• Factors associated with complementary and alternative medicine use in Irritable Bowel Syndrome: A literature review

      Usher, Lee; Fox, Pauline; Lafarge, Caroline; Mitchell, Kathryn; University of West London (PsychOpen, 2013)
      Aim: Irritable Bowel Syndrome (IBS) is a chronic functional bowel condition, which has substantial impact on quality of life and use of healthcare services. Patients often report using complementary and alternative medicine (CAM) for symptom management despite limited evidence to support its use. Psychological factors have been shown to be important in both influencing CAM use and as avenues of intervention to assist in managing IBS symptoms. Therefore, this review assessed prevalence of and psychological factors associated with CAM use by people with IBS. Method: Five electronic databases (including AMED, EMBASE and PsychINFO) were searched for studies that examined both the extent of and the reasons for CAM use. Five studies met the inclusion criteria. Results: Prevalence of CAM use ranged from 9% to 38%. CAM use was associated with psychosocial factors, including concerns about conventional medical care (i.e., the perceived harmful effects of medication, perception that conventional medicine had failed, and lack of satisfaction with conventional care) and anxiety. Conclusion: These findings identify psychological factors associated with CAM use which could be targeted through psychologically oriented management strategies for those affected with IBS.
    • Perinatal grief following a termination of pregnancy for foetal abnormality: the impact of coping strategies.

      Lafarge, Caroline; Mitchell, Kathryn; Fox, Pauline; The University of Derby (Wiley., 2013-12-05)
      Pregnancy termination for foetal abnormality (TFA) can have significant psychological repercussions, but little is known about the coping strategies involved in dealing with TFA. This study examined the relationships between women's coping strategies and perinatal grief. A total of 166 women completed a survey online. Coping and perinatal grief were measured using the Brief COPE and Short Perinatal Grief Scales. Data were analysed through multiple regression analyses. Despite using mostly adaptive coping strategies, women's levels of grief were high and varied according to obstetric and termination variables. Grief was predicted by behavioural disengagement, venting, planning, religion, self‐blame, being recently bereaved, being childless at the time of TFA, not having had children/being pregnant since TFA and uncertainty about the decision to terminate the pregnancy. Acceptance and positive reframing negatively predicted grief. Identifying women vulnerable to poor psychological adjustment and promoting coping strategies associated with lower levels of grief may be beneficial. This could be addressed through information provision and interventions such as Cognitive Behavioural Therapy or Acceptance and Commitment Therapy.
    • Posttraumatic growth following pregnancy termination for fetal abnormality: the predictive role of coping strategies and perinatal grief

      Lafarge, Caroline; Mitchell, Kathryn; Fox, Pauline; University of West London; University of Derby (Taylor and Francis, 2017-01-12)
      Background: Research about termination for fetal abnormality (TFA) suggests that it is a traumatic event with potential negative psychological consequences. However, evidence also indicates that following traumatic events individuals may experience growth. Although TFA’s negative psychological outcomes are well documented, little is known of the potential for growth following this event. Therefore, the study’s objectives were to measure posttraumatic growth (PTG) post-TFA, examine the relationship between PTG, perinatal grief and coping, and determine the predictors of PTG. Design: An online, retrospective survey was conducted with 161 women. Methods: Eligible participants were women over 18 who had undergone TFA. Participants were recruited from a support organisation. They completed the Brief COPE, Short Perinatal Grief Scale and Posttraumatic Growth Inventory. Data were analysed using regression analyses. Results: Moderate levels of PTG were observed for “relating to others,” “personal strengths” and “appreciation of life.” “Positive reframing” was a significant predictor of PTG. Despite using mainly “adaptive” coping strategies, women’s grief levels were high. Conclusions: “Adaptive” coping strategies such as, “positive reframing” are relevant to TFA. They may act as protective factors against distress and as foundations for growth, implicating that interventions such as Cognitive Behavioural Therapy, which aim to reframe women’s experience, may be beneficial
    • Pregnancy termination for fetal abnormality: are health professionals’ perceptions of women’s coping congruent with women’s accounts?

