• Anticipatory versus Reactive Spatial Attentional Bias to Threat

      Gladwin, Thomas; Möbius, Martin; McLoughlin, Shane; Tyndall, Ian; University of Chichester; Radboud University; University of Chester (Wiley, 2018-05-11)
      Dot-probe or visual probe tasks (VPTs) are used extensively to measure attentional biases. A novel variant termed the cued VPT (cVPT) was developed to focus on the anticipatory component of attentional bias. This study aimed to establish an anticipatory attentional bias to threat using the cVPT and compare its split-half reliability with a typical dot-probe task. A total of 120 students performed the cVPT task and dot-probe tasks. Essentially, the cVPT uses cues that predict the location of pictorial threatening stimuli, but on trials on which probe stimuli are presented the pictures do not appear. Hence, actual presentation of emotional stimuli did not affect responses. The reliability of the cVPT was higher at most cue–stimulus intervals and was .56 overall. A clear anticipatory attentional bias was found. In conclusion, the cVPT may be of methodological and theoretical interest. Using visually neutral predictive cues may remove sources of noise that negatively impact reliability. Predictive cues are able to bias response selection, suggesting a role of predicted outcomes in automatic processes.
    • Are Trans diagnostic models of eating disorders fit for purpose? A consideration of the evidence for food addiction

      Treasure, Janet; Leslie, Monica; Chami, Rayane; Fernández-Aranda, Fernando; King's College London; University Hospital of Bellvitge and CIBERobn (ISCIII)
      Explanatory models for eating disorders have changed over time to account for changing clinical presentations. The transdiagnostic model evolved from the maintenance model, which provided the framework for cognitive behavioural therapy for bulimia nervosa. However, for many individuals (especially those at the extreme ends of the weight spectrum), this account does not fully fit. New evidence generated from research framed within the food addiction hypothesis is synthesised here into a model that can explain recurrent binge eating behaviour. New interventions that target core maintenance elements identified within the model may be useful additions to a complex model of treatment for eating disorders.
    • Assessment of metacognitive beliefs in an at risk mental state for psychosis: A validation study of the Metacognitions Questionnaire-30

      Bright, Measha; Parker, Sophie; French, Paul; Morrison, Anthony P.; Tully, Sarah; Stewart, Suzanne L. K.; Wells, Adrian; University of Manchester; Greater Manchester Mental Health NHS Foundation Trust; University of Chester (Wiley, 2018-06-07)
      Aim: The Metacognitions Questionnaire-30 (MCQ-30) has been used to assess metacognitive beliefs in a range of mental health problems. The aim of this study is to assess the validity of the MCQ-30 in people at risk for psychosis. Methods: One hundred and eighty-five participants meeting criteria for an at risk mental state (ARMS) completed the MCQ-30 as part of their involvement in a randomised controlled trial. Confirmatory and exploratory factor analyses were conducted to assess factor structure and construct validity. Results: Confirmatory factor analyses confirmed the original 5-factor structure of the MCQ-30. Examination of principal component analysis and parallel analysis outputs also suggested a 5-factor structure. Correlation analyses including measures of depression, social anxiety and beliefs about paranoia showed evidence of convergent validity. Discriminant validity was supported using the normalising subscale of the beliefs about paranoia tool. Conclusions: The MCQ-30 demonstrated good fit using the original 5-factor model, acceptable to very good internal consistency of items was evident and clinical usefulness in those at risk for psychosis was demonstrated.
    • Associations between peer victimization, fear of future victimization and disrupted concentration on class work among junior school pupils

      Boulton, Michael J.; Trueman, Mark; Murray, Lindsay; University of Chester ; Keele University ; University of Chester (Wiley, 2008)
      This article discusses a study of 485 pupils aged 10-11 (from 11 junior schools in the UK) and levels of, and associations between, physical, verbal, and social exclusion victimization, fear of future victimization, and disrupted classroom concentration.
    • Beyond using composite measures to analyze the effect of unmet supportive care needs on caregivers’ anxiety and depression

