Systematic Literature Review & Empirical Research Project
: PART I – SYSTEMATIC LITERATURE REVIEW: “Third wave” cognitive behavioural interventions and inflammatory bowel disease: a systematic review of psychological and physical health outcomes. PART II – EMPIRICAL RESEARCH PROJECT: The mediating role of psychological inflexibility on internalised stigma and patient outcomes in a sample of adults with inflammatory bowel disease.

Student thesis: Doctoral ThesisDoctor of Clinical Psychology

Abstract

Background: The main purpose of this study was to examine the relationship between psychological inflexibility, internalised stigma and patient outcomes within an adult Inflammatory Bowel Disease (IBD) population. We aimed to explore whether psychological inflexibility mediated the relationship between internalised stigma and patient outcomes.
Methods: This was a cross-sectional quantitative study, which collected data via an online survey using convenience sampling, between May 2020 and December 2020. A total of 382 (n = 302, 79.1% female) individuals with IBD took part in the current study. Participants completed a series of self-report questionnaires including a demographic questionnaire, the Acceptance and Action Questionnaire-II, the Committed Action Questionnaire, the Crohn’s and Ulcerative Colitis Questionnaire 8-item, the Internalised Stigma Scale for Mental Illness – 29 item (adapted for IBD), the Depression Anxiety and Stress Scales – 21 item, the IBD Self-Efficacy Scale, the Chalder Fatigue Scale, the Beliefs About Emotions Scale, the Self-Concealment Scale, and a bespoke Covid-19 questionnaire. Pearson’s correlations were used to examine relationships between pairs of study variables and several exploratory simple mediation analyses were computed to examine whether psychological inflexibility had a mediating effect on the relationship between internalised stigma and patient outcomes and whether psychological inflexibility had a mediating effect on the relationship between public and internalised stigma.
Results: Internalised stigma related to IBD was present for 40.5% of participants. Individuals who had higher psychological inflexibility were found to have higher levels of internalised stigma, lower committed action, poorer health-related quality of life, lower IBD self-efficacy, higher levels of self-concealment, higher levels of fatigue, and had more beliefs around the experience and expression of negative emotions as being unacceptable. Psychological inflexibility was found to partially mediate the relationship between internalised stigma and a number of patient outcomes (psychological distress, IBD health-related quality of life, IBD self-efficacy, and self-concealment). Psychological inflexibility showed complete mediating effects on the relationship between internalised stigma and fatigue. Psychological inflexibility was also found to mediate the association between perceived stigma and internalised stigma.
Conclusion: The results suggest that psychological inflexibility plays an important role in the quality of life of individuals with internalised stigma related to their IBD and appears to mediate the association between internalised stigma and patient outcomes. Our findings highlight potential treatment targets for psychological interventions to improve quality of life in individuals with IBD experiencing internalised stigma. Acceptance and Commitment Therapy which has the primary aim of increasing psychological flexibility may lend itself well to individuals with internalised stigma related to their IBD.
Date of Award1 Oct 2021
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorTrudie Chalder (Supervisor) & Claire Henderson (Supervisor)

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