Understanding psychological resilience to negative stressors and suicidal thoughts and behaviours in people experiencing schizophrenia spectrum disorders.

John Grace QC PhD Scholarship 2016 - University of Manchester, School of Psychological Sciences,

Supervisor: 
Dr. Patricia Gooding, Dr. Sarah Peters, Professor Gillian Haddock.

Summary:
Background: Psychological resilience comprises skills which enable people to cope with, and bounce back from, negative events and stressors. Research which investigates how people with severe mental illnesses develop resilience is lacking. This gap is important to redress because many people with severe mental illnesses experience negative stressors. For some, these negative experiences lead to suicidal thoughts and behaviours.  

Objectives: There are two main objectives of this PhD programme which are, first, to understand how people with schizophrenia spectrum disorders build psychological resilience to negative stressors and suicidal thoughts, and second, to develop and evaluate a simple, brief, psychological intervention which can help to nurture resilience in this population. Hypotheses: Preliminary qualitative work by our team has shown that people with schizophrenia can spontaneously develop strategies which foster resilience. Based on this work, it is predicted that three sources of resilience will be evident which are acceptance, resistance, and active coping. The latter source is expected to encompass emotional regulation techniques and social support. Methods: Three studies are planned. The first will be qualitative and build on our preliminary qualitative findings. The second will be cross-sectional using quantitative, questionnaire based, methods to advance findings from the first study. The third study will progress the first two, and will use a multiple baseline design to investigate focussed, brief, psychological techniques which can improve resilience. Impact: This programme has the potential to make a positive difference to people with schizophrenia because it aims to understand and nurture resilience from service-user perspectives.

Research Student: Kamelia Harris
Profile 

I am a pragmatic, reliable, and fast-learning research associate from the University of Manchester. My research interests in particular relate to understanding the development and treatment of mental conditions. I am also interested in clinical assessment and research using computerised measures (e.g., mobile phone applications, ESM methods). 

Employment & Voluntary Work 

RESEARCH ASSOCIATE, UNIVERSITY OF MANCHESTER, MAY 2015-PRESENT. 

I participate in the day-to-day implementation of projects, including adherence to the project plan, ethical requirements, research governance permissions, recruitment and data collection, preparation of papers for peer-reviewed journals, and liaising with NHS staff, service users and carers. I have a leading role in the planning, co-ordinating, collection and analysis of a range of qualitative data using different interview techniques, as well as NVivo software for qualitative data analysis. I am currently participating in the writing of two articles exploring the need for collaborative antipsychotic prescribing for people with schizophrenia as part of an NIHR-RCF funded study. 

RESEARCH ASSISTANT, UNIVERSITY OF MANCHESTER, MARCH 2015-PRESENT. 

As part of the position I assist in the preparation of research protocols and applications, statistical data analyses, literature reviews, data collection and management, production of summary reports from data analyses, and liaison with University and NHS staff. I have undergone clinical training for assessing the severity of psychosis symptoms (Positive and Negative Syndrome Scale (PANSS)), Good Clinical Practice (GCP), and Mental Capacity Act (MCA). I am currently working on a review article of the incidence of death by suicide in people experiencing psychosis. 

VOLUNTEER RESEARCH ASSISTANT, UNIVERSITY OF MANCHESTER, SEPTEMBER 2013-FEBRUARY 2015. 

In parallel with my formal scientific education I have volunteered as a research assistant on several projects. Specifically, I collected eye movement data on a visual search experiment from 34 participants, using eye-tracking methodology. I also assisted with data scoring on an NIHR funded study probing the inter-relations between insomnia and depression. As part of this work I led and conducted a systematic review into insomnia-related attentional bias, and I have orally presented the findings as part of the University of Manchester sleep seminar series. I have also assisted with the execution and write-up of a systematic review on the psychological impact and distress on the significant others (e.g., family, friends) of people with chronic fatigue syndrome. These voluntary positions have provided invaluable insights into academic life and helped refine my skills in relation to literature searches, scholarly writing and manuscript preparation. 

