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

Systematic Review of the Literature: What factors are associated with engagement in and adherence to psychological therapy for adults with Non-Epileptic Attack Disorder?
Purpose: The purpose of this review was to collate and synthesise the literature on the factors associated with engagement and adherence to psychological therapy as a treatment for adults with Non-Epileptic Attack Disorder (NEAD). Methods: Five electronic databases were systematically searched (PsycInfo, PubMed, CINAHL, MEDLINE, and EMBASE). The quality of these was assessed using the Mixed Methods Appraisal Tool. Results: The search was performed across five databases on the 22nd February 2022, and returned 2,150 papers. Thirteen papers were included in the review, which were of varying quality. Three of the papers were qualitative and 10 were quantitative. The papers reported several different factors associated with engagement and adherence, which spanned across the five dimensions of the World Health Organisation Multidimensional Adherence Model. Demographic characteristics associated with adherence include older age, having a carer, taking anti-epileptic medications, and being unemployed. Reasons people gave for not engaging with or adhering to psychological therapy included logistical barriers, not feeling ready, and not agreeing with the diagnosis of NEAD. A single motivational interviewing session, a brief NEAD educational session, and offering telepsychology appointments was found to significantly increase adherence. Conclusion: The factors associated with engagement and adherence to psychological therapy in NEAD are multifaceted and are not all patient related factors, despite most research being in this area. Future research should involve trialling interventions while controlling for the time spent with the patient.

Service Improvement Project: Investigating the decision-making process regarding surgery for parents of children with craniosynostosis at the Oxford Craniofacial Unit.
Objective: This Service Improvement Project explored the current decision-making process regarding corrective surgery for Craniosynostosis; a decision made by parents/carers on behalf of their children. The study examines what information parents use to make this decision, as well as exploring what is being done well, and what could be improved within the service. Design: Online qualitative surveys were used to collect data. Setting: The study was conducted at one of the five highly specialised Craniofacial centres in the UK. Participants: Eighteen parents of children with Craniosynostosis and ten MDT members participated in the project. Main Outcome Measure(s): Qualitative surveys were analysed using Thematic Analysis. The parent and MDT surveys were analysed separately. Analysis was guided by the Theory of Reasoned Action and Theory of Planned Behaviour. Results: The analysis showed that the MDT are promoting shared decision making across the team. Parents base their decision on a number of factors, including their risk tolerance, values around appearance, and the opinions of others (e.g. society and family/friends). The parents discussed the challenges of the decision and the associated difficult emotions, but praised the support offered by the Craniofacial Team. Suggested improvements to the process are detailed. Conclusions: The decision about corrective surgery is an emotive experience for parents, however this is a process parents feel supported with by the Oxford Craniofacial Team. Suggestions to improve this process for parents even further are listed.

Theory Driven Research Project: Exploring the Impact of Perceived Social Support as a Moderator of the Relationship Between Perceived Public Stigma and Negative Outcomes in Bell’s Palsy
Objective: The main aims of this study were to explore the differences in perceived social support between people with Bell’s Palsy (BP) and the general population, and to test for a potential association between perceived stigma and psychological distress in the BP population. Perceived social support was tested as a potential moderator of this relationship. Design: This study employed a cross-sectional survey design. Participants: Ninety-four people with BP and ninety-one controls without BP participated in this study. Main Outcome Measure(s): Perceived Stigma Questionnaire, Multidimensional Scale of Perceived Social Support, Patient Health Questionnaire-8 (depression measure), and Generalised Anxiety Disorder Assessment-7. Results: People with BP reported significantly lower levels of perceived social support and higher levels of depression and anxiety compared to people in the general population. Perceived stigma was significantly associated with (and predicted) negative psychological outcomes, but perceived social support did not moderate this relationship. Conclusions: Limitations of the study are discussed. Future research should explore other potential moderators of the relationship between stigma and psychological outcomes.

Advisor: Jenner, S
McFarlane, F
Lloyd-White, S
Moore, C
Hamilton, K