The COVID-19 Clinician Cohort (CoCCo) Study: Empirically Grounded Recommendations for Forward-Facing Psychological Care of Frontline Doctors

In this book, we focus on health and wellbeing in the workforce within the context of the global COVID-19 pandemic, and the post-pandemic era. We begin by exploring the impacts of the pandemic on diverse occupational groups, considering the broader mental health impacts of the pandemic, reactions to national lockdowns and behavioural strategies to control the spread of the virus, such as social distancing and self-isolation, attitudes towards infection control and work presenteeism. Next, we explore the relationship between job factors, working conditions and psychological wellbeing of employees. The papers that follow examine changes in work patterns and locations, such as remote, hybrid, and on-site working, the impact of organizational climate on mental wellbeing, and organizational approaches to return-to-work after lockdown. Finally, we present innovative organizational- and individual-level pandemic mitigation interventions, including SARS-CoV-2 testing services and infection control approaches, digital mental health support, and COVID-19 Vaccine Education. This collection demonstrates the breadth of research on work, health and wellbeing, during and beyond the COVID-19 pandemic, covering workforce impacts and workforce interventions in various countries and settings. Learning from this research will help to build global preparedness for future pandemics and foster resilience for responding in times of crisis and uncertainty

Reducing intrusive traumatic memories after emergency caesarean section: A proof-of-principle randomized controlled study.

UNLABELLED: Preventative psychological interventions to aid women after traumatic childbirth are needed. This proof-of-principle randomized controlled study evaluated whether the number of intrusive traumatic memories mothers experience after emergency caesarean section (ECS) could be reduced by a brief cognitive intervention. 56 women after ECS were randomized to one of two parallel groups in a 1:1 ratio: intervention (usual care plus cognitive task procedure) or control (usual care). The intervention group engaged in a visuospatial task (computer-game 'Tetris' via a handheld gaming device) for 15 min within six hours following their ECS. The primary outcome was the number of intrusive traumatic memories related to the ECS recorded in a diary for the week post-ECS. As predicted, compared with controls, the intervention group reported fewer intrusive traumatic memories (M = 4.77, SD = 10.71 vs. M = 9.22, SD = 10.69, d = 0.647 [95% CI: 0.106, 1.182]) over 1 week (intention-to-treat analyses, primary outcome). There was a trend towards reduced acute stress re-experiencing symptoms (d = 0.503 [95% CI: -0.032, 1.033]) after 1 week (intention-to-treat analyses). Times series analysis on daily intrusions data confirmed the predicted difference between groups. 72% of women rated the intervention "rather" to "extremely" acceptable. This represents a first step in the development of an early (and potentially universal) intervention to prevent postnatal posttraumatic stress symptoms that may benefit both mother and child. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT02502513

Using a Novel Gameplay Intervention to Target Intrusive Memories After Work-Related Trauma: Iterative Qualitative Analysis of Intensive Care Unit Staff Experiences

Background: Many intensive care unit (ICU) staff experience intrusive memories following work-related traumatic events, which can lead to long-term mental health outcomes and impact work functioning. There is a need for interventions that target intrusive memories in this population; however, factors such as mental health stigma and difficulty in fitting interventions into busy schedules can pose barriers. The Brief Gameplay Intervention For National Health Service Intensive Care Unit Staff Affected By COVID-19 Trauma (GAINS) study tested a brief, digital imagery-competing task intervention (including computer gameplay) with the aim of reducing the recurrence of intrusive memories, which holds promise for overcoming some of these barriers.Objective: This substudy aims to explore barriers and facilitators to the uptake and practical use of the intervention by ICU staff, along with its acceptability, and iteratively explore the impact of intervention optimizations to further refine the intervention.Methods: The GAINS study is a randomized controlled trial comparing access to a brief digital imagery-competing task intervention for 4 weeks with usual care followed by delayed access to the intervention. The participants were ICU staff who worked during the COVID-19 pandemic and experienced intrusive memories. All participants were sent a questionnaire at 4 weeks to gather data about intervention acceptability. Nested within the randomized controlled trial, a subset of 16 participants was interviewed, and data were analyzed using thematic analysis drawing from a framework approach.Results: Both quantitative and qualitative data indicated high acceptability of the intervention. Intervention use data show that, on average, staff were able to target approximately 73% (3.64/4.88) of their intrusive memories and engaged with the Tetris component for the full 20 minutes per session. Overall, on the acceptability questionnaire, staff found the intervention easy to use, helpful, and highly acceptable. The interviews generated four themes: approach to the intervention, positives of the intervention, negatives of the intervention, and improvements and optimizations. Findings highlighted barriers that ICU staff experienced: stigma, feeling weak for seeking help, not wanting colleagues to know they were struggling, and skepticism. However, they provided suggestions on how barriers could be overcome and discussed the advantages of the intervention when compared with other treatments. Although participants described many positive aspects of the intervention, such as being easy to use, enjoyable, and leading to a reduction in the frequency or intensity of intrusive memories, they also raised practical issues for implementation.Conclusions: The intervention has the potential to overcome stigma and reduce the frequency of intrusive memories after traumatic events among ICU staff. Further refinement is needed to improve the adoption and reach of this intervention. A limitation is that we could not interview the National Health Service staff who were unable or unwilling to take part in the trial