Higher Education 

MRES PSYCHOLOGY, UNIVERSITY OF MANCHESTER, SEPTEMBER 2013-SEPTEMBER 2014. 

I developed my core research skills during a Master’s in psychological research methods. I am proficient in advanced statistical techniques, qualitative and quantitative methods. Through my major research project I have mastered data collection techniques and study design, and familiarised myself with the processing, systematic cleaning, and analysis of large datasets. I was awarded a Distinction on my Master’s research project which assessed the effects of brief sleep restriction therapy on insomnia symptoms and sleep-related attentional bias in patients with sychophysiological insomnia. This was achieved by measuring their reaction times on a well-established attentional bias paradigm (Stroop) and comparing their performance to healthy controls. Insomnia patients were expected to exhibit selective attention towards the sleep-related stimuli at baseline, relative to healthy sleepers. A reduction in sleep-related attentional bias scores and insomnia symptom severity were expected at three months post-treatment, compared to baseline assessment. 

BSC (HONS) PSYCHOLOGY, MANCHESTER METROPOLITAN UNIVERSITY, SEPTEMBER 2010-SEPTEMBER 2013. 

I graduated with BSc (Hons) Psychology with a high 2.1. As an undergraduate I gained experience in planning and conducting research, knowledge in using SPSS, and applying different statistical methods to research. For my undergraduate dissertation I designed and conducted a novel online experiment probing the relationship between information processing biases and subjective mood state, with implication for psychopathology. The hypothesis was that positive and negative mood states would lead to attentional bias towards positive and negative emotional information, respectively.

Start Date: September 2016

Scientific goal: 

1. to understand the mechanisms underlying psychological resilience to negative stressors and suicidal thoughts and behaviours in people experiencing schizophrenia spectrum disorders, and 

2. to develop a simple, brief, psychological intervention which can build and maintain resilience in this population.

2017 Report 

My PhD project aims to understand psychological resilience to suicidal thoughts and behaviours in people with diagnosis on the schizophrenia spectrum. Research has shown that some people with schizophrenia can spontaneously develop strategies which foster resilience. However, we currently do not know how resilience operates to buffer against the impact of suicide risk factors and subsequently reduce suicidal thoughts and behaviours in this population.

In order to explore this issue, I first undertook a systematic literature review which aimed to establish: i) the relationship between resilience and suicidal thoughts and behaviours; ii) the evidence that resilience can help individuals bounce back from such experiences; iii) the extent to which resilience can weaken the relationship between suicide risk factors and suicidal thoughts and behaviours; and iv) the underlying psychological mechanisms by which resilience is protective of suicidal thoughts and behaviours in people with schizophrenia spectrum disorders. The review reports several resilience factors which are associated with reduced suicidal thoughts and behaviours in people with schizophrenia, including recovery; symptom awareness; IQ; cognitive functioning; social support; religion; and having reasons for living. An unexpected finding was that specific psychosis symptoms, such as delusions of grandeur and persecution, were associated with reduced suicidal thoughts and behaviours. The manuscript is in preparation for publication in Clinical Psychology Review.

Data collection for my first planned study is under way. The aim of the study is to examine the individual experiences of psychological resilience to suicidal thoughts and behaviours of people using qualitative methodology. The study involves face-to-face interviews with service users with schizophrenia spectrum disorders and experiences of current or lifetime suicidality.

The plan for the next year is, first, to complete data collection and analysis of the first interview study and to write up the results for publication in a high-impact journal. Second, to plan my next study which will use questionnaires to collect information about individual resilience, suicidality and psychosis over two time points, several months apart. The study will build on information obtained from conducting the systematic literature review and the first interview study. The aim is to assess how resilience constructs are changing across time, from baseline to four months following baseline assessment, in individuals experiencing suicidality and schizophrenia spectrum disorders.

Among planning and conducting my studies, I have also attended training courses in research methods and have successfully completed an applied suicide prevention course to supplement my knowledge and development as a researcher in suicide.