      Lambert, Sylvie D.; Hulbert-Williams, Nicholas J.; Belzile, Eric; Ciampi, Antonio; Girgis, Afaf; McGill University; University of Chester; University of New South Wales (Wiley, 2018-03-06)
      Objective: Caregiver research has relied on composite measures (e.g., count) of unmet supportive care needs to determine relationships with anxiety and depression. Such composite measures assume that all unmet needs have a similar impact on outcomes. The purpose of this study is to identify individual unmet needs most associated with caregivers’ anxiety and depression. Methods: 219 Caregivers completed the 44-item Supportive Care Needs Survey and the Hospital Anxiety and Depression scale [minimal clinically important difference (MCID)=1.5] at 6-8 months, 1, 2, 3.5, and 5 years following the patients' cancer diagnosis. The list of needs was reduced using Partial Least Square regression and those with a Variance Importance in Projection > 1 were analyzed using Bayesian Model Averaging. Results: Across time, eight items remained in the top 10 based on prevalence and were labelled “core”. Three additional ones were labelled “frequent”, as they remained in the top 10 from 1- year onwards. Bayesian Model Averaging identified a maximum of four significant unmet needs per time point – all leading to a difference greater than the MCID. For depression, none of the core unmet needs were significant, rather significance was noted for frequent needs and needs that were not prevalent. For anxiety, 3/8 core and 3/3 frequent unmet needs were significant. Conclusions: Prevalent Those unmet needs that are most prevalent are not necessarily the most significant ones, and findings provide an evidence-based framework to guide the development of caregiver interventions. A broader contribution is proposing a different approach to identify significant unmet needs.
    • A bifactorial solution to the psychopathy checklist screening version in a sample of civil psychiatric patients

      Boduszek, Daniel; Dhingra, Katie; Hyland, Philip; Debowska, Agata; University of Huddersfield ; Manchester Metropolitan University ; National College of Ireland ; University of Chester (Wiley, 2015-03-31)
      Background: There is considerable debate about the underlying factor structure of the Psychopathy Checklist: Screening Version (PCL: SV). An established view is that it reflects a unitary construct underpinned by two correlated factors. More recent research has, however, undermined this conceptualisation. Aims: Our aim was to compare 10 competing models of the PCL: SV in a sample of civil psychiatric patients. Method: Ten distinct factor models were specified and tested using conventional confirmatory factor analytic techniques, along with confirmatory bifactor modelling. Results: A bifactor model, including two general factors (interpersonal-affective and antisocial-lifestyle), and four subordinate factors (interpersonal, affective, antisocial, and lifestyle) provided the best fit to the data. The reliability of the conceptualisation was supported through the use of composite reliability, and the differential relationships exhibited between the general factors and measures of personality, impulsivity, and mental health. Conclusions: The results suggest that two general factors should be taken into account when interpreting the PCL:SV for clinical purposes.
    • The cancer care experiences of gay, lesbian and bisexual patients: A secondary analysis of data from the UK Cancer Patient Experience Survey.

      Hulbert-Williams, Nicholas J.; Plumpton, C.; Flowers, Paul; McHugh, Rhian; Neal, Richard; Semlyen, Joanna; Storey, Lesley; University of Chester; Bangor University; Glasgow Caledonian University; University of Leeds; University of East Anglia; Queen's University (Wiley, 2017-02-27)
      Understanding the effects of population diversity on cancer-related experiences is a priority in oncology care. Previous research demonstrates inequalities arising from variation in age, gender and ethnicity. Inequalities and sexual orientation remain underexplored. Here, we report, for the first time in the UK, a quantitative secondary analysis of the 2013 UK National Cancer Patient Experience Survey which contains 70 questions on specific aspects of care, and six on overall care experiences. 68,737 individuals responded, of whom 0.8% identified as lesbian, gay or bisexual. Controlling for age, gender and concurrent mental health comorbidity, logistic regression models applying post-estimate probability Wald tests explored response differences between heterosexual, bisexual and lesbian/gay respondents. Significant differences were found for 16 questions relating to: (a) a lack of patient-centred care and involvement in decision making, (b) a need for health professional training and revision of information resources to negate the effects of heteronormativity, and (c) evidence of substantial social isolation through cancer. These findings suggest a pattern of inequality, with less positive cancer experiences reported by lesbian, gay and (especially) bisexual respondents. Poor patient-professional communication and heteronormativity in the healthcare setting potentially explain many of the differences found. Social isolation is problematic for this group and warrants further exploration.
    • Cancer experiences in individuals with an intellectual disability: Results from a grounded theory study

      Flynn, Samantha; Hulbert-Williams, Nicholas J.; Hulbert-Williams, Lee; Bramwell, Ros; University of Chester (Wiley, 2015-04-28)
      Increasing numbers of people with an intellectual disability (ID) are diagnosed with cancer, partly due to increased life expectancy. However, there is a paucity of research exploring their cancer experiences.
    • Concurrent and short-term longitudinal associations between peer victimization and school and recess liking during middle childhood

      Boulton, Michael J.; Chau, Cam; Whitehand, Caroline; Amataya, Kishori; Murray, Lindsay; University of Chester ; Middlesex University ; Keele University ; Keele University ; University of Chester (Wiley, 2009)
      This article discusses a study of 429 pupils (aged 9 - 11 years) in the UK which examined concurrent and short-term longitudinal associations between peer victimization (physical, malicious teasing, deliberate social exclusion, and malicious gossiping) and two measures of school adjustment (school liking and recess liking), and test if these associations were moderated by year and sex.
    • Cultural differences in self-recognition: the early development of autonomous and related selves?

