Dr Lucy Hale

Aims: Children and young people (CYP) with type 1 diabetes (T1D) are at increased risk of disordered eating. This study aimed to determine the feasibility and acceptability of a novel, theoretically informed, two-session psychoeducational intervention for parents to prevent disordered eating in CYP with T1D.Methods: Parents of CYP aged 11-14 years with T1D were randomly allocated to the intervention or wait-list control group. Self-reported measures including the Diabetes Eating Problem Survey-Revised (DEPS-R), Problem Areas in Diabetes Parent Revised (PAID-PR), Child Eating Behaviour Questionnaire subscales (CEBQ), Warwick Edinburgh Mental Wellbeing Scale (WEMWBS), clinical outcomes (e.g. HbA1c, BMI, medication and healthcare utilisation) and process variables, were collected at baseline, 1-and 3-month assessments. Acceptability data were collected from intervention participants via questionnaire.Results: Eighty-nine parents were recruited, which exceeded recruitment targets, with high intervention engagement and acceptability (

Background Food allergy (FA) impairs psychological wellbeing because of constant vigilance, planning and preparation, dietary and social restrictions, and fear of accidental ingestion, though psychological interventions are sparse. Objective To examine online, group, low-intensity psychological interventions for adults, children, young people (CYP), and parents with food allergies. Methods The randomized controlled trials assessed the feasibility and signal of the efficacy of a psychological intervention for adults, CYP, and parents with FA. Participants were randomized to receive the psychological intervention or treatment as usual. The intervention consisted of two, 3-hour manualized online sessions spaced 1 week apart. All participants completed relevant Food Allergy Quality of Life Questionnaires (FAQLQ) and worry (Penn State Worry Questionnaires), in addition to exploratory outcomes, at baseline, 1 month, and 3 months. Results A total of 129 participants (n = 44 adults, n = 52 CYP, and n = 33 parents) were recruited and randomized; 95 (74%) (n = 36 adults, n = 35 CYP, and n = 24 parents) were retained at 3 months. Owing to baseline differences, mean change was used for parent and CYP outcomes. The psychological intervention demonstrated large FAQLQ benefits across adults (g = −1.12, 95% CI −0.41 to −1.28), CYP (g = 1.23, 95% CI 0.51-1.95), and parents (g = 1.43, 95% CI 0.54-2.30) compared with controls at 3-months. Conclusion This study provides encouraging findings regarding the feasibility of online, group, low-intensity psychological interventions, in terms of recruitment and retention as well as a signal of efficacy on FAQLQ. A definitive trial including health economic analysis and FA-specific psychological measures with consideration of best routes to implementation, is warranted.

Aims Increasing evidence suggests that children and young people with type 1 diabetes (T1D) are at greater risk of disordered eating compared to children without T1D. Disordered eating in T1D has been linked to impaired well-being, increased health service use, and early mortality. To address this problem, we will co-develop a psycho-education intervention for parents of children and young people with T1D, informed by the Information Motivation Behavioural Skills model. Methods The objective of this study is to assess the feasibility and acceptability of the intervention compared to a waitlist control group using a feasibility randomised controlled trial (RCT) design. We aim to recruit 70 parents of children and young people with T1D (11-14 years), 35 in each arm. Those assigned to the intervention will be invited to participate in two workshops of two hours each. Parents will be asked to complete outcome measures regarding eating habits, diabetes management, as well as a questionnaire based on the Information Motivation Behavioural Skills model which provides a theoretical foundation for the intervention. These will be completed at baseline, 1- month and 3-months post intervention. Children and young people will be asked to complete questionnaires on their eating behaviours at the same time intervals. Parents randomised to receive the intervention will be invited to take part in interviews to feedback on the intervention and research protocol acceptability. Conclusion It is anticipated that the psycho-education intervention aimed at parents will help prevent the development of disordered eating in children and young people with T1D and improve parental wellbeing. The results of this feasibility trial will determine whether this intervention approach is acceptable to families living with T1D, and whether a definitive RCT of intervention effectiveness is justified. Qualitative findings will be used to refine the intervention and study protocols.

