Healthily Psyched at Guy's

King's College London Health Psychology blog

Tips on Patient and Public Involvement and Engagement (PPIE): How to involve patients in research, writing it up for ethics/grants and tips from those who have been involved! (Part 1/2)

Patient and Public Involvement and Engagement (PPIE) is becoming more and more popular with funding bodies and academics, and rightfully so! It is the most important way to establish whether your research is relevant for those whom it is supposed impact and benefit.

Before starting my PhD here in the KCL Health Psychology Section, I worked as the PPIE Lead at the Centre for Adolescent Rheumatology at UCL for three years (http://www.centre-for-adolescent-rheumatology.org/about-the-centre/ the website itself was designed through PPIE contributions based on what young people wanted!). I’m sharing some of my tips that I have learned along the way, supporting researchers to involve patients, families and members of the public, as well as advice from some of the people who were involved, in true PPIE style!

This post will be split into two parts: Part 1 will be a general introduction to PPIE and Part 2 will be focused on how to involve young people specifically.

 Introduction to PPIE

What on earth is PPIE?
“Research being carried out ‘with’ or ‘by’ members of the public/patients rather than ‘to’, ‘about’ or ‘for’ them.” INVOLVE

Participation – where people take part in a research study – complete questionnaires or give blood.

Involvement – where people are actively involved in research processes and management.

Engagement – where information and knowledge about research is shared with the public.

Sometimes the term engagement is also used to mean involvement as seen here by the National Co-ordinating Centre for Public Engagement definition:

“Two-way process, involving interaction and listening so that the activity and benefits of higher education and research can be shared with the public, with the goal of generating mutual benefit.”

“No matter how complicated the research, or how brilliant the researcher, patients/carers and the public always offer unique, invaluable insights. Their advice when designing, implementing and evaluating research invariably makes studies more effective, more credible and often more cost effective.” Professor Dame Sally Davies, Chief Medical Officer, England, 2009

There are several levels of involvement:
Consultation – researcher(s) asks for views/advice from patients/public
Collaboration / co-production – researchers and patients/public work together, e.g. to identify research questions
User led / controlled – patients make the decisions about research, e.g. principal investigator

Ways to involve:
• Research prioritisation and validation of importance
• Developing Ethics application
• Patient partners/co-applicants on grants
• Writing lay summaries for grants
• Membership on patient steering group/advisory board as patient/public representatives
• Changes to study design and methodology, including selection of final study measures e.g. which questionnaires to include or not and why
• Suggestions on practicalities/feasibility of data collection e.g. recruitment strategies
• Developing and reviewing any materials that potential participants may see as part of the research (e.g Patient Information Sheets, Consent Forms and/or Interview Schedules), to make these more patient centred and relevant
• Content development for dissemination events and on social media

Most important considerations before conducting any PPIE activity:

(Image obtained from https://pixabay.com/en/questions-font-who-what-how-why-2245264/)

Hema’s General Tips
1. PPIE is not always expensive but needs funding!

2. Quality over Quantity – a few key statements or suggestions from 3 or 4 people that is implemented to change the project is better than involving 15 people without actually changing anything.

3. When involving patients, remember you are talking to someone who has a long-term illness – be sensitive and age-appropriate when working with young people and parents.

4. Prepare for rejection and disappointment – not everyone wants to be involved or will actually turn up to your planned event.

5. Try to have at least 5 people confirmed for an activity, and maximum 10 (usually 2-3 do not show up).

6. Appreciate how much time is involved beforehand, on the day and afterwards when writing up – Start recruiting about 1-2 months ahead and offer a few different dates and times for people to choose from, e.g. meetings after 6pm or on weekends, so that patients/carers who work or go to school can be included.

7. Focus groups are not the only way! Feedback via Email, Interviews or Clinic approaches are also helpful.

8. PLAN PLAN PLAN ahead but…be flexible! Not everything will go to plan but activities can still be engaging and successful if you’re able to adapt.

9. Use the research team’s strengths (and others!) – if someone is creative in your department get them involved in your event too!

10. What about afterwards? Will you keep the patients involved, updated with the research activity? What have they received in return? Think about what young people/parents will get out of this activity – opportunity to chat to someone about their experiences, work experience, provide references/certificates for involvement.

Public Engagement and Outreach
Here are some questions to think about when doing public engagement which is subtly different to activities mentioned above:

What message do you want to disseminate? Who is your audience?
How can this be explained in a fun and interactive way?
What things can you give out? Leaflets/Pens?
What activities can you run?
Can you turn this into involvement? Can this be a two-way conversation?

Here is an example of a research stand at a public engagement event (taken from @UCL_RheumAYA), where you can see we tried to explain rheumatology and immunology through an interactive game “When Cells Attack!” and we had bone pens as cool freebies!

Writing up PPIE activities for ethics/grants
When writing your PPIE work up for both grant applications and ethics, the key aspects you need to demonstrate is what PPIE you have carried out and what has changed as a result in your research study.

For example, state the number you have involved (and age ranges and diagnoses if appropriate) and how they were involved (e.g. focus group to discuss proposed study measures) and what changes were introduced (e.g. selected to use the brief version of the questionnaire as young people felt the long version was repetitive and too long and included a mood questionnaire as this was felt to be missing from the study and important to include).

Ongoing PPIE and particularly training and support for your patient partners needs to be included as well as appropriate costs.

Tips from KCL Musculoskeletal (MSK) Expert Patients:
The group is involved with all areas of departmental research, teaching and health service improvement. In addition to this, the group helps shape a series of Patient Education Evenings which are a collaboration between academics, patients and clinic staff, and the topics are suggested by patients, for more information about these evenings please click here.

Carol and Kate have been contributing to research studies at KCL for several years through the MSK Expert Patients Group and shared with me what they find helpful for patients when entering into a PPI project. To see more from the KCL MSK Expert Patients check out their blog here.

Carol’s Top Tips for Researchers for Involving patients:
1. My involvement firstly depends on what I think I can usefully contribute (I am not good with figures and collating data). So it is useful for researchers to have some knowledge of the folk they would like to involve (clinic staff can help here) or maybe a short questionnaire to find out their skills or interests without being intrusive (basic tick box usually works).

2. It’s essential to provide comprehensive information on what is involved, time required and travel requirements – both for health reasons and general scheduling. Vagueness puts me off.

3. Keep everyone informed of what is happening on a regular basis. Long gaps make people lose interest!

4. For focus groups you need a strong Chair. Groups of folk with chronic conditions like to air their problems/issues and focus groups give the perfect opportunity. Researcher/Chair needs to keep everyone on track/time but give some ‘rant’ time at end of session!

5. With children, getting them to talk can be a problem – make sure you have a couple of confident kids to get the ball rolling and get some humour in there – and not too long. Short attention span normal!

6. Getting patients involved is historically difficult, partly I think because in the past one attended focus groups, sessions and then never heard the outcome of the research. Patients/public need to feel their contribution is valued. Let them see outcome.

Kate’s Top Tips for Researchers for Involving patients:
1. Be clear and fully explain about set project and what is expected of the patient representatives and what will be reciprocated. For example, it’s so important to communicate fully, especially in relation to deadlines etc.

2. It is essential that patient involvement is not seen or felt to be ‘tokenistic’.

3. It is important to keep the patient in the loop after they are no longer involved, so often we are not and it is disappointing and disconcerting as we have a genuine interest and have given up our time!

Dr Heidi Lempp is an Academic Medical Sociologist who set up the KCL MSK Expert Patient group suggests:

Do:

  • Inform patients/carers clearly in advance what you expect them to do.
  • Arrange an honorary/visiting contract with the Institution to raise patients/carers profile.
  • Discuss potential boundary issues, e.g. researchers/patients/carers.
  • Provide opportunities to meet clinic/research staff – facilitate acceptance and team building
  • Agree realistic deadlines for feedback – so plan ahead for major projects
  • Ensure patient/carer researchers know that contributions are appreciated
  • Recognise contributions and show appreciations through annual dinner or event.

Don’t:

  • Overwhelm patients/carers with work, start gradually with constructive positive feedback. Promise too much that you cannot deliver.
  • Exclude patients/carers from your activities, create ways to contribute.
  • Patronise patient/carer researchers – value their contributions.
  • Assume your colleagues will welcome these new roles – earn respect.

Further resources
Training courses for researchers: http://www.uclhospitals.brc.nihr.ac.uk/investigators/ppi-training

Training courses for PPIE members: http://www.guysandstthomasbrc.nihr.ac.uk/patients-public/for-patients-and-the-public/training-for-patients-and-members-of-the-public/
Generic guidance
https://www.hra.nhs.uk/planning-and-improving-research/best-practice/best-practice-in-public-involvement/top-tips-public-involvement-your-research-application/
• http://www.invo.org.uk/
• http://www.guysandstthomasbrc.nihr.ac.uk/researchers/patient-public-involvement-advice/ppi-toolkit/
• https://www.maudsleybrc.nihr.ac.uk/patients-public/support-for-researchers/
• https://www.rds-london.nihr.ac.uk/Patient-Public-Involvement.aspx (Including their Enabling Involvement Fund if applying for peer-reviewed funding e.g. NIHR grants)
https://www.rdslondon.nihr.ac.uk/RDSLondon/media/RDSContent/files/PDFs/Involving-Users-in-the-Research-Process.pdf

We hope you’ve enjoyed the latest issue of our healthily psyched blog. Please get in touch if you have any questions. In the meantime, we hope to leave you Healthily Psyched for part two of our PPIE post, which will be coming out soon. The post was written by Hema Chaplin and edited by Elaina Taylor.

Stage 2 in Health Psychology – The Professional Doctorate

So, you are interested in pursuing a career in psychology and have come across the field of Health Psychology. You do a Health Psychology MSc course accredited by the British Psychology Society (BPS), and then…?

In order to become a chartered Health Psychologist, you need to do ‘Stage 2’. However, to do this, there are multiple routes you can take:

  1. the doctorate (taught) route
  2. the independent route (via the BPS) and
  3. PhD + Stage two route (offered by a few universities).

From my own experience I found the choice between the independent route and the taught route to be quite a confusing one – there are lots of things to consider.

I am going to try and shed some light on the taught doctorate route, which is the route I decided on. I’ll provide examples and experiences (both my own and from others who have taken this route) by examining ‘Frequently Asked Questions’.

A little bit about what the Professional Doctorate in Health Psychology involves:

  • You enrol with a university for the duration of the programme.
  • You must undertake at least 2 years of supervised practice.
  • Usually, you need to organise your own health-related placement/job(s) which make up a full time equivalent (voluntary or paid, or a combination). Having said that, a few funded places which include a placement are being made available. Part-time is also an option.
  • During your time on the course you create your portfolio, documenting the work you undertake within five competencies: 1) Psychological Interventions, 2) Teaching, 3) Consultancy, 4) Research Methods and 5) Professional Skills (these competencies are the same as the independent route although the write up for each may differ slightly between courses).

