and men but perhaps more importantly a much greater engagement with all sports across all age groups at all levels. 

Shining the light on implicit bias: Do we really know what we believe?

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By Charlotte R. Pennington

In everyday life, you will be asked to report your attitudes and opinions towards a whole host of different things.  When buying a TV, you may be asked retrospectively to provide ratings of the product, or even the person who sold it to you. The reporting of attitudes has become so sought after by companies that specific websites have been developed providing people with an open forum to post their opinions and evaluations of accommodation, restaurants, and services, and even receive arbitrary points and badges for their reviews (e.g., Trip Advisor).  Given the plethora of surveys and questionnaires utilised on a daily basis, you may therefore think that measuring attitudes is relatively easy. Simply ask someone what they think and they will respond with an honest answer. However, psychology has shed light on the limitations posed by self-report tools, such as questionnaires and surveys, which are so readily used by companies and organisations alike.  

Gauging attitudes: A problem of measurement or construct?

Explicit attitudes refer to consciously accessible thoughts and feelings towards people, objects or concepts. They are introspectively accessible, meaning that you can reach inside your mind and report your feelings and thoughts. However, there are many issues when it comes to measuring people’s attitudes accurately. Reflect on the following example; a builder may measure the height of a window frame to fit double-glazed windows. Each time he/she does this, the window measurements remain the same. Windows can be measured, and the builder has the best tools to yield the correct measurements. Unfortunately, the same is not true when it comes to measuring attitudes; they are mental constructs and not tangible things. They are slippery and shape-shift depending on context. This presents numerous issues for researchers trying to measure them.

Studies have shown consistently how people’s attitudes can be altered by systematic factors, such as how the questions are framed and even what order they are presented. For example, a recent study demonstrates how the number of scale points in a questionnaire affects the extent to which gender stereotypes of brilliance are expressed. Specifically, female course instructors were more likely to receive a top rating on a 6-point scale relative to a 10-point scale, whereas this difference did not emerge for male instructors. The author’s reason that this effect occurs because of cultural meanings assigned to the number ‘10’ – perfection. As such, a top-score on a 6-point scale does not carry such strong performance expectations. To me, this is a landmark study demonstrating how the features of tools that are frequently used to judge merit can powerfully affect people’s responses. Who knew that something which appears meaningless can shape our answers in a way that tells a completely different story?

Another issue plaguing questionnaires is that psychologists – or whomever uses them – need to trust that the questionnaire can tap into exactly what we want to measure. When asking people about socially sensitive topics, such as prejudice or discriminatory behaviour this is rarely often the case. Consider how you would answer the following questions when asked by a researcher, someone you barely know: “Do you treat people from other races the same as you treat people from your own race? Do you willingly give to charity or those who need it the most? Think hypothetically about your answers for a minute. Now, reflect on your previous behaviour and try to gauge whether the answers given provide an accurate representation of how you really act. What you might uncover about yourself here is called the ‘willing and able’ problem; people may not be willing to report their honest attitudes, and when put on the spot, may not be able to accurately reflect and report what they truly feel. Answers to questions are usually influenced by self-presentational motives – that is, people’s desire to look good in someone else’s eyes.

A more interesting question is that we might not know what we actually believe. To a lay audience with no psychological training, this may sound surprising. How can we hold attitudes that we are unaware of? Psychology holds the answer. The past three decades of psychological research have revealed the frailties of introspection (the inner workings of our mind), and how little control we possess over our own thoughts. This has led researchers to coin the term ‘implicit attitudes’; introspectively unidentified traces of past experience that mediate favourable or unfavourable feeling towards social objects. The general argument is that individuals harness attitudes that they are not aware of, and these can manifest as judgements or actions.

How do we measure attitudes that people aren’t aware of?

The development of implicit measures have afforded remarkable insight into the human mind, and opened up a new research field termed implicit social cognition. This may leave you wondering, how do we measure such attitudes, and how do they develop in the first place?

Whereas explicit attitudes are measured by asking people directly about their thoughts and feelings (e.g., through questionnaires), implicit attitudes are assessed indirectly through tasks that typically measure response times towards various stimuli and compare systematic variations in people’s performance. One of the most well-known tasks of this kind is the Implicit Association Test (IAT), which tests how quick (or slow) people are at pairing different social categories with various attributes. The race IAT, for example, requires test-takers to categorise pictures of White and Black faces with positive and negative terms as quickly as possible. The underlying theory is that people will be quicker to pair concepts with attributes that are strongly associated in memory, compared to those weakly associated. In order to understand this better, think about learning a new language for the first time; you will always be quicker to think about words from your own language compared to those from a newly learned language because of the automaticity of your native tongue. Going back to the race IAT, research has consistently shown that White people are quicker to associate pictures of White faces with positive terms and Black faces with negative terms. This is referred to as implicit bias.

