• Behavioural measures of listening effort in school-aged children: Examining the effects of SNR, hearing loss, and amplification

      McGarrigle, Ronan; Gustafson, Samantha; Hornsby, Benjamin; Bess, Fred; University of Chester; Vanderbilt University Medical Center (Lippincott, Williams & Wilkins, 2018-06-13)
      Objectives: Increased listening effort in school-age children with hearing loss (CHL) could compromise learning and academic achievement. Identifying a sensitive behavioral measure of listening effort for this group could have both clinical and research value. This study examined the effects of signal-to-noise ratio (SNR), hearing loss, and personal amplification on two commonly-used behavioral measures of listening effort: dual-task visual response times (visual RTs) and verbal response times (verbal RTs). Design: A total of 82 children (aged 6 – 13 years) took part in this study; 37 children with normal hearing (CNH) and 45 CHL. All children performed a dual-task paradigm from which both measures of listening effort (dual-task visual RT and verbal RT) were derived. The primary task was word recognition in multi-talker babble in three individually selected SNR conditions: Easy, Moderate, and Hard. The secondary task was a visual monitoring task. Listening effort during the dual-task was quantified as the change in secondary task RT from baseline (single-task visual RT) to the dual-task condition. Listening effort based on verbal RT was quantified as the time elapsed from the onset of the auditory stimulus to the onset of the verbal response when performing the primary (word recognition) task in isolation. CHL completed the task aided and/or unaided to examine the effect of amplification on listening effort. Results: Verbal RTs were generally slower in the more challenging SNR conditions. However, there was no effect of SNR on dual-task visual RT. Overall, verbal RTs were significantly slower in CHL versus CNH. No group difference in dual-task visual RTs was found between CNH and CHL. No effect of amplification was found on either dual-task visual RTs or verbal RTs. Conclusions: This study compared dual-48 task visual RT and verbal RT measures of listening effort in the child population. Overall, verbal RTs appears more sensitive than dual-task visual RTs to the negative effects of SNR and hearing loss. The current findings extend the literature on listening effort in the pediatric population by demonstrating that, even for speech that is accurately recognized, school-age CHL show a greater processing speed decrement than their normal-hearing counterparts; a decrement that could have a negative impact on learning and academic achievement in the classroom.
    • 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.
    • Becoming part of the team: Female student athletes’ engagement in initiation activities.

      Lafferty, Moira E.; Wakefield, Caroline; University of Chester; Liverpool Hope University (Human Kinetics, 2018-06)
      The aim of the present research was to explore female student athletes’ participation in initiation activities specifically to examining whether activities in the United Kingdom followed similar trends to those reported elsewhere. A sample of eight female athletes, representing both traditional and non-traditional team and individual sports (M age = 20 years 3 months, SD = 1 year 3 months) who met inclusion criteria of having taken part in an initiation ceremony consented to participate in a semi structured interview. Thematic content analysis resulted in the emergence of six higher order themes represented by two general dimensions, the initiation event and initiation outcomes. Findings indicated that female student athletes’ initiation activities encompassed discrete stages as they moved from team newcomer to accepted team member. Of particular concern is the direct and indirect role of alcohol within these events and the health and behavioural risks.
    • 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.
    • Online information and support needs of women with advanced breast cancer: A qualitative analysis

