Clinical Health Psychology

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Paranoia and unusual sensory experiences in Parkinson's disease
(Taylor and Francis Group, 2025-05) Brown, Poppy; Freeman, Daniel; Loe, Bao Sheng; Dow, Rebecca; Johns, Louise; University of Oxford; Oxford Health NHS Foundation Trust; Stanford University, California, USA; University of Cambridge; South Warwickshire University NHS Foundation Trust; Clinical Health Psychology; Additional Professional Scientific and Technical Field; Dow, Rebecca
Objectives: There has been limited exploration into the nature and development of psychotic experiences (PEs) in Parkinson's disease (PD). We aimed to comprehensively assess the frequency, severity, and associated distress of paranoia and unusual sensory experiences (USEs) in PD, and to assess what variables are significantly associated with these experiences, focussing on psychological processes central to understanding PEs in non-PD groups. Method: A questionnaire battery was completed by 369 individuals with PD with a mean age of 66 years and mean time since diagnosis of 5 years. Recruitment was via Parkinson's UK, social media, and local community groups. For a subset of measures, comparisons were made to age-matched controls using pre-existing data. Results: 182 (49%) participants reported USEs, including almost half of those not taking dopaminergic medication. For 83 (23%), the experience was distressing. Paranoia across the sample was significantly lower than in age-matched controls. However, specific paranoid concerns around abandonment (16%) and spousal betrayal (10%) were reported by some. Depression, anxiety, loneliness, and stigma and desire for support with PEs were high across the sample. Almost all psychological variables were significantly associated with PEs in structural equation models. Conclusion: PEs in PD are common, even in those not taking dopaminergic medication. For a small subset, these experiences are distressing and not resolved by existing treatment. Cognitive-affective variables like depression and anxiety could play a maintaining role in PEs in PD thus providing easy avenues for trialling intervention. Keywords: Parkinson’s disease; delusions; hallucinations; psychological; psychotic experiences.
The experience of phenylketonuria in pregnancy and the developing maternal-infant relationship : a qualitative study
(SAGE Publications, 2025-01) Harris, Charlotte; Larkin, Michael; Walker, Anne-Marie; Johnson, George; Birmingham Women's and Children's NHS Foundation Trust; University of Aston, Birmingham; South Warwickshire University NHS Foundation Trust; University of Birmingham; Clinical Health Psychology; Additional Professional Scientific and Technical Field; Walker, Anne-Marie
Phenylketonuria (PKU) is a rare metabolic condition characterised by an inability to metabolise phenylalanine (Phe), found in many foods. When pregnant with PKU, women must adhere to a strict low-Phe diet. If they do not, foetal abnormalities or pregnancy loss can occur. Pregnancies are therefore closely clinically monitored and dominated by dietary management, leaving little "space" for women's emotional experience. This article explores the emotional impact of PKU during pregnancy and how this effects pre-natal bonding. Based on interviews with six women with PKU, conducted whilst they were pregnant, this article explores their unusual and previously undocumented experience. Image-making during interviews allowed women to uncover aspects of their experience that might otherwise have remained hidden. Interpretative phenomenological analysis of the transcripts and images generated five themes summarising the women's experiences. Some themes reiterated findings from previous studies, for example, the huge cognitive burden associated with PKU pregnancies and the importance of both expert and informal support to successful pregnancy management. However, new understanding also emerged, including rich description of the emotional load of these pregnancies and strategies that women use to manage this. Anxiety about baby safety was central to their experiences, and the effect of this on pre-natal bonding was explored. This article calls for increased formal and informal support for women with the emotional aspects of their PKU pregnancies, for example, the creation of "attachment-aware" services that support women with their anxiety, promoting strong pre-natal attachment and subsequently protecting maternal and infant mental health throughout pregnancy and beyond. Keywords: attachment; drawings; interpretative phenomenological analysis; lived experience; phenylketonuria; pre-natal bonding; pregnancy.
