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The Feasibility and Efficacy of a Positive Psychotherapy Group for Community Stroke Survivors and Carers

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The Feasibility and Efficacy of a Positive Psychotherapy Group for Community Stroke Survivors and Carers The Feasibility and Efficacy of a Positive Psychotherapy Group for Community Stroke Survivors and Carers Isla McMakin South Wales Doctoral Programme in Clinical Psychology May 2016 Supervised by: Professor Reg Morris, Professor Neil Frude & Dr Samantha Fisher Thesis submitted in partial fulfilment of the requirement for the degree of Doctor of Clinical Psychology (DClinPsy) at Cardiff University and the South Wales Doctoral Programme in Clinical Psychology. DECLARATION This work has not been submitted in substance for any other degree or award at this or any other university or place of learning, nor is being submitted concurrently in candidature for any degree or other award. Signed ………………………………………… (candidate) Date ………………………… STATEMENT 1 This thesis is being submitted in partial fulfilment of the requirements for the degree of DClinPsy. Signed ………………………………………… (candidate) Date ………………………… STATEMENT 2 This thesis is the result of my own independent work/investigation, except where otherwise stated. Other sources are acknowledged by explicit references. The views expressed are my own. Signed ………………………………………… (candidate) Date ………………………… STATEMENT 3 I hereby give consent for my thesis, if accepted, to be available for photocopying and for inter-library loan, and for the title and summary to be made available to outside organisations. Signed ………………………………………… (candidate) Date ………………………… STATEMENT 4: PREVIOUSLY APPROVED BAR ON ACCESS I hereby give consent for my thesis, if accepted, to be available for photocopying and for inter-library loans after expiry of a bar on access previously approved by the Academic Standards & Quality Committee. Signed ………………………………………… (candidate) Date ………………………… ACKNOWLEDGEMENTS Firstly, I would like to thank all of the stroke survivors and carers who kindly gave up their time to participate in this research project. Without their participation this thesis would not have been possible. It has been a pleasure to get to know such a kind, committed and resilient group of people, your strength and courage is truly inspirational. I would secondly like to give my thanks to my academic supervisors, Professor Neil Frude and Professor Reg Morris, for your continued support, guidance, ‘red pen treatment’ and encouragement throughout this project. I would also like to thank my clinical supervisor, Dr Samantha Fisher, for giving up a huge amount of her time to assist with recruitment of participants, the co-production of the content of the intervention and the co-facilitation of group sessions. It has been a pleasure to work with you again over the past year! I would like to express my gratitude to the assistant psychologist at the Stroke Rehabilitation Centre, Tamsin Miles, for her continued enthusiasm and support in facilitating the group sessions and the undergraduate placement student, Naomi Newton, for helping to set up the group sessions, providing much needed refreshments and assisting with administration tasks. I would like to thank my cohort for being the most supportive colleagues (and friends) anyone could hope for. We have shared many laughs, tears, stresses and plenty of cakes over the past three years! I am fortunate to have a loving and supportive family, who although dotted across the globe, have always continued to support and encourage me to pursue my ambitions and dreams. A big thank you to my sister, Kirsty, who provided daily motivational messages and encouragement over the past 6 months. Finally, I would like to give a special thank you to Jason - my partner. I am so incredibly grateful for your continued love, thoughtfulness, encouragement and patience. I look forward to all the extra time that we will have to spend together and to finally being able to start the next part of our journey together, minus the 350 mile round trip to see each other! i ABSTRACT Psychological distress is common for both survivors and carers following a stroke, but the evidence base for psychological interventions is limited. This study investigated the feasibility and efficacy of an interactive group-based Positive Psychotherapy [PP] intervention for stroke survivors and carers. PP is an approach that focuses on individuals’ strengths and engagement in life with the aim of improving their psychological wellbeing. This study is comprised of two parts (1a and 1b), within which changes in psychological wellbeing and psychological distress were the main outcomes investigated. Study 1a: stroke survivors and carers (n=48) were randomly assigned to the five-week PP group or waiting-list control. Study 1b: stroke survivors and carers (n = 20) were assigned to the PP group only. All participants completed measures of psychological wellbeing (SWEMWBS), psychological distress (HADS), multidimensional wellbeing (PERMA-P) and daily functioning (FAI) at three time points (baseline, 5, 10 weeks post-baseline). Statistical analyses were conducted to examine changes in mean scores across time. Supplementary qualitative feedback regarding the PP intervention was collected via a focus group (n=10). Study 1a participants reported significant improvements in daily functioning following attendance at the PP group. Increases in psychological and multidimensional wellbeing were reported following attendance at the PP groups; however these changes were not statistically significant. In conclusion, the PP intervention was feasible to deliver. A full-scale trial, with the recommended improvements made, is required to further investigate the efficacy of the PP intervention regarding psychological wellbeing and daily functional amongst community-based stroke survivors and carers. ii CONTENTS CHAPTER ONE: INTRODUCTION .................................................................................... 1 1.1 THESIS FOCUS .................................................................................................................... 1 1.2 KEY TERMINOLOGY DEFINITIONS ............................................................................ 3 1.2.1 Stroke .............................................................................................................................. 3 1.2.2 Positive Psychotherapy [PP] ............................................................................................ 3 1.3 THESIS RELEVANCE ........................................................................................................ 3 1.3.1 Stroke .............................................................................................................................. 3 1.3.2 Stroke Carers ................................................................................................................... 4 1.3.3 Emotional Wellbeing after Stroke ................................................................................... 4 1.3.4 National Stroke Strategies .............................................................................................. 5 1.3.5 Psychological Support after Stroke ................................................................................. 7 1.4 Section Summary ................................................................................................................ 10 1.5 POSITIVE PSYCHOTHERAPY [PP] .............................................................................. 11 1.5.1 The Development of Positive Psychology and PP ......................................................... 12 1.5.2 Positive Psychology and Health .................................................................................... 12 1.5.3 Characteristics of Positive Psychotherapy [PP] ............................................................. 13 1.5.4 Theoretical Background ................................................................................................ 14 1.5.5 Research Evidence for the Efficacy of Positive Psychology Interventions .................... 20 1.5.6 Section Summary .......................................................................................................... 24 1.6 SYSTEMATIC REVIEW................................................................................................... 25 1.6.1 Systematic Search ......................................................................................................... 25 1.6.2 Overview of Included Studies ....................................................................................... 29 1.6.3 Quality of the Studies .................................................................................................... 31 1.6.4 Synthesis of the Studies ................................................................................................ 32 1.7 STUDY RATIONALE AND HYPOTHESES .................................................................. 43 1.7.1 Hypotheses.................................................................................................................... 44 CHAPTER TWO: METHODOLOGY ................................................................................ 46 2.1 DESIGN ............................................................................................................................... 46 2.2 PARTICIPANTS ................................................................................................................. 47 2.2.1 Power Analysis .............................................................................................................. 47 2.2.2 Inclusion and Exclusion Criteria ...................................................................................
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