Illness perceptions in irritable bowel syndrome: change over time and relationship with self-reported quality of life

Background: Pathways in an ‘extended’ common-sense model of illness representations (CSM) were examined in those affected by Irritable Bowel Syndrome (IBS) over time. As complementary and alternative medicine (CAM) use is extensive in IBS, participants were grouped according to CAM use (CAM-users and non-users). Methods: An online survey examined 197 participant responses (125 CAM-users, 72 non-users) at baseline and again after a minimum of six months. Illness perceptions, conventional treatment beliefs (captured by the IPQ-R and BMQ-General scale respectively), coping (Brief COPE) and domain specific quality of life (IBS-QOL) were measured at both time-points. Related t-tests were used to examine changes over time within each group and regression analyses were used to assess theorised pathways proposed by the CSM. Findings: Both groups showed improved quality of life ratings (CAM-users: t(124)= -5.97, p<.001; non-users: t(71)= -3.31, p<.01) and significantly lower emotional representations at time-two (CAM-users: t(117)= 3.33, p<.01; non-users: t(68)= 2.60, p<.05). Stronger perceptions of illness consequences CAM-users: Beta=-.67, p<.001; non-users: Beta=-.62, p<.001) and emotional representations at time-one (CAM-users: Beta=-.58; non-users: Beta=-.51, p<.001) predicted reduced quality of life at time-two in both groups. Mediation tests revealed that self-blame and behavioural disengagement mediated the pathway from illness perceptions to quality of life in the CAM-user group only. Discussion: Findings suggest some consistency with CSM theory and addressing components of illness perceptions early in the health care process may improve quality of life in those affected by IBS. CAM-users (and those intending to use CAM) may receive greater benefit from such intervention

Explaining use of complementary and alternative medicine in Irritable Bowel Syndrome: a common-sense model approach

Background: Irritable Bowel Syndrome (IBS) is a prevalent chronic functional gastrointestinal condition. Conventional medical treatment can be unsuccessful and many of those affected use complementary and alternative medicine (CAM) for symptom relief, despite concerns over CAM treatment efficacy. An ‘extended’ common-sense model of illness representations (CSM) was used to examine psychological influences on CAM use. Methods: 653 participants with IBS completed an online survey which included the Revised Illness Perception Questionnaire (IPQ-R), the (general) Beliefs about Medicines Questionnaire (BMQ), the Complementary and Alternative Medicines Beliefs Inventory (CAMBI) and questions regarding CAM use. Unrelated t-tests compared the illness and treatment perceptions of CAM-users to those not using CAM. A binary logistic regression analysis examined which factors predicted CAM use. Findings: 57% of participants reported using CAM to relieve IBS symptoms. CAM-users reported significantly stronger illness identity, illness consequences, medication harm beliefs and stronger emotional representations. CAM-users had more positive beliefs about CAM in terms of feelings towards natural treatments, client participation in treatment and beliefs in holistic treatments. Logistic regression analysis revealed 3-4 years (Odds ratio = 3.62) or over 5 years (3.19) since diagnosis, having A’ levels (1.89) or postgraduate qualifications (2.34), and stronger illness identity (1.10), consequences (1.07), cyclical timeline beliefs (1.08) and medication harm beliefs (1.10) predicted CAM use. Discussion: Findings suggest CAM use is influenced by certain illness and treatment perceptions. Health psychology interventions which address these components may have potential to improve IBS symptom management and support patient’s informed decision making regarding treatment

The role of beliefs about infertility on psychological adjustment: a systematic review

Aims Beliefs about an illness can influence psychological adjustment. This relationship has been studied using the Common Sense Model (CSM). This systematic review explores the association between perceptions of infertility, measured by the Illness Perception Questionnaire (IPQ), and psychological adjustment among patients with difficulty conceiving. Methods Six electronic databases were searched between 1996 and 2012. Results Three papers were selected. Results indicate significant relationships between perceptions of infertility and psychological adjustment. Perceptions of more severe consequences, longer timeline and lower controllability contributed to greater distress and lower well-being. Individuals’ perceptions influenced partner’s psychological adjustment. Gender differences were also observed. Conclusions The review suggests that the CSM is an appropriate framework to study infertility. Thus, interventions based on modifying perceptions of infertility may improve psychological well-being. Given the limited number of studies available and methodological limitations, further research is needed to ascertain the IPQ’s contribution to research on infertility

The Pyramid Club elementary school-based intervention: testing the Circle Time technique to elicit children’s service satisfaction

Children’s views of the social-emotional health services they use are important to service evaluation and development. However, often it is parental or clinician feedback that is gathered. In the current study Circle Time groups were run to identify children’s satisfaction with the Pyramid Club School-based intervention and to test the salience of this technique in eliciting children’s views. Children evaluated Clubs positively, reported no adverse effects and suggested ways to develop the intervention. The efficacy of Pyramid Clubs in building social-emotional competencies is supported by the children’s qualitative reports and Circle Time proved a salient technique for eliciting the views of young children

The role of rumination in adjusting to termination of pregnancy for fetal abnormality: rumination as a predictor and mediator of posttraumatic growth.