The experience of post-traumatic stress disorder following childbirth
(MA Healthcare, 2015-02-16) Poote, Aimee; McKenzie-McHarg, Kirstie; South Warwickshire University NHS Foundation Trust; Clinical Health Psychology; Additional Professional Scientific and Technical Field; Poote, Aimee; McKenzie-McHarg, Kirstie
Post-traumatic stress disorder (PTSD) is a significant mental health problem, which women can develop following childbirth. Partners and staff are also at risk and a larger group of women develop sub-clinical trauma symptoms. PTSD can have an impact on future childbearing, the wider family, intimate sexual relationships and bonding. The relationship between mothers and maternity staff is crucial. Health visitors can help by: supporting realistic expectations of delivery antenatally; early identification of high-risk mothers via rigorous histories; facilitating communication and the father's role in the birth; early identification, screening and referral to specialist perinatal mental health professionals; supporting care pathways; supporting the parent–infant relationship; and facilitating access to social support.
Standard care practices and psychosocial interventions aimed at reducing parental distress following stillbirth : a systematic narrative review
(Taylor and Francis Group, 2015-05-22) Crispus Jones, Helen; McKenzie-McHarg, Kirstie; Horsch, Antje; Looked After Children's Psychology Service, Ealing; South Warwickshire University NHS Foundation Trust; University Hospital Lausanne, Switzerland; Clinical Health Psychology; Additional Professional Scientific and Technical Field; McKenzie-McHarg, Kirstie
Objective: To summarise and critically evaluate the evidence informing the provision of standard care practices and psychosocial interventions following stillbirth. Background: Stillbirth is increasingly recognised as a significant bereavement experience with the potential to cause substantial psychological distress for parents. Standard care practices and psychosocial interventions to support parents have undergone dramatic changes, with limited basis in evidence. Methods: A systematic narrative review was conducted of quantitative studies examining interventions designed to reduce psychological distress in parents following the loss of a stillborn baby. Results: Twenty-five studies met the inclusion criteria for the review. Substantial methodological weaknesses were identified among reviewed studies, including small and heterogeneous loss samples, weak study designs and lack of clarity in reported methods and outcomes. Inadequate replication of many findings substantially limits the generalisability of the evidence. Conclusion: Tentative evidence was found for the provision of mementoes of the baby and information regarding the cause of the loss, support group attendance, and cognitive behavioural interventions for parents identified with clinical levels of distress. Contradictory findings for the impact of contact with the baby prevent the formation of clear conclusions for this practice. Due to the methodological weaknesses prevalent in the research identified, the current evidence base is not considered sufficiently able to reliably inform care practices and intervention approaches. High-quality research evidence in this field is urgently required. Keywords: stillbirth; perinatal loss; interventions; care; evidence-based practice; parents
Post-traumatic stress disorder following childbirth : an update of current issues and recommendations for future research
(Taylor and Francis Group, 2015-04-28) McKenzie-McHarg, Kirstie; Ayers, Susan; Ford, Elizabeth; Horsch, Antje; Jomeen, Julie; Sawyer, Alexandra; Stramrood, Claire; Thomson, Gill; Slade, Pauline; South Warwickshire University NHS Foundation Trust; City University London; University of Brighton; SUPEA, Lausanne, Switzerland; University of Hull; University Medical Centre Utrecht, The Netherlands; University of Central Lancashire, Preston; University of Liverpool; Clinical Health Psychology; Additional Professional Scientific and Technical Field; McKenzie-McHarg, Kirstie
Objective: This paper aimed to report the current status of research in the field of post-traumatic stress disorder following childbirth (PTSD FC), and to update the findings of an earlier 2008 paper. Background: A group of international researchers, clinicians and service users met in 2006 to establish the state of clinical and academic knowledge relating to PTSD FC. A paper identified four key areas of research knowledge at that time. Methods: Fourteen clinicians and researchers met in Oxford, UK to update the previously published paper relating to PTSD FC. The first part of the meeting focused on updating the four key areas identified previously, and the second part on discussing new and emerging areas of research within