Objectives: To evaluate the efficacy of the online cognitive behavioral therapy (CBT)-based Pain Course on levels of pain, disability, and psychological wellbeing in adults with chronic pain living in Ireland, with two-year follow-up. Methods: 133 people were randomly assigned (ISRCTN11292570) to either the Pain Course (n=66) comprising five lessons delivered over eight weeks with clinician support, or to delayed access with usual care in the interim (n=67). The primary outcome was pain-related disability while secondary outcomes were depression, anxiety and average pain, and tertiary outcomes were pain self-efficacy, fear of movement, and pain acceptance. Outcomes were collected at post-treatment, 3-month follow-up (n=55 [83% retention]) and 2-year follow-up (n=29 [44% retention]). Results: Course completion rate was 80%. Improvements were significantly greater for Treatment Group participants compared to Control Group on measures of disability, anxiety, depression, and average pain at post-treatment (Cohen’s d =.48-1.00). Improvements in outcomes were in the range 12%-44% and benefits were maintained or improved at 3 month follow-up. All tertiary outcomes also improved in the treatment group. There was substantial attrition at 2-year follow-up, but for those who responded, treatment effects were largely maintained. High treatment satisfaction ratings were expressed by over 80% of participants. Average clinician contact, per participant, was 81.06 minutes. Discussion: The findings of the current study in an Irish sample corroborate those of previous Pain Course efficacy trials and highlight the potential benefits of internet-based interventions for adults with chronic pain, with treatment effects maintained for up to 2 years in those who responded.

Military personnel are at increased risk of being exposed to potentially traumatic events when compared to the general population. Resilience is a protective against potentially traumatic events, whereby higher resilience moderates the frequency and severity of depression, psychological trauma, and post-traumatic stress disorder. Many psychological interventions have been developed to increase military personnels' resilience however there exist significant debate as to the effectiveness and rigor of many existing programmes. This study involved recruiting a panel of Irish military experts and a cohort of international subject matter experts, ranging in expertise in military psychology, intervention design and civilian resilience programme delivery. The aim of this study was to develop a framework from which to design a novel resilience-building programme for the Irish Defence Forces. The study took place over three rounds, beginning with an open-ended data generation questionnaire and moving through two rounds where we achieved consensus on a range of programme design points. Recommendations include a multimethod approach to building resilience (blend of CBT, Mindfulness etc), taking place in person, and over the course of several sessions. While this research has an Irish focus, the results are generalizable to other militaries & emergency services sectors.

OBJECTIVES:To evaluate the efficacy of the online cognitive behavioral therapy (CBT)-based Pain Course on levels of pain, disability, and psychological wellbeing in adults with chronic pain living in Ireland, with two-year follow-up. METHODS:133 people were randomly assigned (ISRCTN11292570) to either the Pain Course (n=66) comprising five lessons delivered over eight weeks with clinician support, or to delayed access with usual care in the interim (n=67). The primary outcome was pain-related disability while secondary outcomes were depression, anxiety and average pain, and tertiary outcomes were pain self-efficacy, fear of movement, and pain acceptance. Outcomes were collected at post-treatment, 3-month follow-up (n=55 [83% retention]) and 2-year follow-up (n=29 [44% retention]). RESULTS:Course completion rate was 80%. Improvements were significantly greater for Treatment Group participants compared to Control Group on measures of disability, anxiety, depression, and average pain at post-treatment (Cohen's d =.48-1.00). Improvements in outcomes were in the range 12%-44% and benefits were maintained or improved at 3 month follow-up. All tertiary outcomes also improved in the treatment group. There was substantial attrition at 2-year follow-up, but for those who responded, treatment effects were largely maintained. High treatment satisfaction ratings were expressed by over 80% of participants. Average clinician contact, per participant, was 81.06 minutes. DISCUSSION:The findings of the current study in an Irish sample corroborate those of previous Pain Course efficacy trials and highlight the potential benefits of internet-based interventions for adults with chronic pain, with treatment effects maintained for up to 2 years in those who responded.

