Lee Hulbert-Williams

Life events as a risk factor for psychological problems in individuals with intellectual disabilities: a critical review.

BACKGROUND Stressful life events such as bereavement, moving house and changing jobs have repeatedly been implicated as risk factors for mental and physical ill health. Since the 1940s, researchers have demonstrated the negative effects of stressful life events, refined methods of recording such events and investigated the relative impact of different types of event. These investigations have generally not extended to include people with intellectual disabilities. METHODS We conducted a narrative review of research on life events as they occur to people with intellectual disabilities and critically assessed the evidence that life events function as a risk factor for psychological problems. Evidence was reviewed for an association between life events and a range of outcome variables, including affective disorders, challenging behaviour, psychosis and psychological problems more generally. We also critiqued the methodology behind the current evidence base and discussed a number of methodological advances that would help to strengthen it. CONCLUSIONS There is reasonable evidence that life events are associated with psychological problems, and that there is some tentative evidence that life events play a causal role, although to date, no relationship with psychosis in people with intellectual disabilities has been demonstrated. Life events are likely to be pertinent in clinical work with people with intellectual disabilities.

Exposure to life events as a risk factor for psychological problems in adults with intellectual disabilities: a longitudinal design.

BACKGROUND Several cross-sectional studies have shown an association between exposure to life events and psychological problems in adults with intellectual disability (ID). To establish life events as a risk factor, prospective designs are needed. METHODS Support staff informants provided data on the psychological problems of 68 adults with ID and their recent exposure to life events. Using data collected on the same sample 3.5 to 4 years earlier, prospective analysis of the relationships between life events exposure and psychological problems over time was explored. RESULTS Hierarchical linear regression analyses demonstrated a contribution of life events to the prediction of later psychological problems after controlling for earlier psychological problems. Exploratory analyses showed that the relationship between life events and psychological problems might be unidirectional, and non-spurious; remaining present once the impact of other correlates of psychological problems was controlled. CONCLUSIONS These data offer support for the status of life events (with a negative valence) as a risk factor for psychological problems in adults with ID. To establish life events as a causal risk factor, research is needed to examine the mechanisms via which life events have their impact on psychological well-being.

The Mini-Mental Adjustment to Cancer Scale: re-analysis of its psychometric properties in a sample of 160 mixed cancer patients

The mini‐Mental Adjustment to Cancer Scale is designed to assess psychological responses to cancer diagnosis and is widely used in research and clinical practice. Recent evidence demonstrates adequate convergent validity but inconsistent internal consistency and factor structure. This study aimed to provide a parsimonious factor structure with clinical utility.

British English translation of the Food Craving Inventory (FCI-UK).

There is evidence for cultural variation in the foods that may be craved. We have designed and tested, in a sample of 234 participants, a UK-specific version of the Food Craving Inventory. A four-factor structure comprising of sweet foods, fast foods, high fat, and complex carbohydrates was extracted. The final scale was analogous with the original US scale, and shared similar associations with external eating and dietary restraint, although no association was found with BMI. The measure has potential to contribute to the development of theoretical understanding of food craving, and to measuring outcomes in intervention studies and clinical samples.

“You don't know what's wrong with you”: an exploration of cancer-related experiences in people with an intellectual disability

Few empirical studies have explored cancer‐related experiences of people with an intellectual disability (ID), despite rising cancer incidence in this population. The present research aims to better understand the experiences of this population from multiple perspectives, generating theory and further research questions.

Women’s experiences of using drugs in weight management. An interpretative phenomenological analysis

This study examines the experiences of women using drugs in weight management. Whilst some of the commonly used substances have been deemed to be safe, most, if not all, still have potentially dangerous side effects for the individual. Five women spoke of their experiences of using drugs in weight management through semi-structured interviews. These were analysed using Interpretative Phenomenological Analysis (IPA). Three themes arose from the analysis: the challenges of weight management, the appealing aspects of drug use and emotion and control. Findings revealed that participants believed they need to be thin in order to be happy and they found weight management difficult due to a variety of internal and external aspects. Drug use was seen as an easier and guaranteed way to manage weight. Participants felt that the use of substances for the purpose of weight management was erroneous with shame attached to it, and yet, drugs helped them to feel in control of their lives, their weight and also acted as a maladaptive emotion regulation strategy. Clinical implications and suggestions for future research are discussed.

Distinguishing between treatment efficacy and effectiveness in post-traumatic stress disorder (PTSD): Implications for contentious therapies

Research psychologists often complain that practitioners disregard research evidence whilst practitioners sometimes accuse researchers of failing to produce evidence with sufficient ecological validity. We discuss the tension that thus arises using the specific illustrative examples of two treatment methods for post-traumatic stress disorder: eye movement desensitisation and reprocessing and exposure-based interventions. We discuss the contextual reasons for the success or failure of particular treatment models that are often only tangentially related to the theoretical underpinnings of the models. We discuss what might be learnt from these debates and develop recommendations for future research.

Sexuality in the Therapeutic Relationship: An Interpretative Phenomenological Analysis of the Experiences of Gay Therapists

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) clients have reported experiencing heterosexist/homophobic attitudes from heterosexual therapists, but this has seldom been discussed for gay therapists. Such experiences could impact the therapeutic process and a gay therapists willingness to self-disclose their sexuality. Self-disclosure of sexuality can be therapeutically beneficial for LGBTQ or heterosexual clients. Semi-structured interviews were conducted with seven gay male therapists and analyzed using Interpretative Phenomenological Analysis. Five themes emerged: affinity for working with LGBTQ clients, heterosexual males’ resistance to the therapeutic process, the impact of homophobia within the therapeutic relationship, empathy through shared humanity, and utilizing therapist sexuality as a tool within the therapeutic relationship.

Psychosocial experiences of chronic illness in individuals with an intellectual disability: A systematic review of the literature

Background: Increased life expectancy has led to an increase in diagnoses of chronic illness in people with an intellectual disability; despite this increase, research about the psychological impact is rare. This review explored the psychosocial experiences of chronic illness in adults with an intellectual disability, revealing potential predictors and moderators of these experiences. Methods: Online databases were systematically searched to identify relevant literature, using predefined inclusion criteria. Of the 25,058 titles initially identified, 4 were included, that is, those collecting data on people with an intellectual disability and diagnosed with cancer (n = 2), chronic pain (n = 1) and diabetes (n = 1). Results: Narrative synthesis of the data identified six themes, namely, (1) delayed diagnosis, (2) information, communication and understanding, (3) negative psychological consequences, (4) negative physical consequences, (5) social perception and (6) social support. Conclusions: There are unmet needs within this population, including a lack of assistance in understanding their illness. A substantial gap in the literature should be addressed through further empirical work.

Ultra-brief non-expert-delivered defusion and acceptance exercises for food cravings: A partial replication study:

Food cravings are a common barrier to losing weight. This article presents a randomised comparison of non-expert group-delivered ultra-brief defusion and acceptance interventions against a distraction control. A total of 63 participants were asked to carry a bag of chocolates for a week while trying to resist the temptation to eat them. A behavioural rebound measure was administered. Each intervention out-performed control in respect of consumption, but not cravings. These techniques may have a place in the clinical management of food cravings. We provide tentative evidence that the mechanism of action is through decreased reactivity to cravings, not through reduced frequency of cravings.