Madeleine Irish - A thesis submitted in partial fulfilment of the requirements of the degree of Doctor of Clinical Psychology (DClinPsych)

Keywords: carer
remote therapy
COVID-19
predictor
self-blame
IAPT
anorexia nervosa
bariatric surgery
personality
trauma

Critical review of the literature: Personality as a predictor of biological and psychological outcomes in bariatric surgery amongst an adult population: a systematic review.
Background: Certain personality traits have previously been found to be associated with successful bariatric surgery prognosis, however, research has been conflicting. Therefore, the aim of this systematic review was to assess the longitudinal associations between personality traits and biological or psychological outcomes amongst an adult population. Method: PsychINFO, Embase, Medline and PubMed were searched for studies published between 1994 and 2023 with a follow-up period of at least one year post-surgery. Studies were screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and results were reviewed using a narrative synthesis approach. Results: Twenty-one articles, including 6 730 participants, were analysed. The results suggest that lower levels of persistence and higher externalising dysfunction most consistently predict poorer weight loss outcomes post-surgery. Conclusions: Given these findings, assessing personality traits preoperatively could help guide post-surgery support and monitoring for a subgroup of people. Future studies would benefit from measuring outcomes beyond weight loss, such as psychosocial adjustment and quality of life. In addition, given the substantial variability on how weight outcomes were reported across studies, standardised guidance would be beneficial.

Service improvement project: Evaluation of the delivery of individual therapy in the Oxford Talking Space Plus Improving Access to Psychological Therapies (IAPT) service before and during the Covid-19 pandemic and how best to inform the future service model.
The mitigations put in place to reduce the spread of COVID-19 caused widespread disruption to people’s lives and their mental health. It also led to the transition from face-to-face to remote working for many psychological therapies. Although evidence has indicated that remote therapy (i.e., videoconferencing) is effective, little is known about the added impact of a pandemic on treatment outcomes, and the effectiveness for different clinical presentations and demographic characteristics. This service improvement project compared therapy outcomes for 1,047 patients who received high intensity psychological input from an Increasing Access to Psychological Therapy (IAPT) service before the Covid-19 pandemic and during the pandemic (when the majority of therapy was delivered remotely). In addition, the experiences of groups that showed poorer outcomes during the Covid-19 period were explored using qualitative interviews. Despite the psychological impact of the pandemic, and its associated restrictions, the Covid-19 period was not associated with poorer clinical outcomes for many clinical presentations and client demographics. However, recovery rates for those receiving therapy for obsessive compulsive disorder were significantly lower during Covid-19 when compared to pre-Covid-19. Possible reasons for this are explored. The findings suggest that, overall, Covid-19 did not have a significant impact on treatment outcomes, and that remote therapy may be an effective option within an IAPT setting, and could be offered on a permanent basis as part of patient choice.

Theory driven research project: Investigating self-blame and trauma symptoms in parents of young people with Anorexia Nervosa - “Traumatised by the past, desperately trying to keep them well in the present, and worried about the future”.
Caring for a young person with anorexia nervosa (AN) has been associated with psychological distress and found to be a traumatic experience. This can have an impact on patient and family outcomes. Objective: This study aimed to investigate whether self-blame cognitions contribute to post-traumatic stress disorder (PTSD) symptoms in parents of young people with AN, and what the experiences were of those showing high self-blame and PTSD symptoms. Methods: A mixed-methods, cross-sectional design was used. One hundred and twenty-three parents of children with AN completed a range of questionnaires, and an additional 56 with high self-blame and PTSD symptoms provided qualitative feedback. Results: Overall, levels of self-blame cognitions were significantly higher in those experiencing higher levels of PTSD symptoms compared to low levels. Additionally, levels of self-blame cognitions significantly predicted PTSD symptoms over and above demographic factors and illness severity, accounting for 22% of unique variance in PTSD symptoms. Conclusions: The findings suggest that negative appraisals regarding self-blame for their child’s eating disorder (ED) contributed to the potential development and/or maintenance of PTSD symptoms. Parents presenting with thoughts of self-blame would benefit from further support to reduce these feelings and, subsequently, reduce carer distress.