Poor sleep quality has been linked to both poor psychological and physical well-being. Mood and anxiety levels are affected by poor quality sleep, and the relationship between these variables appears to be mediated by a tendency to depersonalize or not. This study examines these relationships in 112 Adults (Female = 82, Male = 30), via an online study. The Pittsburgh Sleep Quality Index, Patient Health Questionnaire4, Cambridge Depersonalization Scale-9, and Patient Health Questionnaire-15 were administered using the Gorilla platform. The following variables were analyzed using correlation statistics, and mediation analyses: sleep quality, anxiety, depression, somatic pain, and depersonalization. Poor sleep quality was associated with higher levels of all psychological variables. As predicted, depersonalization mediated the relationship between sleep quality and anxiety, depression and somatic concerns. The findings indicate that sleep quality and the mediating effect of depersonalization have a significant impact on psychological well-being in adults.

PURPOSE:To explore women's lived experiences of intimacy, sexuality and sexual functioning in the context of cauda equina syndrome (CES). METHODS:Ten women completed an in-depth semi-structured interview exploring the psychosocial impact of CES on their sexuality and data were analyzed using Interpretative Phenomenological Analysis (IPA). RESULTS:One superordinate theme was generated: "Sexuality forever altered, it's changed completely," reflecting the enduring impact of CES on women's sexuality. Five subordinate themes emerged reflecting a range of changed roles and relationships, primarily associated with loss of sexual identity and a sense that health professionals did not prioritize sexual functioning (1): Loss of worth as a sexual being: "Feel like a nothing" (2) Relationships have changed: "It's not a meeting of equals anymore" (3) Lack of professional support: "We don't like to talk about anything below the waist" (4) Challenges for motherhood: "What kind of future will they have with a mother like me…" and (5) Finding ways of coping: "Closed the door on it." CONCLUSION:Findings highlight the detrimental effect of CES, directly and indirectly, on women's sexuality. There is a need for a multidisciplinary approach to address the physical, emotional, cognitive, and behavioural effects experienced in relation to sexuality as part of a rehabilitative process.

Our ability to regulate our emotions plays a key protective role against psychological distress and somatic symptoms, with most of the literature focusing on the role of cognitive reappraisal in interventions such as cognitive behavioral therapy (CBT). This study seeks to examine the relationship between emotion dysregulation and psychological and physical distress in university students through the role of depersonalization (DP) and insecure attachment. This study will try to explain the deployment of DP as a defense mechanism to insecure attachment fears and overwhelming stress, developing a maladaptive emotion responding strategy, which affects wellbeing later in life. A cross-sectional design was used on a sample (N = 313) of university students over the age of 18 which consisted of an online survey of 7 questionnaires. Hierarchical multiple regression and mediation analysis were conducted on the results. The results showed that emotion dysregulation and DP predicted each variable of psychological distress and somatic symptoms. Both insecure attachment styles were found to predict psychological distress and somatization, mediated through higher levels of DP, whereby DP may be deployed as a defense mechanism to insecure attachment fears and overwhelming stress, which affects our wellbeing. Clinical implications of these findings highlight the importance of screening for DP in young adults and university students.

Objectives: Dissociation refers to disrupted integration of conscious awareness, emotions, memories, body representation, and motor control (American Psychiatric Association [APA], 2013). Despite the burden of unexplained somatic symptoms on individuals, and on healthcare providers, research to date has focused on the use of the Dissociative Experiences Questionnaire (DES-II) which measures the psychological compo-nents of dissociation, with measures of somatic manifestations of dissociation, such as the Somatoform Dis-sociation Questionnaire (SDQ-20) often being overlooked. The aim of the current study was to examine how attachment, alexithymia and childhood trauma relate to symptoms of psychoform and somatoform dissocia-tion based on self-report measures. Additionally, the study sought to examine the mediating role of self -reported attachment-style and alexithymia in the relationship between childhood trauma and dissociation. Methods: A cross-sectional survey of 220 adults in the general population, aged 18 - 76, was carried out. Par-ticipants completed a number of self-report measures online. Hierarchical logistic regression and mediation analyses were conducted.Results: Results indicated that the difficulty identifying feelings component of alexithymia significantly pre-dicted an increased likelihood of scoring above the clinical cut-off for somatoform dissociation. Difficulty identifying feelings also partially mediated the relationship between physical neglect and somatoform disso-ciation scores. Avoidant attachment style and difficulty identifying feelings significantly predicted an increased likelihood of scoring above the clinical cut-off for psychoform dissociation. Both avoidant attach-ment style and difficulty identifying feelings partially mediated the relationship between emotional abuse and psychoform dissociation scores.Conclusion: The findings of the current study suggest that it may be of relevance to consider the role of both traumatic experiences and dissociative processes in persistent somatic presentations. Findings also suggest that treatments which support emotional awareness and are informed by attachment theory may relevant for those that self-report debilitating somatic symptoms (c) 2023 Elsevier Masson SAS. All rights reserved.

