Healthily Psyched at Guy's

King's College London Health Psychology blog

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.



Afzal, M., Potokar, J. P., Probert, C. S., & Munafò, M. R. (2006). Selective processing of gastrointestinal symptom-related stimuli in irritable bowel syndrome. Psychosomatic medicine68(5), 758-761.

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.

Ehrman, R. N., Robbins, S. J., Bromwell, M. A., Lankford, M. E., Monterosso, J. R., & O’Brien, C. P. (2002). Comparing attentional bias to smoking cues in current smokers, former smokers, and non-smokers using a dot-probe task. Drug and alcohol dependence67(2), 185-191.

Hakamata, Y., Lissek, S., Bar-Haim, Y., Britton, J. C., Fox, N. A., Leibenluft, E., Ernst, M., & Pine, D. S. (2010). Attention bias modification treatment: a meta-analysis toward the establishment of novel treatment for anxiety. Biological Psychiatry, 68, 982-990.

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.

Keogh, E., Ellery, D., Hunt, C., & Hannent, I. (2001). Selective attentional bias for pain-related stimuli amongst pain fearful individuals. Pain91(1), 91-100.

Keogh, E., Thompson, T., & Hannent, I. (2003). Selective attentional bias, conscious awareness and the fear of pain. Pain104(1), 85-91.

MacLeod, C., & Mathews, A. (2012). Cognitive bias modification approaches to anxiety. Annual Review of Clinical Psychology, 8, 189-217.

Shafran, R., Lee, M., Cooper, Z., Palmer, R. L., & Fairburn, C. G. (2007). Attentional bias in eating disorders. International Journal of Eating Disorders40(4), 369-380.

Sharpe, L., Ianiello, M., Dear, B. F., Perry, K. N., Refshauge, K., & Nicholas, M. K. (2012). Is there a potential role for attention bias modification in pain patients? Results of 2 randomised, controlled trials. Pain153(3), 722-731.

Sheeran, P., Gollwitzer, P. M., & Bargh, J. A. (2013). Nonconscious processes and health. Health Psychology, 32, 460.

Schoth, Daniel E., and Christina Liossi. “Biased interpretation of ambiguous information in patients with chronic pain: A systematic review and meta-analysis of current studies.” Health Psychology 35.9 (2016): 944.

Townshend, J., & Duka, T. (2001). Attentional bias associated with alcohol cues: differences between heavy and occasional social drinkers. Psychopharmacology157(1), 67-74.

Tkalcic, M., Domijan, D., Pletikosic, S., Setic, M., & Hauser, G. (2014). Attentional biases in irritable bowel syndrome patients. Clinics and research in hepatology and gastroenterology38(5), 621-628.

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.


Christmas Special from Healthily Psyched

The Ig Nobel Prizes were developed in 1991 to reward improbable research, specifically research that makes people laugh and then makes them think. The awards focus on research that is unusual, imaginative and that helps satisfy people’s curiosity. As it is nearly Christmas, we thought we would use this Healthily Psyched blog post to share some of the most interesting (and vaguely Health Psychology related) Ig Nobel Prize winners:

Are night owls more likely to be psychopaths?

Night owls, or people who habitually stay up late, are on average, more psychopathic, more manipulative and more narcissistic than early birds, according to a study which won the Psychology Prize in 2014. Researchers surveyed 263 students on a series of personality traits and found those who habitually stayed up late were more likely to score higher on the Dark Triad (narcissism, psychopathy and Machiavellianism). The authors postulate that this is due to Dark Triad traits being adaptive for darkness, solitude and night time living. However, night owls need not worry too much about becoming a psychopath, as the correlations between personality traits and chronicity were all small (r=.13-.20)

How can anyone not like cheese?

christmas 1

In 2017, the Ig Nobel Prize for Medicine was awarded to Jean-Pierre Royet and colleagues for their paper entitled ‘The Neural Bases of Disgust for Cheese: An fMRI Study’. This study involved 15 people who liked cheese and 15 people who did not like cheese being exposed to both images and odours of cheese. fMRI results showed that certain parts of the brain (basal ganglia structures) were more activated in those who disliked cheese than in participants who liked to eat cheese. Whilst these results show clear differences in brain activation between cheese lovers and cheese haters, it fails to explain how anyone could not like cheese.

Ugly art and lasers

Some people may find that attending art galleries for hours on end is a painful experience, however they may change their minds after reading the following study. In 2014, the Art Prize was awarded to a study investigating the relative pain people suffered while looking at paintings rated ugly, neutral and pretty, while being shot by a powerful laser beam. Paintings viewed as beautiful produced lower pain scores in comparison to neutral and ugly paintings. This led the authors to suggest that pain can be modulated at the cortical level by the aesthetic content of distracting stimuli. In other words, beauty and ugliness exert a different effect on pain. We look forward to seeing the fascinating interventions which may stem from this study for chronic pain conditions, but it gives a whole new meaning to the quote, ‘art is pain’.

Is it mentally hazardous to own a cat?

christmas 2

The 2014 Public Health Prize was awarded to a series of studies investigating whether it was mentally hazardous for human beings to own a cat, mostly due to the existence of the parasite Toxoplasma gondi which is transmitted from cats to humans. This parasite can change the behaviour of rats so that instead of fearing the smell of cat urine, they become attracted to it, thus making them more likely to be eaten by a cat and further spreading toxoplasmosis. This research compared people with and without toxoplasmosis on a series of mental health and personality related factors. Results showed that people who were toxoplasma-positive had lower guilt proneness and were less impulsive and less disorderly. Similar studies have drawn links between toxoplasmosis and suicide, depression and schizophrenia. Whilst this may signal bad news for some cat-owning members of the Healthy Psyched blog team, the NHS says we shouldn’t be too concerned about findings like these, and other large rigorous studies have shown no links between cat ownership and mental health problems.

Beauty is in the eye of the beer-holder

christmas 3

The results of this next study are useful to keep in mind at any forthcoming Christmas parties. In 2013, the Psychology Prize was awarded to Laurent Bègue and colleagues from the University of Grenoble. The study was conducted within a naturalistic setting (a bar-room) in which ‘customers’ were breathalysed to measure blood alcohol level, and rated how attractive, bright, original and funny they believed they were. Results suggested that the higher their blood alcohol level, the more attractive participants rated themselves as. In a further study, they found that participants need not have consumed any alcohol at all, but that the mere belief that one has consumed alcohol increases self-perceived attractiveness, thereby supporting dual-process alcohol models suggesting alcohol stimuli operate on implicit expectancies. Unfortunately, the first part of this study was correlational so it is not certain whether more attractive people drink more. Nor did it test whether intoxicated participants were in fact, more attractive.

How to take a good group photo

christmas 4Successful shot of the Healthily Psyched blog team.

