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Title: Mental defeat in long term health conditions
Author: Mawby, Zoe
ISNI:       0000 0004 7967 7734
Awarding Body: University of Bath
Current Institution: University of Bath
Date of Award: 2018
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Health Psychology research has recently explored the role of Mental Defeat (MD) as a process contributing towards psychological distress in certain LTCs, including chronic pain. MD has been defined as the perceived loss of autonomy in the face of uncontrollable traumatic events, resulting in the person giving up efforts to retain identity and self-will. MD has been likened to a type of catastrophising focused on the self, the person's life and their identity. In contrast, general catastrophising is focused on what the pain/illness means for the person in terms of their health. In the chronic pain literature MD raised levels of MD have been indicated as an important mediator of distress and disability and as a predictor for heightened suicide risk. So far there is limited research on MD outside of chronic pain. If mental defeat does occur in other LTCs it may be a cognitive process that affects treatment seeking, suicidality, symptom severity, and levels of distress, making it a useful area for research to both improve the support available for patients and minimise unnecessary medical visits. This study aimed to explore whether mental defeat (MD) occurs in two long term health conditions (LTCs) with differing symptomology and pain levels; chronic kidney disease and (CKD) and inflammatory arthritis (IA). The primary hypothesis was split into two parts 1a) There will be a difference in levels of MD between renal and arthritic patients (due to the difference in symptoms and treatment) and 1b) There will be no difference in levels of general catastrophizing (due to the chronic yet uncertain nature of both diseases). The secondary hypotheses were 2a) Psychological distress will be associated with mental defeat and 2b) Fear of disease progression will be associated with health anxiety. This study used a cross sectional questionnaire design with two groups IA and CKD. Participants from both groups were recruited from NHS outpatient clinics in the local area and online via social media adverts linked to two charities supporting the conditions respectively. 28 participants were recruited in the CKD group and 54 participants were recruited in the IA group. Participants completed a battery of questionnaires about their experience of, and their beliefs and feelings about their health condition. A mixed model ANOVA and stepwise regressions were conducted to explore hypotheses 1 and 2 respectively. MD occurred in individuals with both IA and CKD at levels higher than that of a healthy sample, but that was no significant difference between the two conditions. The results presented here suggest that the experience of sensory pain is not necessary for MD to be present. Catastrophising occurred equally in both groups. Having a LTC with an unpredictable and uncertain prognosis may contribute to negative beliefs about the future of the illness itself and its effect on an individual, as well as negative beliefs about the self and identity. A stepwise regression revealed that MD, health anxiety, disability and catastrophising were all associated with psychological distress. A second regression revealed that MD, age, and health anxiety predict fear of disease progression. Pain was removed from both regression models, suggesting that it was not associated with psychological distress or fear of disease progression in either group. Overall the CKD group scored higher on many psychological variables, including MD, catastrophising and health anxiety, than the IA group. This may be accounted for by the younger age of the CKD group or by the difference in disease prognosis. There were significant differences in gender between the two groups, with the CKD group being 89% female. This difference, along with numbers recruited and age differences between the two groups is a limitation of this study. Through this initial exploration it has been identified that MD occurs in individuals with two LTCs above the level of a healthy control and that specific symptomology may be less of an indicator for MD than initially thought. In order to target individuals with the most need for intervention, we need to explore whether there are certain types of LTCs where MD is more likely e.g. those with a highly uncertain prognosis, or whether there are in fact a certain demographic of individuals who are more vulnerable to experiencing it.
Supervisor: Davis, Cara ; Salkovskis, Paul Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available