Migraine and chronic migraine are caused by a combination of modifiable and non-modifiable genetic, social, behavioral and environmental risk factors. Further research of possible modifiable risk factors for this headache disorder is merited, given its role as one of the leading causes of years lived with disability per year. The first aim of this online cross-sectional study was to investigate the psychosocial risk factors that predicted chronic migraine and severe migraine-related disability in 507 Irish and UK participants, focusing specifically on childhood maltreatment, attachment and tendency to dissociate, or experience depressed mood and/or anxiety. Additionally, this study aimed to examine variables that mediated the relationships between these psychosocial risk factors and migraine chronicity or severe migraine-related disability. Adjusted binary logistic regression revealed that shutdown dissociation (Odds Ratio [OR] 4.57, 95% Confidence Interval [CI] 2.66-7.85) and severe physical abuse (OR 4.30, 95% CI 1.44-12.83 had significant odds of predicting migraine chronicity, while depression (OR 3.28, 95% CI 1.86-5.77) significantly predicted severe migraine-related disability. Mediation analyses indicated that shutdown dissociation mediated the relationship between seven predictor variables and both chronicity and severe disability including possible predisposing factors emotional abuse, physical neglect, avoidant attachment and anxious attachment. These findings suggest that early life stressors (such as childhood trauma and avoidant attachment style), shutdown dissociation and depression may impact on migraine trajectory. To investigate whether these psychosocial factors are risk factors for migraine chronicity or disability, prospective research should be conducted in this area to account for fluctuations in migraine chronicity over time.

There is limited research into the experiences of adopted individuals in adulthood despite the fact that adoption is a lifelong process. One key element of adoption is the processing and integration of one’s adoptive identity. This becomes increasingly salient in adulthood and especially so when becoming a parent as it leads to a re-examination of the individual’s adoptive narrative. However, this phenomenon is not well researched and lacks a theoretical framework. This study employed a classic grounded theory (CGT) methodology to develop a theory that explains how adopted individuals readjust their adoptive identity when they become parents. Twelve interviews were conducted with adoptees who had become parents and analysed using CGT. From this data, the theory of Creating a New Narrative emerged to chart the process and explain how adopted individuals readjust their adoptive identity in parenthood. It involves parents revisiting their adoption narrative and being empowered to reclaim their identity, rescript their family concept and parenting values and expand their repertoire for navigating hypervigilance regarding rejection. All of these elements are influenced by the level of openness and acceptance parents have experienced in relation to their adoptive status. The model thus provides a new theoretical framework that integrates the various research findings in this area.