Social psychologists theorise that implicit bias, such as that demonstrated by White people taking the race IAT, are learned through experience. This occurs either directly through encounters with a particular social group, or indirectly through exposure to information about this social group. In Western cultures, White people are inundated with cultural messages and stereotypes that portray Black people as uneducated, relatively poor and more likely to be in trouble with the law. Consequently, implicit bias may form through exposure to cultural milieu. Do you know what your own IAT test result shows? Anybody can take these tests through the Project Implicit website. Your test result may surprise you, but it’s important to recall that this might not reflect your personal beliefs but rather learned associations imbued through exposure to your cultural or social environment. Research has revealed remarkable findings through the use of the IAT.  For example, a recent longitudinal study shows that implicit attitudes towards race, skin-tone and sexual orientation have trended towards neutrality over the last 12 years (i.e., people’s implicit bias towards these social categories seems to be decreasing). However, attitudes towards age and disability have remained stable, and have increased in relation to body-weight stigma. Moreover, implicit attitudes appear to hold predictive validity; studies have shown that people’s preference for White people on the race IAT predicts intention to vote for a White relative to Black presidential candidate. Now that’s a cool finding!

However, implicit measures have also received their fair share of criticism. Research indicates a weak relationship between explicit and implicit attitudes, suggesting that they may reflect separate attitude representations. An alternative theory, however, is that explicit and implicit measures allow people to edit their responses to varying degrees. In 2016, as a PhD student I wrote my first commentary reflecting on what exactly do implicit measures assess? In addition, although the IAT has shown some predictive validity (e.g., voting behaviour), other research indicates that for more socially sensitive attitudes, the IAT does not predict resulting discriminatory behaviour. Although the IAT was heralded to provide new insights into human cognition and behaviour, some researchers believe this test has been oversold. Nevertheless, I argue that the reason that implicit attitudes may not predict real-world behaviour is influenced by the same issues that plague self-report measures – social desirability. That is, people may think negatively about a certain out-group member, but that doesn’t necessarily mean they will act upon this. The same may be true for weak correlations between explicit and implicit attitude measures; people distort their attitudes on self-report questionnaires, whereas implicit measures aren’t susceptible to these self-presentational motives. Should we expect correlations between these two measures when one is tapping into controllable beliefs and the other is uncovering introspectively unidentified traces of past experience?

In order to answer these questions, I was awarded funding through the Vice Chancellor’s Early Career Research Awards (VC ECR Award) at UWE Bristol to investigate other implicit socio-cognitive mechanisms that may predict implicit bias. The blue sky thinking behind this research is to develop other measures that can potentially measure implicit behavioural manifestations of bias. At this stage, we are too early in our research endeavour to reveal any findings; however other influential and impactful avenues have already stemmed from this research.

At the same time as I have been conducting my research, Ellie Bliss (Adult Nurse Lecturer) and Alisha Airey (BME Project Officer) have been running staff workshops at UWE Bristol, reflecting upon how implicit (unconscious) bias can play out in the higher education classroom. I am now involved in supporting these workshops, providing research-led guidance on how we access implicit bias, and answering the many questions that staff have about this rather ambiguous construct. One interesting discussion centres on whether implicit biases can be viewed as unconscious when we are increasingly acknowledging them through teaching and training. The majority of attendees come away from the workshop with new reflections on how teaching practice is orientated towards Western culture, and with classroom strategies to implement to prevent implicit bias playing out. However, a handful of attendees are surprised and doubtful of the concept of implicit bias and the tools that purportedly measure it. They have difficulty in accepting that they may hold certain biases. But the truth is, we all do.

Where is implicit social cognition headed?

In this blog post I hope I have demonstrated that we are shining the light on what implicit bias really is and the nature of our unconscious attitudes. Such research has paved the way for training workshops which teach people to acknowledge their deep-rooted attitudes and reflect upon how these may impact our thinking and behaviour towards other people. But what’s next for this research arena? There are still lots of unanswered questions and controversies surrounding implicit bias, which makes it an exciting topic to study. Do implicit measures really provide a window into the unconscious mind? Is implicit bias relatively stable when measured at different time points? Can implicit bias be changed, and if so, are such changes short or long-term? Are attitudes towards some social groups easier to change than others? Can we, as a field, develop other (implicit) behavioural measures that more accurately predict implicit attitudes better than self-reports? Such investigations will represent the future of implicit social cognition and I, for one, am extremely excited to see what’s to come.