You are required to regularly attend university, typically every two to four weeks, depending on your year of study. This is where you will cover the competencies and also be provided with supervision.

So now we know a bit of the background details, let’s find out more by hearing from students past and present…

Dr. Katrin Hulme – Health Psychologist & Post-doctoral Associate.

Anjulie Dhillon – Trainee Health Psychologist

Harpreet Sohal – Trainee Health Psychologist

Dr. Dan Masterson – Health Psychologist & Consultant for local authorities on urban planning designs.

 

Why did you decide to do Stage 2 via the taught route?

What really interested me about Health Psychology is the application of research and theory into real-world settings. I wanted the chance to get practical experience based in different settings, where I could work with patients, healthcare professionals and other stakeholders, so I didn’t think a PhD was for me. Another main reason I had for doing this route is the ‘Dr.’ title, which the independent route via the BPS does not give you. Although both allow you to practice as a Chartered Health Psychologist, I felt the Dr. title was an important addition. I also liked the idea of the university setting, giving me access to regular supervision and meeting course-mates in the same boat as me. (Katrin)

I decided to apply for the Professional Doctorate after seeing a post for a funded bursary for this role. I had always wanted to study further in this area and this was the perfect opportunity for me. I was exposed to many different aspects of Health Psychology in this role; I had the opportunity to work with patients, teach staff and deliver group interventions, which really helped me broaden and progress my skills. (Anjulie)

I decided to pursue the doctorate as I wanted to expand my knowledge and skills in the field of health psychology. Specifically, I believe this branch of psychology offers a holistic approach in the development and delivery of health care interventions, aimed at improving, preventing and managing health and well-being issues. (Harpreet)

At the time of undertaking my Masters in Health Psychology (stage 1), I was still exploring career options and had not yet made the decision to become a health psychologist. I was very fortunate to be taught by an excellent Health Psych team including Prof. Sarah Grogan and their passion, drive and teaching inspired me. During the Masters, the available routes were presented in detail but the key consideration for me was that I wanted to learn and work alongside an experienced team. (Dan)

 

What was your placement/job during the doctorate?

Over the course of the two and a half years, I worked at King’s College London on a few intervention development projects, as well as volunteering part-time at Milton Keynes Hospital in the Health Psychology department for a period of six months. (Katrin)

The job I had whilst on the doctorate was based at a local hospital. The role involved working as part of a clinical health psychology team with paediatric burns patients and their families. I also worked with adult diabetes and cardiac patients as well. (Anjulie)

I am currently working within a pain management service as an Advanced Wellness Practitioner. As part of my role, I deliver CBT-based techniques to support patients with developing self-management strategies for a better quality of life. I work within a wider team of physiotherapists, nurses and occupational therapists and we aim to deliver a biopsychosocial approach to pain management at both individual and group level. My role is largely focused on working with patients who are struggling to come to terms with the psycho-social impact of living with a chronic condition. (Harpreet)

As is the case for most early career researchers, I had a number of placements due to short-term contracts. These were predominantly research based at Staffordshire University with elements of consultancy. Prior to applying for the Professional Doctorate, I was conducting two behaviour change interventions with the emergency services as well as bits and pieces of other research. I acted as a research consultant for what was then a Primary Care Trust, a research associate on a project exploring the health benefits of natural environments, and then became a senior researcher in healthy urban planning. (Dan)

 

What is the best part of doing the doctorate?

I really enjoyed having a cohort (albeit a small one) to do the course with, particularly as we became firm friends. I also liked being ‘taught’ again; learning from experts in the field. Being able to discuss my work, get feedback on drafts and have designated hand-in dates, meant the course was structured and supportive. I think this made it easier to combine with working full time. (Katrin)

The best part of doing the doctorate is being able to apply the theory we learn as part of teaching to real world settings, and being able to do that through many projects, which are diverse and add to your skill set. (Anjulie)

The best parts of the doctorate for me were: i) the guided learning in a classroom environment (which I preferred over the independent route), ii) the collaboration between your university supervisors and workplace supervisors, iii) working with, and learning from, fellow colleagues on the course, which has been a wonderful experience. (Harpreet)

The best thing about the doctorate is that I came away with the confidence and ability to reflect on how to develop as a Health Psychologist, a researcher and a critical thinker. (Dan)

 

What have you found most challenging and what should potential stage two students bear in mind?  

Although do-able, it isn’t easy at times to combine the doctorate with working full time. The trick is to find opportunities to fulfil competencies through the things you are doing at work anyway. Good organisation is key – to do lists, keeping up to date with a diary, summary emails and file notes of meetings, making sure to take time for you too – I found all of these helpful. (Katrin)

I have found the time aspect most challenging. Projects have always taken longer than anticipated, especially working in the NHS. If you are thinking about applying for the course I would advise individuals to have ideas about how they can meet each competency and to also consider the time that it takes to complete the course, as it has taken me longer than I had anticipated! (Anjulie)

Something that is worth being mindful of, is that the course does require you to be an independent learner and good at self-motivating, although seeing your university supervisors regularly definitely helps! Also, managing your time between your work and the doctorate – in hindsight I would have either worked less hours, or gone part-time on the doctorate as it has been difficult at times to manage both. One other thing before committing to the course, would be to ensure that your workplace supervisor can both accommodate your needs to fulfil the competencies of the doctorate but also provide any necessary support. (Harpreet) 

Self-confidence. Imposter syndrome. That nagging self-doubt that I imagine many people feel, despite all their hard work, that they don’t belong, or that they have somehow duped the system and will be found out. My initial reflection skills were embarrassingly self-critical and developing those to be constructive and useful was challenging at first. I think that for people who do question whether they are ready to undertake the professional doctorate, or whether they are good enough, to bear in mind, that they might not feel they are at the beginning but that they will be ready at the end. Considering our professional limitations is an essential and required skill for a psychologist and at the end of the doctorate, you quickly realise that the development of a career in health psychology has only just begun. (Dan)

 

Did anything surprise you?

How much I enjoyed being taught again – the university days were great! I also realised just how important supervision and reflection is for personal development. (Katrin)

I knew Health Psychology was applicable to many areas of work but it has still surprised me to learn about its application in areas I hadn’t thought about previously. (Anjulie)

 

Any advice for budding health psychologists considering what route to take?

Take some time to think about the things you enjoy and are good at, and try to structure what you do around that. Then, even if it is difficult at times, you’re still doing things you enjoy. Also, think about what you might like to do in the future and consider the route and opportunities that might help you fulfil that best – i.e. if you would like to work clinically the doctorate route may be able to provide you with more applied experience than a PhD (independent route), for example. (Katrin)

I would look at the differences between the taught and independent route and think about how this fits in with your life/job role. I chose the taught route because I liked the idea of taught sessions plus independent learning. (Anjulie)

Having only experienced one route I could not advise on which route to take but I can offer thoughts on what to consider when making a decision. As either route will be challenging, it may be best to focus on your learning style and approach,  strengths and weaknesses, and consider a route that suits you. My weakness was putting my placement (work) demands ahead of my personal development, which slowed me down. By undertaking the taught route, there was a structure to guide me, focus upon and also to justify why I needed one day per week to work on my doctorate. Had I undertaken the independent route, I may have struggled with this issue as I rarely got that one day per week to study once the structured teaching sessions had ended. (Dan)

 

What questions did you have when looking at your options?

  • Do I have to live near the university? No – the important thing is you are able to travel to the university to attend study days.
  • How do you get on the course? Once you have decided you would like to pursue the doctorate route, you need to apply to the course at your chosen university(ies). The application process includes writing a personal statement, references and an interview. Details can be found on each university’s website.
  • When are the application deadlines? Again, these vary by university so we recommend you check the websites for exact dates.
  • So which universities offer the Doctorate route? The BPS website provides an overview of the accredited courses: https://www.bps.org.uk/public/become-psychologist/accredited-courses
  • How much does it cost? This depends on whether you are a UK or international student, and the university you choose. We recommend you check the websites for details but typically fees are around £6,000-£6,500 for full-time UK/EU students.
  • How often will I have deadlines? This varies from course to course, so we recommend you look at the websites and/or get in contact with the course leaders to find out about their specific course structure.
  • How long will it take me to complete the course? How quickly you complete the course depends on the individual and route taken. You will have to complete two years minimum of supervised practice. Then, taking writing up time, submission and doing your viva into account, it will take at least 2.5-3 years. It may take longer – depending on your opportunities to fulfil competencies and your circumstances, and whether you decided to do the course part-time or full-time.
  • Are there any exams? There are no written exams, although you will have to defend your portfolio in a viva voce examination at the end.

 

Now that we have heard from some students past and present, let’s answer some FAQs with Professor Karen Rodham – Director of the Health Psychology course at Staffordshire University and Past Chair of the BPS.

Typical questions about the course

  • What jobs are suitable placements?

Broadly, any setting where health psychology is practised would be appropriate (e.g. hospitals, primary healthcare, health promotion and academic settings) and where you would be able to get the opportunity to complete most of the competences (i.e. teaching, research, psychological interventions and professional competence). Placements can be paid or voluntary – the most important thing is that you get the right experience(s) through your placement

  •  I have a job already but it is a short-term contract job. What happens if I get a new job but it is not suitable for a placement?

Before you start the course, your placement, and any subsequent placement you take, needs to be formally approved. It is your responsibility to find a placement that is suitable for you to meet the competencies. If your new job is not appropriate, there would be a couple of options:

1) You arrange a voluntary placement (in addition to your job) that would meet the criteria.

2) You could ‘Intermit’ – see answer to the question below about taking a break from the course.

  • I am a bit worried because I am working in an academic setting. Can I complete the competencies based in this academic setting?

You are expected to arrange learning opportunities to ensure that you are able to attain the competencies required on the Professional Doctorate. It is rare for one placement to enable the completion of all the competences. It may be that you need to develop relationships with other organisations, perhaps on a voluntary basis in order to be able to complete some of the more practice-based competencies.  We are also sometimes able to help you find opportunities because people approach us asking for help with consultancy or teaching, for example.

  • Do you provide placements?

We do have contacts with placement providers who may be willing to provide voluntary positions, but we are not able to provide placements I’m afraid.  Candidates are required to find these themselves before they apply.

  • What happens if I need to pause the course during my studies?

Sometimes ‘life happens’ and students need to take time out from their studies. If this happens to you, you have the ability to ‘Intermit’. Intermitting means that students take a break from their studies because of illness, financial or personal reasons for example.  A student can intermit at any point during the academic year.  During the intermission period you remain as a student at the University and can continue using the University facilities such as the library, Students Union, Careers etc. but you cannot attend any classes or submit work.

  • What do you think are the positives of the taught doctorate route?

Students tell us that the main reason they choose to complete the taught doctorate route, rather than the independent route, is so that they have a cohort of other trainees, with whom they meet regularly on campus and in so doing, form a supportive community. We, like many other programmes, also encourage students to engage in a formal mentoring scheme to further facilitate this.

  • Final word: things to think about/do.