Previous research has continuously identified a need for a comprehensive model of working with first mothers in adoption. This gap in knowledge has hindered the development of services, to the detriment of the quality of life and well-being of this group. This study seeks to remedy this deficiency by exploring the lived experiences of Irish mothers who have lost a child through closed adoption. It aims to expand understanding of the impact of such loss, in particular exploring how it affects their journey of reconnection and reunion with their child in adulthood. Semi-structured interviews were undertaken with six women from Ireland who had lost a child in this way and their narratives were analysed using Interpretative Phenomenological Analysis (IPA). Two superordinate themes emerged from the data: ‘Motherhood concealed: the loss of autonomy and connection’ and ‘Motherhood revealed: a pathway towards autonomy and reconnection’. Within each superordinate theme, two subordinate ones were identified: ‘Dehumanised, disempowered and dismissed’, ‘Coping through disconnection’, ‘Breaking the silence’ and ‘Reunion and reconnection’. The first two of these encapsulate the loss of personal autonomy and connectedness resulting from the loss of a child and how participants coped with it. The two others describe the participants’ experiences of growth in personal autonomy and agency through the process of breaking the silence of their concealed motherhood and of reconnection and reunification with their now adult children. The findings indicate that engaging in therapeutic services and/or with adoption peer support enables participants to express their feelings of grief and move from coping strategies dominated by disconnection to ones marked by the autonomous processing of emotion and new coping patterns. The process of reunification with their children plays a significant role in this transition.

Clinical Impact Statement Whilst a depth of research has been completed with large global actors such as the UK armed forces and the American military, there has been a dearth of work focusing on the peacekeeper orientated organisations such as the Irish defence forces. The findings of this research highlight the processes that can foster and galvanise or degrade an individual's resilience and ability to overcome stressful challenges. We discovered that these factors are operating at the personal, interpersonal, and wider institutional level. This foundational work provides the basis for further research into the military peacekeeper and humanitarian domain. Background: Military personnel are at a heightened risk of being exposed to potentially traumatic incidents in the line of duty. Evidence would suggest that the risk of developing psychological trauma and/or PTSD after a traumatic event is predicted by the interaction of pre-trauma, peri-trauma and post-trauma risk and protective factors. Objective: This research will explore military personnels' experience of potentially traumatic events while deployed. In particular, the research aims to gain an understanding of both protective and risk factors which influence personnels' experience of potentially traumatic events. Method: One to one, semi-structured interviews were conducted with 12 members of the Irish Defence Forces. We conducted a thematic analysis in line with the recommendations provided by Braun & Clarke 2006. Results: There was a wide variety of potentially traumatic events experienced by participants, ranging from stressful naval migrant rescues to armed standoffs. Aside from more pointed events, chronic stress was reported to negatively affect personal resilience while factors such as positive mindset and a belief in the mission had a galvanizing effect. Both the family back home and the "military family" were reported to provide sources of comfort and support, while at times being a source of significant stress. The organisational context of the military, including training and formal psychological supports was viewed with mixed opinions by our participants. Conclusions: The findings of this research illuminate the unique stress and strains faced by Irish military personnel at pre, peri and post deployment. The results highlight the need for effective predeployment resilience building programmes to equip personnel with the tools to deal with traumatic events. This foundational work provides the basis for further research into the military peacekeeper and humanitarian domain.

This study interviewed mothers who lived in Ireland.Each mother had a son with Autism Spectrum Disorder and Intellectual Disability.Their sons were aged between 15 and 24.The mothers were asked about their feelings and thoughts as their son became a young adult.The mothers felt that they had to:Be the voice of their son Make sure his needs were met Make sure he was treated properly when away