The impact of having a child with diagnosed obsessive-compulsive disorder (OCD) can reportedly cause significant disruption to caregiver routines and negatively affect their mental health. Less is known about the impact to other first-degree relatives such as siblings due to limited research. It should not be assumed that findings in the caregiver literature can simply be applied to siblings. This study, therefore, aimed to explore the experiences and responses of cohabiting siblings of a brother or sister with an OCD diagnosis. Eight participant siblings were recruited from a UK specialist OCD NHS clinic and interviewed via telephone about their experiences co-habiting with a brother or sister with OCD. Interviews were transcribed and subjected to interpretative phenomenological analysis (IPA). Two superordinate themes of 'OCD as a dangerous dictator' and the 'unifying/polarising influence of OCD on relationships' were interpreted from the eight participant experiences. Siblings spoke to OCD creating a dictatorial environment characterised by sibling loss, helplessness and adjustment. This fragile domestic environment seemingly pushed non-anxious siblings to the periphery of the family or conversely centralised their position through parentification. Many of the sibling experiences of frustration, distress avoidance, helplessness and symptom accommodation are mirrored in the burgeoning caregiver literature. Longitudinal studies are required to track sibling experiences over the course of their siblings OCD journey and expand our knowledge in this area. Counselling services, sibling support groups and inclusion in family assessment, formulation and treatment are possible avenues of exploration for siblings of those with an OCD diagnosis.

Children and young people (CYP) with type 1 diabetes (T1D) are twice as likely to develop disordered eating (T1DE) and clinical eating disorders than those without. This has significant implications for physical and mental health, with some eating disorders associated with repeated diabetic ketoacidosis and higher HbA1c levels, both of which are life threatening. There is currently limited psychological support for CYP and families with T1D but increasingly, policy and practice are suggesting disordered eating in T1D may be effectively prevented through psychological intervention. We describe the development and theoretical underpinnings of a preventative psychological intervention for parents of CYP aged 11-14, with T1D. The intervention was informed by psychological theory, notably the Information Motivation Behaviour Skills model and Behaviour Change Technique Taxonomy. The intervention was co-developed with an expert advisory group of clinicians, and families with T1D. The manualised intervention includes two online group workshops, and supplementary online materials. The intervention continues to evolve, and feasibility findings will inform how best to align the intervention with routine care in NHS diabetes teams. Early detection and intervention are crucial in preventing T1DE, and it is hoped that the current intervention can contribute to improving the psychological and physical wellbeing of young people and families managing T1D.

Eating disorders (EDs) have an estimated prevalence rate of 1%–5% across Europe. Effective adjunct interventions are needed to support the 20%–40% of families whose recovery requires additional support to first line approaches. This systematic review and meta‐analysis aimed to establish whether multi‐ family therapy (MFT) improves the physical and psychological health of patients and family members. Searches were conducted in PsycINFO, MED-LINE, PubMed, EMBASE, CINAHL, and the Cochrane Library in March 2021. 15 studies (850 patients) met the inclusion criteria. Meta‐analysis demonstrated MFT resulted in significant benefits in weight gain, ED symptoms, patients' and parents' depression symptoms, and parents' negative experiences of caregiving. However, significant improvements were only evident when comparisons were drawn before and after the intervention; these dissipated when MFT was compared to another intervention. There was no evidence MFT improves family functioning, positive aspects of caregiving, nor patient and parental anxiety. Intervention completion rates ranged from 86% to 100% indicating a high level of acceptability. Studies varied with regard to intervention length and structure, follow‐up period, and outcome measures uti-lised; most were rated as moderate or weak in methodological quality. More rigorous and large scale randomised controlled trials are needed to fully assess the effectiveness of MFT.

BackgroundEating disorders have the highest mortality rates among psychiatric conditions. It is imperative that health professionals are able to recognise the symptoms of eating disorders and are aware of how to signpost to the appropriate treatments. Trainee clinical psychologists are likely to come into contact with people suffering from an eating disorder, and it is important that they are trained to recognise the signs and symptoms, treat if appropriate, or signpost to an eating disorder service. The British Psychological Society’s Faculty for Eating Disorders (FED) provide guidelines on ensuring trainees receive appropriate learning opportunities to work with people with eating disorders.  Aims This project aimed to gather information on the current eating disorder training provided on doctoral training programmes in clinical psychology in the UK. It also aimed to provide data on the eating disorder teaching provision and eating disorder placement and research opportunities available to trainees. This information will be of interest when the pending updated FED teaching guidelines are published later this year.MethodsThis project was an evaluation. Participants included representatives from UK clinical psychology doctoral programmes. Participants completed an online survey answering questions on their course’s eating disorder teaching, placement and research opportunities. The survey involved both quantitative and qualitative items and was analysed using descriptive statistics and content analysis.Results Ten respondents (N = 10) out of the 31 courses contacted took part in the survey (a response rate of 32%). Teaching Provision ·      100% of course respondents reported providing specific eating disorder teaching delivered by an eating disorder specialist psychologist. ·      Courses reported offering specialist teaching in Year 1 and Year 3.·      One course reported providing 0-4 hours of eating disorder specific teaching, seven courses reported providing 5-8 hours of this teaching, and two courses reported providing 12+ hours of this teaching. ·      Some courses reported not having a modular structure to their course, however those that do stated that eating disorder teaching took place across a variety of modules. These modules included those focused on young people and families, adult mental health, evidence-based practice, Cognitive Behaviour Therapy, and Systemic Therapy. ·      One course reported having a specific eating disorder teaching ‘strand’ in their course structure. Eating disorder Placement Provision ·      100% of course respondents offer placement to trainees in eating disorder services. These were offered across years 1-3. Eating Disorder Research Provision·      44% of course respondents reported employing eating disorder specialist staff who can supervise doctoral research projects in the area of eating disorders. ·      100% of course respondents reported having other staff members and links with external psychologists who have the potential to supervise doctoral research projects in the area of eating disorders. ·      Of the 10 institutions who responded, 87.5% have a trainee completing their doctoral research in the area of eating disorders, and 55.5% have a trainee completing a service-related project in this area.  Approach to eating disorder teaching, placement and research provisionOne course mentioned the need to cover eating disorder teaching in first year as first years are likely to work with clients where the main presenting problem is not an eating disorder, but unhealthy eating habits are present. Another course mentioned the need to integrate learning on the separate teaching sessions on children with eating disorders and the adult with eating disorders. One course noted the opportunity for their trainees to meet certain learning objectives in their final year if they wish to pursue a career in eating disorders. Conclusions and recommendations The results of this study provide data on the current standards of the provision of eating disorder learning opportunities which will be of interest when the BPS FED release their guidelines on teaching later this year. It would be beneficial to re-run this project when the pending guidelines have been released and for more course directors to complete the survey, so the data is more representable of UK courses. It would be interesting to then compare these results against the published guidance and see whether any consistent discrepancies across courses exist. This would enable further development and dissemination of good practice in relation to eating disorder training provision.