A key thing to do when thinking about Stage 2 is to look carefully at the course structure. Some courses require students to complete competences in a set order at a particular time. Other courses (like ours at Staffordshire University) have more flexibility built in so that students can take advantage of opportunities as and when they arise. The different approaches will suit different students. So think about your preferences when exploring the different courses.

Contact the course leaders by email if you have any questions – you will find that course leaders are very happy to answer queries. Sometimes it is possible to put potential applicants in touch with current trainees so that you can quiz them about their experiences.

If a course has an open day, do go along and see the facilities that you will have access to and get a sense of the feel of the place – you will be spending a big chunk of time at the university, so you need to know that it suits you.

 

To summarise the key differences for the Professional Doctorate route compared to the independent route are:

1) The doctorate is based at a university – you attend study days where you are taught/discuss/do group work on all of the competencies.

2) After completing the doctorate you are able to use the Dr. title.

3) Everything is included within the course structure – teaching, supervision, support services (if needed), handing work in (for each competency and then the final completed portfolio) and the viva examination.

4) You are part of a cohort of students – everyone has different placements and experiences which can create a really interesting and stimulating learning environment.

 

Thanks for reading our latest post. This post was written by Katrin Hulme and edited by Elaina Taylor. We hope you enjoyed this post and we will be back again on 1st September with our next post. Hoping to leave you Healthily Psyched until then!

 

 

 

 

 

A day in the life of a health psychologist: Academia and Industry

In our final blog post of this series, we look at the differences between working in industry and in academia. We talk to three different commercial organisations who work with health psychologists to explore the benefits and challenges of working outside academia. We hope this gives some insight into the different career paths available to health psychologists, and how you can take your academic skills and apply them elsewhere.

 

Atlantis Healthcare

Anna O’Sullivan 

Anna is a Clinical Health Psychologist (New Zealand registered), and Health Psychology Specialist at Atlantis Healthcare.

https://atlantishealthcare.com/en-us/

International company that designs, develops, and delivers support programmes for people with long-term conditions to improve health outcomes, quality of life, and patient self-management

 

What is it like to work in the industry compared to academia/NHS?

Working in the patient support industry I have learnt a lot from my non-health psychology colleagues who have a great deal of commercial and pharmaceutical experience. I work closely with account managers, digital and print designers, and digital operations colleagues, meaning that I have built new skills that I would not have had the chance to learn in academia or a clinical setting. For example, I worked with our Creative Director to ensure the content and functionality of digital wireframes for several online interventional modules were in line with recommendations obtained from patients during focus groups.

How do you use Health Psychology in your work?

Health Psychology underpins our patient support programmes, so we are constantly thinking with our ‘Health Psychology’ hats on. Our programmes are designed to change behaviour. The moment we begin a project we are thinking of the factors that might be driving the behaviour we want to change – for example, when addressing medication adherence we need to focus on particular issues relating specifically to that patient population, and we consequently design the programme around these drivers.

 

Spoonful of Sugar

Dr Tom Kenny 

Tom is the Medical Director and CEO of Spoonful of Sugar (SoS), a behaviour change consultancy that facilitates the translation of world-class research into practical programmes and solutions to achieve improved health outcomes.

http://sos-adherence.co.uk/

 

 

Can you tell me about the differences between industry and academia?

Working in a small company, I, personally, like it a lot better. You’ve got to be a lot more flexible and creative. The bureaucracies that govern working in a big organisation just don’t work in a small company. The spans of decision-making are much shorter, so you can make decisions and get things moving very quickly.

There was a small-scale piece of research that we wanted to do. Actually, under a research governance framework, it’s actually a piece of service evaluation. But somebody said, it’d be really useful to have this piece of research and to obtain this piece of insight into how patients are viewing the services they receive. It doesn’t exist in the current literature so how could we go about finding it out? And by the end of the day, we’d set it up. So, it’s just that the timescales for decision-making are shorter and we have to get resources ready and moving faster.

Every day we’re using psychological theory as it’s applied to health; evidence from the field, the theoretical underpinnings-It’s useful. It might not be the answer but it certainly helps. I try and encourage our clients always to start from what is known. Good reviews of literature can be fast and really add value.

 

Sprout Behaviour Change Ltd

Dr Christina Jackson and Dr Lina Eliasson 

Christina and Lina are joint founders and directors of Sprout Behaviour Change Ltd, a consulting business which works with organisations of all sizes to improve health by changing behaviour of people with long term conditions and healthcare professionals. Christina is also Programme Manager for King’s Health Partners’ Centre for Adherence Research and Education.

 http://sproutbehaviourchange.com/

 

Can you tell me a bit about what you do?

CJ: We work with pharmaceutical companies and with agencies like medical communications agencies and patient support agencies to develop strategies around adherence to medication, which might include developing patient support programmes and evaluating patient support programmes. We take theory and evidence from the health psychology world and we apply that to medicines adherence, often with a pharmaceutical company as the sponsor. We’re applying health psychology in the real world.

Do you think that gives you more of a chance to get things put into practice than in academia?

CJ: Absolutely. I think one of the things you might find sometimes in academia is once the grant money runs out, the project has to come to a close or you’re trying to put in a new application for more money. Whereas the programmes that we set up, once they’re running, they might run for a very long time with incremental changes to them over time. Those programmes might help people for years to come; potentially at a scale that you can’t achieve within academia. Lina and I have both worked on programmes that are rolled out internationally. You’re not just helping patients in the UK but all over Europe or in the USA. I’ve worked on one programme that was in Dubai. The scale of what you do, and the number of patients within in each country, can be much larger than you’d typically reach in academia.

One of the things that we are really passionate about in Sprout is to take all that published work and learning from academia where people have done really good RCTs and developed really good interventions, and apply that to the programmes that we create. For us, what is really exciting is to think about how we can continue that great work that has started in academia and then roll out into the real world.

Can you talk about the other differences between academia and where you are now?

LE: I think that one of the main differences is the pace. Within academia things tend to take a bit longer: the grant applications, the ethics approvals and accumulating the robust evidence base that you need to move ahead. Within industry, the pace is much faster and you often have the opportunity to move forward with a good idea based on a good rationale even if you do not have the breadth of published evidence that you need in an academic setting. I think that’s what makes it most exciting to work within industry. One of the benefits of this fast pace, for example, is that we can implement programmes using the latest technology. If a project is slow moving, a technology-based intervention may actually be obsolete by the time you implement it.

Are you still involved in publishing papers?

LE: In terms of publishing on the interventions, unless the intervention was done as part of a research study, it’s very rare. When there is a commercial sponsor, such as a pharmaceutical company, there are restrictions around what data you can and can’t capture and how that data is used. However, we continue to write and publish papers when we have been involved in a research study and, of course, simply out of interest as well.

CJ: This was something that took a little while to come to terms with when I moved from academia into industry. In academia you measure your value to some extent by the number of publications you have.  That’s a way of seeing that you’re making progress. Once you go into industry it is very frequently the case that you can’t publish what you’ve been working on, so you have to let go of that idea of measuring your value by publications. Take all the publication opportunities that come your way, but find a different way to measure how successful you think you’re being.

Is there a sales element? Do you go out and approach clients and engage them?

LE: Yes, definitely. In terms of finding new clients it would be a mix of reaching out to known and unknown contacts that we think might have some interest in the type of work we do. Clients, both new and returning, often reach out to us directly to request a proposal for a new project.

CJ: That’s another thing, before I went into industry, I thought of ‘sales’ as a dirty word. But actually, it’s something that I really enjoy and I think Lina enjoys it as well. It’s not like being a door-to-door hoover salesman. People genuinely have an issue that they are trying to tackle that they can’t work out how to solve. They need someone to help them work out the problem. What exactly is going on here? What can we do about it? The sales process is much more like having an interesting discussion, finding out what people’s issues are and helping them to solve their problems.

These interviews highlight some of the benefits of working in industry over academia, including a much faster pace, the ability to work at a larger scale and the increased likelihood of projects being rolled out to client groups. Working in companies like these might also give you the opportunity to work within much more varied teams. However, there may be stricter regulations working with some companies such as pharmaceutical firms and you may have to take more responsibility outside of your comfort zone. Most importantly, people working in industry still rely on research conducted in academia in order to develop theoretically and empirically-sound interventions.

We hope you have enjoyed this series on careers in health psychology and that it has left you excited about starting you career, or continuing your journey as a health psychologist. This series of posts were written by Zoë Moon and Federica Picariello. Hoping to leave you Healthily Psyched until next time.

Continuing with our series of showcasing different career paths for health psychologists, in this next post, our contributors share their career journey and provide career advice. Although there are certain prerequisites for a career in Health Psychology, as discussed in an earlier blog post, the necessary Health Psychology competencies are broad and flexible, so no two journeys are the same. We thought it would be interesting to hear about the journeys of Health Psychologists working in different settings or those working in this field and their helpful advice for people starting out in their careers.

 

Dr Nicky Thomas (NHS)

Nicky Thomas is Head of Psychological Services and a Consultant Health Psychologist at Guy’s and St Thomas’ NHS Foundation Trust. Nicky works in the Department of Haematology and set up the first health psychology service for sickle cell patients. 

  •  What was your previous experience / training before starting this job?

I trained and practiced as a nurse (RGN & DIPn) before psychology. I have a PhD in health psychology, an Advanced Diploma in psychodynamic counselling and an Advanced Diploma in CBT in children & adolescents.  I also undertook a BSc in psychology before my PhD.

  • What advice would you give someone starting out in their career?

The NHS Health setting offers good opportunities for health psychologists. Where one door closes try another one! Always use an evaluative framework, use appropriate outcomes. Let your work speak for you- that’s why outcome matters!

 

Ellen Jardine (NHS)

Ellen is a Health Psychologist/Applied Psychologist in Health Improvement (NHS) in the Public Health Department in NHS Dumfries and Galloway. 

  •  What was your previous experience / training before starting this job?

I completed an undergraduate degree in Psychology and Spanish. I then spent a couple of years working for a children’s hospice in the fundraising department. There I became a volunteer on the care team to spend more time with the children and their families. Through training I learnt lots of new skills such as counselling skills, supporting people through bereavement, talking to people with communication difficulties and discussing death and dying. It was after this, I made the decision to do a Master’s degree in Health Psychology which took me to London. From there, I got onto the NHS Education for Scotland Stage 2 training programme.

  • What advice would you give someone starting out in their career?

I think flexibility is key. There are opportunities everywhere in the NHS so keep your eyes peeled and don’t turn opportunities down just because you think it’s not for a health psychologist. Be welcoming, approachable, and listen to what people need as you might be able to fill the gap.

And if you’re able to volunteer – it’s a great way to gain new experiences, learn skills and meet interesting people.

 

Anna O’Sullivan (Atlantis Healthcare – industry)

Anna is a Clinical Health Psychologist (New Zealand registered), and Health Psychology Specialist at Atlantis Healthcare.

https://atlantishealthcare.com/en-us/

International company that designs, develops, and delivers support programmes for people with long-term conditions to improve health outcomes, quality of life, and patient self-management.