In 2006, the Mathematics Prize was awarded to Nic Svenson and CSIRO scientist Dr Piers Barne, for determining how many photos you need to take in order to find one where no one is blinking. After determining that blinks are completely random and independent of each other, Nic and Piers calculated the average number of blinks per minute (10), the average length of a blink (250 milliseconds), and the camera shutter length (8 milliseconds). It was then possible to model how many shots you would need to be almost certain of getting a good photo. Results gave a useful rule of thumb for photographing less than 20 people: divide the number of people by three in good light, or two in bad light.

Other interesting Ig Nobel Prize winners:

  • Medicine Prize (2015): For discovering that some allergic reactions may be reduced following intense kissing or sexual intercourse.
  • Medicine Prize (2011): For investigating how decision making changes when people have a strong urge to urinate.
  •   Veterinary Medicine Prize (2009): For showing that cows who are nameless give less milk than cows who have names.
  • Economics Prize (2008): For the discovery that lap dancers earn higher tips when they are ovulating.
  • Aviation Prize (2007): For the strange discovery that Viagra aids jetlag recovery in hamsters.

This post was written by Zoë Moon and Elaina Taylor. If you have any further interesting health psychology related studies you’d like to share, we’d love to hear from you. In the meantime, thanks for reading our post and we hope to leave you healthily psyched until next year.









From MSc to PhD: question and answer session with Healthily Psyched PhD students

Pippa and Louise blog photoPippa and Louise graduated from the Health Psychology MSc in 2016 and are currently enrolled as PhD students in faculties at King’s College London. Louise is based at the Faculty of Nursing, Midwifery and Palliative Care researching chronic pain in inflammatory bowel disease. Pippa is based at the Institute of Psychiatry, Psychology and Neuroscience (IoPPN) investigating infant feeding practices among women who deliver large-for-gestational-age (LGA) infants. Together, we have teamed up to answer some of the frequently asked questions about making the jump from MSc to PhD, how we got here, and offer some friendly (and hopefully, helpful) advice for anyone interested in or about to make the transition.

1. Did you always know you wanted to do a PhD?
Definitely not! During my undergraduate degree (BSc Psychology) my academic supervisor strongly recommended I apply to do a PhD and I just remember thinking “that’s definitely not me”. She must have seen something I couldn’t see at the time, because fast-forward three years and somehow it is me.

I started coming round to the idea of doing a PhD during the MSc – the course offered the opportunity to tailor quite a few of the assignments to fields of research we were interested in, and I had started to explore pregnancy health and breastfeeding. The more I read about the topic, the more interested I became and I found myself wanting to know more. For as long as I can remember I have been fascinated with pregnancy health, but I never considered the idea that I could have a career based on exploring it.

Completing a PhD is not essential to becoming a fully qualified Health Psychologist (more on ‘Routes into Health Psychology’ later), but it provides the opportunity to carry out in-depth, original research into a topic or specialty subject that you find particularly interesting. The MSc allowed me to find a research area I was really interested in and one that I knew I wanted to pursue further, but I didn’t feel like I had enough research experience to start a PhD straightaway. When I graduated I began looking for Research Assistant (RA) posts on projects related to breastfeeding and pregnancy health and was lucky enough to be offered an RA job on a project investigating ways to empower healthcare professionals to provide tailored breastfeeding support. Throughout my role I was able to develop my research skills in the area and simultaneously conceptualise the idea for my PhD to put forward for funding.

Louise: Not at all. Throughout my undergraduate and master’s degree I was really interested in the subject areas but knew in the long term I wanted have a clinical role, working face-to-face with people and amongst a team. During the MSc I took up a number of both paid and volunteering opportunities to gain experience and expand my skillset and network of contacts. These opportunities included being a student representative for the course and a couple of research assistant (RA) positions. The RA positions in particular allowed me to work closely with PhD students and gain a real insight into the day to day life of doing a PhD. It was then that I began to realise some of real advantages and interesting challenges of a PhD. Particularly in a Health Psychology-related subject, a PhD seemed to involve obviously extensive research and project management but also collaborative work with patients and healthcare staff, as well as other academics in decision-making. Although you focus on a specific subject area for a PhD, I realised that throughout the 3 years you take on a variety of tasks, from recruiting and interviewing patients, applying for ethics, going to conferences (sometimes abroad!) and writing up and critiquing papers. I also knew that even though I wanted to end up long-term in a clinical role, a PhD is a great opportunity to challenge yourself and widen your skillset for whatever career you go on to do thereafter.

2. How did you go about trying to find a PhD?
Pippa:  There are a number of options available for finding a PhD project to suit you and your circumstances (Funded vs. Unfunded (Self-funded) / Part-time vs. Full-time / Established project vs. Self-constructed project) and lots of different ways of sourcing such opportunities. When I had settled on the idea that I wanted to complete a PhD in pregnancy-related health and breastfeeding, I initially started looking for projects that had already been funded and were open to applications. I signed up to and and got daily and weekly updates on projects available. There were plenty of great opportunities being advertised and lots I could have applied for, but as time went on I realised none of them really hit the nail on the head in terms of what it was I wanted to investigate. So, I then started looking into applying for funding for my own research project. I had been told this was going to be a little more difficult than signing up to established projects, but I had taken the approach that I wasn’t going to sign up to a project I didn’t want to do 110%. I looked for PhD Studentships/Scholarships through Research Councils (Medical Research Council (MRC), Economic and Social Research Council (ESRC)), The Wellcome Trust, and various other charities focused on pregnancy and neonatal health. I eventually put forward for two pieces of funding from different organisations.

Coming up with my own idea for the PhD took time because it meant I had to establish a good understanding of the current literature in the area to justify the objectives of my research. When I had a stable idea of what I wanted to do, I started looking for academic supervisors whose area of expertise were aligned with my own interests. I approached people I thought would be interested to discuss my academic ambitions and to ask whether they would be interested in supervising the project going forward. Throughout the process of developing the research project, I also contacted multiple professionals in both academic and clinical settings to discuss the project and ask whether they had any advice or recommendations about the idea. Looking back, this was crucial to ensure that the research I was proposing to funders was justified academically and relevant to current healthcare initiatives. Finding relevant and feasible funding opportunities took time and patience but I’m glad I did it.

Louise: Similarly to Pippa, I also signed up and to receive weekly updates on any PhD roles. But I also approached my supervisors and a couple of lecturers on the course to discuss that I was increasingly interested in doing a PhD. Some of the time, these individuals will know of PhD opportunities in the pipeline, so if you voice your interest (particularly to supervisors who you can see yourself working well with) then it gives them the opportunity to think of you when they come available.

That is how I eventually got my PhD. My MSc thesis supervisor informed me of an opportunity that was going to be available (and shortly advertised on these PhD career websites) for a PhD on chronic pain in inflammatory bowel disease. Applying for the PhD felt very much like any other job opportunity; I applied (by both emailing the supervisors personally and formally online), provided a cover letter and then went for an interview where I had to give a short presentation. I was fortunate enough that I didn’t have to apply for my own funding, as all of the funding and arrangements had already been put in place.