      Kemp, Emma; Koczwara, Bogda; Butow, Phyllis N.; Turner, Jane; Girgis, Afaf; Schofield, Penelope; Hulbert-Williams, Nicholas J.; Levesque, Janelle V.; Spence, Danielle; Vatandoust, Sina; et al. (Springer, 2018-04-24)
      Purpose: Women with advanced breast cancer (ABC) face significant adjustment challenges, yet few resources provide them with information and support, and attendance barriers can preclude access to face to face psychosocial support. This paper reports on two qualitative studies examining (i) whether information and support-seeking preferences of women with ABC could be addressed in an online intervention, and (ii) how an existing intervention for patients with early stage cancer could be adapted for women with ABC. Methods: Women with ABC participated in telephone interviews about their information and support- seeking preferences (N = 21) and evaluated an online intervention focused on early-stage cancer (N = 15). Interviews were transcribed and underwent thematic analysis using the framework method to identify salient themes. Results: Participants most commonly sought medical, lifestyle-related, and practical information/support; however, when presented with an online intervention, participants most commonly gave positive feedback on content on coping with emotional distress. Difficulty finding information and barriers to using common sources of information/support including health professionals, family and friends, and peers were reported; however, some women also reported not wanting information or support. All participants evaluating the existing intervention gave positive feedback on various components, with results suggesting an online intervention could be an effective means of providing information/support to women with ABC, given improved specificity/relevance to ABC and increased tailoring to individuals circumstances and preferences. Conclusions: Adaptation of an existing online intervention for early stage cancer appears a promising avenue to address the information and support needs of women with ABC.
    • Relationships between unmet needs, depression and anxiety in non-advanced cancer patients

      Ferrari, Martina; Ripamonti, Carla I; Hulbert-Williams, Nicholas J.; Miccinesi, Guido; University of Chester; Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; ISPO Clinical Epidemiology Unit, Florence, Italy (Wichtig Publishing, 2018-04-16)
      Introduction: In oncology settings, less attention is given to patients’ unmet need and to existential and emotional distress, compared to physical symptoms. We aimed to evaluate correlations between unmet needs and emotional distress (self-reported anxiety and depression) in a consecutive cohort of cancer patients. The influence of socio- demographic and clinical factors was also considered. Methods: Three hundred cancer patients recruited from an out-patient Supportive Care Unit of a Comprehensive Cancer Centre completed the Need Evaluation Questionnaire (NEQ) and the Edmonton Symptom Assessment System (ESAS). Unmet needs covered five distinct domains (informational, care/assistance, relational, psycho-emotional and material). Results: After removal of missing data, we analysed data from 258 patients. Need for better information on future health concerns (42%), better services from the hospital (43%), and to speak with individuals in the same condition (31%) were the most frequently reported as unmet. Based on the ESAS, 27.2% and 17.5% of patients respectively had a score of anxiety or depression > 3 and needed further examination for psychological distress. Female patients had significantly higher scores for anxiety (p<.001) and depression (p=.008) compared to males. Unmet needs were significantly correlated with both anxiety (rs=.283) and depression (rs=.284). Previous referral to a psychologist was significantly associated with depression scores (p=.015). Results were confirmed by multiple regression analysis. Conclusions: Screening for unmet needs whilst also considering socio-demographic and clinical factors, allows early identification of cancer patients with emotional distress. Doing so will enable optimal management of psychological patient-reported outcomes in oncology settings.
    • A leftward perceptual asymmetry when judging the attractiveness of visual patterns

      Rodway, Paul; Schepman, Astrid; Crossley, Becky; Lee, Jennifer; University of Chester (Taylor & Francis, 2018-04-15)
      Perceptual judgements concerning the magnitude of a stimulus feature are typically influenced more by the left side of the stimulus than by the right side. This research examined whether the leftward bias also applies to judgements of the attractiveness of abstract visual patterns. Across four experiments participants chose between two versions of a stimulus which either had an attractive left side or an attractive right side. Experiments 1 and 2 presented artworks and experiments 3 and 4 presented wallpaper designs. In each experiment participants showed a significant bias to choose the stimulus with an attractive left side more than the stimulus with an attractive right side. The leftward bias emerged at age 10/11, was not caused by a systematic asymmetry in the perception of colourfulness or complexity, and was stronger when the difference in attractiveness between the left and right sides was larger. The results are relevant to the aesthetics of product and packaging design and show that leftward biases extend to the perceptual judgement of everyday items. Possible causes of the leftward bias for attractiveness judgements are discussed and it is suggested that the size of the bias may not be a measure of the degree of hemispheric specialisation.
    • Affective theory of mind inferences contextually influence the recognition of emotional facial expressions