      Lafarge, Caroline; Mitchell, Kathryn; Breeze, Andrew C. G.; Fox, Pauline; University of West London; University of Derby; Leeds Teaching Hospitals NHS Trust (Biomed Central, 2017-02-08)
      Background Pregnancy termination for fetal abnormality (TFA) may have profound psychological consequences for those involved. Evidence suggests that women’s experience of care influences their psychological adjustment to TFA and that they greatly value compassionate healthcare. Caring for women in these circumstances presents challenges for health professionals, which may relate to their understanding of women’s experience. This qualitative study examined health professionals’ perceptions of women’s coping with TFA and assessed to what extent these perceptions are congruent with women’s accounts. Methods Fifteen semi-structured interviews were carried out with health professionals in three hospitals in England. Data were analysed using thematic analysis and compared with women’s accounts of their own coping processes to identify similarities and differences. Results Health professionals’ perceptions of women’s coping processes were congruent with women’s accounts in identifying the roles of support, acceptance, problem-solving, avoidance, another pregnancy and meaning attribution as key coping strategies. Health professionals regarded coping with TFA as a unique grieving process and were cognisant of women’s idiosyncrasies in coping. They also considered their role as information providers as essential in helping women cope with TFA. The findings also indicate that health professionals lacked insight into women’s long-term coping processes and the potential for positive growth following TFA, which is consistent with a lack of aftercare following TFA reported by women. Conclusions Health professionals’ perceptions of women’s coping with TFA closely matched women’s accounts, suggesting a high level of understanding. However, the lack of insight into women’s long-term coping processes has important clinical implications, as research suggests that coping with TFA is a long-term process and that the provision of aftercare is beneficial to women. Together, these findings call for further research into the most appropriate ways to support women post-TFA, with a view to developing a psychological intervention to better support women in the future.
    • The role of rumination in adjusting to termination of pregnancy for fetal abnormality: rumination as a predictor and mediator of posttraumatic growth (in press).

      Usher, L; Mitchell, Kathryn; Fox, Pauline; The University of Derby (2019)
      Objective: Rumination is important in adjusting to traumatic events. Evidence suggests that deliberate rumination predicts posttraumatic growth (PTG), and mediates the relationship between coping and PTG. This study examined the relationship between rumination and psychological adjustment following pregnancy termination for fetal abnormality (TFA). Method: A cross-sectional, online study was conducted with women who had undergone TFA. Women were recruited from a support organisation; 161 women completed the Brief COPE, the Perinatal Grief Scale, the Event-Related Rumination Inventory and the Posttraumatic Growth Inventory. Data were analysed using regression and mediation analyses. Results: The results show that women engaged in high levels of intrusive and deliberate rumination post-TFA and that intrusive rumination predicted grief. Intrusive and deliberate rumination predicted PTG, although intrusive rumination was a negative predictor of growth. Deliberate rumination mediated the relationship between grief and PTG. It also mediated the path between positive reframing and PTG, and religious coping and PTG, although the mediation effect depended upon the inclusion of the grief variable in the models. Conclusions: The results confirm the applicability of the PTG model to TFA and support the relevance of rumination to the PTG experience. The results also have clinical implications. Given the positive relationship between deliberate rumination and PTG, promoting interventions that encourage reflective thinking and narrative construction would benefit women post-TFA, particularly those experiencing high levels of distress and/or at risk of complicated grief.
    • Strengthening socio-emotional competencies in a school setting: Data from the Pyramid project

      Ohl, Madeline; Fox, Pauline; Mitchell, Kathryn; University of West London (Wiley, 2013)
      Background. Development of socio-emotional competencies is key to children's successful social interaction at home and at school. Aims. This study examines the efficacy of a UK primary school-based intervention, the Pyramid project, in strengthening children's socio-emotional competencies. Sample. Participants were 385 children from seven schools in two UK cities. All children were aged 7-8 years and in school Year 3. Children were screened for socio-emotional difficulties through the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997) and a multi-agency meeting of relevant professionals before being allocated to attend a Pyramid Club intervention (n= 103) or a comparison group (n= 282). Method. A 2 2 mixed-model design was used: group (intervention group vs. comparison group) 2 time points (pre- vs. 12 weeks post-intervention) with repeated measures on the time factor to investigate the impact of the Pyramid Year 3 intervention. Teachers completed the SDQ-T4-16 for all children pre- and post-intervention to measure participants socio-emotional health status. Results. As measured by the two SDQ difficulty sub-scales of Emotional and Peer problems and the SDQ strength sub-scale of Prosocial behaviour, post-intervention improvements in the Pyramid attendee group were of greater magnitude than those of the comparison group. Conclusions. The Pyramid project intervention improves the socio-emotional health of vulnerable children through promoting positive outcomes as well as reducing socio-emotional deficits. These findings further support the inclusion of a salutogenic approach in promoting children's socio-emotional well-being.
    • Women's experiences of coping with pregnancy termination for fetal abnormality.

      Lafarge, Caroline; Mitchell, Kathryn; Fox, Pauline; University of West London (Sage, 2013)
      Pregnancy termination for fetal abnormality (TFA) can have significant psychological consequences. Most previous research has been focused on measuring the psychological outcomes of TFA, and little is known about the coping strategies involved. In this article, we report on women's coping strategies used during and after the procedure. Our account is based on experiences of 27 women who completed an online survey. We analyzed the data using interpretative phenomenological analysis. Coping comprised four structures, consistent across time points: support, acceptance, avoidance, and meaning attribution. Women mostly used adaptive coping strategies but reported inadequacies in aftercare, which challenged their resources. The study's findings indicate the need to provide sensitive, nondirective care rooted in the acknowledgment of the unique nature of TFA. Enabling women to reciprocate for emotional support, promoting adaptive coping strategies, highlighting the potential value of spending time with the baby, and providing long-term support (including during subsequent pregnancies) might promote psychological adjustment to TFA.