Look out for more on ‘Tips on applying for PhD funding’ in our follow-up blog post next year!

3. Do you have to be passionate about a particular subject to do a PhD on it?
This is a tough one – yes and no. Throughout the year of the MSc there were particular things I was more interested in, so I had a general idea of the sorts of topics I wanted to do a PhD on. There were also some particular long term conditions I was more interested in, and felt more passionately about making a difference in. But at the same time, I also felt quite flexible, and knew that as long as the PhD project involved having an impact on patient care, and/or working with healthcare professionals, I didn’t mind.

I have always thought the ‘go with your initial gut instinct’ is fairly reliable. But when I was informed of the PhD on chronic pain in inflammatory bowel disease (IBD), I had mixed feelings. I had always been really interested in the area of pain and psychological influences on pain, but I had no clinical experience in pain and hardly any knowledge of IBD. But after some research both into the PhD and the specific condition of IBD, it felt like a really interesting project. I am now over a year into the PhD, and find IBD a really fascinating and complex long term condition. I still have lots to learn!

Pippa: I agree with Louise – this is a tricky one. When I was looking for opportunities I was told countless times “Don’t do something you’re not 100% interested in – it will be difficult, so you want something you’re really passionate about”.

Because I have always been naturally interested in pregnancy and neonatal health, I never had a difficult decision of what area to study. But it wasn’t just the topic or research question that was important. There were plenty of projects advertised investigating infant feeding and pregnancy-health that I didn’t want to apply for. Just because I am passionate about the topic, didn’t mean I was willing to investigate anything in the field. I signed up to do the PhD I’m doing because it is in the right location; in an institution that has a strong reputation for empirical research in my academic area of interest (Health Psychology in the context of Midwifery and Women’s Health); means I have two incredibly supportive and expert supervisors; access to academic and clinical collaborations among KCL institutes and allied health partners; and that my project investigates the bigger picture of how to improve perinatal support for women.

While I think it’s helpful to be passionate about a topic, you don’t need to be infatuated with an idea. When you find the right opportunity, you know when you know it’s the right one.

4. What’s the jump like from MSc to PhD academically?
I think we’ve been quite lucky in that the MSc programme we completed was able to provide us with fundamental academic skills needed to undertake a PhD. A lot of the training we completed as part of the MSc has been crucial to the tasks I have completed in the first 6-months of my studies: Protocol writing, conducting a systematic review, critical appraisal of evidence, synthesizing and summarising existing literature, submitting ethics applications. I think it becomes slightly more challenging in the jump from MSc to PhD research when you’re transferring research fields, moving across disciplines, or having to move country to pursue your studies. Knowing what kind of support the University offers has been helpful to know where to go for support and information i.e. Library services, academic skills training courses, seminars and induction sessions.

One of the biggest adjustments I’ve come to terms with is that time is very much your own. Unlike a taught postgraduate programme, there isn’t a stream of (seemingly) endless short-term deadlines that organise when to prioritise your work for you – you have to create the deadlines and priorities yourself. This also means that instead of work being sequential (e.g. do the essay due first and hand it in before starting on the next one) you have to juggle multiple pieces of work all at once and divide your time in your day/week/month accordingly. This might come easy to some, but I’ve found it quite difficult to be continuously switching between pieces of work throughout the day/week. Breaking my ‘To Do’ lists down into the smallest possible components has really helped with staying on top of things on a week-to-week basis!

Louise: I agree with Pippa, it has been a huge advantage for me coming straight from the MSc. A lot of my PhD colleagues in my office in the Nursing and Midwifery department have either had quite a few years out of academia or their previous degrees where in a completely different subject. A lot of the assignments that you do for the MSc are the same for a PhD, such as a systematic review, study planning and recruitment, and writing up a research paper and working on feedback. Moreover, the fact that you do both quantitative and qualitative courses in the MSc really sets you up for your PhD; you go in with some level of confidence about analysing and presenting research data (again, a lot of my colleagues felt quite worried about this).

The main jump for me however, is that the quality of your writing and how you are presenting your research data has to be at a higher standard. Ultimately, you are generating new and interesting findings that your supervisors will want you to share with the academic world! Whether this is in poster presentations for conferences or submitting papers for publications to highly cited academic journals. This is a little bit daunting, because you need to be thorough and professional with your research conduct and presentation of findings. However, if you have a good set of supervisors who support you and give you good feedback with your writing, then this jump is manageable.

5. What are the biggest challenges moving from MSc to PhD?
Pippa: Your PhD will be a marathon, not a sprint. Having long-term goals to work towards (e.g. Write thesis) can easily become overwhelming, and you can sometimes feel like you’ve not achieved very much over time. I’ve found having specific, individual aims and objectives for the week/month that I can tick off as I go along really encouraging – especially on an ‘off’ day when I look back and can see a list of things I’ve already done!

A PhD is a form of academic training; it’s very individual and can involve a lot of lone working. Because you don’t always have someone there to get answers from (like a programme leader or module supervisor in an MSc), you have to learn to be confident in decision making about your work. What do I work on now? Are my search terms okay? What measures should I use? Is this questionnaire helpful? Your supervisors will be there to guide you in the right direction on your decisions and offer expert advice, but a lot of the time there’s not a ‘right’ or ‘wrong’ answer so it’s ultimately your decision. Having such a high degree of autonomy over your work is great – it just takes a little time to get used to!

Louise: I also agree with Pippa. A PhD involves a lot of planning and decision-making, and ultimately you will be the one who has to decide. For example, when you are critiquing models or deciding on suitable questionnaires, you have to develop your own way of thinking and be confident in your decisions. In the world of academia you are surrounded by influential people with strong opinions, and it’s important to learn how to reach a decision with your supervisors. Sometimes I felt like the more reading and research I did the more confused I got when making decisions, because I would read more and more stances on a particular viewpoint and lose track. In this process, it’s fundamental that you can back up your decisions with evidence – what does the research on the whole tell you? If someone challenged you on your decision, how would you back yourself up? Think ahead to those pesky examiners in your Viva and how you would justify yourself.

Another obvious answer to this question, but it’s important to say it anyway, is time management. Although you have a main task to carry out for your PhD, throughout your PhD you will also be exposed to a wide number of opportunities, whether it’s teaching, collaborative work or service development. A PhD is great at allowing you to build up your CV but it’s important to remember to distribute your time effectively, so that you are getting your work done effectively whilst taking up opportunities.

6. What does your day-to-day look like?
Louise: As the tasks throughout your PhD vary so much, your day-to-day can vary considerably depending on what stage you are at. For example, in the depths of recruitment, you may not see your desk for a few days at a time, if you are going into hospital sites or arranging meetings with the clinical team. However for the majority of the time, I am working at my desk in a big postgraduate office. I treat my PhD very much like a working job, working Monday-Friday unless the volume of work means I need to do the odd weekend here and there. I seldom work at home, and really enjoy sitting amongst other PhD students who will frequently be able to answer your questions if you are struggling with an ethics query for example.

