Kids just wanna have fun: Children's experiences of a weight management programme.

OBJECTIVES: To explore children's accounts of their experiences of the UK's largest childhood obesity programme, MEND (Mind, Exercise, Nutrition...Do it!) (See www.mendprogramme.org). DESIGN: Semi-structured interviews were conducted with children who had completed the MEND obesity programme. Interviews were transcribed verbatim and analysed using Interpretative Phenomenological Analysis (IPA). METHOD: Fourteen children spanning diverse areas of London comprised this study (eight male, six female), aged between 11 and 14 years and in secondary school. Participants were interviewed a year after completing one of the London-based MEND obesity programmes. RESULTS: This article focuses on the most common and striking theme to emerge from the original dataset (The complete analysis may be found in L. Watson, Unpublished doctoral thesis): Fun. Subthemes were: 'going with the flow'; active participation in activities that led to new experiences ('actually doing it' - seeing the fun side); the importance of others in the experience of fun ('you do games in unity' - 'it's not as fun on your own'). CONCLUSION: Children have fun when engaged in interactive and varied activities with opportunity for individual feedback and improvement. When designing childhood obesity programmes, conditions that optimise children's experience of fun should be emphasised over didactic and risk-heavy information pertaining to childhood obesity. STATEMENT OF CONTRIBUTION: What is already known on this subject? Continued growth in childhood obesity and its associated health problems, psychological effects, and economic burden make tackling childhood obesity a public health priority. Multicomponent lifestyle interventions to treat childhood obesity within the community have been shown to reduce overweight and obesity from pre- to post-treatment, increase self-esteem, and are found to be acceptable by parents. MEND is the most widely disseminated evidence-based programme of this kind in the United Kingdom. What does this study add? This study is the first qualitative study to explore the child's experience of attending MEND. The post-treatment maintenance period, where most behaviour change is consolidated (or not), is also captured in this study, with children interviewed at least 1 year post-treatment. Findings unearthed an unexpected and strong theme - that of 'fun' - integral to their experience during their time at MEND. Optimizing conditions for fun is imperative to children's (and adults'?) engagement with, and maintenance of, healthy lifestyle activities.

Women entering clinical psychology: Q-sort narratives of career attraction of female clinical psychology trainees in the UK.

The great majority of the UK clinical psychology workforce are women, and this fact prompted an examination of the various ways clinical psychology might be seen as attractive to women--a neglected research topic. Female clinical psychology trainees from a variety of training programmes Q-sorted statements of potential job attractors. The process of analysis is outlined before most of the article is devoted to explicating the five narratives of attraction generated: making a difference, waiting for what I want, idealising challenge, identifying with distress and acknowledging power and privilege. Two super-ordinate 'stories' spanning the narratives are suggested--an over-riding attraction to the profession and a rebuttal of the suggestion that this attraction may be based on any overtly gendered grounds. In the absence of previous empirical data of women's attraction to clinical psychology, the small but significant contribution to understanding the profession made by the analysis is acknowledged--as is the need for further research to confirm and develop the findings.

Hope for recovery - how clinicians may facilitate this in their work.

BACKGROUND: The importance of having hope for recovery has been highlighted in numerous qualitative studies of recovery. It is identified as a vital part of this process, and guidelines suggest that service providers should therefore facilitate hope in their clinical work; however, they do not indicate how this guidance can be operationalised. AIMS: To identify the sources of hope for recovery based on the accounts of people with experience of recovery; to ascertain how these accounts show service providers can facilitate such hope in their therapeutic work. METHOD: Semi-structured interviews were conducted with eight people with experience of recovering from mental health problems. A grounded theory analysis was undertaken. RESULTS: A model conceptualising the role of hope in recovery was developed with three categories: "influence of others on hope", "personal hope" and "doing recovery". The model indicates a complex interaction between hope and recovery with an important role for social context and interpersonal relationships, including those with clinicians. CONCLUSIONS: Mental health service providers occupy a powerful position in relation to service users' hope, and must carefully consider how they communicate their own hopefulness about clients' recovery. Suggestions are made about facilitating hope for recovery.

Changes in internal states across the binge-vomit cycle in bulimia nervosa.

While there is considerable evidence that bulimic behaviors serve the function of modifying internal states (e.g., satiety, mood), there is less clarity over the roles of the different behaviors across the binge-purge cycle. The present study examines the impact of bingeing and vomiting upon these internal states at different time points, and evaluates the potential reinforcement of those behaviors by the changes in internal states. Twenty-three women with diagnoses of bulimia nervosa completed a diary of all binge-vomit episodes over the course of 7 days, rating their internal states (satiety, negative mood, positive mood) at four time points during each episode. There were substantial changes across the cycle in levels of hunger, fullness, guilt/shame, anxiety/worry, and happiness/relief, but not in other states. The changes indicate that the binge-vomit cycle is maintained by the effects of both behaviors, but that the vomiting behavior evokes the strongest pattern of reinforcement. Further research is needed to determine the levels of internal states during the binge itself.

Experiencing a dilemma--accounts of working with PND.

Various ways of thinking about postnatal depression (PND) are evident from the literature. From the clinical-medical perspective, it is an illness of the individual mother. The social approach locates its cause in the environment Feminists/social constructionists have critiqued such models as problematising women--they see them as pressured by oppressive forces such as society's stereotype of 'the joy of motherhood'. From the psychoanalytic perspective it arises from unrecognised conflict and ambivalence, related to the re-emergence of conflict between the mother and her own parents. Health visitors working with PND--the frontline of health professionals in this aspect of maternal mental health--stand between the professional/academic accounts on the one hand, and the lay accounts of their clients on the other. The aim of this study was to examine how health visitors understand and make sense of PND. We adopted qualitative research methodology to analyse transcripts from interviews with eight health visitors about their work with PND. The findings demonstrate the diverse roles they have to adopt, and the complexity and lack of clarity of the very concept of PND itself. There were clearly ambiguities and dilemmas of thinking involved--not apparent from the literature, tensions with which the participants struggled. A subsequent paper will present training to address these issues.

Broader skills for working with perinatal depression.

Health visitors' involvement in work with maternal depression has developed considerably over the last 10 years, with a focus upon problems in the postnatal period. In a paper last month we reported on research highlighting dilemmas that can arise for health visitors connected with a lack of an agreed conceptual framework. Conflicting roles they find themselves using when working with distressed mothers, and within a pressured organisational work setting, make it hard to give sufficient priority to such work. By focussing too narrowly on postnatal depression, other important perinatal psychological difficulties may be left unattended. We argue the need to create workplace time to address these issues by describing the provision of a training and supervision package to facilitate this. We give some informal indications of its success and some indicators of the broadening development of its membership and its content