Cognitive behaviour therapy (CBT) is the recommended psychological therapy for obsessive compulsive disorder (OCD). However, CBT is not a panacea with only moderate response rates and relatively high drop-out rates. A mindfulness-based approach could enable people to notice intrusive thoughts without attaching significance and meaning to them. The purpose of this paper is to establish a rationale for using mindfulness for OCD and then to review the evidence for mindfulness-based approaches for OCD and to address three questions: (1) is mindfulness-based therapy effective in reducing symptoms of OCD? (2) is mindfulness-based therapy acceptable to people diagnosed with OCD, and (3) if effective, what are the mechanisms of change following mindfulness-based therapy for OCD? An electronic literature search was conducted using six databases. The final papers selected for review consisted of four empirical studies investigating mindfulness techniques in the treatment of OCD. The four empirical research papers retrieved included two single case studies, one A-B-C replication case series and one quasi-randomised controlled trial of a mindfulness group. All of the studies reviewed found positive effects of mindfulness on symptoms of OCD. This literature review provides an early indication that mindfulness-based therapy has promise as an intervention for the treatment of OCD. However, the conclusions drawn are limited by the designs used in the studies. The largest, arguably most rigorous study to date was conducted among a non-clinical sample.

This study examined a theoretical model that suggests family/carer accommodation mediates the relationship between family/carer distress tolerance (more specifically, intolerance of uncertainty (IU) and tolerance of negative emotions; TNE) and OCD symptom severity. Thirty two adults experiencing symptoms of OCD and someone who lived with them completed a survey comprising of screening questions, demographic information and self-report questionnaires (total N=64). The mediation analysis found that the 95% confidence intervals crossed zero, showing that levels of relational accommodation did not significantly mediate the relationship between carer IU or TNE and OCD symptom severity. Furthermore, carer IU and TNE did not significantly predict levels of accommodation to the OCD symptoms. Levels of accommodation predicted OCD symptom severity (p<.05), but this did not remain significant when controlling for carer mental health. This is the first study to examine whether accommodation of OCD symptoms mediate the relationship between distress tolerance in a significant other living with someone with symptoms of OCD and OCD symptoms. This study concluded that accommodation of the OCD symptoms is common amongst adults with OCD who live with someone. The proposed theoretical model was not supported empirically in this study and the hypothesised factors explained a limited amount of the variance in levels of accommodating behaviours. It was concluded that although the study was underpowered, there are likely to be other factors not accounted for in the proposed model that explain some of the variance in accommodating behaviours. Whilst the study replicated the finding that there is a significant correlation between levels of family accommodation and OCD symptom severity, it calls for the need to control for carer mental health in analysis. The authors continue to develop the study to investigate factors that predict levels of accommodation, in addition to developing the mediation model proposed.

This evaluation aims to provide insight into trainees’ experience of delivering cognitive behavioural therapy (CBT) whilst on placement. Thematic analysis was employed to analyse data from a focus group consisting of trainees on a selected clinical doctorate programme. Results highlighted the importance of supervisors’ CBT background, teaching focused on the structure and the providing of materials, and trainees’ reactions to CBT. Future directions were suggested for enhancing CBT training and further evaluation.