Once a week I will attend an MDT meeting at the hospital near my office, as this allows me to keep a relationship with the clinical team and listen to discussion of interesting patients cases on complex medication regimes. During recruitment periods, this meeting also gives you the opportunity to locate any suitable participants. I also do a bit of teaching when I can during my PhD. I teach as a TA on a statistics course which I do weekly in the autumn term, and occasionally do blocks of weekly teaching throughout the year in a secondary school (as part of a charity scheme), where I teach my research to high-achieving students in deprived schools.

Doing a PhD forces you to be organised, so I find it helpful writing a list at the beginning of the week and keep a physical diary to have everything down that I am doing. Although no one is keeping tabs on you to clock out at the end of the day, being able to tick off your lists of tasks gives you a structured way to carry out our day and ensures you don’t fall behind on anything.

Pippa: I come into the office every day Monday – Friday because I find it almost impossible to work from home. I also work more efficiently later in the day, so tend to come in and leave a little later than the rush hours.  Usually I have three or four tasks for the day that I aim to tick off and start with the one that will take the most time, leaving smaller tasks or ones that require less brainpower (like collecting search results from systematic review searches) for the afternoon. I save tasks that need the most brainpower until my optimal ‘thinking’ hours and if I’m in flow I tend to run with it until my brain/body tell me it’s time to lock up and go home! At the moment I’m working on two systematic reviews, a protocol for a cohort study and writing a background chapter justifying why I’ve included the measures I have included. I am also part of a parent support group and a local neonatal unit which I attend one lunch time a week, and attend monthly family support MDT meetings there. In the lead up to setting up my cohort study I have also had the opportunity to attend an antenatal clinic specifically for women with diabetes. Observing clinicians in the clinic has given me insight into the feasibility of recruiting women for the study and (hopefully) means I will be prepared for any challenges that lie ahead.

Our ‘Ten Top Tips’:
1. Network– when getting a PhD idea together, starting on a project, or putting a study together, use all the resources available to you to discuss your ideas and ambitions and get feedback from professionals in the area.  Ask them what they think, if they have any recommendations, and if they’d like to be involved moving forward.

2. Your supervisor(s) are key – Making sure you have good mutual expectations and a clear and open dialogue will mean you are able to get the support you need academically.

3. Treat it like a ‘9-5’ – Although you might still be referred to as a ‘Student’, for all intents and purposes your PhD is your full-time job so make sure to treat it like one. Find your optimal working hours, if you’re an early bird or night owl, and try to set your work around that but still be available during normal work hours.

4. Don’t compare yourself! – Every PhD is unique and every student has a different style of working, so comparing yourself to other PhD students around you isn’t going to be helpful a lot of the time. There isn’t a set structure or timeframe of tasks to adhere to so as long as you’re meeting the targets you have set, you’re doing okay!

5. Don’t be afraid to ask for help – Colleagues, Post-docs, former PhD students, academic support staff, PhD students ahead of you, supervisors, Institutional support (e.g. Library services, counselling services). They all want to see you succeed and are happy to help at every step along the way. Better to reach out earlier than wait until it’s all on top of you.

6. Break down your to-do lists – Having smaller achievable goals for your day or week will really help to organise your work and keep you moving forward. Being able to look back at last month and seeing all the things you achieved will also help keep up your motivation!

7. Support network – Having a good support network both personally and academically is crucial. There will be highs and lows so making sure you have people to celebrate with and pick you up is important.

8. Make the most of your time – Spend some time seek out other opportunities relevant to your work that can help you build up helpful skills. This could include teaching opportunities, volunteering positions in clinics or even getting involved in student representative boards at King’s.

9. Be confident with your decision making! Being surrounded by so many academics and other PhD students – it’s hard to know which is the correct way of doing things. As long as you have done your research and have a good argument to back up your decision-making, go with it and be confident with your supervisors. They won’t want you to rely on them.

10. Enjoy the ride! Sometimes it can feel a bit daunting having such a large amount to accomplish when you are mindful that you have limited time. But enjoy each stage and the new skills you are learning.


This post was written by Louise Sweeney and Pippa Davie who are PhD students at King’s College London. You can find out more about their research here. We hope you’ve enjoyed this article and that we’ve left you healthily psyched for more.

Modifying measures: How to get the most out of your questionnaires for your PhD. An example using the Revised Illness Perception Questionnaire (IPQ-R).

A key stage to writing your PhD proposal, after coming up with your main research questions and hypotheses, is deciding how exactly you’re going to measure these factors. It may seem like the obvious choice is to pick the most widely used, validated questionnaire, but it’s important to spend some time considering whether that questionnaire will be relevant to your population, able to capture the unique experiences of your patient-group, and whether it fits in with the wider theory. Using a pre-validated generic questionnaire can save time but may lead to important idiosyncratic experiences of your target population being missed.

In this article, we briefly describe how we modified the Revised Illness Perception Questionnaire (IPQ-R; Moss-Morris et al., 2002) in two different patient populations: 1) patients with atrial fibrillation (AF), an irregular heart rhythm predisposing patients to a five-fold increased risk of stroke (Taylor, O’Neill, Hughes & Moss-Morris, 2017) and breast-cancer survivors (BCS; Moon, Moss-Morris, Hunter & Hughes, 2017), who have completed active treatment for breast cancer but who may require continued therapy and monitoring.

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A brief background of the questionnaire

The IPQ-R measures patients’ cognitive representations of illness (illness representations) which are developed based on abstract (disease labels) and concrete (symptom-based) information sources. Illness representations consist of a number of different components including: identity (symptoms association with the illness), causes, consequences, timeline (acute, chronic or cyclic), controllability (treatment control/cure and personal control of illness) and illness coherence (whether the illness makes sense) (Moss-Morris et al., 2002). Emotional representations about illness (e.g. fear) are processed alongside these cognitive representations (Moss-Morris et al., 2002). Cognitive and emotional representations of illness can be understood within the context of the Common Sense Model (CSM; Leventhal, Meyer & Nerenz, 1980) which proposes that patients’ cognitive and emotional representations of illness guide coping behaviours, quality of life (QoL) and clinical outcomes, as supported by a wide range of research (Hagger, Koch, Chatzisarantis & Orbell, 2017). Whilst the scale was developed as a generic measure to assess illness representations across conditions, the authors recommend that it is modified to suit the specific needs of each illness population (Moss-Morris et al., 2002).

Step 1: Qualitative interviews

To understand the target population, we carried out interviews with our patient groups. Questions specifically related to components of the IPQ-R, outlined above. For instance, the following question related to the personal control component; ‘Is there anything you can do to control/prevent the risk of recurrence?’. Transcripts were analysed using deductive thematic analysis and key themes were identified which informed the modification of the IPQ-R.