  • What was your previous experience / training before starting this job?

Before working in the commercial world, I attended the University of Auckland (NZ) and completed a Bachelor of Science majoring in Psychology, followed by a Master of Science in Health Psychology. I also completed a 2-year clinical training programme involving full-time work as an intern psychologist in a multidisciplinary chronic pain clinic. After I passed my exams I worked part-time as a Registered Health Psychologist of New Zealand and part-time in the commercial world.

  • What advice would you give someone starting out in their career?

 My advice would be to try everything you get the opportunity to try as a student – whether that’s commercial work or academic work or clinical work. That way when you come to making decisions you might have a clearer idea of what you would enjoy most, where your strengths are, and which industry would benefit most from having you.

 

Holly Martin-Smith (NHS)

Holly is a Health Psychologist working in the Department of Clinical Health Psychology at Salford Royal NHS Foundation Trust.

  •  What was your previous experience / training before starting this job?

I first completed a BSc at Liverpool John Moores in Psychology and Biology. I then went on to study an MSc in Health Psychology at University College London. During these courses I worked as a receptionist at a busy GP surgery, gaining an appreciation of a medical workplace. Through this I became a Smoking Cessation Specialist running a clinic to support patients to stop smoking, gaining skills in behaviour change interventions and communication. I also volunteered at a Breast Cancer Support group, supporting women who had been diagnosed with Breast Cancer where I was also able to conduct some research for my undergraduate degree. During my MSc I had a placement at an IAPT service in North London, where I supported the community liaison and service user involvement projects, observed clinical practice across both low and high intensity therapies and assisted with research activities seeking to improve services.

After my MSc I became a Trainee Health Psychologist with NHS Grampian where I completed my stage 2 qualification.

With NHS Grampian my main role was to deliver psychological interventions based on cognitive behavioural therapy (CBT), mindfulness-based stress reduction, motivational interviewing and acceptance and commitment therapy (ACT), to people with Types 1 and 2 diabetes. During my training my main piece of doctoral level research was a consultancy project for a consultant in Public health. This involved developing a questionnaire and using advanced statistical analyses to investigate the knowledge, attitudes and associated behaviours of university students, regarding STI testing.  Teaching and training involved delivering workshops to students and healthcare professionals on a variety of relevant psychology topics. I also had the opportunity to gain some experience of providing health psychology input to a number of projects in the Health Improvement department of Public Health; Leading and managing 2-day helping people change for health training course; Developing, delivering and evaluating overweight/obese pregnancy intervention to promote healthy lifestyles and emotional well-being; Supporting sexual health campaigns and conducting a review of training provision by the health promotion department.

  • What advice would you give someone starting out in their career?

It is a very exciting time for Health Psychology, as it is becoming more recognised and valued however at times it feels like a struggle and a bit of a mine field. It is completely normal not to feel very sure about how to get from doing an undergraduate degree to being a qualified health psychologist but don’t be put off, it’s such a worthwhile career and in time things fit into place. Try and get relevant experience, try and connect with health psychologists out there both academically and in practice. There is a huge health psychology presence on social media- use this to your advantage, badger people and don’t be afraid to ask questions.

 

Hope Clayton (NHS)

Hope is a Health Psychologist working in the Renal Service at East and North Hertfordshire NHS Foundation Trust.

  •  What was your previous experience/ training before starting this job?

Prior to attending university, I worked as a care assistant (CA) in a care home for older adults for one year. I continued working as a CA and support worker for people with learning disabilities part time throughout my undergraduate degree at Cardiff University and post graduate degree in Health Psychology at King’s College London. I did a few voluntary placements throughout university including cooking at a homeless shelter and being a befriender for people with mental health problems. During my MSc in Health Psychology I did a placement which involved helping to facilitate a mindfulness based cognitive therapy programme for people with MS.

Following my MSc, I was lucky enough to be offered a place on the NHS Scotland ‘Health Psychologists in Training’ programme where I was paid to work and train in a health board for two years! This took me up to Aberdeen where I mainly worked in respiratory medicine and cancer screening. After qualifying I was offered a full-time job working in diabetes, respiratory medicine and public health but I always wanted to move back near London and after a few months I accepted my current post in renal medicine.

  • What advice would you give someone starting out in their career?

The most helpful advice that was given to me by my first ever supervisor (a consultant health psychologist) was that most health psychologists feel as though they don’t have a clue about what they’re doing for the first 5 years of their career so accept the anxiety and carry on!

 

 

Dr Christina Jackson and Dr Lina Eliasson (Bridging Academia and Industry)

Christina and Lina are joint founders and directors of Sprout Behaviour Change Ltd, a consulting business which works with organisations of all sizes to improve health by changing behaviour of people with long term conditions and healthcare professionals. Christina is also Programme Manager for King’s Health Partners’ Centre for Adherence Research and Education.

 http://sproutbehaviourchange.com/

  • What was your previous experience/ training before starting this job?

LE: Christina and I have quite a similar career progression. We did our PhDs in adherence at the same time at UCL School of Pharmacy. After, I worked in academia at Imperial College London and then we started around the same time at one of the agencies that design patient support programmes. The last two and a half years, just before Christina and I started Sprout (a behaviour change consultancy), I worked for a big clinical research organisation leading their European patient reported outcomes group where the focus of my work was around measures of patient experiences. It was then that Christina and I started to talk about opportunities within the space we really love working in, which was treatment adherence, and whether we could do something together.

  • What advice would you give someone starting out in their career?

LE: What helped me to get the right experience for working in industry was being open to all opportunities coming my way. For example, if you’re doing your PhD on a particular topic of interest to pharma, they might be open to you coming in to do a presentation. You can find these small opportunities of working with industry. I also think attending conferences that are related to the area you want to work in, meeting people and building relationships throughout your studies is invaluable.

CJ: One of the things that can hold people back is that you get to the end of your PhD and you don’t feel like you’re an expert. You still don’t feel like you know very much. But actually, outside academia, if you think about the fact that you’ve spent three or four years studying this subject, you are an expert. Sometimes coming out of academia, people can undervalue their expertise but actually they know about a billion times more than most people who might work in that field. Don’t sell yourself short. There are more opportunities in industry than there used to be. Companies are starting to advertise in the same places that you’d see academic jobs so they will come up from time to time. My other tip for people is to identify businesses where you think your skills might be useful and reach out to them about having an informal chat about opportunities. It’s just networking. Even if they don’t have anything at their company they might know someone who does. It’s a good way of finding out what’s going on.

  • And do you have any tips on finding organisations like yours?

LE: Companies like ours may be referred to as ‘behaviour change consultancies’, ‘patient support agencies’ ‘adherence agencies’, there isn’t one specific label. There are also health communication and health technology agencies that do similar work to us. Some of those agencies work with us if they do not have expertise or capacity in-house to come up with strategies to effectively change behaviour. Something which adds complexity to our field is that agencies develop their own behavioural models and jargon. Some people might talk about adherence, others about activation and others still about engagement.

CJ: I’ve found Linkedin to be a really helpful way of finding people. Once you start linking with people you can see who they are linked to and get a feel for what companies are out there, look them up and see what they do.

LE: I personally have always been very happy when people contact me on Linkedin and very happy to speak with people and advise people. As mentioned, do not be scared of networking. You might have some people who don’t reply or say no, but there will be ten times as many people who are really happy to give advice and link up.

 

Dr Katrin Hulme (King’s College London – academia)

Katrin is a Health Psychologist working in the Health Psychology Section at King’s College London.

  •  What was your previous experience / training before starting this job?

My interest in Health Psychology arose towards the end of my undergraduate degree in Natural Sciences (Psychology, Biology and Anthropology) at Durham University, so I enrolled on the MSc at Northumbria University and completed that part-time, alongside playing basketball for the county, and a part-time position as an Assistant Psychologist in the respiratory department at a local hospital. I then worked at King’s on fatigue-related projects and have been here on and off since. I have also worked in a hospital health psychology department, as well as doing some consultancy work at a university. To qualify as a Health Psychologist, I chose to do the Professional Doctorate in Health Psychology at Staffordshire University and did this alongside these projects.

I also chose to do a few extra courses/workshops outside of this (for example, CBT, Motivational Interviewing and self-compassion), to gain confidence for more clinically-based work and learn about different, yet compatible, approaches. I think it’s important to consider a variety of techniques for managing health and health behaviour, as it allows you to tailor the approach to the needs of the people you’re working with.

  • What advice would you give someone starting out in their career?

Do not be afraid to try and make opportunities for yourself. Definitely take opportunities if they are presented to you, but if you have something in mind you would like to try, don’t be afraid to do your research and then approach people and ask – at worst all they can say is no!

 

Dr Tom Kenny (Spoonful of Sugar -industry)

Tom is the Medical Director and CEO of Spoonful of Sugar (SoS), a behaviour change consultancy that facilitates the translation of world-class research into practical programmes and solutions to achieve improved health outcomes.

http://sos-adherence.co.uk/

  • What advice would you give someone starting out in their career?

I’m always looking for good people. And what I mean by good people is people who have common sense and are prepared to use it, who are willing to turn their hand to whatever needs doing. But, above all, people who will support and help their colleagues. I want people to come clean on what skills they have and what they enjoy doing -that’s really important. There are plenty of people who have skills out there but they don’t actually enjoy using them and that’s no good. One of the really important bits of the culture that I wanted to create is, actually, that we’re doing work that is meaningful, inherently interesting and having fun doing it. And I don’t mean Wolf of Wall Street kind of fun. I mean, inherently enjoying the work that you are doing. So, people knowing what their skills are and then having joy in using those – that’s the critical thing.

Have something, a topic area that you are particularly interested in and then you can talk about it and explain what’s exciting about that area. I’ve taken quite a few new graduates, but I’ve taken people who have come interested in an area because if somebody is interested in an area, they’re often interested in other areas.

 

These stories further highlight how different experiences are valued when it comes to building a career in Health Psychology, but what really matters is discovering what it is you are passionate about. It is important to not be afraid of asking questions and understanding that it is natural to  feel lost at times, or get imposter syndrome. As mentioned by health psychologists here, connect with people and build your network during conferences or by attending seminars and through social media – these connections can turn into future collaborations or job opportunities. We think the main take home here is to not undersell yourself, and to reach out and make connections with people.

Continuing with our series of showcasing different career paths for health psychologists, this next post will outline some of the most challenging and the most rewarding aspects of working as a health psychologist or in this field. Hopefully this will give you some food for thought as to which career path might be best for you.

 

Hope Clayton (NHS)

Hope is a Health Psychologist working in the Renal Service at East and North Hertfordshire NHS Foundation Trust.

  

What is the most enjoyable or rewarding part of your job?

It has got to be working with the patients. As a health psychologist I am often seeing people at one of the most difficult times of their lives. Working with people in such distress cannot really be described as enjoyable but it is certainly meaningful and definitely worthwhile. The best part of my job is working with so many different people, both patients and staff. I have so much respect for the hard work and compassion that our team demonstrate on a daily basis and genuinely enjoy their company.