      Ross, Josephine; Yilmaz, Mandy; Dale, Rachel; Cassidy, Rose; Yildirim, Iraz; Zeedyk, M. Suzanne; University of Dundee; University of Chester; University of Veterinary Medicine Vienna (Wiley, 2016-01-29)
      Fifteen- to 18-month-old infants from three nationalities were observed interacting with their mothers and during two self-recognition tasks. Scottish interactions were characterized by distal contact, Zambian interactions by proximal contact, and Turkish interactions by a mixture of contact strategies. These culturally distinct experiences may scaffold different perspectives on self. In support, Scottish infants performed best in a task requiring recognition of the self in an individualistic context (mirror self-recognition), whereas Zambian infants performed best in a task requiring recognition of the self in a less individualistic context (body-as-obstacle task). Turkish infants performed similarly to Zambian infants on the body-as-obstacle task, but outperformed Zambians on the mirror self-recognition task. Verbal contact (a distal strategy) was positively related to mirror self-recognition and negatively related to passing the body-as-obstacle task. Directive action and speech (proximal strategies) were negatively related to mirror self-recognition. Self-awareness performance was best predicted by cultural context; autonomous settings predicted success in mirror self-recognition, and related settings predicted success in the body-as-obstacle task. These novel data substantiate the idea that cultural factors may play a role in the early expression of self-awareness. More broadly, the results highlight the importance of moving beyond the mark test, and designing culturally sensitive tests of self-awareness.
    • The effect of Steiner, Montessori, and national curriculum education upon children's pretence and creativity

      Kirkham, Julie A.; Kidd, Evan; University of Chester ; The Australian National University; University of Chester; The Australian National University (Wiley, 2015-03-15)
      Pretence and creativity are often regarded as ubiquitous characteristics of childhood, yet not all education systems value or promote these attributes to the same extent. Different pedagogies and practices are evident within the UK National Curriculum, Steiner and Montessori schools
    • The Effect of Superstitious Thinking on Psychosocial Stress Responses and Perceived Task Performance

      Lasikiewicz, Nicola; Teo, Wan Yee; University of Chester; James Cook University Singapore (Wiley, 2018-02-18)
      Abstract Previous research on superstition, a subset of paranormal belief, suggests that people tend to invoke luck-related superstitions in stressful situations as an attempt to gain an illusion of control over outcomes. Based on this, the current study examined whether luck-related superstition, in the form of a ‘lucky’ pen, could influence the psychological response to a psychosocial stressor. Participants (N =114) aged between 17 and 59 years (M = 22.98, SD = 4.57) from James Cook University Singapore, were randomly assigned to one of four conditions: (1) no-stress with no ‘lucky’ pen; (2) no-stress with a ‘lucky’ pen; (3) stress with no ‘lucky’ pen; (4) stress with a ‘lucky’ pen. The results revealed that participants provided with a “lucky” pen experienced lower state anxiety when exposed to the stressor. Further, participants provided with a ‘lucky’ pen perceived their performance to be better than those without it. However, superstitious belief did not significantly change following exposure to stress. Taken together, the present findings add some support to the suggestion that belief in transferable luck may facilitate coping with a stressor. However, further research is needed to fully understand the mechanisms behind the potential benefits of superstitious belief.
    • The Emotional Face of Anorexia Nervosa: The Neural Correlates of Emotional Processing