In the AF study 30 participants were interviewed with a range of demographic characteristics including different treatment types and pre/post treatment status.  Key themes included unpredictability of AF and a struggle to gain control of symptoms. Patients reported engaging in targeted behaviours such as avoidance to try to control symptoms. Patients also believed certain events or behaviours could trigger AF symptoms. Patients expressed different concerns relating to treatment-type. (For separate qualitative study see Taylor, O’Neill, Hughes, Carroll & Moss-Morris, 2017).

In BCS, 18 women prescribed tamoxifen were interviewed about their perceptions of cancer and suvivorship. A key theme was that the majority of patients did not identify as currently having breast cancer. Instead, when asked about control, consequences and causes, patients tended to discuss their risk of recurrence. Patients attributed symptoms to tamoxifen, an adjuvant treatment, rather than to their breast cancer. Specific causes of recurrence and symptoms were also elicited during the interviews.

Step 2: Modification of questionnaire

Interviews led to questionnaire modification through 1) retention of items, 2) minor revisions 3) development of new items.

Examples of minor revisions included wording changes such as replacing ‘my illness’ with ‘my AF/BCS’ and inclusion of population-specific symptoms onto the identity scale. For instance, in AF patients this included items such as heart palpitations and in BCS this included items such as hot flushes and night sweats.

Development of new items in AF patients related to the unpredictability theme. Three new items related to personal control behaviours (slowing down and avoidance): ‘Avoiding certain activities will control my AF’, ‘Resting will prevent me from having symptoms’, ‘By doing less and slowing down I can control whether I have AF symptoms’. In addition, AF patients seldom mentioned the original cause of AF but reported triggering AF symptoms instead. This led to changing the causes scale into a triggers scale to reflect factors which patients believed triggered AF. Due to different treatments, the treatment control component was re-worded to relate to pharmacological (antiarrhythmic and anticoagulant) and procedural (cardioversion, catheter ablation and AV-node ablation) treatments.

The modification of items in BCS focussed mainly on replacing references to ‘my breast cancer’ with ‘risk of recurrence’. For example, treatment control items were modified to assess the extent to which patients felt their treatment could reduce their risk of recurrence. The timeline scales were amended to reflect the fact that patients did not have symptoms which come and go, and instead are at increased risk of a recurrence. The identity scale was modified to identify symptoms attributed to tamoxifen as well as breast cancer.

Step 3: Think-aloud

Think aloud techniques enable the researcher to establish whether items on the questionnaire are interpreted as intended (i.e. face validity). In our studies, a small subset of patients were given the modified questionnaire and asked to read each item aloud during telephone interviews and to verbalise their thought process on how they would answer questions (Ericsson & Simon, 1998).

Changes were made in both studies to improve the clarity of questions. For instance, in BCS items were revised to improve applicability of questions to all participants. Some items were deleted where possible to reduce repetitiveness. In AF patients, some items were expanded upon to provide further context and improve interpretation.

Step 4: Factor analysis

Confirmatory factor analysis (CFA) is used when testing a hypothesised model and to ensure the original factor structure is still relevant for the modified questionnaire. Exploratory factor analysis (EFA) may be used when more significant changes have been made to the questionnaire and when the factor-structure is not pre-specified. Both analyses were used in Moon et al. (2017) and Taylor et al. (2017).

In both studies a CFA was conducted in MPlus (version 7) on the main scale of the IPQ-R (i.e. timeline (chronic/cyclic), consequences, control (personal and treatment), illness coherence, emotional representations). Items were specified to load on these hypothesised components using syntax to test model fit. It is recommended that CFA is run with at least 200 participants (Brown, 2015). While there are various methods of assessing model fit, both studies used Comparative Fit Index (CFI), Tucker Lewis Index (TLI) and Root Mean Square Error of Approximation (RMSEA), as recommended by Jackson, Gillaspy & Purc-Stephenson (2009). RMSEA values of less than 0.08 indicate reasonable fit and CFI/TLI values of greater than 0.95 suggest acceptable model fit (Hu & Bentler, 1999). For further useful instructions on conducting CFA see Brown (2014).

EFA was conducted on the causal attribution scale in both studies, as recommended by Moss-Morris et al. (2002) and because substantial changes were made to both this scale in both studies. In AF patients, Taylor et al (2017) conducted the EFA in SPSS (V22) using maximum-likelihood extraction and oblique rotation as factors were expected to correlate. For a useful paper on conducting EFA in SPSS see Yong & Pearce (2013). In BCS, Moon et al. (2017) used SPSS with R-menu for ordinal factor analysis based on polychoric correlations, which has shown some benefits over using SPSS alone (Basto & Pereira, 2012). Preliminary interpretation of the data should examine any ceiling effects, which can be tested by examining/removing item frequencies in which >80% of participants disagreed with any specified items. You should also examine whether there is a patterned relationship amongst variables to see if any items should initially be removed. Kaiser-Meyer-Olkin Measure (KMO) of >0.50 will also indicate that the data is suitable for an EFA. The number of factors to be extracted are indicated by using Kaiser’s criterion (eigenvalues of 1.0 cut-off), visual inspection of scree plots or parallel analysis. Items which do not load onto any factors or cross-load onto multiple factors can be removed. Factors should be labelled based on the items contained. For example, in the EFA for AF patients, a factor was labelled as ‘emotional triggers’ which contained items related to stress, mental attitude and emotional state.

Step 5: Testing the psychometric properties of the modified questionnaire

Internal reliability measures how well a set of items measure a particular concept. High internal reliability suggests that all items are measuring the same concept. Cronbach’s alpha can be examined using SPSS. Acceptable alpha values range from 0.70 to 0.95, with 0.95 indicating excellent reliability, (Tavakol & Dennick, 2011) and values higher than this indicating redundancy across items

Test-retest validity examines whether patients’ responses are consistent over time, and the stability of the questionnaire. Participants were asked to complete the questionnaire at baseline and at two-weeks. Intra-class correlations (ICC) can vary between 0 and 1.0 whereby 1 indicates perfect reliability. To examine any potential outliers, Bland-Altman plots can be used (Bland & Altman, 1986).

Construct validity examines the extent to which a test measures what it claims to be measuring, and can be tested by looking at the relationships between the subscales of the modified questionnaire and other theoretically-related questionnaires. Correlations range from 0 to 1.0, with scores closer to 1.0 indicating high correlation.

In the AF study, the modified IPQ-R was examined with a measure of treatment beliefs; the Beliefs about Medicines Questionnaire (BMQ, Horne, Weinman & Hankin, 1999), and an AF-specific QoL measure (AFEQT; Spertus et al., 2010). The BCS study examined the modified IPQ-R with the BMQ and Hospital Anxiety and Depression Scale (HADS; Zigmond & Snaith, 1983).