Objective: Rumination is important in adjusting to traumatic events. Evidence suggests that deliberate rumination predicts posttraumatic growth (PTG), and mediates the relationship between coping and PTG. This study examined the relationship between rumination and psychological adjustment following pregnancy termination for fetal abnormality (TFA). Method: A cross-sectional, online study was conducted with women who had undergone TFA. Women were recruited from a support organisation; 161 women completed the Brief COPE, the Perinatal Grief Scale, the Event-Related Rumination Inventory and the Posttraumatic Growth Inventory. Data were analysed using regression and mediation analyses. Results: The results show that women engaged in high levels of intrusive and deliberate rumination post-TFA and that intrusive rumination predicted grief. Intrusive and deliberate rumination predicted PTG, although intrusive rumination was a negative predictor of growth. Deliberate rumination mediated the relationship between grief and PTG. It also mediated the path between positive reframing and PTG, and religious coping and PTG, although the mediation effect depended upon the inclusion of the grief variable in the models. Conclusions: The results confirm the applicability of the PTG model to TFA and support the relevance of rumination to the PTG experience. The results also have clinical implications. Given the positive relationship between deliberate rumination and PTG, promoting interventions that encourage reflective thinking and narrative construction would benefit women post-TFA, particularly those experiencing high levels of distress and/or at risk of complicated grief.N/

Women's coping with pregnancy termination for fetal abnormality: a comparison between health professionals' perceptions and women's accounts

Background: Termination of pregnancy for fetal abnormality (TFA) may have profound psychological consequences. Evidence suggests that women’s experience of care influences the way they adjust to TFA. Yet caring for parents in these circumstances presents some challenges for health professionals, which may relate to their understanding of women’s experience. Objectives: This study examined health professionals’ perceptions of women’s coping with TFA. Data were compared with women’s accounts of their coping processes to identify similarities and differences. Methods: A qualitative study was conducted among health professionals in two fetal medicine units in England. Fifteen semi-structured interviews were conducted with a range of professionals. Data were analysed using Thematic Analysis and compared with the results of a qualitative study of women’s experience of coping with TFA. Results: Health professionals’ perceptions of women’s coping with TFA covered six areas, also present in women’s accounts: support, acknowledging the baby, problem-solving, avoidance, meaning making and another pregnancy. Health professionals also considered their role as information providers as essential in women’s ability to cope with TFA, while women, generally placed more importance on health professionals’ emotional support. Results also indicate a lack of insights into women’s long-term coping processes, although midwives appeared more knowledgeable than fetal medicine consultants on this point. Conclusion: Health professionals’ perceptions of women’s coping with TFA closely matched women’s accounts suggesting a high level of understanding. However, the lack of insight into women’s long-term coping processes has important clinical implications, as research suggests that coping with TFA is a long-term process

Evaluating the impact of the Pyramid intervention on the emotional health and school performance of students in early secondary education

Background: Poor mental health in childhood and adolescence is associated with a range of negative outcomes. The unique role of schools to support pupils with psychological difficulties has been increasingly recognized (Layard and Clark, 2014; Fazel et al, 2014). However, gaps in school-based research have provoked a demand for real-world evaluations to provide models of good practice (DH, 2013; Fazel et al, 2014). Pyramid is a targeted, school-based intervention which promotes the socio-emotional well-being (SEWB) of vulnerable pupils. Evidence from primary school evaluations has demonstrated improvements in vulnerable children’s SEWB (Ohl et al 2008, 2012; McKenna et al, 2014). Aim(s): To examine the impact of Pyramid on adolescent pupils (aged 11-13), including secondary effects on school performance. To explore intervention facilitators which bring about change. Methods: The impact of the Pyramid intervention on 45 pupils from six secondary schools was examined through a mixed-methods design. Quantitative measures included cross-informant Strengths and Difficulties Questionnaires (SDQ: Goodman, 1997, 1998). Qualitative data was collected from focus groups. Results: Teacher–rated SDQ results demonstrated improvements in the intervention group’s socio-emotional competencies compared to a comparison group. A thematic analysis of the qualitative data supported the findings and also identified potential causal mechanisms facilitating change. Moreover, secondary outcomes on school performance were elicited. Conclusion: These findings will contribute to ongoing research on a larger cohort and provide preliminary support for Pyramid as a developmentally appropriate model for vulnerable young people in early secondary education. The supplementary impact of Pyramid on school performance warrants further investigation

Nowhere to Run; Nowhere to Hide: The Reality of Being a Law Library Director in Times of Great Opportunity and Significant Challenges

This is an edited version of remarks presented at \u27Nowhere to Run, Nowhere to Hide\u27: The Reality of Being a Law Library Director in Times of Great Opportunity and Significant Challenges, January 5, 2015, at the Association of American Law Schools Annual Meeting, Washington, D.C