What are the most challenging parts of your job?

Being relatively newly qualified I sometimes feel out of my depth when I am working with a patient who presents with an issue I haven’t come across before. However, I think I manage to appear swanlike, e.g. looking calm and collected on the outside but paddling like mad underneath! I am lucky to have an experienced, patient and approachable team of counsellors and social workers as well as my supervisor (a health psychologist) around me to provide advice and support. They are also great in helping lessen the ‘imposter syndrome’ that I regularly experience by reminding me that I can do it!

 

Holly Martin-Smith (NHS)

Holly is a Health Psychologist working in the Department of Clinical Health Psychology at Salford Royal NHS Foundation Trust.

 

What is the most memorable or rewarding part of your job?

The most rewarding part of my job is being able to support people who are struggling in some way and to help them to live the kind of life they would like to. I feel privileged that I am able to spend time with clients, learn about what is going on for them and work with them to teach skills and strategies to help them manage better. Sometimes I can reflect on the huge difference therapy makes for clients, and other times it may just be something small, but in most cases I feel that working together with them has made some difference for the better.

Other rewarding parts of the job are working in a team and the variety of the role. Working in a team provides support and opportunities for reflection, whilst we work towards a common goal. The variety of the role keeps things interesting. A typical day merely describes the format and structure but the fact that you are working with so many different clients across a broad range of health conditions, means that you are constantly learning and developing skills to try and provide the best support for them.

What are the most challenging parts of your job?

Some of the most challenging aspects of the job are time pressures and keeping up with admin. In addition to this, working within an emotionally distressed patient group requires a lot of resilience, self-compassion and reflection. Wondering whether you are doing the right thing, questioning your own abilities and feeling unconfident are also challenges.

 

Anna O’Sullivan (Atlantis Healthcare – industry)

Anna is a Clinical Health Psychologist (New Zealand registered), and Health Psychology Specialist at Atlantis Healthcare.

https://atlantishealthcare.com/en-us/

International company that designs, develops, and delivers support programmes for people with long-term conditions to improve health outcomes, quality of life, and patient self-management

 

What is the most memorable or rewarding part of your job?

In my work as a clinical Health Psychologist I supported individuals on a one-to-one basis, which was very rewarding. While I do not have regular contact with patients (aside from when conducting research) in my current role, I know that the support programmes we develop make a difference to the lives of many adults and young people living with chronic conditions around the world. The feedback we get from patients and healthcare professionals about the value of our support programmes is rewarding and motivating for myself, and all my colleagues.

What are the most challenging parts of your job?

The most challenging aspects of my job include time management and sticking to budgeted hours. Working for a commercial company means you must think more about how many hours you are spending on certain projects. It may be that you only have 10 hours to write some content, as that is what was agreed with the client. It takes some getting used to after having the luxury of time on university projects, but it means you work more efficiently!

 

Dr Tom Kenny (Spoonful of Sugar -industry)

Tom is the Medical Director and CEO of Spoonful of Sugar (SoS), a behaviour change consultancy that facilitates the translation of world-class research into practical programmes and solutions to achieve improved health outcomes.

http://sos-adherence.co.uk/

 

What is the most memorable or rewarding part of your job?

I think when people see the impact of the work that we’ve done; the research we’ve done to gather insight and particularly, when you identify something that’s surprising or nobody’s spotted or articulated, and then seeing that being used. In academia, research takes a longer time to have an impact in comparison to the industry. It’s really satisfying to see people seeing the impact of their work – very tangible.

What are the most challenging parts of your job?

In a small company, there are always challenges. The biggest challenge that we have is finding good people who can work in the uncertainty of a small company. And not being able to say, ‘this is what my exact job is’, and ‘this is all I need to do’ because in a small company, everyone has to muck in and do bits of all sorts of things. Much like my day, you’ve got a rough outline of the kind of work that’s going, but things come up that need to be dealt with rapidly. Unless people are responsive and deal with those things, the company very quickly ceases to exist.

 

 Ellen Jardine (NHS)

Ellen is a Health Psychologist/Applied Psychologist in Health Improvement (NHS) in the Public Health Department in NHS Dumfries and Galloway. 

 

 What is the most memorable or rewarding part of your job?

The teams that I work with make my job rewarding. I’ve met many people who have welcomed me into their teams, taught me about their own areas of work and shown interest in health psychology. These experiences have really helped me to build an understanding of what ‘Applied Psychology’ means in an NHS setting and what it has the potential to contribute.

What are the most challenging parts of your job?

Promoting Health Psychology is the best and most challenging part of the job!

 

Dr Christina Jackson and Dr Lina Eliasson (Bridging Academia and Industry)

Christina and Lina are joint founders and directors of Sprout Behaviour Change Ltd, a consulting business which works with organisations of all sizes to improve health by changing behaviour of people with long term conditions and healthcare professionals. Christina is also Programme Manager for King’s Health Partners’ Centre for Adherence Research and Education.

 http://sproutbehaviourchange.com/

 

What is the most memorable or rewarding part of your job?

LE: It’s definitely when a support programme is launched. In particular when you start getting feedback from users about whether the programme is helpful, or they like it, or they support it.

CJ: And I think that feedback from people is really important. I had some feedback recently on a protocol I developed for nurses who are going to visit people in their homes.  I included some behaviour change techniques that they could use and getting feedback from nurses saying “I use that technique every time I see somebody” is really nice. Bringing that kind of insight to healthcare professionals who are actually on the ground working with people is what I enjoy. One of the things that I’ve really enjoyed over the years is working in multi-disciplinary teams, and this is a bit different from academia as well. For example, when you’re working on materials for patients, working with a creative team, they take your psychology speak and turn it into something that sounds like a consumer magazine. It looks beautiful and it’s really easy to read. I think working in teams like that, you come up with stuff which is so much better than you could do when you’re working on your own, which I’ve really enjoyed.

What are the most challenging parts of your job?

CJ: Regulation! The pharmaceutical industry is highly regulated. For example, when you’re working on materials for patients and for healthcare professionals, everything you do has to be compliant with regulations. What that means in practice is that all of the materials that you produce, every question you suggest in a questionnaire, gets very heavily scrutinised by the pharmaceutical company and it has to all be sanctioned.

LE: Another challenge is that the regulatory compliance space is a grey area. It can be hard to know exactly what you can and can’t do and it comes down to the pharmaceutical company’s compliance team to make a recommendation, which has to be followed. We have worked on projects where we have come up a beautiful design that we think will really work. Then the medical-legal team or pharmacovigilance team review the design and decide that you need to cut this and that out, and you can end up with such a watered down programme that it essentially becomes ineffective. It’s really refreshing when you work with companies who want to be at the edge of the game, pushing the boundaries to go into that grey area and make something which is really great for the end users.

CJ: Over time, managing the regulatory compliance aspect is something that you get more skilled at dealing with. For example, we both know from painful previous experience, that you need to involve the people who are going to approve it (the medical and pharmacovigilance teams) in the project in the very early stages. That means that if they see something that they think is a bit dodgy, they can flag it up before you have included it in a beautifully designed programme. Also, I think you get a much better at understanding how you can adapt what you say or how you do things to have the same effect. With experience, you also get better at working with those departments; to negotiate that if we can’t have the intervention that way, how about we have it this way? It can be a source of frustration but you do get better at navigating it over time.

 

Dr Katrin Hulme (King’s College London – academia)

Katrin is a Health Psychologist working in the Health Psychology Section at King’s College London.

 

 What is the most memorable or rewarding part of your job?

 I like the variety of the work and being part of an applied project that is working towards creating something that can be integrated into healthcare. I especially enjoy talking to patients to involve them in the process, which is hugely valuable in terms of making an accessible and helpful product.

Something I find particularly rewarding is the ‘lightbulb moment’ when I’m working with clients (both individuals and groups) towards managing health or changing behaviour – that moment where something clicks into place, or they understand something relative to their experiences which helps them progress. Throughout my training I learnt the value of Socratic questioning and, whilst a difficult skill to master, I’m realising more and more how powerful it can be.

What are the most challenging parts of your job?

I think most challenges often boil down to tight deadlines and keeping all parts of a project ticking along simultaneously. Making sure that all the bits that need to can come together at the different milestones can sometimes be difficult. That’s why I find writing lists so helpful, to break down the bigger picture into what’s happening day-to-day, and keep track of things – essentially trying to practice what I preach!

Across the different career types, the rewarding aspects of working as a health psychologist seem to all focus on patient benefit, and supporting patients through difficult times, as well as working in multidisciplinary teams and the shared expertise and skills this can bring. The challenges seem to differ between working in the NHS and industry – navigating legal issues and budgets in industry and treating patients with complex issues in the NHS. Unsurprisingly, time constraints appear to be a challenge across industries.

Stay tuned for our next post in this series providing useful career advice for setting out as a health psychologist.  

A day in the life of a health psychologist

Health psychology is a relatively young branch of psychology and as such, it often seems as if there is no clear career path for people to follow. To help reduce some of this uncertainty, this blog post series will showcase the careers of six different health psychologists over the next eight weeks.

HCPC registration is necessary to work as a health psychologist in the UK, which can be attained after obtaining relevant qualifications (health psychology stage 1 and stage 2 training). Health psychologists may work in a wide range of areas, including adjustment to chronic illness, public health, smoking cessation, adherence to medication, communication of risk information, pain management, healthcare professionals’ behaviour and communication. There is rarely one defined role or career path. Therefore we thought it would be particularly interesting and relevant for those just embarking on their journey to becoming health psychologists, to ask established health psychologists, working in different settings, what their typical day looks like and what their role and responsibilities are.

 Our first post will introduce you to a few of the health psychologists we will be talking to and tell you a bit about their day to day lives and what they are responsible for.  We hope this will give you a good flavour for the different roles health psychologists can fulfill.

Stay tuned to read about career advice, previous experience, memorable / challenging parts of the job and finally to read about the differences between industry and academia.

Dr Nicky Thomas (NHS)

Nicky Thomas is Head of Psychological Services and a Consultant Health Psychologist at Guy’s and St Thomas’ NHS Foundation Trust. Nicky works in the Department of Haematology and set up the first health psychology service for sickle cell patients. 

 Describe a typical day

My days are varied but usually includes; Therapies, department meetings, business planning meetings, talking to service managers about the role clinical health psychology, and our vision,  attending meetings about the Trust’s integrating mind & body strategy and making every contact count. I also undertake clinical and management supervision meetings with psychologists and other members of MDT and see a few complex patients.

What are you responsible for?

I am professionally responsible for the Trust psychological services and their delivery, its governance and overall risk management of patients who present to a Trust psychologist.

Ellen Jardine (NHS)

Ellen is a Health Psychologist/Applied Psychologist in Health Improvement (NHS) in the Public Health Department in NHS Dumfries and Galloway. 

Describe a typical day

Work tends to be on the busy side but it didn’t used to be. When I started in Public Health, Health Psychology was a relatively new role so it took time to establish areas of work. I’ve now worked here for three and a half years and currently I’m working on two projects. The first project is focussed on supporting staff to deliver behaviour change interventions in the local community; the second is around improving staff health and wellbeing and reducing sickness absence.