The arts and wellbeing: A burgeoning research area

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By Nicola Holt

“I am happy to be alive as long as I can paint.” Frida Kahlo, artist

“To write poetry is to be alive.” Rainer Maria Rilke, poet

The therapeutic role of the arts in fostering healing, growth, well-being and emotional expression is well-attested and long-standing. Whether painting, creative writing, crafting, singing or colouring, arts-based approaches are beginning to be recognised as credible and effective ways to promote good psychological health for all.

There is currently a burgeoning of research on the arts and health, that is impacting policy and treatment. For example, recent research has suggested that singing can help reduce post-natal depression and improve lung-functioning, dance can help improve the balance and gait of people with Parkinson’s disease, poetry therapy can be a useful intervention for patients recovering from anorexia, expressive writing can decrease stress and improve immune system functioning, art making can help to reduce pain and distress in cancer patients, improve mental health and enable positive experiences such as happiness and mindfulness. Bodies such as the All-Party Parliamentary Group on Arts, Health and Wellbeing  have assimilated such findings, and, based on these have made policy briefings recommending the increased commissioning of the arts to improve health and wellbeing (including ageing well, mental health, and the self-management of chronic conditions). While this may be having some impact (for example, the Government’s recent plans to increase access to arts on referral), caveats remain. There are limitations with the evidence base and numerous questions about the efficacy of the arts remain unanswered. For example, effects require replication, many reviews include heterogenous interventions, groups of people and wellbeing outcomes. This can make it difficult to know which art treatments work best for whom, and why. It is also unclear how interventions should best be delivered, for example, the number of sessions required and the optimal spacing between them. The long-term benefits of arts interventions are also little known. Much profitable research has yet to be conducted on the arts and health, which will help to answer such questions.

I became interested in the arts and wellbeing when studying for an MSc in consciousness studies twenty years ago. I became interested in the shifts in conscious experience (e.g., perception, attention, cognition, mood, awareness of body, time and agency) that I personally experienced while painting and began to explore the literature for explanations, leading to an MSc thesis and a PhD on consciousness and creativity. One common type of experience, described by humanistic psychologists such as Rollo May and Abraham Maslow as a form of ‘peak experience’ or ‘creative attitude’, and popularised by Mihaly Csikszentmihalyi, is the ‘flow state’, involving detachment from time and space, absorption in the activity of the present moment, deep fascination and concentration. The accounts given by Marion Milner, in her book ‘On not being able to paint’, were my favourite ones at the time, for example, she described what she called moments of ‘creative participation’ in the following way:

“The process always seems to be accompanied by a feeling that the ordinary sense of self had temporarily disappeared, there had been a kind of blanking out of ordinary consciousness; even the awareness of blanking out had gone, so that it was only afterwards when I had returned to ordinary consciousness that I remembered that there had been this phase of complete lack of self-consciousness.” (Milner, 1950, p. 152)

Indeed, my recent research suggests that ‘flow’ might be one mechanism to explain the health benefits of engaging with the arts. The arts might offer people the opportunity to experience degrees of absorption or flow in their daily lives, in a way that promotes wellbeing, either by being temporarily distracted from one’s pain or worries, or through engagement, joy and a consequent sense of mastery. Various crafts and arts activities might facilitate this experience, including drawing, knitting, and colouring. Colouring is an and accessible art activity that has been increasingly advocated for wellbeing, and evidence supports its use as a stress-reduction tool for University students. Recent research that I have conducted at UWE, with students on our undergraduate psychology programme, suggests that, not only might colouring, temporarily, at least, improve mood and promote the flow state, but might also improve cognitive functioning – both selective attention and creativity, potentially helping students to solve problems in everyday life.

Of course, the flow state can be experienced in many activities in everyday life, and a range of other mechanisms have been proposed to explain the health benefits of art-making, some specific to particular forms of art. For example, it has been proposed that expressive writing may reduce cognitive rumination and anxiety following stressful events, creating a meaningful and more manageable narrative, impacting both psychological and long-term physical wellbeing (by improving immune system functioning). Further, many art groups perform an important social function, helping to reduce feelings of loneliness and isolation and improving people’s ability to relate to and communicate with others. Research on the mechanisms behind any wellbeing effect is important because we can help to identify to active ingredients of arts for health interventions (e.g. type of art, skills of the arts practitioner, group interaction) and modify these accordingly to optimise wellbeing.  

