The relationship between trait eating behaviours and food-related attentional biases

Attentional bias (AB) refers to the tendency to selectively attend to (orientation towards) and/or hold attention on (slowed disengagment from) disorder-relevant stimuli. Females with eating-related concerns are thought to preferentially process threatening stimuli, which in turn is thought to maintain and exacerbate eating concerns. The aim of the present thesis was to explore AB for threatening stimuli in females characterised by restrained, external or emotional eating, and those with high levels of (non-clinical) eating psychopathology. This was carried out with the intention of identifying cognitive processes that contribute to eating behaviours in females, in order to assess the relevance of an attention training (AT) programme for reducing such biases. A pilot study assessed orientation/slowed disengagement, for mood and food words amongst females with high/low levels of restraint. Forty females completed a modified Stroop task with three conditions. Food and mood conditions included sequences of five words ( target food/mood followed by four neutral). The neutral condition consisted of all neutral words. Performance did not significantly differ according to high/low restraint groups. All participants took longest to colour-name word position 2 (demonstrating slowed disengagement lasting one consecutive trial). However, this pattern was also found in the neutral condition. Methodological limitations were then addressed in study one. High/low restrained eaters (n=48) completed a modified Stroop where targets (food, interpersonal threat, animal) were presented prior to four neutral words. Participants were slow to disengage from targets (slowest for word position 2) in all conditions. Patterns of responding indicated that restrained eaters might take longer to disengage (i.e. the carry-over effect from the food word seemed to last longer than one trial). However, more neutral words in the sequence were needed to assess this. As slowed disengagement from animals also arose, a categorical effect may have occurred. Study two explored attention processing of food using modified Stroop and dot probe tasks. In the Stroop task targets (food, interpersonal threat, household objects) were presented prior to six matched neutral words. This task revealed no evidence of AB. No significant pattern of differences between restrained (n=29)/unrestrained eaters (n=31) emerged; however, binge eating scores were significantly negatively correlated with response times. A dot probe task with food/neutral picture pairs also revealed no evidence of AB. Both restrained/unrestrained eaters had negative mean interference scores indicating avoidance of food. None of the following eating behaviours significantly correlated with AB: restraint, disinhibition, external eating, emotional eating and non-clinical eating psychopathology. Study three employed a further modified dot probe task based on image ratings. There was no evidence of AB, and no significant relation between task performance and restrained, emotional or external eating. 2000ms bias scores (assessing disengagement) were significantly negatively correlated with eating psychopathology and age, suggesting that those with high levels of non-clinical eating psychopathology attentionally avoid food stimuli and that younger females are slower to disengage attention from food (although found within a limited age range). Study four employed further modified Stroop and dot probe tasks, and assessed whether AB mediates the negative mood-eating relationship. Participants were allocated to negative or neutral mood conditions. No evidence of AB was found with the dot probe, but greater levels of emotional eating were associated with slower responding. In the Stroop task, all participants displayed an orientation bias towards food. Emotional eating and drive for thinness (DFT) scores were significantly positively correlated with food word colour-naming times but only amongst participants in a negative mood. However, those with high levels of external eating showed greater AB towards food when in a neutral mood. Highly emotional eaters in a negative mood showed a greater desire to eat than those in a neutral mood but did not increase in food intake. Furthermore, those with a high DFT (in a negative mood) showed no evidence of increased desire to eat or food intake. AB was not significantly related to subjective appetite or food intake. Therefore, AB does not seem to mediate the negative-mood eating relationship. The present thesis provides important suggestions for modifications of Stroop and dot probe tasks targeting orientation and disengagement. A modified Stroop has been more sensitive at detecting food AB than the dot probe. Implications of biased attention processing are discussed in relation to the development of harmful eating behaviours, and the present findings have important implications for developing programmes to prevent eating disorders amongst at-risk females (e.g. through AT or training at-risk females how to effectively cope with negative mood)

