Rebecca Underwood - Thesis submitted in partial fuifilment of the degree of Doctor of Clinical Psychology (DClinPsych)
Keywords: autism
neurology
audiology
non-epileptic seizures
adjustment
cochlear implant
hearing
transgender
epilepsy
psychoeducation
neurofibromatosis
NF2
auditory brain stem implant
oncology
psychology
hearing aid

Scoping review: Does Psychoeducation for Non-Epileptic Seizures increase quality of life and/or decrease seizure occurrence?
This research examined the content and efficacy of psychoeducational interventions for non-epileptic seizures (NES) in terms of seizure frequency and quality of life. Databases were searched and seventeen eligible studies identified. Findings revealed that components and modalities of interventions varied greatly, though all included information about NES, its symptomology and the mind-body link. Methods of evaluating the interventions also varied and though reporting on significance of findings was inconsistent, there was a general trend in symptom reduction and improvement in general wellbeing. Findings illustrate that psychoeducation has potential benefit as an intervention in its own right, however inconsistency in the findings suggests that psychoeducation is unlikely to be a sufficient intervention as a standalone treatment for most people and may be best placed as a second step in a stepped care model, between initial diagnosis and further psychological treatment. Furthermore, the present literature needs replication and greater sample sizes for more certain conclusions to be drawn.

Service Improvement Project: Decision making in NF2 Hearing Interventions
The project aimed to understand experiences of people with Neurofibromatosis type 2 (NF2) under the Oxford and South West service, in terms of psychological impact of NF2 and support required for decisions to take up hearing interventions (hearing aids, auditory brain stem implants (ABI) and cochlear implants (CI)). Fifty surveys were completed and analysed. Qualitative findings demonstrated physical symptoms contributed to emotional distress, social isolation and challenged sense of identity. Quantitative findings showed people generally felt informed and ready to take up hearing interventions, with many feeling satisfied with the outcome. People without CI/ABI expressed that surgery risk and visibility of devices were barriers. Service recommendations include increasing accessibility of psychological support before interventions, greater provision of information, and consideration of communication and emotional needs of patients.

Theory Driven Research Project: How do autistic traits influence affirmative experiences of gender identity?
This research examined the experiences of gender diverse people with differing levels of autism spectrum disorder (ASD) traits in their physical and social affirmations of gender. Responses to an online survey were split into two groups and analysed according to high and low ASD trait levels. Findings revealed that no differences existed between the groups in importance and sense of passing as their identified gender. There were also no differences between groups in social belonging to gender diverse groups and gender congruence. The only significant difference found was that people with higher levels of ASD traits reported lower psychological functioning. Thus, services need to be mindful of ensuring they are autism-informed in their standard approach and recognise the additional stress that ASD can place on wellbeing. This is particularly salient when people belong to multiple minority groups where impression management occurs across an intersection of stigmatised identities.