This blog post by Elaina Taylor and Zoe Moon has outlined how we modified and validated the IPQ-R specific to the patient populations we are studying. If you have any questions, please feel free to get in contact with us via the Healthily Psyched blog page. You can also check out the papers that we’ve written on this topic which are linked up to our profiles. In the meantime, we hope we’ve left you healthily psyched for more.



Basto, M., & Pereira, J. (2012). An SPSS R-menu for ordinal factor analysis. Journal of Statistical Software, 46, 1–29.

Bland, J.M., & Altman, D. G. (1986). Statistical methods for assessing agreement between two methods of clinical measurement. Lancet, 327(8476), 307-310.

Brown, T.A. (2014). Confirmatory factor analysis for applied research. New York: Guilford Publications.

Ericsson, K. A., & Simon, H. A. (1998). How to study thinking aloud in everyday life: Contrasting think-aloud protocols with descriptions and explanations of thinking. Mind, Culture, and Activity, 5, 178-186.

Hu, L.T, & Bentler, P.M. (1999). Cut-off criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modelling: A Multidisciplinary Journal, 6(1), 1-55.

Hagger, S., Koch, S., Chatzisarantis, N. L. D., & Orbell, S. (2017). The common-sense model of self-regulation: Meta-analysis and test of a process model. Psychological Bulletin.

Horne, R., Weinman, J., & Hankin, M. (1999). The beliefs about medicines questionnaire: The development and evaluation of a new method for assessing the cognitive representation of medication. Psychology and Health, 14, 1-24.

Jackson, D.L., Gillaspy, J.A., & Purc-Stephenson, R. (2009). Reporting practices in confirmatory factor analysis: an overview and some recommendations. Psychological Methods, 14(1), 6-23.

Leventhal, H., Meyer, D., & Nerenz, D. (1980). The common sense representation of illness danger. Contributions to Medical Psychology, 2, 7–30.

Moon, Z., Moss-Morris, R., Hunter, M.S., & Hughes, L. D. (2017). Measuring illness representations in breast cancer survivors (BCS) prescribed tamoxifen: Modification and validation of the Revised Illness Perceptions Questionnaire (IPQ-BCS). Psychology & Health, 1, 1-20.

Moss-Morris, R., Weinman, J., Petrie, K., Horne, R., Cameron, L., & Buick, D. (2002). The revised illness perception questionnaire (IPQ-R). Psychology and Health, 17(1), 1-16.

Spertus, J., Dorian, P., Bubien, R., Lewis, S., Godejohn, D., Reynolds. M. R., …& Burk, C. (2010). Development and validation of the atrial fibrillation effect on quality-of-life (AFEQT) questionnaire in patients with atrial fibrillation. Circulation: Arrhythmia and Electrophysiology, 10(5),15-25.

Tavakol, M., & Dennick, R. (2011). Making sense of Cronbach’s alpha. International Journal of Medical Education, 2, 53-55.

Taylor, E. C., O’Neill, M., Hughes, L., & Moss-Morris, R. (2017). An illness-specific version of the Revised Illness Perception Questionnaire in patients with atrial fibrillation (AF-IPQ-R): Unpacking beliefs about treatment control, personal control and symptom triggers. Psychology and Health, 32, 1-19.

Taylor, E. C., O’Neill, M., Hughes, L. D., Carroll, S., & Moss-Morris, R. (2017). ‘It’s like a frog leaping about in your chest’: Illness and treatment perceptions of patients with persistent atrial fibrillation. British Journal of Health Psychology, 22, 1-19.

Yong, A. G., & Pearce, S. (2013). A beginner’s guide to factor analysis: Focusing on exploratory factor analysis. Tutorials in Quantitative Methods for Psychology, 9(2), 79-94.

Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370.


Early Career Paths into Health Psychology: Introducing the Healthily Psyched at Guy’s team

King’s College London Health Psychology Section in Guy’s Hospital is home to a number of PhD students, early career postdocs and trainees working in the field of health psychology. All of us share the research interest of working with individuals with long-term conditions, yet there is a lot of diversity in the particular areas in which we work. For our first post and the launch of our new Healthily Psyched at Guy’s blog, we thought it would be of interest to other early career researchers, trainees, clinicians and students to hear more about the different areas in which we work and the different entry pathways we have taken into a career in health psychology.

The majority of the Healthily Psyched team have completed a Masters in Health Psychology, which constitutes the Stage I part of training to become a health psychologist. When choosing a Masters programme in Health Psychology, you should be sure that the course is accredited by the British Psychological Society to constitute Stage I training. In order to become a qualified health psychologist you need to complete further training to constitute Stage II. There are different ways you can do this. Some universities run Professional Doctorates in health psychology, which grant you accreditation as a health psychologist and make you eligible for Health and Care Professional Council (HCPC) accreditation. You may also choose the British Psychological Society independent route, which is known as the Stage II Qualification in Health Psychology. We will provide subsequent posts about the alternative routes with more details on each. Individuals may also work in the field of health psychology without applying for accreditation as a health psychologist. Amongst us we have a physiotherapist, a clinical psychology trainee, an IAPT trained postdoc and PhD candidates and postdocs who are currently not planning on completing Stage II training.

Below we have collated a brief introduction to the Healthily Psyched team and the different areas of health psychology they have chosen to work in. You can find out more about the team here.

Federica Picarello- Full time PhD candidate developing and evaluating a biopsychosocial model of fatigue in End-Stage Kidney Disease.

Elaina Taylor- Part time PhD candidate examining illness and treatment beliefs in patients with persistent atrial fibrillation. Lecturer in Psychology at the University of Suffolk.

Katrin Hulme- Professional Doctorate in Health Psychology and researcher on fatigue.

Zoe Moon- Postdoctoral researcher on Breast Cancer Now grant.

Jo Hudson- Postdoctoral clinical health researcher.

David Herdman- Physiotherapist and part time PhD candidate developing an integrated rehabilitation programme for persistent dizziness.

Alicia Hughes- Postdoctoral clinical health researcher and Stage II trainee health psychologist.

Sula Windgassen- Part time PhD candidate exploring cognitive and behavioural factors in irritable bowel syndrome (IBS), part time researcher in IBS and Stage II trainee health psychologist.

Alice Sibelli- Part time PhD candidate studying the role of emotional factors in irritable bowel syndrome (IBS). Researcher in IBS and inflammatory bowel disease.

Pippa Davie- Full time PhD student investigating factors that contribute to successful breastfeeding and infant feeding practices among women who deliver large-for-gestational-age (LGA) infants.

Louise Sweeney- Full time PhD student investigating chronic pain in inflammatory bowel disease.

Susan Carroll- Full time PhD candidate and trainee health psychologist developing a biopsychosocial model and self-management treatment for fatigue in paediatric multiple sclerosis.


