| Summary: | Main Project Multiple Sclerosis (MS) is an incurable disease which is commonly associated with psychological complications. Previous research by Hayter and colleagues found that in patients with MS, health anxiety (HA) can account for part the variance in quality of life (QoL) independent of any physical and cognitive impairment caused by the disease and that MS patients with health anxiety perceived their (intact) physical and cognitive performance as impaired relative to MS patients without health anxiety, attributing the impairment to MS. The findings suggest that such misperceptions might be useful targets in the treatment of health anxiety in MS using adapted cognitive behavioural therapy (CBT). The first of two studies presented here sought to replicate the findings from Hayter et al. before a second presents the findings from a brief case series of treatment for HA using CBT. In Study 1, twenty participants with Relapsing and Remitting MS were screened for HA and assigned to either a high or low HA group. Participants then completed assessment of cognitive and physical functioning before rating their performance on these tasks. Measures of QoL, mood and physical disability were then completed. Four participants in the high HA group subsequently received six sessions of CBT using a consecutive AB case series in Study 2. Study 1 replicated the main findings from the earlier study. In Study 2, three of the four patients who received treatment showed substantial improvements in HA and mood and all showed improvement in QoL. Given the high rates of HA in MS patients and its impact on QoL, this case series suggests a brief CBT intervention could significantly improve patients’ wellbeing. The findings pave the way for larger, controlled studies into the effectiveness of CBT for health anxiety in MS. Service Improvement Project Background: Early diagnosis of neurodevelopmental conditions such as Autism Spectrum Disorders (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) in children are enshrined in national UK policy, as is ensuring that parents’/carers’ views shape service delivery. Aim: The present study attempted to measure adherence to service guidelines of a neurodevelopmental disorders assessment clinic within a Child and Adolescent Mental Health Service (CAMHS) to identify service needs. It also assessed parents’/carers’ satisfaction with the service and what information should be included in a patient information leaflet. Method: An audit of cases referred during 2012 -2013 plus a postal survey of parents/carers of children referred during the audit period. Results: The service was mostly compliant with NICE guidelines but quantifying this was difficult under its current record keeping. While satisfied with the clinic’s service, the main concern of parents/carers was the length of time the assessment process took. Conclusions: Adoption of NICE audit tools would help document compliance with guidelines. A patient information leaflet might help manage parents’ expectations about the time the assessment process takes. Literature Review This review considers the closely related concepts of rumination and worry; examining their role in insomnia and chronic pain. Worry has been seen for many years as a major contributor to insomnia but only recently has attention been paid to the role of rumination. Similarly, worry and rumination have both been implicated in the maintenance of distress in chronic pain. However, across these two diagnostic categories (and the wider research literature) definitions of worry and rumination vary and are often used interchangeably. This review considers the research literature on rumination/worry in relation to insomnia, chronic pain and insomnia that occurs alongside chronic pain (pain-related insomnia). The empirical findings to date suggest patterns of repetitive negative thinking characterise both worry and rumination, but the content of the thinking may be distinct, opening the way for the application of transdiagnostic approaches. It suggests cognitive behavioural approaches to treating pain-related insomnia can be improved by incorporating elements which have been successful elsewhere in allowing people to manage repetitive negative thinking. Assessment of these targeted treatments in future research should lead to a reduction in suffering for patients with chronic pain who have trouble sleeping.
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