      Stewart, Suzanne L. K.; Schepman, Astrid; Haigh, Matthew; McHugh, Rhian; Stewart, Andrew; University of Chester; Northumbria University; University of Manchester (Taylor & Francis, 2018-03-14)
      The recognition of emotional facial expressions is often subject to contextual influence, particularly when the face and the context convey similar emotions. We investigated whether spontaneous, incidental affective theory of mind inferences made while reading vignettes describing social situations would produce context effects on the identification of same-valenced emotions (Experiment 1) as well as differently-valenced emotions (Experiment 2) conveyed by subsequently presented faces. Crucially, we found an effect of context on reaction times in both experiments while, in line with previous work, we found evidence for a context effect on accuracy only in Experiment 1. This demonstrates that affective theory of mind inferences made at the pragmatic level of a text can automatically, contextually influence the perceptual processing of emotional facial expressions in a separate task even when those emotions are of a distinctive valence. Thus, our novel findings suggest that language acts as a contextual influence to the recognition of emotional facial expressions for both same and different valences.
    • 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.
    • Justify Your Alpha

      Lakens, Daniel; Adolfi, Federico G.; Albers, Casper J.; Anvari, Farid; Apps, Matthew A. J.; Argamon, Shlomo E.; Baguley, Thom; Becker, Raymond B.; Benning, Stephen D.; Bradford, Daniel E.; et al. (Nature Publishing Group, 2018-02-26)
      In response to recommendations to redefine statistical significance to p≤ .005, we propose that researchers should transparently report and justify all choices they make when designing a study, including the alpha level
    • 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.
    • Adjuvant endocrine therapy (AET) after breast cancer: A qualitative study of factors associated with adherence

      Brett, Jo; Boulton, Mary; Fenlon, Deborah F.; Hulbert-Williams, Nicholas J.; Walter, Fiona M.; Donnelly, Peter; Lavery, Bernadette; Morgan, Adrienne; Morris, Carolyn; Watson, Eila; et al. (Dove Medical Press, 2018-02-16)
      Introduction : Despite evidence of the efficacy of Adjuvant Endocrine Therapy (AET) in reducing the risk of recurrence and mortality after treatment for primary breast cancer, adherence to AET is suboptimal. This study aimed to explore factors that influence adherence and non-adherence to adjuvant endocrine therapy (AET) following breast cancer to inform the development of supportive interventions. Methods: Interviews were conducted with 32 women who had been prescribed AET, 2-4 years following their diagnosis of breast cancer,. Both adherers (n=19) and non-adherers (n=13) were recruited. The analysis was conducted using the Framework approach. Results: Factors associated with adherence were: Managing side effects including information and advice on side effects, and taking control of side effects, Supportive relationships, and Personal influences. Factors associated with non-adherence were: Burden of side effects, Feeling unsupported, Concerns about long term AET use, Re-gaining normality, including valuing quality of life over length of life, and Risk perception Conclusions: Provision of timely information to prepare women for the potential side effects of AET and education on medication management strategies are needed, including provision of timely and accurate information on the efficacy of AET in reducing breast cancer recurrence, and on potential side effects and ways to manage these should they arise. . Trust in the doctor-patient relationship and clear patient pathways for bothersome side effects and concerns with AET are important. Training and education around AET for GPs should be considered alongside novel care pathways such as primary care nurse cancer care review, and community pharmacist follow-up.
    • No evidence against Sketch Reinstatement of Context, Verbal Labels or the use of Registered Intermediaries for children with Autism Spectrum Disorder: Response to Henry et al. (2017)

      Dando, Coral J.; Ormerod, Thomas C.; Cooper, Penny; Marchant, Ruth; Mattison, Michelle L. A.; Milne, Rebecca; Bull, Ray; University of Westminster; University of Sussex; City, University of London; Triangle Services; University of Chester; University of Portsmouth; University of Derby (Springer Verlag, 2018-02-13)
      Recently, Henry et al. (2017) found no evidence for the use of Verbal labels, Sketch Reinstatement of Context and Registered Intermediaries by forensic practitioners when interviewing children with a diagnosis of Autism Spectrum Disorder. We consider their claims, noting the limited ecological validity of the experimental paradigm, the impacts of repeated interviewing where retrieval support is not provided at first retrieval, question the interviewer/intermediary training and their population relevant experience, and comment on the suppression of population variances. We submit that rejecting these techniques on the basis of this study is completely unwarranted and potentially damaging, particularly if used in legal proceedings to undermine the value of testimony from children with ASD, who continually struggle to gain access to justice.
    • ‘Section 28’ and the pre-recording of cross-examination: What can advocates expect in 2018?