      Halls, Daniel; Leslie, Monica; Leppanen, Jenni; Sedgewick, Felicity; Surguladze, Simon; Fonville, Leon; Lang, Katie; Simic, Mima; Nicholls, Dasha; Williams, Steven; et al.
      Social-emotional processing difficulties have been reported in Anorexia Nervosa (AN), yet the neural correlates remain unclear. Previous neuroimaging work is sparse and has not used functional connectivity paradigms to more fully explore the neural correlates of emotional difficulties. Fifty-seven acutely unwell AN (AAN) women, 60 weight-recovered AN (WR) women and 69 healthy control (HC) women categorised the gender of a series of emotional faces while undergoing Functional Magnetic Resonance Imaging. The mean age of the AAN group was 19.40 (2.83), WR 18.37 (3.59) and HC 19.37 (3.36). A whole brain and psychophysical interaction connectivity approach was used. Parameter estimates from significant clusters were extracted and correlated with clinical symptoms. Whilst no group level differences in whole brain activation were demonstrated, significant group level functional connectivity differences emerged. WR participants showed increased connectivity between the bilateral occipital face area and the cingulate, precentral gyri, superior, middle, medial and inferior frontal gyri compared to AAN and HC when viewing happy valenced faces. Eating disorder symptoms and parameter estimates were positively correlated. Our findings characterise the neural basis of social-emotional processing in a large sample of individuals with AN.
    • Evaluating the impact of COVID-19 on supportive care needs, psychological distress and 3 quality of life in UK cancer survivors and their support network.

      Hulbert-Williams, Nicholas J.; Leslie, Monica; Hulbert-Williams, Lee; Smith, Eilidh; Howells, Lesley; Pinato, David J; University of Chester; Maggie's Cancer Centres; Imperial College London
      Objectives: The COVID-19 pandemic is having considerable impact on cancer care, including restricted access to hospital-based care, treatment and psychosocial support. We investigated the impact on unmet needs and psychosocial wellbeing. Methods: 144 participants (77% female), including people with cancer and their support networks, were recruited. The most prevalent diagnosis was breast cancer. Forty-one participants recruited pre-pandemic were compared with 103 participants recruited during the COVID-19 pandemic. We measured participants’ unmet supportive care needs, psychological distress and quality of life. Results: Half of our patient respondents reported unexpected changes to treatment following pandemic onset, with widespread confusion about their longer-term consequences. Although overall need levels have not increased, specific needs have changed in prominence. People with cancer reported significantly reduced anxiety (p=.049) and improved quality of life (p=.032) following pandemic onset, but support network participants reported reduced quality of life (p=.009), and non-significantly elevated anxiety, stress and depression. Conclusion: Psychological wellbeing of people with cancer has not been detrimentally affected by pandemic onset. Reliance on home-based support to compensate for the lost availability of structured healthcare pathways may, however, explain significant and detrimental effects on the wellbeing and quality of life of people in their support and informal care networks.
    • Evaluating unmet needs in patients undergoing surgery for colorectal cancer: A patient reported outcome measures (PROMS) study

      Sutton, Paul; Bourdon-Pierre, R; Smith, Carly M.; Appleton, Nathan; Lightfoot, Tina; Gabriel, Claire; Richards, B.; Mohamed, S.; Mason-Whitehead, Elizabeth; Hulbert-Williams, Nicholas J.; et al. (Wiley, 2019-03-03)
      Aim Patient reported outcome measures (PROMs) are self-reported measures of patients’ health status or health related quality of life at a single point in time. We aimed to evaluate the use of a colorectal PROM, and conducted a focus group to further explore this and other unmet needs in our patient population treated surgically for colorectal cancer. Method A multidisciplinary research group consisting of colorectal surgeons, nurse specialists, psychologists, sociologists and patient representatives devised a composite tool of new and existing outcome measures which was piloted in our local population (n=35). Participants were subsequently invited to attend a semi-structured focus group during which the PROM was reviewed and an unmet needs analysis performed. Thematic analysis of focus group transcripts was undertaken for emergent themes. Results Initial consensus was for a tool including the EQ-5D, FACT-C, the distress thermometer, a validated measure of stigma, an unmet needs analysis, and questions assessing the psychological impact of cancer. Median and IQR values suggested all metrics were discriminatory with the exception of FACT-C. All participants agreed the tool was acceptable, and reflected the current state of their health and emotions. Thematic analysis of focus group transcripts identified four major themes: Physical symptoms, emotional response, information provision and coping mechanisms. Conclusion Through expert consensus, local piloting and patient focus groups we have evaluated a novel PROM for colorectal cancer. Furthermore, through our direct engagement with patients we have identified several unmet needs which we are currently exploring within the clinical service.
    • An Exploration of the Benefits of Animal-Assisted Activities in Undergraduate Students in Singapore