Evaluation of the mid Essex Recovery College, October – December 2013

Introduction: Recovery from mental health difficulties involves a process of making sense of what has happened, becoming an expert in self-care, building a new sense of purpose, discovering your own resourcefulness, and using resources in order to pursue goals. Recovery Colleges aim to assist people in the journey to recovery through education, bringing together both professional and lived experience of mental health challenges in a non-stigmatising college environment. Following promising evaluation results elsewhere in the UK, a decision was taken to pilot a Recovery College in Mid Essex for one year, beginning in the autumn of 2013. The North Essex Research Network (NERN), a group of current or former mental health service users, was commissioned to evaluate the pilot. Methods: Recovery College students completed measures of social inclusion and mental wellbeing at the beginning of their college attendance (baseline) and again three months later (follow-up). Demographic information was collected on the baseline questionnaire and further ratings of students’ experiences of the college were collected at follow-up. The measures were supplemented with qualitative data collected via two focus groups and an individual interview. Results: Scores on both measures improved from baseline to follow-up. At follow-up the majority of participants rated their experience of the college very positively. Additional comments on the questionnaires and the views of participants in the focus groups and interview support the quantitative results. Participants identified a wide range of ways in which their wellbeing and social inclusion had improved, and also put forward suggestions for further developing the Recovery College

Zinc Arts: Promoting young people’s mental health and wellbeing through participation in the arts

Introduction Zinc Arts is a dynamic, leading arts and education charity that promotes inclusion through “arts without exception”. Zinc Arts runs a wide range of creative courses (including music, sculpture, drama, spray painting, stop-frame animation, film, and visual arts) and is underpinned by the ethos that the arts can be a very positive and powerful force in individual’s lives; awakening them creatively, inspiring future choices, providing a voice for self-expression, serving as a tool for learning, stimulating change, and resulting in a product which serves as an end in itself. ArtZone, a three-year arts programme run by Zinc Arts, involved working with young people aged 11-25 with or at risk of mental ill health through engaging them with a wide range of arts activities. The programme enabled Zinc Arts to deliver a mixture of six-to-ten week outreach projects to an array of organisations who work with young people in both secure and non-secure mental health services. Anglia Ruskin University was commissioned to provide a service evaluation of the ArtZone project from August 2012 to July 2015. Methods The evaluation comprised both quantitative and qualitative methods. The quantitative strand comprised 122 ArtZone participants (across years one to three) completing measures of mental illness severity and mental wellbeing pre/post course completion, and completing a measure of course satisfaction at the end of their course. The qualitative strand comprised focus groups and semi-structured interviews with 34 ArtZone participants during years one and two of the programme. Findings ArtZone participants significantly decreased in mental illness severity and significantly increased in mental wellbeing from pre- to post-intervention. Furthermore, participants were highly satisfied with their courses, with 99.1% rating the quality of their course as good or excellent, 96.5% indicating that the course met most or almost all of their needs, 98.3% being mostly satisfied or very satisfied with the amount of help they received and 99.1% being mostly satisfied or very satisfied with the course as a whole. Of particular importance 92.9% said that the course had helped them deal with their problems better. Furthermore, the qualitative findings revealed that the project led to a number of social and emotional benefits to participants, most notably: decreased social isolation and increased social inclusion (through an increased sense of community and connection, the development of peer support networks and friendships, increased communication and understanding); and increased mental wellbeing (through the provision of an emotional outlet, distraction, motivation, relaxation, increased self-confidence, and increased self-esteem). In addition, the qualitative strand revealed that the project sparked imagination and creativity in the participants, built new skills and competencies, and prompted thinking ahead and making future plans. Conclusion The present evaluation has found that the Zinc Arts ArtZone project has been hugely beneficial to its participants, and has achieved its aim of engaging young people with mental health problems in the arts, enabling them to use the arts to express themselves in a safe and secure setting. The findings also support Zinc Art’s ethos that the arts can be a very positive and powerful force in individual’s lives; awakening them creatively, inspiring future choices, providing a voice for self-expression, serving as a tool for learning, stimulating change, and resulting in a product which serves as an end in itself. The project has provided opportunities for over a hundred young people in both secure unit and community settings, and their engagement with and enjoyment of the project has been clearly evident. The evaluation has shown that the Zinc Arts ArtZone project has achieved important measurable outcomes, with statistically significant improvements in mental wellbeing and significant reductions in mental illness severity. Furthermore, the qualitative findings have revealed that the project has led to a number of social and emotional benefits to participants, having an impact at both an individual and community level. The evaluation results demonstrate the importance of sustaining the ArtZone programme, so that these benefits to young people with or at risk of mental ill health may continue. Further research exploring the longer-term benefits of the courses would be highly valuable