Objective: Socio-emotional difficulties are thought to be important maintaining factors of eating disorders. Several studies point to deficits in facial affect recognition in anorexia nervosa (AN). However, the majority of these studies fail to control for comorbidity and its effect on emotional processing. This study aims to explore how patients with AN recognize happiness and sadness in human faces, controlling for different comorbidities, namely anxiety, depression, and obsessive-compulsive symptoms. Methods: Thirty patients with AN, and 40 healthy participants completed a facial emotion recognition task. This task measured discrimination accuracy, response bias and response time towards sad and happy faces presented at different durations (500 ms, 2000 ms). The associations between facial affect recognition and clinical symptoms and intelligence quotient were explored. Results: Regression analysis showed that discrimination accuracy of sad faces presented for 500 ms was significantly associated with AN diagnosis, body mass index, and Obsessive-compulsive symptoms. However, the level of Obsessive-compulsive symptoms was the strongest predictor of a poor discrimination of briefly presented sad faces. Conclusions: Our results support previous studies that report emotional processing deficits in AN with obsessionality playing a pivotal role in this deficit.

Purpose This study aimed to explore how parents of young people with a restrictive eating disorder (ED) experience and manage uncertainty. Methods Seventeen parents of young people with a restrictive ED were recruited from multi-family therapy groups run within a specialised ED clinic. Five focus groups were conducted asking parents about their experience of uncertainty both prior and after the onset of their child’s illness. Results Data were analysed using interpretative phenomenological analysis which yielded seven superordinate themes. (1) Anorexia nervosa and uncertainty, (2) Positive and negative experiences of uncertainty (3), Helpful and unhelpful ways of coping with uncertainty, (4) Parent’s self-efficacy and uncertainty (5), Needs of parents, (6) Parents’ perceptions of intolerance of uncertainty in their children and (7) Impact of uncertainty on family life. Conclusion Parents caring for young people with a restrictive ED exhibit a strong intolerance of uncertainty, particularly in relation to their child’s illness. This ‘negative uncertainty’ was thought to reduce their confidence as parents in how they managed their child’s ED. Targeting high levels of intolerance of uncertainty in parents caring for young people with an ED could be beneficial for supporting parents when faced with their child’s illness, increasing parental self-efficacy, decreasing accommodating behaviours and ultimately contributing to improved treatment outcomes. Level of evidence Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Research is consistently reporting elevated levels of intolerance of uncertainty (IU) in individuals with an eating disorder (ED). Less is known about the phenomenology of uncertainty for this clinical group. The present study aims to advance our understanding of the relationship between IU and restrictive EDs by providing insight into young people’s subjective experiences of uncertainty.Thirteen young people with a restrictive ED were recruited from multi-family therapy groups run within the Maudsley Centre for Child and Adolescent Eating Disorders at the South London and Maudsley NHS Foundation Trust. Three focus groups were conducted asking young people to discuss their views, experiences and coping strategies when faced with uncertainty.Data were analysed using interpretative phenomenological analysis which yielded five superordinate themes: (1) young people perceived uncertainty as something negative; (2) high levels of anxiety and stress were identified as primary responses to uncertainty; (3) ED behaviours were given a functional role in reducing uncertainty; (4) need to control various aspects of young peoples’ lives was of high importance; (5) young people discussed how they struggled to find ways to cope with uncertainty and often used behaviours associated with the eating disorder psychopathology as coping strategies.Young people’s experiences of what uncertainty is like for them revealed a dynamic interplay between ED symptoms and fear of uncertainty. Findings support IU as a relevant concept for young people suffering from a restrictive ED and indicate that further exploration of IU from both theoretical and clinical perspectives could be fruitful.V.

The Cognitive Behavioural Therapy (CBT) pathway enables trainees to develop their CBT competencies and to meet the BABCP Level 2 Minimum Training Standards upon qualification from doctoral training. The paper outlines trainees’ experiences of the pathway, including its strengths, challenges, and future recommendations.

Accommodation of obsessive compulsive disorder (OCD) symptoms by family members is common. This paper presents a systematic meta-analytic review on family accommodation and OCD symptom severity. Fourteen studies investigating the relationship between family accommodation and OCD symptoms were selected. The medium effect size of the relationship between family accommodation and OCD symptom severity was significant (r = .35; 95% CI: .23 to .47), based on a Hunter-Schmidt random effects model with a total of 849 participants. Although there was some evidence of publication bias, Rosenthal's fail-safe N suggested that 596 studies with zero effect would be needed to reduce the mean effect size to non-significant. Findings are discussed in the context of the limitations of the studies, and in particular the reliance on cross-sectional designs which impede causal conclusions. Future research to evaluate a family accommodation intervention in a randomized controlled design and using mediation analysis to explore change mechanisms is called for.