the field. Results: A number of advances have been made in research within the area of PTSD FC. Prevalence is well established within mothers, several intervention studies have been published, and there is growing interest in new areas: staff and pathways; prevention and early intervention; impact on families and children; special populations; and post-traumatic growth. Conclusion: Despite progress, significant gaps remain within the PTSD FC knowledge base. Further research continues to be needed across all areas identified in 2006, and five areas were identified which can be seen as ‘new and emerging’. All of these new areas require further extensive research. Relatively little is still known about PTSD FC. Keywords: PTSD, childbirth, review, theory, research
Post-traumatic stress disorder after birth
(Taylor and Francis Group, 2015-04-17) Ayers, Susan; McKenzie-McHarg, Kirstie; Slade, Pauline; City University London; South Warwickshire University NHS Foundation Trust; University of Liverpool; Clincal Health Psychology; Additional Professional Scientific and Technical Field; McKenzie-McHarg, Kirstie
This Special Issue Editorial reviews the development of post-traumatic stress disorder (PTSD) in women in response to difficult or traumatic birth experiences, and the interventions available.
Debriefing interventions for the prevention of psychological trauma in women following childbirth
(Cochrane Collaboration, 2015-04-10) Bastos, Maria Helena; Furuta, Marie; Small, Rhonda; McKenzie-McHarg, Kirstie; Bick, Debra; Fiocruz, Rio de Janeiro, Brazil; Kyoto University, Japan; Judith Lumley Centre, Melbourne, Australia; South Warwickshire University NHS Foundation Trust; King's College London; Clinical Health Psychology; Additional Professional Scientific and Technical Field; McKenzie-McHarg, Kirstie
Background: Childbirth is a complex life event that can be associated with both positive and negative psychological responses. When giving birth is experienced as particularly traumatic this can have a negative impact on a woman's postnatal emotional well-being. There has been an increasing focus on women's psychological trauma symptoms following childbirth, including the relatively rare phenomenon of post-traumatic stress disorder (PTSD), and the benefit of debriefing interventions to prevent this. In this review we examined the evidence for debriefing as a preventative intervention for psychological trauma following childbirth. Objectives: To assess the effects of debriefing interventions compared with standard postnatal care for the prevention of psychological trauma in women following childbirth. Search methods: The trials registers of the Cochrane Depression, Anxiety and Neurosis Group (CCDANCTR-References and CCDANCTR-Studies) and the Cochrane Pregnancy and Childbirth Group were searched up to 4 March 2015. These registers include relevant randomised controlled trials from the following bibliographic databases: the Cochrane Library (all years to date), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). Additional searches were conducted in CENTRAL, MEDLINE, EMBASE, PsycINFO, and Maternity and Infant Care. The reference lists of all included studies were checked for additional published reports and citations of unpublished research. Experts in the field were contacted. Selection criteria: We included randomised controlled trials (RCTs) and quasi-randomised trials comparing postnatal debriefing interventions with standard postnatal care for the prevention of psychological trauma of women following childbirth. The intervention consisted of at least one debriefing intervention session, which had the purpose of allowing women to describe their experience and to normalise their emotional reaction to that experience. Data collection and analysis: Three authors independently assessed trial quality and extracted data. Meta-analysis was conducted where there were more than two trials examining the same outcomes. Main results: We included seven trials (eight articles) from three countries (UK, Australia and Sweden) that fulfilled the inclusion criteria. The number of women contributing data to each outcome varied from 102 to 1745. Methodological quality was variable and most of the studies were of low quality. The quality of evidence for the prevalence of psychological trauma (primary outcome) and the prevalence of depression symptoms was rated low or very low, based on few studies (ranging from a single study to three studies) with high risk of bias in main domains such as performance bias, random sequence generation, allocation concealment and incomplete outcome data. The quality of evidence for the remaining outcomes (that is prevalence of anxiety, prevalence of fear of childbirth, prevalence of general psychological morbidity, health service utilization and attrition