BACKGROUND:Military personnel and frontline emergency workers may be exposed to events that have the potential to precipitate negative mental health outcomes such as depression, symptoms of post-traumatic stress and even post-traumatic stress disorder (PTSD). Programmes have been designed to build psychological resilience before staff are deployed into the field. This review presents a synthesis of the literature on these "pre-deployment resilience-building programmes". OBJECTIVES:The objective of this review was to assess the effectiveness of programmes that seek to build resilience to potentially traumatic events among military and frontline emergency service personnel prior to their deployment. These resilience programmes were compared to other interventions, treatment as usual or no intervention. SEARCH METHODS:Studies were identified through searches of electronic databases including Ovid MEDLINE, Embase, PsycINFO, Web of Science and Google Scholar. The initial search took place in January 2019, with an updated search completed at the end of September 2020. SELECTION CRITERIA:Only studies that used a randomised controlled trial (RCT)/cluster-RCT methodology were included. The programmes being evaluated must have sought to build resilience prior to exposure to trauma. Study participants must have been 18 years or older and be military personnel or frontline emergency workers. DATA COLLECTION AND ANALYSIS:Studies that met the inclusion criteria were assembled. Data extracted included methods, participants' details, intervention details, comparator details, and information on outcomes. The primary outcomes of interest were resilience, symptoms of post-traumatic stress and PTSD. Secondary outcomes of interest included acute stress disorder, depression, social support, coping skills, emotional flexibility, self-efficacy, social functioning, subjective levels of aggression, quality of sleep, quality of life and stress. Assessment of risk of bias was also completed. A total of 28 studies were included in a narrative synthesis of results. MAIN RESULTS:All 28 included studies compared an experimental resilience building intervention versus a control or no intervention. There was a wide range of therapeutic modalities used, including cognitive behavioural therapy (CBT) informed programmes, biofeedback based programmes, stress-management programmes, mindfulness and relaxation programmes, neuropsychological-based programmes, and psychoeducational-informed programmes. The main outcomes are specified here, secondary outcomes such as depression, social support, coping skills, self-efficacy, subjective levels of aggression and stress are reported in text. No studies reported on the following pre-specified outcomes; acute stress disorder, emotional flexibility, social functioning, quality of sleep and quality of life. Resilience Eight studies reported resilience as an outcome. We narratively synthesised the data from these studies and our findings show that five of these interventions had success in building resilience in their respective samples. Two of the studies that reported significant results utilised a CBT approach to build resilience, while the other three successful programmes were mindfulness-based interventions. Symptoms of post-traumatic stress Our narrative synthesis of results included eight studies. Two of the eight studies produced significant reductions in symptoms of post traumatic stress compared to controls. These interventions used neuropsychological and biofeedback intervention models respectively. PTSD caseness Four studies reported PTSD caseness as an outcome. Our narrative synthesis of results suggests that evidence is mixed as to the effectiveness of these interventions in reducing clinical diagnosis of PTSD. One study of a neuropsychology-orientated Attention Bias Modification Training (AMBT) programme had success in reducing both symptoms of post-traumatic stress and numbers of participants receiving a diagnosis of PTSD. A stress-management programme reported that, when baseline differences in rates of pre-deployment mental health issues were controlled for, participants in the control condition were at 6.9 times the risk of a diagnosis of PTSD when compared to the intervention group. Given the diversity of intervention designs and theoretical orientations used (which included stress-management, neuropsychological and psychoeducational programmes), a definitive statement on the efficacy of pre-deployment programmes at reducing symptoms of post-traumatic stress and PTSD cannot be confidently offered. AUTHORS' CONCLUSIONS:While a number of evaluations of relevant programmes have been published, the quality of these evaluations limits our ability to determine if resilience-building programmes 'work' in terms of preventing negative outcomes such as depression, symptoms of post-traumatic stress and diagnoses of PTSD. Based on our findings we recommend that future research should: a) report pre-/post-means and standard deviation scores for scales used within respective studies, b) take the form of large, RCTs with protocols published in advance, and c) seek to measure defined psychological facets such as resilience, PTSD and stress, and measure these concepts using established psychometric tools. This will provide more certainty in future assessments of the evidence base. From a clinical implications point of view, overall there is mixed evidence that the interventions included in this review are effective at safe guarding military personnel or frontline emergency workers from experiencing negative mental health outcomes, including PTSD, following exposure to potentially traumatic events. Based on this, practitioners seeking to build resilience in their personnel need to be aware of the limitations of the evidence base. Practitioners should have modest expectations in relation to the efficacy of resilience-building programmes as a prophylactic approach to employment-related critical incident traumas.

Background A new legal capacity act was introduced in Ireland in 2015. This study aimed to identify and critically examine key issues in the area of decision-making capacity from the perspective of psychologists working with adults with an intellectual disability. Methods A qualitative exploratory approach was employed, and the study was positioned in a social constructionist framework. Purposive and snowballing sampling methods were used to recruit 15 clinical psychologists working with adults with an intellectual disability. Data were collected with the use of individual semistructured interviews. Interview transcripts were analysed using a model of thematic analysis. Results Six themes were identified: (1) a presumption of capacity but a culture of incapacity, (2) supporting decision making as a process, (3) authenticity of decision making, (4) need for support and training, (5) contributions of psychology and (6) the way forward. Conclusions Participants described that people with intellectual disabilities were often excluded from decision-making processes. They welcomed the functional approach to decision making, considered substituted decision making to be necessary within a support framework and described supporting decision making as a process. Systemic, resource and attitudinal challenges were identified.

