Saba Hassan - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych)
Keywords: non-syndromic craniosynostosis
fear of falls
eating disorders

Systematic reviewObjectives:
This systematic review focuses on neuropsychological outcomes in school-aged children (5-17yrs old) with a confirmed diagnosis of non-syndromic craniosynostosis (NSC). Methods: PsycINFO, PubMed & CINAHL, and reference lists of previous reviews were searched until March 2023. Inclusion criteria: Standardised neuropsychological tests, were performed on children between the age range of 5-17 years old, and quantitative data was available. Two raters were used for screening, eligibility, extraction, and quality assessment.
Results: 18 eligible studies were included in this systematic review. The quality of studies was mixed, with n=7 “strong”; n=5 “moderate”; n=6 “weak”. Data indicated that children with sagittal, metopic and Unicoronal NSC were not significantly different in Full Scale Intelligence Quotient (FSIQ) and specific cognitive domains in comparison to controls. Sagittal NSC patients most consistently demonstrated no difference in cognitive profile from the general population. For metopic patients, some studies showed a more uneven cognitive profile. Unicoronal focussed studies showed cognitive differences between left/right sides. However, these two sub-types had lower sample sizes in general.
Discussion: Overall, evidence to date indicates children with NSC are performing similarly to controls, with some differences between suture sub-types. Higher quality research studies are needed to draw reliable conclusions regarding outcomes in this population. However, there is an improvement in quality since 2015. The biological, developmental, and environmental factors that may mediate the results are discussed. Finally, recommendations are made to future researchers for acknowledgments of bias, improved methodological quality and directing research toward those in hard-to-reach populations.
Service Improvement Project
Aims: This service improvement project aimed to increase access to psychological support for older adults admitted to the Major Trauma Centre (MTC) who have a Fear of Falls (FOF). This entailed working in conjunction with MTC physiotherapists to promote the use of cognitive behavioural therapy (CBT) strategies and developing a psychoeducation resource for older adults.
Methods: This project was carried out in three phases: Phase 1 involved scoping of the literature and current interventions used by physiotherapists and their response to proposed interventions. Phase 2 consisted of the development of resource materials including a psychoeducation workbook for older adults with FOF to use in the MTC and designing and implementing a staff training session on working psychologically with FOF. Phase 3 involved an informal evaluation of the materials developed using a questionnaire on confidence and knowledge of FOF pre and post training and qualitative feedback on the psychoeducation workbook.
Results: Findings from phase 1 revealed limited inpatient interventions for FOF in older adults in the United Kingdom. Staff were motivated to attend training and have more access to resources such as psychoeducation. In phase 2, a psychoeducation workbook and training session were developed. In phase 3, staff rated their confidence and knowledge as being higher post training; main differences included psychological explanations of FOF and introduction of cognitive restructuring strategies. Staff gave positive feedback on the use of a psycho-educational workbook and felt it would be a useful resource across inpatient wards.
Discussion: Future directions of this project should look at formal evaluations over longer time points to assess the impact of psychoeducation material and training with both physiotherapists and the older adult population admitted to the MTC.
Theory Driven Research Project
Aims: Current cognitive behavioural conceptualisations of eating disorders (EDs) place an emphasis on dysfunctional assumptions (DAs) relating to shape, weight, eating and size, and give little attention to addressing longitudinal or predisposing cognitions such as core beliefs. The current study aimed to compare the role of DAs and core beliefs in an adult female sample grouped into “low ED symptoms” and “high ED symptoms”. Further exploration focused on the content of the core beliefs, specifically “self-loathing” and whether this uniquely contributed to high ED symptoms, even when potential covariates were controlled. Finally, it was investigated whether participants’ qualitative responses were in line with our current understanding of the contents of these beliefs.
Method: A mixed method cross sectional method was employed in a non-clinical sample. The high group (n=82) and low group (n=77) completed demographic measures, measures of ED symptoms, DAs, and core beliefs relevant to EDs, as well as measures of potential covariates. A further content analysis was conducted to ascertain participant self-beliefs.
Results: Mixed method ANOVAs, post hoc t-tests and regression analyses were used. There was a significant difference between high and low ED symptom groups on DAs and negative self-beliefs (NSB’s), with the high symptom group reporting higher scores on DAs and NSBs than the low ED symptom group. There were significantly higher DAs than NSBs in the high ED group compared to the low group. Further analyses revealed that DAs accounted for more variance in ED symptom severity than core beliefs. The secondary analyses revealed all core belief subscales were higher in the high ED symptom group compared to the low ED symptom group revealed no significant interaction between different core belief subscales in the low and high groups. However, when self-loathing was analysed, it explained a small but significant amount of variance in symptom severity, over and beyond other sets of core beliefs. The content analysis revealed that self-loathing statements were significantly stronger in the high symptom group and matched those found in the “self-loathing” subscale of the measure.
Conclusions: The hypotheses were partially supported. DAs explained greater variance in ED symptom severity than negative core beliefs in this sample. This supports current understanding about the vital role of DAs in EDs. However, self-loathing beliefs were unique in explaining some variance in ED symptoms. This study was limited by using a non-ED sample and did not control for comorbidities. Future studies may focus on investigating self-loathing further as a potentially key core belief in relation to ED symptoms.