from treatment) was not assessed as data were not available.Among women who had a high level of obstetric intervention during labour and birth, we found no difference between standard postnatal care with debriefing and standard postnatal care without debriefing on psychological trauma symptoms within three months postpartum (RR 0.61; 95% CI 0.28 to 1.31; n = 425) or at three to six months postpartum (RR 0.62; 95% CI 0.27 to 1.42; n = 246). The results were based on two trials, respectively. Among women who experienced a distressing or traumatic birth, there was no evidence of an effect of psychological debriefing on the prevention of PTSD (measured by the MINI-PTSD) at four to six weeks postpartum (RR 1.15; 95% CI 0.66 to 2.01; n = 102) or at six months (RR 0.35; 95% CI 0.10 to 1.23; n = 103). The results were based on one small trial. One trial involving low-risk women who delivered healthy infants at or near term reported no significant difference between the intervention group and the control group in the proportion of women who met the diagnostic criteria for psychological trauma during the year following childbirth (RR 1.06; 95% CI 0.88 to 1.28; n = 1745). We did not find any information about attrition rates. Authors' conclusions: We did not find any high quality evidence to inform practice, with substantial heterogeneity being found between the studies conducted to date. There is little or no evidence to support either a positive or adverse effect of psychological debriefing for the prevention of psychological trauma in women following childbirth. There is no evidence to support routine debriefing for women who perceive giving birth as psychologically traumatic.Future research should provide greater detail of the outcome measures used, and with scales for measuring psychological trauma validated against clinical diagnostic interviews. High rates of obstetric intervention in some birth settings may mean that women require improved emotional care from health professionals to reduce the risk of childbirth being experienced as traumatic. As all included trials excluded women unable to communicate in the native language of the study setting, there is no information on the response of these women to psychological debriefing. No included studies were conducted in low or middle-income countries.
Testing a cognitive model to predict posttraumatic stress disorder following childbirth
(BioMed Central, 2017-01-14) King, Lydia; McKenzie-McHarg, Kirstie; Horsch, Antje; Warneford Hospital, Oxford; South Warwickshire University NHS Foundation Trust; University Hospital Lausanne, Switzerland; Clinical Health Psychology; Additional Professional Scientific and Technical Field; McKenzie-McHarg, Kirstie
Background: One third of women describes their childbirth as traumatic and between 0.8 and 6.9% goes on to develop posttraumatic stress disorder (PTSD). The cognitive model of PTSD has been shown to be applicable to a range of trauma samples. However, childbirth is qualitatively different to other trauma types and special consideration needs to be taken when applying it to this population. Previous studies have investigated some cognitive variables in isolation but no study has so far looked at all the key processes described in the cognitive model. This study therefore aimed to investigate whether theoretically-derived variables of the cognitive model explain unique variance in postnatal PTSD symptoms when key demographic, obstetric and clinical risk factors are controlled for. Method: One-hundred and fifty-seven women who were between 1 and 12 months post-partum (M = 6.5 months) completed validated questionnaires assessing PTSD and depressive symptoms, childbirth experience, postnatal social support, trauma memory, peritraumatic processing, negative appraisals, dysfunctional cognitive and behavioural strategies and obstetric as well as demographic risk factors in an online survey. Results: A PTSD screening questionnaire suggested that 5.7% of the sample might fulfil diagnostic criteria for PTSD. Overall, risk factors alone predicted 43% of variance in PTSD symptoms and cognitive behavioural factors alone predicted 72.7%. A final model including both risk factors and cognitive behavioural factors explained 73.7% of the variance in PTSD symptoms, 37.1% of which was unique variance predicted by cognitive factors. Conclusions: All variables derived from Ehlers and Clark's cognitive model significantly explained variance in PTSD symptoms following childbirth, even when clinical, demographic and obstetric were controlled for. Our findings suggest that the CBT model is applicable and useful as a way of understanding and informing the treatment of PTSD following childbirth. Keywords: Childbirth; Cognitive model; Cognitive predictors; PTSD; Postnatal; Risk factors; Traumatic.