A typical day might involve the following:

  • Creating plans – setting priorities according to project deadlines (I do this most mornings)
  • Consultation – at the start of a project and often throughout, I consult with members of staff to understand a ‘problem’ area and any needs they might have (such as training)
  • Research – most recently I’ve conducted a review to examine the different factors that affect staff health and wellbeing in the workplace
  • Training – I am currently developing training that will support teams in delivering 1:1 interventions aimed at encouraging healthy behaviours
  • Building relationships – I work with Public Health Specialists and Consultants, Health Improvement Officers, Clinical Psychologists, staff in Human Resources and Data Analysts… Building strong professional relationships can make or break a piece of work
  • Reports and presentations – I spend quite a bit of time creating reports and presentations to summarise progress and findings from projects. This tends to be for different audiences so sometimes it might be for a management team or for the team involved in the project
  • Walking and standing at my desk – I try my best to go for a walk on my lunch break and use my standing desk (which I admit I don’t always have the motivation for…)

What are you responsible for?

With regard to consultation, I am responsible for providing psychological input based on evidence. For example, advising a manager on the competence requirements of staff for a specific health improvement intervention.

I might be responsible for creating a project plan in accordance with specific deadlines. This means I’m responsible for progressing work, identifying and overcoming any obstacles and largely working on my own initiative.

Anna O’Sullivan (Industry)

Anna is a Clinical Health Psychologist (New Zealand registered), and Health Psychology Specialist at Atlantis Healthcare (https://atlantishealthcare.com/en-us),  an international company that designs, develops, and delivers support programmes for people with long-term conditions to improve health outcomes, quality of life, and patient self-management

Describe a typical day

A typical day will involve team meetings – think psychologists, account managers, graphic designers, project managers, and developers – as well as reading and responding to emails (inevitable in a job like mine!), and planning for, writing, or reviewing content for the patient support programmes we design. Just recently I spent some days writing 200+ SMS that will be delivered to adolescents on a particular treatment.

What are you responsible for?

 Myself and other ‘Health Psychology Specialists’ in my team are responsible for much of the patient aspects of the design and development of support programmes. If we are involved with the project early on, then we may see it through from the pitch stage (where we try to win the business of our clients), to the literature review/patient research phases, to the development of the patient journey and algorithms, through to the writing and reviewing of content that is designed to change the behaviour of patients or caregivers (or doctors!). We must make sure that the support programme is designed in a way, and has the right content, to change behaviour. This means making sure our work is theory and evidence-based.

Holly Martin-Smith (NHS)

Holly is a Health Psychologist working in the Department of Clinical Health Psychology at Salford Royal NHS Foundation Trust.

Describe a typical day

I arrive at 8am and spend at least half an hour doing some admin i.e. checking and replying to emails, arranging appointments for any new referrals, organising my electronic diary and checking my clinic matches up with the electronic patient appointments system.

I will then spend an hour or so preparing for my clinics (am and pm) that day. For any new assessments this involves looking on their patient electronic record so I can gather information of the person’s current and past health. Typically I see 3 clients back to back in the morning and 2 in the afternoon.

I am given 1 hour per client although I tend to try and stick to 50mins to allow some time in between sessions to complete necessary admin i.e. typing up notes, processing the outcomes of each appointment, jotting down ideas for formulations or session plans etc.

After each appointment we are required to enter notes onto the electronic patient record. Thus I usually spend an hour after each clinic entering the necessary information onto the databases. For initial assessments these tend to be more detailed whereas therapy sessions are brief and often the content can be captured by scanned worksheets/photos of the white board to illustrate what has been covered and the agreed homework.

I will also write up any initial assessment reports that then get sent back to the referrer with the client and GP and any other appropriate health professionals copied in. These reports summarise the assessment, with a formulation and treatment plan.

Other tasks may include speaking to health professionals for advice re a client, attending team meetings or weekly supervision/monthly peer supervision.

What are you responsible for?

As part of a team I am responsible for providing psychological support to those that get referred into the general medicine psychology service with a physical health condition. I am also responsible for deciding collaboratively with clients’ whether their needs would best be met by a different service and referring/signposting on if appropriate.

If a client decides to engage with therapy I will usually offer 8-12 sessions with regular reviews dependent upon progress and the clients own reflections.

As part of the team I am also responsible for collecting outcome data in order to help audit and evaluate the general medicine psychology service. This service recently obtained funds to extend and employ 3 full time posts to provide psychological support to those struggling with a health condition, aimed at improving links with departments in the hospital, to reach as many people as possible. As such I am also responsible for meeting with consultants and other health professionals to explore and streamline new referral pathways or stepped care models within their discipline.

Hope Clayton (NHS)

Hope is a Health Psychologist working in the Renal Service at East and North Hertfordshire NHS Foundation Trust.

Describe a typical day

Firstly, I check my emails and get a cup of tea! I usually spend some time responding to emails and check my schedule for the day. Typically I will have 3 to 4 outpatients booked in although this is dependent on where I am that day. I may also see patients on the dialysis unit and when I am at the hospital I will also tend to see a couple of inpatients on the ward. Most of my clinical work is done face-to-face but I may also conduct telephone consultations if a patient cannot get to the hospital/dialysis unit.

What are you responsible for?

The patients I see present with a range of emotional and psychological difficulties related to their renal condition including: struggling with the uncertainty of how their health condition will progress or what treatment they will require; feeling low in mood because they aren’t able to manage activities that they used to; being phobic of needles; difficulty adjusting to a change in lifestyle and identity as a result of having a transplant. There are many reasons why someone might see me and there is not enough room to cover them all here! I use a range of psychological approaches in my work including CBT, ACT, mindfulness and motivational interviewing. I am also involved in assessing live donors and transplant recipients to determine whether they are suitable candidates.

Often, and with the patient’s permission, a lot of my day will be spent liaising with the other health professionals in our team (including consultants, doctors, nurses, dieticians and social workers) about how to best work together to support a patient.

Other tasks include: keeping up with admin; developing and delivering training for staff (at the moment I am training all staff who work in dialysis units about what to do if a patient presents with an ‘acute psychological episode’); service development (I am currently doing a literature search about which interventions are effective in reducing psychological distress in transplant patients); attending training and CPD events.

Katrin Hulme (Academia)

Katrin is a Health Psychologist working in the Health Psychology Section at King’s College London.

 Describe a typical day

In terms of what I do, it can really vary. At the moment I am working on an online intervention development project so day-to-day tasks centre around creating the content for that and working with programmers to plan its design and online hosting. Within this there will be lots of smaller things to do, e.g. talking to patients to get their feedback, supervising a placement student, and reading through healthcare guidelines and policies.

Previously, I have also worked clinically part-time in chronic pain and on a trial with people with IBD and fatigue. On these days what I did revolved around patient contact; planning for the sessions, talking to patients, supervision, writing up notes etc. I find this experience also really helps when designing the online intervention now as I try to incorporate the different elements of care into the programme, despite it being online.

During the day, I try to make sure I take a lunch break and chat to colleagues or go for a walk – I’ve learnt I am a lot more productive in the afternoon if I have some time away from my desk! If I haven’t managed to get something done, or I know I need to do something tomorrow, that will go on my list for the following day.

What are you responsible for?

At the moment my main responsibility (in collaboration with my colleagues on the project) is the creation of the online intervention and its components. As part of this, I am also responsible for the PPI (patient and public involvement) aspect of the project, keeping track of the budget, and liaising with the website programming company.

We learnt from these brief interviews that Health Psychologists work in teams, that their work is driven by patients and research, and that admin work is unavoidable, regardless of the setting! The amount and type of patient contact will differ according to the setting, as working in an  applied setting inevitably requires more time spent working therapeutically with patients. These insights provide a more concrete depiction of what it is like to work as a Health Psychologist in different settings, particularly, for those who are unsure as to which setting to pursue. Stay tuned to hear more from our health psychologists!

The do’s and don’ts of running a trial

Alice Sibelli and I (Sula Windgassen) both worked on a large randomised controlled trial (RCT) for irritable bowel syndrome (IBS) part time, whilst completing our PhDs part time. The RCT had three arms (1) therapist telephone cognitive behavioural therapy (CBT) with a paper manual (2) website based CBT intervention with some telephone support from a therapist (3) treatment as usual. In total 567 participants were recruited across South London and Hampshire.

Along the way we picked up some key skills in trial management. We have picked out some key tips for the various aspects of running a trial. While we were lucky in that we had a trial team to refer to for decision making and to rely on for some aspects of the work, you will always find that there is scope to delegate and resources to be called upon. This is true if you are doing a PhD project and it is a crucial skill to gather as many resources (human and otherwise) possible to allow you to do a more efficient job.

Gathering resources

Alice and I were fortunate to have each other to split tasks with, as well as another research assistant for part of the trial. This was essential to manage all of the tasks and responsibilities of such a large multi-sited trial. Even with this support, at times we recognised that our pooled resources were not adequate in the time constraints that we had to complete particular tasks. We could raise this with the trial team and consult the budget to see if there were temporary research assistants that could be appointed to a specific task in order to ensure we would meet the deadline. Outside of a well-funded RCT this may not be possible, but the key was recognising inadequate resources. This did not mean inadequacy of us! It just meant something had to be done. In another context such as a full time PhD with no trial team, other solutions for increasing human resources may involve identifying a Masters student in the same department that may be able to help as part of their own thesis or placement project, or just for some extra experience. It would be better if the student has a vested interest in the completion of the task/s they have been allocated however, as when things get busy, if your project is non-essential it is likely to be dropped! Many PhD students in our department made use of Masters and undergraduate students in arrangements that benefited both parties. Other avenues to explore to for gathering human resources for help with your project are:

  • Availability of research nurses if you are recruiting in clinics
  • Collaborators and volunteers who may open doors. If you are working with different organisations such as charities, the more networking within the organisation and face to face meetings you can have the better. Often you’ll find that other collaborators have great ideas and solutions for limited resources
  • PhD peers who may help with proof reading, problem solving, stats issues and much more (especially emotional support)
  • Grants and funding that may be available for supplying additional resources such as a temporary RA (especially if you are working on a postdoc project). King’s College London circulate an ‘awards and prizes’ email with details of the latest opportunities

Trial Management

You could argue that every aspect of work in a trial is ‘trial management’ but we use this heading to refer to the overarching organisational aspects involved in a trial:

  • Write and publish a Study Protocol – no one can accuse you of ‘fishing’ if you did what you set out to do and that is clearly evidenced in a published protocol
  • Allocate enough time to apply for the appropriate Ethics and Sponsorship approvals as these processes can (and do) take longer than expected. You can always make minor amendments if needed along the way
  • Spreadsheets are not just for data! These can be invaluable for tracking a variety of trial processes including recruitment activities, data collection activities, work delegations and much more. Get familiar with excel filter function, freeze panes and pivot tables!
  • Have regular meetings with key team members (even if that’s just you and your supervisor/s) with a clear agenda and minutes. These are invaluable for decision making processes and also logging decision rationales later on down the line when writing up for publication