      Muckle, Jolene; Lasikiewicz, Nicola; University of Chester; James Cook University, Singapore (Wiley, 2017-07-03)
      The rise in psychological problems, attrition and suicide rates of university students has been linked to the stressful challenges faced during university life. To buffer this, Animal-Assisted Activities (AAA) may assist in improving psychological and physiological well-being in students, however, to date, there is little empirical evidence for their effectiveness. Consequently, this study explored the psychological and physiological benefits of AAA in a sample of undergraduate students. Sixty-two students from two local universities participated in an hour-long AAA session delivered by Therapy Dogs Singapore (TDS). Measures of perceived stress, anxiety, state self-esteem, and blood pressure (BP) were taken before and after the sessions. The results indicated that students experienced significant decreases in state anxiety, systolic and diastolic BP post AAA, and when compared to a quiet reading comparison session. State self-esteem increased post AAA and, further, was found to moderate the change in anxiety in addition to perceived stress, whereby, perceived anxiety reduced more in those with low state self-esteem and high perceived stress. These results suggest that AAA can be an effective intervention for stress among undergraduate students, which utilizes a novel, easy to implement and enjoyable approach for Singaporean students.
    • Exploring thematic Nightmare content and associated self-harm risk

      Hochard, Kevin D.; Ashcroft, Sam; Carroll, Janine; Heym, Nadja; Townsend, Ellen; University of Chester; Nottingham Trent University; University of Nottingham (Wiley, 2017-09-28)
      Nightmares have been shown to be robust predictors of self-harm risk, beyond depressive symptoms and hopelessness at times. However, few studies have investigated associations between nightmare content and increased self-harm risk. The present study explored associations of thematic nightmare content with history of self-harm, and risk of self-harm phenomena the morning following a nightmare. A mixed-method diary study was employed. Prospective nightmare reports were obtained from 72 participants. A total of 47 nightmare reports met inclusion criteria and were analyzed for themes using inductive thematic analysis. Chi-square and bootstrap Pearson’s correlation tests were performed to assess the associations between nightmare themes and self-harm history and risk of self-harm phenomena following a nightmare. ‘Powerlessness to Change Behavior’ was associated a history of self-harm engagement, whereas ‘Financial Hardship’ indicated reduced risk. Themes were not significantly associated with increased risk of self-harm phenomena following a nightmare. Content may be of use in detecting lifetime history of self-harm engagement particularly in populations where disclosure is seen as taboo. However, nightmare symptom severity remains better indicators of risk. Evidence for the utility of nightmare content in assessing immediate self-harm risk is presently lacking. Replication with increased power is recommended.
    • Factors Associated with Intentional and Unintentional Non-adherence to Adjuvant Endocrine Therapy Following Breast Cancer

      Brett, Jo; Fenlon, Deborah F.; Boulton, Mary; Hulbert-Williams, Nicholas J.; Walter, Fiona M.; Donnelly, Peter; Lavery, Bernadette; Morgan, Adrienne; Morris, Carolyn; Watson, Eila; et al. (Wiley, 2016-11-30)
      Adherence to adjuvant endocrine therapy (AET) following breast cancer is known to be sub-optimal despite its known efficacy in reducing recurrence and mortality. This study aims to investigate factors associated with non-adherence and inform the development of interventions to support women and promote adherence. A questionnaire survey to measure level of adherence, side effects experienced, beliefs about medicine, support received and socio-demographic details was sent to 292 women 2-4 years post breast cancer diagnosis. Differences between non-adherers and adherers to AET were explored, and factors associated with intentional and unintentional non-adherence are reported. Approximately one quarter of respondents, 46 (22%), were non-adherers, comprising 29 (14%) intentional non-adherers and 17 (8%) unintentional non-adherers. Factors significantly associated with intentional non-adherence were: the presence of side effects (p<0.03), greater concerns about AET (p<0.001), and a lower perceived necessity to take AET (p<0.001). Half of the sample (105/211) reported that side effects had a moderate or high impact on their quality of life. Factors associated with unintentional non-adherence were: younger age (<65), (p<0.001), post-secondary education (p=0.046), and paid employment (p=0.031). There are distinct differences between intentional non-adherence and unintentional non-adherence. Differentiation between the two types of non-adherence may help tailor support and advice interventions
    • Friendship as a moderator of the relationship between social skills problems and peer victimisation

      Fox, Claire L.; Boulton, Michael J.; Keele University ; University College Chester (Wiley, 2006-02-10)
      This article discusses a study in which of 449 aged 9 to 11 year olds completed a peer nomination inventory which was then used to assess social skills problems, peer victimisation, peer acceptance, and several different aspects of friendship.