Rebecca Bird - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych)
Keywords: correspondence
causal attributions
recipient
donor
writing letters
coping styles
secondary traumatic stress
‘thank you’
foster carers
Chronic Fatigue Syndrome
self-efficacy outcomes
transplantation

Critical Review of the Literature
Background: Chronic Fatigue Syndrome (CFS) is a complex disorder characterised by extreme exhaustion not improved with rest (NICE, 2021). Cognitive behavioural models for understanding CFS adopt a Biopsychosocial framework which asserts that cognitive, behavioural, and affective factors perpetuate CFS symptoms and effect treatment outcomes. Purpose: The present review adopted a narrative synthesis approach to explore the relationship between self-efficacy and causal attributions on therapeutic outcomes (fatigue & functional impairment), as detailed in Vercoulen et al.’s (1998) model. Method: A systematic review of databases (Psychinfo, Medline, CINAHL & PubMed) was carried out. Studies were included if psychological intervention was delivered to participants, 16 years of age and above, with a diagnosis of CFS and if scores of selfefficacy and causal attributions were reported. Results: Fifteen studies were included in this review. Only one study demonstrated a relationship between attributions on outcomes whereas several studies indicated a relationship between self-efficacy on outcomes, however, this relationship was reported to be small in several studies. Conclusions: The findings of this review do not conclusively provide support for Vercoulen et al.’s model. Clinicians should take caution when applying this model to clinical practice. Further research should focus on what works well for whom and when, possibly using network analysis.

Service Improvement Project
Background: The process of an organ recipient writing to a donor/donor family is supported by NHS Blood and Transplant (NHSBT, n.d). Objectives: This service improvement project aimed to understand the barriers and facilitators faced by professionals when supporting recipients to think about writing this letter, at the Oxford Transplant Centre (OTC). Method: Eight post-transplant professionals (five nurses & three consultants) attended individual interviews and four pre-transplant nurses attended a focus group. Two Likert-scale questions were asked which explored importance and confidence in supporting recipients with letter writing. Results: Reflexive Thematic Analysis was employed to analyse the data. Five themes were identified in the focus group, with six sub-themes, and six themes were identified in the interviews, with 10 sub-themes. These themes shed light on some of the barriers (information overload) and facilitators (empathetic understanding) to talking with recipients about letter writing. Conclusions: Recommendations were drawn from these themes, which included increasing recipient awareness of the possibility of letter writing (e.g., by displaying a poster in the waiting room/ward).

Theory Driven Research Project
Background: Caregiver resources could mediate against the development of Secondary Traumatic Stress (STS) in foster carers, according to a conceptual model (Whitt-Woosleyet al., 2020). The relationship between coping styles (emotion-focused, problem-focused,and avoidant; Carver et al., 1997) and STS has yet to be researched in UK foster carers. Aims: To explore the relationship between STS and coping styles whilst controlling for anxiety and depression and to explore group differences in the use of the individual facets on the Brief COPE. Design: A cross-sectional, between subjects design. Method: Data was collected from 132 foster carers at one time point using online self-report questionnaires. Two groups were formed, ‘high’ and ‘low’ STS based on the clinical cut-off score of ‘38’ on the Secondary Traumatic Stress Scale (Bride et al., 2004). Results: Analysis of Covariance (ANCOVA) found that foster carers who reported high STS also reported significantly greater use of problem-focused and avoidant coping styles, with the greatest effect size in problem-focused coping. Exploratory analysis identified ‘behavioural disengagement’, ‘substance use’, and ‘denial’ were significantly different between the two groups. Discussion: The majority of the sample reported high STS. The greater use of the coping facets in the high STS group suggest that STS could be impacting on the effectiveness of coping responses. Greater awareness and screening for STS could allow for early intervention focused on secondary trauma which could support the effectiveness of the coping strategies employed. Future research should explore this relationship further and the efficacy of a trauma-based intervention.