Understanding emotional distress in Burns and Plastics patients
Research type
Research Study
Full title
Qualitative analysis of emotional distress in burns and plastic reconstructive surgery patients from the perspectives of Cognitive and Metacognitive theories
IRAS ID
289258
Contact name
Adrian Wells
Contact email
Sponsor organisation
University of Manchester
Clinicaltrials.gov Identifier
N/A, N/A
Duration of Study in the UK
1 years, 1 months, 30 days
Research summary
Summary of Research
Burns and injuries which require plastic reconstructive surgery are often serious, unexpected, and require prolonged medical treatment. The injuries can have a negative effect on a person's mental health leading to the development of anxiety, low mood, and post-traumatic stress symptoms. Between 20-67% of burns and plastics patients require mental health support.The most common mental health support is cognitive behavioural therapy (CBT). Research shows that CBT may be not be that effective for patients who experience distress after a physical injury. CBT often relies on making distinctions between realistic and unrealistic thoughts and this becomes difficult if the concerns are around diagnosed conditions. New and more effective therapies are needed. One promising therapy is metacognitive therapy (MCT) as it focusses less on the content of thoughts. It has shown to be effective in mental health and physical health settings (i.e. cancer and cardiac patients). MCT has not yet been applied to burns and plastics patients so we don't know if it is suitable for these people.
This research aims to understand the emotional distress that burns and plastics patients experience and to determine whether the Cognitive or Metacognitive models best explains this distress.
Ten-fifteen burns and plastics patients referred to the psychology service at Wythenshawe Hospital will be recruited between February 2021 and April 2022. Participants will complete symptom questionnaires and attend a single 45-60 minute interview. Interviews will focus on understanding the types of distress these people have experienced since their injury. Qualitative analysis will be carried out to determine whether the Cognitive or Metacognitive theory provides a better fit.
This study will help us to understand peoples’ mental health after a physical injury and which model of therapy might be best suited to support these people. This might lead to new treatments for patients with burns and physical injuries.
Summary of Results
Previous research shows that there is a high level of psychological distress after burns or injuries requiring plastic reconstructive surgery. No studies had aimed to understand this distress or to see how models of therapy might make sense of it. We set out to:1) Understand your distress.
2) See how two different therapeutic models might explain your distress.The findings of aim one: Everyone spoke about the distress that they experienced after the event that led them to be treated by the Burns, Plastics, and Reconstructive Surgery team. There was a lot of variability in how people’s distress showed. There were a wide range of distressing emotions described. Most common were low mood, anxiety, anger, and grief/loss. Everyone described engaging in ‘repetitive negative thinking’ as a feature of their distress. That is either worrying and/or thinking back on things over and over again. There was a wide range in the content of these thoughts. There were also lots of different strategies that people described using to manage their thoughts and feelings. Some examples include distraction, pushing thoughts away, and keeping busy.
The findings of aim two: The models we looked at were the cognitive model and the metacognitive model. The cognitive model looks at how the content of thoughts might maintain distress through biases in our thinking. It aims to challenge unrealistic thoughts. The metacognitive model looks at our thoughts and beliefs about thought processes (why we may worry, rather than what we worry about).
We found that both models did a good job in explaining the distress that was described. The metacognitive model may offer a more straightforward explanation. This is because it looks at the reasons behind why people might engage in repetitive thinking rather than the wide range of things people think about. This is particularly helpful when people are distressed by reasonable thoughts – often concerns related to physical health – which may not be open to challenge in the way the cognitive model uses.
Because the metacognitive model may be better at explaining the distress in this study, a therapy based on the model, metacognitive therapy (MCT), is worth exploring in this population. We recommended that MCT should be investigated further to understand whether it is an acceptable treatment in this population. If it is acceptable, studies could then look at how well MCT reduces symptoms of depression and anxiety in Burns, Plastic, and Reconstructive Surgery Patients. This could lead to more efficient delivery of psychological care and greater patient choice.
REC name
North West - Greater Manchester Central Research Ethics Committee
REC reference
21/NW/0050
Date of REC Opinion
18 Mar 2021
REC opinion
Favourable Opinion