Healthily Psyched at Guy's

King's College London Health Psychology blog

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

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?

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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?

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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

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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?
Pippa:
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 www.findaphd.com and www.jobs.ac.uk 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 www.findaphd.com and www.jobs.ac.uk 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?
Louise:
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?
Pippa:
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.

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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.

 Blog table

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).

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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.

 

References

Basto, M., & Pereira, J. (2012). An SPSS R-menu for ordinal factor analysis. Journal of Statistical Software, 46, 1–29. https://doi.org/10.18637/jss.v046.i04

Bland, J.M., & Altman, D. G. (1986). Statistical methods for assessing agreement between two methods of clinical measurement. Lancet, 327(8476), 307-310. https://doi.org/10.1016/S0140-6736(86)90837-8

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. https://doi.org/10.1207/s15327884mca0503_3

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. https://doi.org/10.1080/10705519909540118

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. https://doi.org/10.1037/bul0000118

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. https://doi.org/10.1080/08870449908407311.

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. https://doi.org/10.1037/a0014694

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. https://doi.org/10.1080/08870446.2016.1275629

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. https://doi.org/10.1080/08870440290001494

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. https://doi.org/10.1161/CIRCEP.110.958033

Tavakol, M., & Dennick, R. (2011). Making sense of Cronbach’s alpha. International Journal of Medical Education, 2, 53-55. https://doi.org/10.5116/ijme.4dfb.8dfd

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. http://dx.doi.org/10.1080/08870446.2017.1373113

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. https://doi.org/10.1111/bjhp.12267

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. https://doi.org/10.20982/tqmp.09.2.p079

Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x

 

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