Validation of the Social Inclusion Scale with Students

Interventions (such as participatory arts projects) aimed at increasing social inclusion are increasingly in operation, as social inclusion is proving to play a key role in recovery from mental ill health and the promotion of mental wellbeing. These interventions require evaluation with a systematically developed and validated measure of social inclusion; how-ever, a “gold-standard” measure does not yet exist. The Social Inclusion Scale (SIS) has three subscales measuring social isolation, relations and acceptance. This scale has been partially validated with arts and mental health project users, demonstrating good internal consistency. However, test-retest reliability and construct validity require assessment, along with validation in the general population. The present study aimed to validate the SIS in a sample of university students. Test-retest reliability, internal consistency, and convergent validity (one aspect of construct validity) were as-sessed by comparing SIS scores with scores on other measures of social inclusion and related concepts. Participants completed the measures at two time-points seven-to-14 days apart. The SIS demonstrated high internal consistency and test-retest reliability, although convergent validity was less well-established and possible reasons for this are dis-cussed. This systematic validation of the SIS represents a further step towards the establishment of a “gold-standard” measure of social inclusion

Arts participation, mental well-being and social inclusion: Mixed methods evaluation of an Open Arts studio for people with mental health needs

Participatory arts projects are thought to increase mental well-being and social inclusion for people with mental health difficulties. This article presents a one-year evaluation of the Open Arts studio at Hadleigh Old Fire Station (HOFS) in Essex, England, established to provide opportunities for mental health service users to carry out art-making independently with professional support. The evaluation was a mixed-methods design, with qualitative and quantitative strands. A total of 23 studio members completed measures of mental well-being and social inclusion at baseline and follow-up, and scores increased significantly over time. Members’ comments indicated increased social support, confidence, motivation and mental well-being, in addition to decreased social isolation. Despite small sample sizes, this evaluation provides promising evidence of gains in mental well-being and social inclusion. The question of longer-term benefits beyond the studio placement remains to be addressed, but results add further support to the use of participatory arts in promoting mental health and well-being

Arts participation, mental well-being and social inclusion: Mixed methods evaluation of an Open Arts studio for people with mental health needs

Participatory arts projects are thought to increase mental well-being and social inclusion for people with mental health difficulties. This article presents a one-year evaluation of the Open Arts studio at Hadleigh Old Fire Station (HOFS) in Essex, England, established to provide opportunities for mental health service users to carry out art-making independently with professional support. The evaluation was a mixed-methods design, with qualitative and quantitative strands. A total of 23 studio members completed measures of mental well-being and social inclusion at baseline and follow-up, and scores increased significantly over time. Members’ comments indicated increased social support, confidence, motivation and mental well-being, in addition to decreased social isolation. Despite small sample sizes, this evaluation provides promising evidence of gains in mental well-being and social inclusion. The question of longer-term benefits beyond the studio placement remains to be addressed, but results add further support to the use of participatory arts in promoting mental health and well-being

Creative Writing through the Arts. Final full report.

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Creative Writing through the Arts. Final summary report

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A qualitative study of 2Create: A mental health service user-led art group

Background: 2Create is a mental health service user-led art group in the UK established by graduates of Open Arts, a community arts and mental health project. The study aimed to explore group members’ experiences over its first year. Methods: Semi-structured interviews were conducted with five current and one former member of 2Create. Results: Key themes related to organisation (evolving; flexibility; finance; leadership challenges), the studio environment, personal gains (social inclusion; self-esteem; well-being) and future plans (increasing membership; exhibitions; funding applications; social events). Conclusion: The gains reported indicate that 2Create is beneficial to its members. Although a number of challenges were identified, all participants identified personal and group-wide gains and emphasised that challenges are to be expected when setting up a new group. The key implication for independent mental health user-led arts groups is that support is needed in the early stages and that independence can then be achieved with time