Recruitment

The recruitment phase can be really rewarding and really demoralising! One thing to keep in mind is that usual recruitment does snowball (if you are doing all you can to get the momentum up) so do not be disheartened by a slow start! That is not to say however that you should rest easy – pour as much time and effort as you can in to it and try and think of it from the participant point of view. If you received one invitation with a bit of info and an email address to contact, would you be really motivated to get in touch? What else could you add to this invitation to make someone more likely to get in touch? A freepost envelope with an easy to complete slip may help. A rationale of why they have been invited may provide some clarity. A clear attention grabbing explanation of why they may be interested will go a long way…

  • If you are relying on other recruitment sites to get participants for you, it is crucial that you make it as easy as possible for them to do so. This may involve:
    • Setting up a recruitment site file for them to keep with all the necessary paper work, processes, site agreements, posters and leaflets, invitations, etc.
    • Desk reminders can help for busy GPs or clinicians seeing patients. Posters in waiting rooms with slips that can be torn can also increase recruitment opportunities.
    • Liaising with as many of the individuals from the site who are likely to be involved with recruitment as possible and keeping in touch. The head GP may be the one who signs the paper work and has agreed to meet, but likelihood is that the practice manager will do most of the running around to get invitations sent out, databases searches done, etc., etc. Make an effort to get to know them and fill them in.
    • Keep in touch – don’t assume that your site is self-sufficient and motivated, however helpful they have been when you initially met. Sites get busy with competing tasks and even other studies. Give your contacts a call at reasonable intervals, drop emails with recruitment figure progress, let them know of challenges other practices are having and see if they are having similar issues. Offer to problem solve and congratulate when they do well!
  • Motivate potential participants to participate in your study without overselling it
    • It is important to explain the study in clear lay terms. Many individuals will not understand what randomisation is or how it works. People may be disappointed if they are allocated to the control condition when they have been hoping to enter the experimental condition (especially if they have been coping with a long-term condition)
    • Explain that participants can withdraw at any point but also be truthful about the extent of commitment that you would ideally like from participants including the extent of measures and questionnaires that will be expected.

Follow-ups

Reaching and maintaining good follow-up rates requires not only dedication and patience, but also the ability to appropriately interact with participants through different communication modes (e.g. telephone, text, email, letter by post). Here is where an excel spreadsheet becomes your best friend again as you can log communication attempts, notes about interactions, filter participants by the date they need to be followed up or were last followed up, etc. Here are some extra tips we have picked up to help with following up participants

  • As much as possible establish a good rapport with participants early on. It may seem obvious but make sure you appreciate that they are taking time out of their lives to partake in your research and that this is a valued effort
  • Ask participants at the beginning of the study their preferred way of communication
  • Write short hand notes about past correspondence to help your memory about particular circumstances of the participant or progress with questionnaires
  • Use as many modes of communication as you can for reminders
  • Try and make the follow up process the least onerous as possible (online questionnaires are much easier than coming in or spending time over the phone, yet some participants prefer paper questionnaires they can return in the post)
  • Start reminding them before the deadline, that they will have to fill something out. Standardise reminders and the timing of them afterwards, to save you time. However, a personal note goes a long way!

 

Data management

The management of electronic data files can be challenging. It is important to be aware of the ethical issues inherent to online trials, such as data protection, confidentiality, anonymity of information, and online consent, where and how to save the data, regular back-ups, amongst others. Familiarise yourself with the data policies of your university and also of particular governing bodies you are bound by/or working in conjunction with.

  • Minimise the number of databases is key when collecting data through both online and paper questionnaires!
  • Allocate budget for an independent member to conduct data checks on a percentage of the data manually entered
  • Create an ‘interaction log’ at the outset which details the format of each item of data you will be collecting. For example if items are dichotomous, categorical on a scale of 0-5, continuous, free-text, etc. This will help with data entry and checks.
  • Be mindful of how many people have access to the central data file and have the ability to make changes. If you are using students and a variety of research assistants, things can easily be changed with no tracking and it is very hard to identify what and when got changed correctly or incorrectly.
  • Log changes made to the database once all the data has been collected. This will prevent/identify systematic errors in the data

Key skills

At the top of our list are two things! Interpersonal skills and organisational skill. It is crucial to be able to accept different points of view and reach agreements within heterogeneous teams of professionals (different types of health professionals, statisticians, web programmers and developers). Part of this will involve asking a lot of questions to ensure clarity. A good team, asks a lot of questions from each other. An even better team answers patiently and respectfully! Celebrate successes even if they seem comparatively small to the overall aim. Trials are often long with many different milestones. They can be stressful and all-encompassing, so it is important to mark the little victories. Even if it is just with one colleague who can appreciate its significance!

Even the most organised people can feel flustered by the sheer amount of different things that they need to keep track of when working on a trial. This is normal and doesn’t mean you’re not being organised! The trick is setting up organisational processes (such as tracking spreadsheets, document templates, filing structures) that may be quite time consuming in the beginning but save a lot of time and hassle in the long run. Delegate some of these tasks where possible and make sure you are not the sole gate-keeper. This means that if you suddenly disappeared (fingers crossed you won’t!) other people in your team would able to decipher where everything is up to and how to access different trial resources and information. This is really important in preparation for annual leave, new team members joining, delegation in the event that you have to turn your attentions to a different aspect of the trial and much more.

Other important skills are:

  • Time management – keeping on top of those deadlines and keeping other deadlines in mind is crucial!
  • Communication – keep everyone on the same page with clarity
  • Resilience – things hardly ever go exactly to plan! Don’t despair, problem solve, learn, work with others and move forward
  • Flexibility – as in the point above, you need to be able to adapt to changing priorities, challenges and also additional resources. Make use of new resources as much as possible – don’t let them pass by. Adapt plans to allow the capitalisation on particular opportunities. For example if there is going to be an event that would be great to recruit at, but you had planned to dedicate the week to writing the protocol that was due for submission soon, it would make more sense to readjust the timeline and make the most of the event for recruitment opportunities.

Managing a trial is very complex with a lot of different variables at play. We hope we have broken some of the key skills and considerations down. Here we have not talked about aspects involved in intervention development as this is a blog in its own right! We will be pooling our resources to bring you a post on this in the coming months.

You’ve got this!

Alice & Sula 🙂

Embarking on a global PhD: conducting research in Zimbabwe

When I applied to an advert for a studentship for HIV-related work in Zimbabwe and was successful, I was incredibly excited. I knew the next step on my career path was completing a PhD. The focus of the PhD was to develop a new measure assessing barriers of adherence to Antiretroviral Therapy (ART; combining antiretroviral drugs to slow the progression of HIV and suppress the HIV virus) for adults living with HIV in Zimbabwe. I was working as a research assistant examining HIV in South Africa (although I was based in London) so it was a perfect fit. At the time, the advert mentioned travelling and spending time in Zimbabwe, but strangely I did not think in depth about that part. I was just happy to be moving on in my career. After it had sunk in, I realised that this was going to be more of challenge than I had expected. Undergoing a PhD is a daunting task, but this included living in a country I had never been to before, for an indefinite amount of time. I realised this would not only challenge me academically, but also personally.

I lived in Harare, Zimbabwe’s capital, for around six months. Prior to embarking on my PhD, I knew very little about the country. There were definitely moments when I wished I had chosen to complete a PhD locally, particularly when applying for ethical approval. However, I am really happy I took on this challenge. It has given me experiences I may never get a chance to encounter again- the chance to live and research for months in another country.

The first major hurdle of recruiting participants abroad, was achieving ethical approval. I was going to administer a survey to approximately 300 participants in an HIV clinic in Harare. The ethics process in the UK was very simple and only required approval from King’s College London. In Zimbabwe, I had to obtain approval from the HIV clinic, then the Hospital the clinic was attached to, then the main ethics board in Zimbabwe, and then another ethical board because I am a foreign researcher. To achieve the last one, I also had to be accepted as an affiliate of an establishment in the country (in this case the University of Zimbabwe). Each one had to be completed in order and I had to receive the ethical approval from King’s prior to starting the process in Zimbabwe. I was not allowed to enter the country until I received the final approval. To make matters more interesting, everything is paper-based. I had to complete the forms and then send it to someone in Zimbabwe to prepare everything and submit. It was an incredibly frustrating process, but I am extremely grateful for everyone who helped me. It was during this time that an issue occurred with the ethical process in which I thought I would never get a chance to complete my PhD. It was a roller-coaster ride and I had to try and think of multiple plan B’s. It was the lowest point of my PhD; however, everything did work out and the feeling of relief was unbelievable.

Due to the delays, I ended up re-scheduling flights to Harare for data collection four more times. Eventually I flew to Harare, two days after receiving the final approval. I was a bundle of nerves. Prior to this flight I had completed a small trip to Harare the year before (early on in my PhD) to meet potential collaborators, look around the clinic and explore places I could stay while I was there. I was so happy I did, because it helped me to find out where I was going, what I needed to take with me, and the visa required for me to stay when I eventually moved over.

Zimbabwe was (and still is) having a cash crisis. Previously, I had tried to send money to the country via bank transfer and it had been cancelled. King’s was sending money to the University of Zimbabwe for my research; however, by the time I flew I did not know if the money had gone through, so I had to carry bundles of cash (US dollars) just in case. Luckily the transfer did go through so I could use that money on my research; however, it was not easy to take money out from any bank so I could only request small amounts at a time.

A conference destination with a view!

Living in Harare for months was a fantastic experience. I really loved the people and the culture. Everyone was so warm and friendly. I would definitely recommend Zimbabwe as a holiday destination. There was a language barrier, but many people speak English so it was not as difficult as expected. I had a wonderful research assistant who was fluent in English and Shona (the main indigenous language) who helped me while recruiting participants. Even though there were power cuts I was still able to contact home regularly via Skype. There were some interesting experiences I had while I was there- one of which was crossing the road! I could walk to the HIV clinic from where I was staying; however, I had to cross two main roads getting there. There were no pedestrian crossings so I had to wait each day to ensure I crossed with groups of locals. The locals seemed to have no problem, but I felt much safer crossing the road in numbers!

I would definitely recommend embarking on a global PhD or postdoc; however, it’s important to plan prior to starting. I would suggest to:

1) Find out as early as possible about the process of ethical approval;

2) Know the process for visa applications. This could take much longer than expected;

3) Take a short trip out, prior to moving over, to get a good idea of the country, i.e. cost of living and the best places to stay;

4) Start building up your network. Contact other researchers and find out about conferences in that area. I was lucky enough to travel to a local conference near Victoria Falls to present my work. It was such a fabulous trip and completely unexpected. Knowing the surrounding area as well as your local area is important too– Harare does not require malaria tablets, but Victoria Falls does (which I only remembered at the very last minute!).

