Sazan Meran - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych)

Critical Review of the Literature
Background: Chemical warfare agents (CWA) cause death and injury to humans through their toxic properties. Despite their ban under international law, CWAs have been used to attack civilians by both state and non-state actors.
Objectives: To synthesise available evidence on the psychological impact of attacks using CWAs on civilian populations, assess the quality of this data, and identify gaps in the literature.
Methods: Key words relating to “chemical warfare agents”, “civilians” and “psychological impact” were searched via PsycINFO, CINAHL, PubMed and Scopus. Studies were assessed using predefined eligibility criteria and assessed for quality. Nineteen studies were included.
Results: There is evidence that CWA attacks can create a considerable burden of mental ill-health in civilian populations, with elevated levels of PTSD, anxiety, and depression persisting decades after the event. Chemical weapons attacks appear to have a unique psychological impact, over and above that caused by conventional warfare.
Discussion: Further research using psychological in addition to epidemiological outcome measures are needed. Studies investigating whether psychological treatments are effective in CWA-exposed populations are also needed. The quality of research can be strengthened using appropriate comparison groups, tighter accounting for confounding variables, and improved sampling techniques.

Service Improvement Project
OCD is common in children, with many adult sufferers reporting onset of the disorder in childhood. Whilst CBT (including ERP) is an effective and NICE-recommended treatment for OCD, individuals typically struggle to access this via Child and Adolescent Mental Health Services (CAMHS). OCD UK is a service-user run charity providing CBT-informed educational workshops for parents of children with OCD. Using a mixed-methods approach, we evaluated the impact of these workshops. Parents’ understanding of and confidence in managing OCD substantially increased post-workshop. Other outcomes included increased hope of recovery, reduced parental guilt, improved parent-child relationships and less distress among both parents and children. Thematic analysis of focus group data yielded four overarching themes: (i) feeling let down by the NHS, (ii) barriers to workshop attendance, (iii) the value of lived experience, and (iv) improved family relationships and coping. Parents’ recommendations for improvement related to better advertising and reducing barriers to workshop attendance.
Theory Driven Research Project
Background: There is a longstanding health inequality in access to talking therapy, with black and minoritised ethnic individuals less likely to be referred to psychology and to be offered therapy post-assessment. However, there is little understanding of the barriers causing this disparity. This study investigates whether discrimination by clinicians when assessing suitability for therapy plays a role.
Methods: The impact of race and accent (a proxy for perceived migrant status) on clinical decisions about a client’s suitability for therapy is explored. 161 clinicians providing psychological therapy and working in the United Kingdom participated, completing measures in response to watching one of four video vignettes depicting a fictional client with depression.
Results: There was a significant effect of race on suitability for therapy scores, although not in the predicted direction, with black conditions scoring more highly than white conditions. There was no significant effect of accent and no significant interaction effect of race and accent on suitability for therapy scores.
Discussion: Results indicate that a client’s race plays a role in clinical decision-making about their suitability for therapy. Further research is needed to understand this role and to investigate the barriers leading to a pronounced inequality in access to psychological treatment.

Keywords: racism
sulphur mustard
health inequalities
chemical weapons
obsessive compulsive disorder
CAMHS
mental health
psychology
sarin
talking therapy
lived experience
access
workshops
civilians
psychological impact
parents
discrimination
third sector
Advisor: Carrigan, N
Salkovskis, P
Thew, G