The COVID-19 Clinician Cohort (CoCCo) Study: Empirically grounded recommendations for forward-facing psychological care of frontline doctors

This study aimed to develop empirically grounded recommendations and a coherent model of psychological care derived from the experiences and psychological care needs of COVID-19 frontline doctors, using semi-structured interviews and thematic analysis. Participants were UK frontline doctors specialising in Emergency Medicine, Anaesthetics, or Intensive Care (n = 31) purposively sampled for maximum variation on gender, specialty, ethnicity, and trauma-related dis-tress; most worked in ICU during the pandemic (71%). Four themes were derived: (1) ‘coping strategies’, participants used many, including exercise, mindfulness, and “wait until it gets really bad”; (2) ‘sources of support’, participants valued embedded psychological support, digital services, and informal conversations with colleagues or family, though there was little opportunity; (3) ‘organisational influences on wellbeing’, participants reported a love–hate relationship for concepts like ‘wellbeing’, seen as important but insulting when basic workplace needs were unmet; (4) ‘improving engagement with support’, analysis suggests we must reduce physical and psychological barriers to access and encourage leaders to model psychologically supportive behaviours. Doctors’ front-line COVID-19 working experiences shine a ‘spotlight’ on pre-existing problems such as lack of physical resources and access to psychological care. Empirically grounded recommendations and a model of incremental psychological care are presented for use in clinical services

Understanding expressed emotions : Illness perceptions in people with bipolar disorder and their relatives

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Clinical translation of a simple cognitive task to reduce the occurrence of intrusive memories after a psychological trauma

Preventive interventions after psychological trauma are lacking. Intrusive memories in the first few weeks after a traumatic event can be highly distressing, and also predict later post-traumatic stress disorder (PTSD). Laboratory studies with healthy volunteers have found that engaging in a visuospatial cognitive task soon after an experimental trauma film can reduce the frequency of intrusive memories over the following week. The aims of this research were to a) develop the a simple cognitive task intervention (a memory reactivation cue followed by playing the computer game "Tetris") for use in a hospital emergency department (ED) with patients who had experienced a road traffic accident, and b) provide a preliminary test of the efficacy of the intervention using a randomised controlled trial design. First, the current evidence base for preventive interventions after trauma was reviewed, and theory was drawn from experimental psychology and clinical psychology to propose that delivering a simple cognitive task involving playing Tetris in the immediate aftermath of trauma may offer a novel preventive intervention for PTSD symptoms (Chapter 1). Next, the laboratory procedure was adapted for use in a hospital ED, based on direct observation in the ED, and existing literature (Chapter 2). An initial pilot study (n = 10) tested key procedures in the ED, namely recruitment of road traffic accident patients, practical delivery of the intervention and completion of an intrusion diary over the first week (Chapter 3). A second pilot study (n = 23) was conducted to improve the study procedures, test both the intervention and control conditions, and assess participant experience (Chapter 4). The recruitment rate, eligibility criteria, drop-out rate and completion rate of the intrusion diary were all improved. Participant feedback was used to refine the intervention and control procedures. Finally, a main randomised controlled study (n = 71) was conducted, comparing the simple cognitive task intervention with usual care in the emergency department (with a simple activity diary). As predicted, participants in the intervention group had fewer intrusive memories in the first week, and less severe clinical intrusion symptom scores, than those in the control group. Further, participant feedback highlighted the value of being offered an intervention in the emergency department. This research was the first to successfully translate laboratory findings to a clinical emergency department setting. Findings provide a first step towards developing an accessible, low intensity preventive intervention to target intrusive memories after trauma. Further trials and mechanism studies are warranted.</p