Rachael Kathryn Beale - Thesis submitted in partial fulfilment of the requirements of the degree of Doctor of Clinical Psychology (DClinPsych)

Systematic Review of the Literature: Multiple Concussions and Later-Life Cognitive Functioning: A Systematic Review
Aims: This study aimed to review the evidence relating to the possible association of multiple concussions with later-life cognitive decline. Method: A systematic search was performed across five databases: Medline, Embase, Web of Science, PsycINFO, and SportDISCUS. Studies were included if they were original research investigating later-life cognitive function in individuals with multiple concussion histories, in any setting, using at least one neuropsychological measure. Data on study design, participant characteristics, exposure and outcome assessment, and key findings were extracted from included studies. Risk of bias was assessed using the Newcastle-Ottawa scale. Findings were qualitatively synthesised, due to the heterogeneity of included studies, for the domains of complex attention, learning and memory, executive function, language, and perceptual-motor function. Results: Twenty-three cross-sectional studies were identified (conducted with former football, rugby, and ice hockey players, and military veterans). The strongest evidence was for a subtle effect of multiple concussions on verbal learning and memory, and language. Evidence with regards to executive function was mixed, and the evidence did not support effects in the domains of complex attention or perceptual-motor function. Discussion: This review found no conclusive evidence of a relationship between multiple concussions and later-life cognitive decline; however, the findings should be interpreted with consideration of significant methodologic limitations in the literature. Further high-quality, powered, longitudinal research is needed, which includes a wider range of populations known to sustain multiple concussions, in order to draw firm conclusions about any associations between multiple concussions and later-life cognitive decline. Clinical implications of the findings are discussed.
Service Improvement Project: “When You're on a Machine, You Want Some Kind of Humanity Around You”: An Exploration of the Psychological Needs and Experiences of Patients with End-Stage Renal Disease Treated with Haemodialysis within a Regional Renal Service
Aims: This study aimed to provide a descriptive exploration of the psychosocial needs and experiences of patients receiving hospital-based haemodialysis treatment in a regional renal service, in order to inform meaningful developments in the provision of emotional and psychological support within the service. Design: A qualitative study using semi-structured interviews and questionnaires was conducted between September and December 2020. Method: A sample of 34 patients receiving hospital-based haemodialysis treatment participated in the study. Interviews were conducted with seven participants about their experiences of living with haemodialysis and receiving support from the service. To maximise the proportion of unique patient perspectives that could be included, interview data were supplemented with open-ended written feedback from a further 27 participants. Both datasets were combined and analysed using thematic analysis. Results: Four themes were developed from the qualitative data: ‘a restricted life’, ‘the psychological impact’, ‘coping’, and ‘meeting patient needs.’ Discussion: The findings demonstrated a considerable impact on quality of life for patients living with haemodialysis and highlighted the need for an integrated approach to providing renal care. Identified needs are discussed and recommendations are made to the service to guide future developments in the emotional and psychological support offered to patients receiving haemodialysis treatment.
Theoretically Driven Research Project: Thought-Action Fusion as a Mediator of the Relationship Between Mental Imagery and Obsessive-Compulsive Symptoms
Aims: The purpose of this study was to extend research about the cognitive-behavioural model of obsessive-compulsive disorder (OCD), as it relates to intrusive mental images. It aimed to do this by investigating one mechanism potentially theorised to mediate the relationship between mental imagery and OCD symptoms, namely thought-action fusion (TAF), a cognitive bias relating to exaggerated beliefs about the morality of having certain thoughts or the likelihood that they will come true. Method: Participants (n=131) completed online measures relating to mental imagery use, TAF, and OCD symptoms. Mediation analyses were conducted using a percentile bootstrapping method. Participants were also asked questions about their lived experience of intrusive obsessional imagery. Secondary analyses (using a mix of quantitative and qualitative methods) compared the responses of participants who scored high for OCD, to those who scored low for OCD. Results: The proposed model of TAF mediating the relationship between mental imagery use and OCD symptom severity was supported in this sample. When likelihood- and moral-TAF were included in the model separately, only likelihood-TAF was a significant mediator. Also, participants scoring high for OCD reported more frequent, vivid, uncontrollable, and distressing intrusive images, and stronger likelihood- and moral-TAF appraisals of idiosyncratic intrusive images, than low scorers. Discussion: Overall, these results are in line with the key assumptions of cognitive-behavioural models of OCD. Findings are discussed, and the strengths and limitations of the study are considered.

Advisor: Steel, C
Halldorsson, B
Anderson, C
Hankinson, L
King, N