The relationship between caregivers and daughters' food and body shape scripts: A dyadic analysis.

Research indicates a key role for parenting in a daughter's relationship with food and body shape. One possible mechanism for this translational process is through scripts. The present study used a dyadic design to investigate the relationship between caregivers and daughters' scripts regarding food and body shape. Caregivers (n = 40) and their daughters (n = 40) rated word lists of their current and childhood scripts and caregivers completed an additional measure of their parenting scripts. Non-dyadic analysis showed consistent correlations between daughters' current scripts and their recollections of childhood scripts, and several (but less consistent) correlations between caregivers' current scripts, their own childhood scripts and the scripts they had used as a parent. Dyadic analysis showed consistent correlations between the daughter's current scripts relating to negative eating and both positive and negative body scripts and their caregiver's parenting scripts, and between the daughter's current scripts relating to positive and negative eating and body looking positive and their caregiver's current scripts. No associations were found between the daughter's current scripts and the caregiver's childhood scripts. The results indicate that whilst daughters' current scripts relating to food and body shape are often concordant to those reported by their caregivers, they are more closely linked to what they remember from their childhoods. Further, they suggest that those scripts which do transfer between generations may be more related to body size and negative eating than food per se. Finally, the results suggest that scripts do not inevitably pass across the generations possibly due to parents choosing not to repeat the errors of their own parents or due to the role of factors other than just parenting in creating the scripts we hold.

Multisensory medical illustrations of Buruli ulcer for improved disease detection, help seeking behaviour and adherence to treatment.

Buruli ulcer (BU) is a skin infection caused by Mycobacterium ulcerans and a neglected tropical disease of the skin (skin NTD). Antibiotic treatments are available but, to be effective in the absence of surgery, BU must be detected at its earliest stages (an innocuous-looking lump under the skin) and adherence to prescribed drugs must be high. This study aimed to develop multisensory medical illustrations of BU to support communication with at-risk communities. We used a Think Aloud method to explore community health workers' (n = 6) experiences of BU with a focus on the role of their five senses, since these non-medical disease experts are familiar with the day-to-day challenges presented by BU. Thematic analysis of the transcripts identified three key themes relating to 'Detection,' 'Help Seeking,' and 'Adherence' with a transcending theme 'Senses as key facilitators of health care'. New medical illustrations, for which we coin the phrase "5D illustrations" (signifying the contribution of the five senses) were then developed to reflect these themes. The senses therefore facilitated an enriched narrative enabling the production of relevant and useful visuals for health communication. The medical artist community could utilise sensory experiences to create dynamic medical illustrations for use in practice.

Care or sabotage? A reflexive thematic analysis of perceived partner support throughout the bariatric surgery journey.

OBJECTIVE: Social support is mostly seen as a positive resource for many health outcomes. However, some research indicates that weight loss may disrupt the equilibrium of relationships and highlights the potential for a more negative form of social support. This qualitative study aimed to explore bariatric surgery (BS) patients' perceptions of the way in which their current or previous partner supported them throughout their BS journey. DESIGN: BS patients (N = 30) participated in semi-structured interviews. METHODS: The data were analysed using an inductive approach to reflexive thematic analysis. RESULTS: Four themes were derived from the data. While two themes reflected social support as a form of caring (Mutual Investment and Positive Reinforcements), the other two themes indicated aspects of sabotage (Feeder Behaviours and Negative Reactions to Weight Loss Attempts and Successes). Transcending these themes was the notion of Bariatric Surgery as an Opportunity or Threat to the Relationship. CONCLUSIONS: Some patients perceived social support as a positive resource in BS success involving Mutual Investment from their partners and being offered Positive Reinforcements for changes in their weight status and wellbeing. Some, however, described more negative aspects of support which had undermined their BS goals, either unintentionally or intentionally, through acts of sabotage including Feeder Behaviours and Negative Reactions to Weight Loss Attempts and Successes. Future research should develop interventions to help prepare the partners of those undergoing BS for the changes to both their partner's weight status and the dynamics of their relationship.

Managing patients with eating disorders: a qualitative study in primary care.

BACKGROUND: General Practitioners (GPs) play a key role in the diagnosis and management of eating disorders (EDs). AIM: To explore GPs' experiences of managing patients with eating disorders (EDs). DESIGN & SETTING: A qualitative study utilising remote semi-structured interviews. METHOD: Fourteen GPs were interviewed about their experiences of supporting patients with EDs. The interviews were recorded, transcribed and analysed using thematic analysis. RESULTS: The analysis described four themes: i) 'Continuity of care' addressing the GPs relationship with patients and family, patients transitions across life stages and geographical areas and patient non-attendance; ii) 'The role of guidance' focusing on guidelines and protocols, referrals and specialist professionals as points of contact; iii) 'Structural barriers' including waiting times, lack of resources, referral criteria and relationships between services; iv) 'Confidence and skills' reflecting professional and personal experience in EDs, previous training and training needs. Transcending these themes was the notion of the 'Limits to the care' GPs can provide due to professional boundaries and the emotional impact of managing patients with EDs. CONCLUSION: This study found that whilst GPs want to help patients with EDs many limits remain to the care they can provide due to both internal and external factors. Funding is required for training and accessible specialist ED support and greater clarity is needed regarding referral processes if ED management in Primary Care is to be optimised.

The Role of Social Support and Belonging in Predicting Recovery from Problem Gambling.