      Cooper, Penny; Mattison, Michelle L. A.; City, University of London; University of Chester (Lexisnexis Butterworths, 2018-01-05)
      In 2018, so long as the recently identified technological issues are remedied (rumoured to be about storage capacity for the recordings), pre-recorded cross-examination will be rolled out across Crown Courts in England and Wales. The process evaluation report (MoJ, 2016) for the pilot of section 28 Youth Justice and Criminal Evidence Act 1999 (YJCEA 1999) was encouraging as well as realistic; it acknowledged that findings might not be replicated on roll-out because courts in the study might not being representative of courts in general. The authors believe that the success of the scheme substantially rests in the hands of judges and practitioners. Here we briefly summarise the background to the roll-out, highlight some important aspects of the new guidance in the Criminal Practice Directions (CPD), illustrate practice with real case studies, and discuss the implications for professional development.
    • Sweet Emotion: The Role of Odor-Induced Context in the Search Advantage for Happy Facial Expressions

      Damjanovic, Ljubica; Wilkinson, Heather; Lloyd, Julie; Liverpool John Moores University; University of Chester (Oxford University Press, 2017-12-23)
      The current study investigated the extent to which the concurrent presentation of pleasant and unpleasant odors could modulate the perceptual saliency of happy facial expressions in an emotional visual search task. Whilst a search advantage for happy faces was found in the no odor and unpleasant odor conditions, it was abolished under the pleasant odor condition. Furthermore, phasic properties of visual search performance revealed the malleable nature of this happiness advantage. Specifically, attention towards happy faces was optimized at the start of the visual search task for participants presented with pleasant odors, but diminished towards the end. This pattern was reversed for participants in the unpleasant odor condition. These patterns occur through the emotion-inducing capacities of odors and highlight the circumstances in which top-down factors can override perceptually salient facial features in emotional visual search.
    • Psychometric properties of the Beliefs about Medicine Questionnaire (BMQ)-AET for Women taking Adjuvant Endocrine Therapies (AET) following early-stage breast cancer

      Brett, Jo; Hulbert-Williams, Nicholas J.; Fenlon, Deborah F.; Boulton, Mary; Walter, Fiona M.; Donnelly, Peter; Lavery, Bernadette; Morgan, Adrienne; Morris, Carolyn; Horne, Rob; et al. (SAGE, 2017-11-17)
      Objectives: To evaluate the Beliefs about Medicine Questionnaire to explore adherence to adjuvant endocrine therapy after treatment for breast cancer (BMQ-AET). Method: Factor structure of the BMQ-AET was explored alongside internal consistency, convergent validity and acceptability. Results: The BMQ-AET Specific Scale fitted the original 10 item model. Internal consistency of the BMQ-AET was much improved compared to the original BMQ and convergent validity showed predicted direction of correlation, although correlation with BMQ-AET concerns scale was low. Acceptability was good. Conclusions: The evaluation of the BMQ-AET is encouraging, and could facilitate future research around adherence to AET.
    • An exploration of male student athletes’ engagement in initiation activities.