Previous studies have indicated that childhood adversity and emotional attachment difficulties are common in hoarding disorder. The aim of this cross-sectional study was to explore whether current insecure attachment style, operationalized as insecure attachment to romantic partners, and emotional over-attachment to objects might be one mechanism linking the experience of early adversity to later hoarding tendencies. Data was gathered using an online survey from 463 adult participants; n = 216 scored in the clinical range for hoarding. The experience of two types of childhood trauma (emotional abuse and physical neglect) predicted higher levels of hoarding symptoms. Attachment anxiety and avoidance were positively correlated with hoarding symptoms and with emotional attachment to possessions. Current attachment insecurity and emotional attachment to objects partly mediated the relationship between childhood trauma and hoarding symptoms, after controlling for anxiety and depression. This study provides evidence for a novel way by which traumatic life events may influence hoarding symptomatology via attachment to significant others and object attachment. The findings are limited by the use of a cross-sectional design; however, they support the growing body of research which points to the importance of early adverse events and attachment difficulties in the aetiology of hoarding.

Introduction Multimorbidity refers to the presence of two or more chronic health conditions within one person, where no one condition is primary. Research suggests that multimorbidity is highly correlated with chronic pain, which is pain lasting longer than 3 months. Psychotherapeutic interventions for people living with chronic illness have resulted in reduced symptom reporting and improved psychological well-being. There is a dearth of research, however, using online psychotherapy for people living with multimorbidity where chronic pain is a central condition. This study will compare the effectiveness of an online acceptance and commitment therapy (ACT) intervention with a waiting list control condition in terms of improving health-related quality of life (HRQoL) and reducing levels of pain interference in people with chronic pain and at least one other condition. Methods and analysis 192 adult participants with non-malignant pain that persists for at least 3 months and at least one other medically diagnosed condition will be randomised to one of two study conditions. The experimental group will undergo an eight-session internet-delivered ACT programme over an 8-week period. A waiting list group will be offered the ACT intervention after the 3-month follow-up period. HRQoL and pain interference will act as the primary outcomes. Data will be analysed using a linear mixed model and adjusted to account for demographic and clinical variables as necessary. A Study Within a Trial will be incorporated to examine the effect on recruitment and retention of showing participants an animated educational video. Ethics and dissemination Ethical approval has been granted by the Research Ethics Committee of the National University of Ireland, Galway. Dissemination of results will be via peer reviewed journal articles and conference presentations. Trial registration number ISRCTN22343024.

This research study explores the relationship between treatment outcome and intervention type, by comparing two large group cognitive behavioural therapy based stress management programmes; ‘Stress Control with Progressive Muscle Relaxation’ versus ‘Stress Control with Mindfulness Body Scan’. The experiment was conducted in a rural Irish community setting, inviting participation from the general public (n = 86). All participants attended the standard six-week Stress Control intervention. Participants in Group A received Stress Control augmented with a 15-min Progressive Muscle Relaxation audio recording for home use between classes, while participants in Group B received Stress Control augmented with a 15-min Mindfulness Body Scan audio recording for home use between classes. All participants completed the Depression, Anxiety and Stress Questionnaire (DASS 21) at pre-intervention, post-intervention and at three-month follow-up. Participants in both groups were also asked to complete weekly skill practice questionnaires to assess adherence to treatment. Participants in both groups made significant improvement, over time, on measures of psychological well-being, stress and anxiety. Only participants in the ‘Stress Control with Mindfulness Body Scan’ intervention group demonstrated significant improvement in levels of depression. The data suggests that when treatment approaches are specifically tailored to target specific symptoms, the results lead to a greater degree of intervention effectiveness. Future research implications in view of the findings are considered.