The impact of miscarriage and stillbirth on maternal-fetal relationships: An integrative review
(Routledge, 2017-02-01) Lee, Louise; McKenzie-McHarg, Kirstie; Horsch, Antje; The Oxford Institute of Clinical Psychology Training; Warwick Hospital; University Hospital Lausanne, Lausanne, Switzerland; Department of Clinical Health Psychology; Additional Professional Scientific and Technical Field; McKenzie-McHarg, Kirstie
Objective: To synthesise and summarise existing literature investigating whether and how psychological distress as a consequence of perinatal loss and associated coping impact upon maternal–fetal relationships subsequent to miscarriage and stillbirth. Background: Although now widely accepted that the relationship between mother and child developsin utero, little is known about how a previous miscarriage or stillbirth impacts upon these processes in a subsequent pregnancy. Methods: An integrative review methodology was chosen for the review. Results: Fifteen empirical and theoretical articles were reviewed and summated into two topic areas: psychological distress following perinatal loss and the subsequent maternal–fetal relationship, and coping following perinatal loss and the subsequent maternal–fetal relationship. Conclusions: Studies show that perinatal loss can cause psychological distress in subsequent pregnancy. It is not clear whether and how such distress impacts on maternal–fetal relationships because studies have yielded mixed findings. Mothers employ a complex self-protective mechanism to cope with this distress, and use strategies to reassure themselves and to maintain hope that the pregnancy will result in a live birth. It is not clear whether the use of this mechanism impacts upon the development of the mother–fetus relationship in subsequent pregnancy. Further research is now required to determine how these strategies are employed, the impact of these strategies on pregnancy-specific anxiety, maternal–fetal relationships and the postnatal attachment relationship. Health professionals working with parents in these circumstances should acknowledge that anxiety and associated coping behaviours are common, and support be provided when parents show signs of considerable psychological distress.
Identifying ‘what matters?’ : an ACT-based group programme for people with cancer
(BMJ Publishing Group, 2019-11) Arnold, Angie; Poyner, Jo; Lewis, Rhiannan; Playford, E Diane; Gordon, Carolyn; Slatter, Georgina; The Shakespeare Hospice, Stratford upon Avon; South Warwickshire University NHS Foundation Trust; CERU; Clinical Psychology; Additional Professional Scientific and Technical Field; Playford, Diane; Gordon, Carolyn; Slatter, Georgina
This Service Development, Models and Collaborative Working poster abstract from the Hospice UK 2019 National Conference describes a collaborative project, which aimed to develop an Acceptance and Commitment Therapy (ACT)-based group programme for cancer patients.
Interventions for confabulation: A systematic literature review
(Taylor and Francis Group, 2022-11) Francis, Cheryl; MacCallum, Fiona; Pierce, Siân; University of Warwick; South Warwickshire University NHS Foundation Trust; CERU; Clinical Psychology; Additional Professional Scientific and Technical Field; Pierce, Siân
Objective: Confabulations are false memories which are expressedwithout the intention to deceive and arise following brain damage or psychological dysfunction. Confabulations can become a barrier to effective neuropsychological rehabilitation and consequently, intervention is required.The current review aimed to provide a detailed evaluative account of existing interventions for confabulation and their relative effectiveness. Method: The search process found 11 studies conducive with the inclusion and exclusion criteria. A methodological quality assessment was then carried out and the majority of included studies demonstrated poor methodological quality. Results: Ten types of interventions were identified and the majority of theseled to a reduction or elimination of confabulations. Conclusion: Since methodological quality of many included studies was deemed unsatisfactory, further large-scale experimental research and standardised measures are necessary to adequately compare the relative effectiveness of these interventions. Further research and clinical implications are also highlighted.

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