Federica Picarello

My background is purely in Psychology, having completed a Psychology BSc and a Health Psychology MSc. The Health Psychology module in the BSc sparked my interest in the role that psychology can play in physical health and that it is not purely confined to mental health. With the growing life expectancy, there is an increasing number of people who live with long-term physical conditions and psychological support is invaluable, yet to date this has been often overlooked and a stark separation persists between physical and mental health. This is both in the eyes of clinicians and patients.

I am currently completing my PhD funded by the NIHR through the BRC. The overarching aim of my PhD is to develop and evaluate a biopsychosocial model of fatigue in End-Stage Kidney Disease. What still astonishes me every day is that patients may have adequate blood test results, but this often has little bearing on their self-reported well-being, further highlighting the importance of beliefs and behaviours in physical health. In the future, I would like to combine research and clinical work to get the best of both worlds.

Elaina Taylor

My interest in Psychology began at A-level where I was one of two students in a small class taught by an inspirational teacher who unconventionally welcomed us to class each morning with a cup of tea made with goat’s milk. At university I undertook a combined honours degree majoring in Psychology with English literature and Archaeology. During a stats-heavy MSc at Glasgow, I wrote a dissertation focussing on stress and coping strategies in postgraduate students- a topic I would later become rather familiar with. The MSc led me to become interested in pursuing a PhD in Health Psychology in two ways. Firstly, my dissertation topic led me to become interested in the way cognition and behaviours interacted with physical health. Secondly, I gained immense satisfaction in completing a piece of work I felt proud of.

After graduating with the MSc, I took up a teaching post in Suffolk. I applied to London on the basis that I could commute and undertake a PhD part-time, but also to work with top researchers in Health Psychology, and more specifically in the area of illness representations. Working part-time has enabled me to develop six years of higher education teaching while undertaking my PhD. After completing four out of six years, I’m encouraged by the achievement of small milestones (in the form of publications) and look forward to developing a career as a researcher and lecturer in Health Psychology.

Katrin Hulme

I’ve always been interested in the human body, sport, nutrition and health. Although I did not realise it at the time, the topic I chose to explore for my dissertation (quality of life in Irritable Bowel Syndrome) was my first taste of health psychology. This, coupled with my personal interests, led me to the Health Psychology MSc; a very exciting discovery as I had not realised previously that this route existed.

My undergraduate degree was at Durham University where I studied Natural Sciences, combining Psychology, Biology and Anthropology (accredited by the BPS). I studied Health Psychology MSc at Northumbria University and then enrolled on the Professional Doctorate at Staffordshire University for Stage II, whilst working full-time at King’s College London as a researcher on fatigue intervention projects.

I handed in my doctorate at the end of June and finished at King’s in July. Next steps are: viva in the Autumn and decide what I would like to do next, after enjoying some time off over the summer months. I enjoy the behaviour change aspect of health psychology, as well as translating research into practice, so I would like to find a role which draws upon these aspects, and challenges me to develop further.

Zoe Moon

I studied Psychology at undergraduate level and left the BSc feeling unsure as to what I wanted to do in the future. I was not exposed to Health Psychology during the BSc and it wasn’t until after my course that I saw a listing for an MSc in Health Psychology. This felt like a natural progression for me and a good way to apply my psychology background to real world settings. Throughout university I had a lot of exposure to the NHS, living with trainee doctors/nurses and with people who had significant health problems and frequent hospitalisations. When I found the MSc, I was excited at the prospect of using psychology to support people with long-term conditions or to help improve the healthcare system. After finishing the MSc at King’s College London, I completed a PhD, which investigated adherence to adjuvant treatment in breast cancer patients. The PhD was full time and was funded by Breast Cancer Now. As part of the PhD I conducted several studies including a qualitative study, a large longitudinal study and a feasibility study of a self-management intervention.  I am now extending this work as a postdoctoral researcher in the department.

Jo Hudson

When visiting my Nan this weekend I was thinking about this post. In fact, it is because of my Nan that I became interested in health psychology. With my Nan being a hoarder of anything Grandchildren-related (thankfully she only has three!); I can share my attempt in the 90s at deterring her from smoking below:


In the end, it was taxation that altered my Nan’s and indeed many others’ smoking related behaviour. My lack of success with my Nan’s attempt to quit did not deter me from following a career in health psychology. Perhaps, the public health “side” of health psychology was not for me. There will be more on the different “sides” of health psychology in later blogs.

Now, I work as a post-doctoral clinical-health psychology researcher. I focus on developing psychological interventions that support individuals in adjusting to living with a physical long-term condition. After my Health Psychology MSc, I worked in a Primary Care Mental Health Service. Here I completed a post-graduate certificate in psychological therapies. The one-year training programme focused on evidence-based treatments for the management of depression and anxiety. When I applied these CBT treatments to people with physical health conditions, I felt frustrated at the lack of integration between mental and physical health care provision. I completed a PhD to research these challenges further. After my PhD, I worked at the Centre for Primary Care, University of Manchester before moving down to the big city of London!


David Herdman

I am a physiotherapist specialising in the management of people with dizziness and balance disorders. My interest in health psychology is very much borne out of my clinical practice and experience of working with people with persistent physical symptoms. I have obtained an NIHR Clinical Doctoral Research Fellowship to develop an integrated (mind & body) rehabilitation programme for people with persistent dizziness that can be delivered by physiotherapists.

At the time I started my PhD I was also looking for some new challenges. However, I still enjoy my clinical work, which is why I chose to study for a PhD part-time. Although studying in a different field is challenging, it is also really inspiring and the opportunity to bring together experts from these fields is very exciting.

I hope to continue to combine research and clinical practice in the future. Clinical-academic roles for physiotherapists are in their infancy but again we have a lot to learn from clinical psychology in this regard.

Alicia Hughes

In the final year of my BSc, I had the horrible realisation that I still had no idea what career I wanted. Whilst my undergraduate experience had given me a passion for psychology, my interests were broad and with graduation looming I still didn’t know which interests I should pursue, let alone how to pursue them.

Then followed several years of gathering experience in different areas of psychology; working in low paid jobs, often for free and working all the tenuous connections I had, to shadow psychologists in different disciplines. After much debate and 8 months of finding myself in the outback, I was firmly fixed on the career of a health psychologist.

For me, the major draw to health psychology was that it is a broad church. Health and psychology are concepts applicable to everyone; from helping healthy people avoid ill health through changing their behaviours, to supporting people who have ill-health cope with and manage their condition. Since I had found my psychological niche, I applied to the MSc in Health Psychology at King’s College London and once there I began to learn more about the clinical application of health psychology. I became particularly interested in medically unexplained persistent physical symptoms, an area of research I subsequently pursued in my PhD.

I am now a postdoctoral researcher and Stage II trainee Health Psychologist. The first post involves research and the second provides training and supervision, which will (once complete!) allow me to work in an applied setting as a HCPC chartered health psychologist.