In the Faculty of Health and Social Sciences at UWE we have a number of academics interested in the arts and health, including our music therapy team. Academics from different disciplines come together as a teaching team on the Level Three Psychology module, The Arts and Mental Health, led by myself, delivering an exciting and diverse array of topics, including art psychotherapy, music therapy, music in prisons, poetry therapy, craftivism, and the arts and dementia. As a next step I have begun a multidisciplinary Special Interest Research Group at UWE with Dr Liz Jenkinson, hoping to facilitate research collaborations on the arts and health, within and beyond UWE. This is entitled DRAW: Developing Research on the Arts and Well-being, housed within the Promoting Psychological Health strand of PSRG (Psychological Sciences Research Group). Interests of DRAW include developing new arts interventions, evaluating existing arts interventions, researching mechanisms to explain the health benefits of engagement with the arts and the use of the arts in creative research methods.

The members of DRAW bring together a diverse range of knowledge and expertise and we are looking forward to collaborating and extending our research and evaluation of arts for health. For instance, Dr Liz Jenkinson and the health psychology team at UWE are experts in understanding patient experiences of acute and chronic health conditions, and the design and evaluation of effective psychosocial support. The use of the arts in health care as a therapeutic tool in promoting good psychological and physical health is an area in which DRAW has begun to collaborate with organisations such as Fresh Arts, who provide arts-based interventions for patients at Southmead Hospital, including arts on referral for cancer patients. Liz is also working with colleagues at UWE in Visual Culture and the Arts with the aim of developing a new arts for health intervention with young mums. Another DRAW member, Dr Mike Chase has over 20 years of experience of working and researching in the voluntary and statutory community sector, and has been using mixed-methods to evaluate the use of music and arts interventions in community settings, including the Outsider Gallery, in London. Mike hopes to extend this collaboration further, for example taking arts and music interventions to young people’s forensic units in Bristol.

At DRAW we have also been evaluating whether ‘prescribing’ a course of art workshops to people experiencing depression, anxiety or loneliness can improve wellbeing. ‘Arts on prescription’ or ‘arts on referral’ forms part of the wider remit of social prescribing, where doctors, nurses or other primary care professionals prescribe non-clinical activities (including nature walks, cooking or singing workshops) with the expectation that this will improve the health of participants. Although the Government plans to increase the use of social prescribing in the NHS, including arts on prescription, there is only a limited, but encouraging, evidence base for its efficacy. I have been working with the recently formed Bristol Arts on Referral Alliance (BARA) to help contribute to the evidence base for arts on prescription. BARA provides 13 art workshops across Bristol, and 6 follow-on groups, embedded within a larger social prescribing scheme, funded by Bristol City Council, Bristol CCG and charitable foundations. We have been using a mixed methods design, including semi-structured interviews with participants, and drawing on existing pre-post intervention evaluation frameworks. Further, based on my research using the experience sampling method, participants have been tracking their mood over time, for the duration of each 12-week-long art course. Indeed, this has become a meaningful part of the art workshops for participants, reflecting on their current mood at the start and end of each workshop. This data will enable us to test whether any increases in wellbeing at the end of each course are predicted by reductions in stress, increased energy and happiness, directly following making art. The first round of data collection is now complete and will be analysed and disseminated over the next few months, some initial outcomes having been presented at the 1st International Social Prescribing Network Research Conference in June 2018.

The team at DRAW are interested in using the arts themselves as tools for collecting and disseminating data. Led by Victoria Clarke, and in collaboration with Psychologists at the Universities of Aston and Bath, Liz and I have received funding from the BPS to run a seminar series exploring the potential for creative and arts-based methods for applied psychological research. You can learn more about this venture here. We hope that this series will inspire us to use the arts more creatively, as a research tool, in future projects. Using the arts and evaluation tools might offer a creative, more empowering and enjoyable way for participants in arts for health interventions to communicate their experiences and to disseminate these to others.

These are exciting times to be conducting research on the arts and health, with potential for new and innovative projects and collaborations. We hope to grow our research and evaluation at UWE on this topic and develop collaborations with others, within UWE and beyond.  We welcome members to our new special interest group, DRAW, and hope you can join us for our upcoming seminar series which runs from May-July 2019. In the meantime, why not have a go at some arts for health activities – for example UWE’s Feel Good February events include crafting and creative writing!