      Lafferty, Moira E.; Wakefield, Caroline; University of Chester; Liverpool Hope University (Taylor and Francis, 2017-11-14)
      Despite a zero tolerance approach by the National Union of Students, British Universities and Colleges Sport, and higher education institutions initiation ceremonies still take place as a means of welcoming new members to sporting teams (Lafferty et al. 2016, International Journal of Sport and Exercise Psychology). With the majority of research focused on North American and Canadian sport relatively little is known about initiation activities in a United Kingdom context, or why athletes engage in such behaviours. Waldron and Kowalski (2009, Research Quarterly for Exercise and Sport, 80, 291-302) have suggested that engagement could be explained by over conformity to two elements of the sport ethic model (Hughes and Coakley, 1991, Sociology of Sport Journal, 8, 307-325), namely making sacrifices and striving for distinction. Therefore, the aim of the present research was to examine the nature of initiation activities in male university sport players and explore whether emergent themes mapped to the sport ethic model. Following institutional ethical approval information advertising the study was sent to sporting societies at several higher education institutions. Athletes who met the inclusion criteria of having participated in an initiation ceremony were invited to contact the research team. This random purposeful sampling approach (Patton, 2002, Qualitative evaluation and research methods (3rd Ed.).California: Sage) resulted in a participant sample of 19 male athletes (mean age: 20.4 ± 1.5 years) representing a range of sports. After giving informed consent each athlete participated in a semi-structured interview lasting between 35 -50 min. All interviews were recorded, transcribed verbatim, and analysed through a two phase procedure of data organization and interpretation following established thematic analysis guidelines (Braun and Clarke, 2006, Qualitative Research in Psychology, 3, 77-101). Results were captured within two dimensions, the initiation and outcomes representing 6 and 2 themes respectively. Within these dimensions emerging themes of the group structure and hierarchy, shared experiences, coercion, initiation challenges, health risk behaviours through alcohol consumption, and feelings of being a team member mapped to the four areas of the sport ethic model in contrast to the work of Waldron and Kowalski (2009). These findings suggest that there are both similarities and differences in initiation activity engagement of UK student athletes compared to the United States. Furthermore, the highlighted differences in over conformity to the sport ethic model suggest that intervention development to deter participation in initiation activities should be context and culturally specific.
    • Fear of cancer recurrence in oral and oropharyngeal cancer patients: An investigation of the clinical encounter

      Ozakinci, Gozde; Swash, Brooke; Humphris, Gerry; Rogers, Simon; Hulbert-Williams, Nicholas J.; University of St Andrews; University of Chester; Edge Hill University (Wiley-Blackwell, 2017-10-12)
      Fear of cancer recurrence (FCR) is common among individuals treated for cancer. Explorations of how this fear is expressed within an oncology setting and responded to are currently lacking. The aim was to investigate how head and neck cancer survivors in follow-up consultations express FCR, how a health care professional addresses recurrence fears, and examining how survivors experience this interaction. We recorded the follow-up consultations of those participants who have reported FCR as a concern on the Patient Concerns Inventory. We also conducted a follow-up phone interview with the participants. We analysed the transcripts using thematic analysis. Five men and six women were recruited, aged 55-87 (mean age = 64). Follow-up consultation analyses revealed that the consultant used ‘normalising FCR,’ ‘reassurance,’ and ‘offer of referral to a counsellor’. Interviews revealed themes around how they coped with FCR, relevance of personal history on FCR, and the impact of feeling gratitude towards the consultant on expression of FCR. Analyses indicate that patients may feel reluctant to raise their FCR with their clinician for fear of appearing ‘ungrateful’ or of damaging a relationship that is held in high esteem. Findings indicate the initiation of FCR with patients can be beneficial for patient support.
    • Intermediaries, vulnerable people and the quality of evidence: An international comparison of three versions of the English intermediary model

      Cooper, Penny; Mattison, Michelle L. A.; Birkbeck University of London; University of Chester (2017-09-29)
      Since 2004, witness intermediaries have been utilised across the justice system in England and Wales. Two witness intermediary schemes based on the English model have also been introduced in Northern Ireland (2013), and more recently, in New South Wales, Australia (2016). The purpose of the intermediary in these jurisdictions is to facilitate the questioning of vulnerable witnesses, but there are clear differences in the application of the role. This paper presents the first comparative review of the three related intermediary models, and highlights the pressing need for further research into the efficacy and development of the role in practice.
    • 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.