Sula Windgassen

My favourite module in my final year of my Psychology BSc at the University of Leeds was health psychology and I completed my undergraduate thesis in this area of research. However, after working in marketing for a year after graduating, it was personal circumstances that drew me back to pursuing a career in health psychology. I came to experience severe medically unexplained symptoms that caused me to seek professional help to manage them and the distress they were causing. A family member, who is a clinical health psychologist, introduced me to both cognitive behavioural therapy and mindfulness, and guided me through a formulation, which really empowered me allowing me to feel like I had some control and hope! Use of mindfulness and CBT techniques transformed my experience of the illness, which causes me very little trouble on an on-going basis these days. When I do get a flare up, I feel that I know how to manage it and therefore this causes very minimal disruption in my life. This is a stark contrast to when I first started experiencing problems. Both the CBT formulation and the experience of mindfulness very much inspired me and I have become passionate about working to improve the experience of individuals with long term conditions.

I completed an MSc in Health Psychology at King’s College and I am now finishing my part time PhD exploring cognitive and behavioural factors in irritable bowel syndrome whilst I work part time as a researcher on the ‘Assessing cognitive therapy in irritable bowel (ACTIB) trial. I have just handed in my Stage II portfolio to qualify as a health psychologist and hope to go on to train therapeutically whilst continuing my research in long-term conditions.

Alice Sibelli

I was born in Italy but I have lived abroad most of my life, enjoying the opportunity to study and work in unique countries with diverse cultural backgrounds. As I grew up, I was never sure of what type of professional path I wanted to follow but I was always fascinated by the different (and sometimes contrasting) ways we react to illness and the vulnerabilities of our human body.

Completing three years of medical training made me realise that many doctors and patients still hold a strong, dichotomised view of body and mind. This reality (which was hard to digest at first) provided me with a deep insight into the role I actually wanted to play in terms of patient care. I then decided to pursue a career in psychology.

After completing my MSc in Health Psychology at the University of Southampton, I realised that I had found exactly what I was looking for: the opportunity to blend my medical and psychological knowledge to contribute to the delivery of a holistic support for individuals with health problems.

I am currently completing a part-time PhD focused on the emotional processes of individuals with Irritable Bowel Syndrome (IBS) after receiving Cognitive Behavioural Therapy (CBT). Conducting a rigorous mixed methods PhD has allowed me to have close interactions with participants to explore in depth how they perceive their condition, the care they receive, their struggles and the way they feel in general. Learning from their own experiences and integrating them with current scientific knowledge has allowed me to propose novel ways to enhance existing evidence-based psychological treatments for IBS. I have also being in charge of delivering the modules focused on qualitative research methods to MSc and BSc students, which has been a fantastic opportunity to learn from each other’s perspectives.

In the future, I would like to continue doing research focused on long-term conditions from a person-centred approach. I would love to work not only with patients but also with health professionals to overcome the obstacles that seem to persistently obstruct the patient-doctor communication.

Pippa Davie

I started thinking about what I wanted to do when I grew up only after I’d finished my undergraduate Psychology degree. I knew I was interested in research, health and illness, that I enjoyed caring for people, and that I was fascinated with pregnancy health and well-being. I wasn’t interested in Clinical Psychology and at the time, I couldn’t see many other options in Psychology. After some discussion with my academic supervisors, I decided I’d apply for Medicine thinking it would be a good way to combine my interests. Knowing the odds of a successful first application were stacked against me, I remained on the lookout for other opportunities – which is when I read about Health Psychology at King’s. I had done an elective module in Health Psychology during my undergraduate degree and really enjoyed it, so I remember being really confused as to why I’d not thought of it before! I approached the department to ask if there was any way I could gain any insight or experience and was offered a research internship later that academic year I’ve not looked back since. I completed the Health Psychology MSc in 2016 where I started exploring my interest in pregnancy health and breastfeeding, and was awarded the IoPPN PhD Studentship Prize 2016/17, which has enabled me to research an area I hope to continue exploring throughout my academic career.

Louise Sweeney

After completing a BSc in Psychology, I worked as Behavioural Health Care Assistant in a hospital in Bristol, predominantly working one to one with patients with brain trauma or neurological conditions, including Parkinson’s and Dementia. This gave me an insight into patient’s experiences living with a long-term illness and the huge effects this has on their psychological well-being and that of their families. I then became aware of Health Psychology as a discipline after having been to a talk about the biological effects of poverty and stress on health, and the steep prevalence of long term conditions such as diabetes and cardiac problems in poor and deprived areas. I was struck by the huge impact that ‘wellness’ and social conditions had on people’s physical health and functioning. It was this that led me to pursue an MSc in Health Psychology.

I am now studying a PhD investigating chronic pain in inflammatory bowel disease, in the aim of developing an online self-management treatment program for patients. Since starting my PhD I have carried out a number of teaching jobs, and look forward to working with both patients and healthcare staff to develop an effective treatment program for patients. After the PhD, I aim to pursue a career working as a clinical academic, so I can keep up my interest in teaching and research alongside working with patients.

Susan Carroll

During my childhood and teenage years, I had my fair share of medical quirks, and so experienced a spectrum of wonderful, to not so wonderful, healthcare. Whilst experiences in hospitals were not always fun, they inspired my fascination with how people adjust to long term conditions (LTCs) and difficult medical diagnoses, the role of healthcare professionals in helping people to adjust, and how psychologists can contribute to improving adjustment and management of LTCs.

After my undergraduate degree at Trinity College Dublin, I fed my interests through voluntary work, taking on some patient advocacy roles and working as a part-time research assistant, part-time retail assistant. Alongside that, I spent a lot of time asking google how I could make my interests into my career. I came across the MSc Health Psychology at King’s College London, which attracted me because of its balance between research, teaching and clinical placement. I took a punt and applied, with somewhat low expectations. When the acceptance letter came through, I felt like Harry Potter getting into Hogwarts! Being a bit of a home bird, the big move to London was nerve-racking, but from day one in the Health Psychology Section at Guy’s, I never looked back.

During my MSc, the opportunity arose to do a PhD on fatigue in paediatric multiple sclerosis with a fantastic team of supervisors at KCL and Great Ormond Street Hospital for Children (GOSH). Doing a PhD has been a fruitful, challenging and rewarding experience, filled with opportunities to meet inspiring colleagues. While balancing my PhD with Stage 2 Health Psychology Training, I’ve decided that I want to balance research with clinical practice in my career. I will be starting the Doctorate in Clinical Psychology at the IoPPN in October, and look forward to a career in Clinical Health Psychology.



We hope you’ve enjoyed our first blog post introducing you to the Healthily Psyched at Guy’s team! Hopefully it has also highlighted the various different methods of entry into health psychology. More specific information regarding different health psychology career paths will be discussed in subsequent posts. In the meantime, we hope to leave you healthily psyched for more.


The Healthily Psyched team