View of Victoria Falls

Overall, I feel more confident in my abilities to cope with stressful and difficult situations. I imagine no PhD runs smoothly, but this definitely had its ups and downs. It was an adventure and it was so worthwhile.

This blog post was written by Natasha Croome who recently completed a PhD at King’s College London (KCL), Centre for Global Mental Health, supervised by Dr Lyndsay Hughes (Health Psychology Section, KCL). You can find out more about Natasha’s research here. The post was edited by Elaina Taylor. Hoping to leave you healthily psyched until next time!

Glossophobia – there is a term for the fear of public speaking, but is there a solution?

Heart racing, cotton mouth, sweaty palms, shaky legs, a million thoughts in my mind: “I will forget what I need to say”, “I will look like a fool”, “Everyone will see how nervous I am”…That’s me every time, before I give a talk. This experience is familiar to many, particularly if you are an early career researcher and just starting to present your work at conferences: it can be quite an intimidating experience at first. The annoying thing with this kind of anxiety is that unfortunately it can have an impact on how the talk is delivered. I had a couple of occasions when my anxiety took over and I lost my train of thought or felt that my voice was shaking, and it’s a downward spiral from there, as these events only feed the anxiety.

The traditional remedy, “imagine everyone in the audience is in their underwear”, has never worked for me. Instead this is what helps me:

  1. Regular exercise is great, but even more so for anxiety. I always try to fit in a cardio work out either the night before or the morning of my talk. It may be a placebo effect, but I feel much calmer and positive after exercising. Aerobic exercise causes the release of endorphins that resemble drugs like morphine, giving us a euphoric high. This translates into better mood and if you are feeling good this will counterbalance the anxiety and lead to a more relaxed presentation.
  2. Impactful and engaging slides are a must. The worst is when you are presenting and see someone yawning in the audience and straight away the negative thoughts take over (“I must be boring etc. etc. etc.”). Although nice slides do not mean that no one will ever yawn, they ensure that the audience stays interested. What I mean by ‘nice’ slides is something visually appealing that has an effect on the audience and not countless bullet points on a white background slide. Following a training session on presentation skills which I attended, I now use a lot of impactful images and keywords, which helps me to avoid reading from my slides. An easy and quick way to find many images is to search Google Images and in the “Tools” tab filter them by “Usage Rights” (even if an image is labelled as free to use, make sure to cite it).
  3. Practice, but do not over-practice. I am still trying to find the balance between not practicing enough and over-practicing. It is important to know your slides and what you are planning to say, particularly in a 10-15 minute presentation, but having a speech and knowing it by heart can make your delivery very robotic. Also, when you have a memorised speech, any little mistake can throw you off course and you also have more time during the talk to overly focus on yourself, rather than concentrating on getting your message across. The talks that I have given, that I felt went well, were the ones I practiced least, but had still done background preparation for.
  4. Re-appraise the anxiety in positive terms. Most people experience a little bit of anxiety before giving a talk, regardless of how senior they are, so it is highly unlikely that with a lot of exposure one day you will never be anxious of giving a talk. But why would you want to anyway? It is important to reduce high levels of anxiety, but I find that a little bit of anxiety is necessary as it makes you look excited to give the talk. So think of anxiety as excitement.
  5. Visualisation is great. Repeatedly imagine giving the talk and how well it goes. This technique helps me to stay calm and focused and boosts my confidence. By repeatedly visualising giving the talk, similar pathways get activated in your brain as if you were giving the talk, so your brain gets used to the process.

Unfortunately, there is no magic cure for public speaking anxiety and having given quite a few talks over the past 3 years, I still get very anxious before each talk. However, using these tips I learnt to better manage my nerves, and recently, I actually caught myself enjoying giving a talk!

As conference-season draws ever closer, it’s important to find out which techniques work best for you and to use any upcoming talks to practice these techniques. This article was written by Federica Picariello and edited by Elaina Taylor. Hoping to leave you healthily psyched and looking forward to the upcoming health psychology conferences.

This year, pay attention to your resolutions: The importance of automatic thoughts

Haunted by Pino Grigio

I decided to go t-total in January. As a person who enjoys a glass of vino regularly, I knew this was going to be a challenge. Now, one week into 2018, I feel like I am being haunted by Pino Grigio. Everywhere I look my attention seems to be grabbed by some tempting alcoholic beverage. I seem to have developed an attentional bias for wine!

I am not overly concerned as I know we all preferentially attend to information that is temporarily salient or personally meaningful. However, whilst this rather flippant example of attentional bias is doing me no real harm (other than testing my resolve), in certain situations attentional biases can and do become problematic.

Cognitive biases, anxiety and depression

A cognitive bias is the tendency to notice, interpret, or remember only certain aspects of the environment. For example, when speaking in a group, someone who is particularly socially anxious may overly attend to negative facial expressions (e.g., anger and disgust) rather than neutral expressions. They may also be more likely to interpret a negative facial expression as indicating a disapproval or dislike of them, rather than the context of their conversation. This habit of selectively attending (attention bias) and interpreting (interpretation bias) creates a vicious cycle in which an ambiguous world is experienced as threatening.

Several decades of research in clinical psychology has identified that these types of cognitive biases play a central role in the onset and maintenance of anxiety and depression. Clinical psychologists have led research in this field, developing computerized experimental methods to tap into how people implicitly process salient, emotive and threatening information. Researchers are now refining procedures to modify these cognitive biases –called cognitive bias modification (CBM) (MacLeod & Mathews, 2012).

CBM aims to modify the attention or interpretation bias, by repeatedly training attention towards more positive or benign information. CBM can test the causal relationship between cognitive biases and symptoms by experimentally manipulating the bias and measuring any associated change in symptoms.

Though CBM techniques are in their relative infancy, they have shown some promise as a clinical tool (Hakamata, et al., 2010) and as an adjunct to conventional forms of psychological interventions (Williams, et al., 2013).

Cognitive biases and health behaviours

Traditional health psychology models have largely focused on the role of reflective, intentioned action and beliefs (Sheeran et al., 2013), such as weighing up the pros and cons of my dry January. Attention (excuse the pun) is also now being paid to more habitual or automatic drivers of behaviour, such as my increased perception of alcohol cues.

For example, attentional biases towards food has been identified in eating disorders (Shafran, Lee, Cooper, Palmer, & Fairburn, 2007), for cigarettes in smokers (Ehrman, et al. 2002), and for, you guessed it, alcohol in alcohol use (Townshend & Duka, 2001).

Building upon this basic science research, a growing number of studies have employed CBM techniques to attempt to shift these cognitive biases. In addiction, there is some evidence that CBM may be effective as an ‘add-on’ to traditional, behavioural interventions. For example, a study of a CBM with people with alcohol addiction, called alcohol-avoidance training, found that trained alcoholic patients showed less relapse at one-year follow-up than control patients (Wiers et al., 2011). A further study replicated this result, and found that a shift in the attentional bias mediated this effect (Wiers et al., 2013).

Cognitive biases and symptom experience

Experimental research has also begun to explore the role cognitive biases may play in how people experience physical symptoms, such as pain. Research has shown that if a person is expecting pain or they are particularly fearful and catastrophic about the experience of pain, they have a lower threshold of perception for pain. Thus, vague, commonplace pains may more readily capture attention and may be interpreted as indicating damage or disease (Keogh, Ellery, Hunt, & Hannent, 2001; Keogh, Thompson, & Hannent, 2003).

These types of illness-specific cognitive biases have been identified in chronic pain (Crombez, Van Ryckeghem, Eccleston, & Van Damme, 2013; Schoth & Liossi, 2016), chronic fatigue syndrome (Hughes, Hirsch, Chalder, & Moss-Morris, 2016) and irritable bowel syndrome (Afzal, Potokar, Probert, & Munafò, 2006; Chapman & Martin, 2011; Tkalcic, Domijan, Pletikosic, Setic, & Hauser, 2014).

CBM work in this area is just beginning. Several CBM studies in chronic pain suggest that training people to direct attention away from pain-related information (i.e. reducing an attentional bias) is associated with reduced anxiety and pain related fear (Carleton, Richter, & Asmundson, 2011; Schoth, Georgallis, & Liossi, 2013; Sharpe, et al., 2012). However, as yet, mediation has not been established in these studies.

Experimental health psychology

The potential for experimental research to contribute to health psychology is substantial.  CBM research can help establish if cognitive biases drive certain health behaviours or help maintain symptoms and distress in certain conditions. Our interventions may be optimized by targeting these implicit cognitive processes. For example, reducing attentional biases to food cues may in turn reduce impulsivity and thereby help regulate impulsive eating. There may also be a role for implicit processing in coping. For example, if survivors of breast cancer have persistent attentional bias for cancer related information and tend to interpret ambiguous information as cancer related, they may consequently experience increased anxiety and fear of recurrence.

Experimental research within health psychology is small but growing. However, in order for this research to be fruitful, experimental methods must be tailored and adapted appropriately for the population being studied. *For a guide to developing illness-specific materials for experimental research see Hughes, A. M., Gordon, R., Chalder, T., Hirsch, C. R., & Moss‐Morris, R. (2016). Maximizing potential impact of experimental research into cognitive processes in health psychology: A systematic approach to material development. British Journal of Health Psychology21(4), 764-780.

I hope this article encourages you to consider the role implicit processes may play in your area of research and to explore how you might conduct experimental research to assess these hypotheses. This post was written by Alicia Hughes and edited by Jowinn Chew. Thanks for reading our post. Hoping to leave you healthily psyched for more until our next edition in February.

 

References

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Carleton, R. N., Richter, A. A., & Asmundson, G. J. (2011). Attention modification in persons with fibromyalgia: A double blind, randomized clinical trial. Cognitive behaviour therapy, 40, 279-290.

Chapman, S., & Martin, M. (2011). Attention to pain words in irritable bowel syndrome: increased orienting and speeded engagement. British journal of health psychology16(1), 47-60.

Crombez, G., Van Ryckeghem, D. M., Eccleston, C., & Van Damme, S. (2013). Attentional bias to pain-related information: a meta-analysis. Pain154(4), 497-510.

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Hughes, A., Chalder, T., Hirsch, C., & Moss-Morris, R. (2016). Illness specific cognitive biases in chronic fatigue syndrome independent of mood and attentional control deficits. European Health Psychologist18(S), 696.

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Williams, A. D., Blackwell, S. E., Mackenzie, A., Holmes, E. A., & Andrews, G. (2013). Combining imagination and reason in the treatment of depression: A randomized controlled trial of internet-based cognitive-bias modification and internet-CBT for depression. Journal of consulting and clinical psychology, 81, 793.

Wiers, R. W., Eberl, C., Rinck, M., Becker, E. S., & Lindenmeyer, J. (2011). Retraining automatic action tendencies changes alcoholic patients’ approach bias for alcohol and improves treatment outcome. Psychological science22(4), 490-497.

Wiers, R. W., Gladwin, T. E., & Rinck, M. (2013). Should we train alcohol-dependent patients to avoid alcohol?. Frontiers in psychiatry4.

 

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