Research indicates a role for both social support and belonging in addiction recovery, however little is known about the role of these constructs in the recovery from problem gambling, and whether they relate to the effectiveness of mutual aid groups such as Gamblers Anonymous. The aim of this study was therefore to explore the relationship between social support and belonging, and to assess the role of demographics (including group membership of GA), social support and/or belongingness in predicting gambling addiction recovery in terms of gambling urges and quality of life. Using a cross sectional design, participants identifying as having problem gambling (n = 60) completed an online questionnaire with two independent variables (Social Support and Belonging), two dependent variables (Gambling Urges and Quality of Life) to assess gambling addiction recovery and measures of GA membership. The results showed no significant association between gender, age, ethnicity, education or employment status and gambling urges or quality of life. Membership to GA, and length of membership were significantly associated with gambling recovery indicating that being a member of GA and longer membership was associated with lower gambling urges and higher quality of life. Further, the results showed a high but not perfect correlation between social support and belonging (r(58) = .81, p = < .01). A regression analysis showed that although there was a significant correlation between social support and belongingness, they played different roles in gambling addiction recovery. Social support alone predicted higher quality of life, but not a reduction in gambling urges; belonging (along with being a member of GA) predicted a reduction in gambling urges, but not an increase in quality of life. Social support and belonging have a differential impact on aspects of gambling addiction, and should be considered as different constructs. In particular, whilst the process underpinning reduced gambling urges is membership of GA and the sense of belonging it provides its members, social support per se is a better predictor of quality of life. These findings have implications for the development of treatment for problem gamblers in the future.

Sabotage, Collusion, and Being a Feeder: Towards a New Model of Negative Social Support and Its Impact on Weight Management.

PURPOSE OF REVIEW: Whilst research indicates the positive impact of social support across a number of health domains, including weight management, not all social support is beneficial. RECENT FINDINGS: This paper reviews the evidence for both positive and negative social support in the context of behavioural interventions and surgery for obesity. It then presents a new model of negative social support focusing on sabotage ('active and intentional undermining of another person's weight goals'), feeding behaviour ('explicit over feeding of someone when they are not hungry or wishing not to eat'), and collusion ('passive and benign negative social support to avoid conflict') which can be conceptualised within the context of relationships as systems and the mechanisms of homeostasis. There is increasing evidence for the negative impact of social support. This new model could form the basis of further research and the development of interventions for family, friends, and partners to maximise weight loss outcomes.

Exploring Rates of Adherence and Barriers to Time-Restricted Eating.

Whilst the treatment and prevention of overweight and obesity-related disease is managed by restricting daily energy intake, long-term adherence to dietary strategies appears unsustainable. Time-restricted eating (TRE) aims to position energy intake in an eating window under 12 h per day and offers an alternative behavioral intervention, which can aid weight management and improve cardiometabolic health. Adherence to previous TRE protocols is estimated at between 63 and 100%, although the accuracy of reporting is unclear. This study therefore aimed to provide an objective, subjective, and qualitative overview of adherence to a prescribed TRE protocol, and to identify any potential barriers affecting adherence. Adherence after 5 weeks of TRE was estimated at ~63% based on continuous glucose monitoring data when compared with time-stamped diet diaries. Subjective participant responses reported adherence at an average of ~61% per week. Barriers to adopting TRE, including work schedules, social events, and family life, were identified by participants during qualitative interviews. The findings of this study suggest that the development of personalized TRE protocols may help to navigate the barriers to adherence leading to improved health-related outcomes.

The implications of defining obesity as a disease: a report from the Association for the Study of Obesity 2021 annual conference.

Unlike various countries and organisations, including the World Health Organisation and the European Parliament, the United Kingdom does not formally recognise obesity as a disease. This report presents the discussion on the potential impact of defining obesity as a disease on the patient, the healthcare system, the economy, and the wider society. A group of speakers from a wide range of disciplines came together to debate the topic bringing their knowledge and expertise from backgrounds in medicine, psychology, economics, and politics as well as the experience of people living with obesity. The aim of their debate was not to decide whether obesity should be classified as a disease but rather to explore what the implications of doing so would be, what the gaps in the available data are, as well as to provide up-to-date information on the topic from experts in the field. There were four topics where speakers presented their viewpoints, each one including a question-and-answer section for debate. The first one focused on the impact that the recognition of obesity could have on people living with obesity regarding the change in their behaviour, either positive and empowering or more stigmatising. During the second one, the impact of defining obesity as a disease on the National Health Service and the wider economy was discussed. The primary outcome was the need for more robust data as the one available does not represent the actual cost of obesity. The third topic was related to the policy implications regarding treatment provision, focusing on the public's power to influence policy. Finally, the last issue discussed, included the implications of public health actions, highlighting the importance of the government's actions and private stakeholders. The speakers agreed that no matter where they stand on this debate, the goal is common: to provide a healthcare system that supports and protects the patients, strategies that protect the economy and broader society, and policies that reduce stigma and promote health equity. Many questions are left to be answered regarding how these goals can be achieved. However, this discussion has set a good foundation providing evidence that can be used by the public, clinicians, and policymakers to make that happen.

Body Positivity or Humorous Parody? The Impact of Instagram Imagery on Body Image Concerns.

Research has shown that Instagram imagery can affect women's body image. However, it remains unclear how Instagram images are perceived, and which type of images can have a positive impact on body image. In this study (N = 170), we examined whether exposure to body positive and humorous parody (vs. body ideal) imagery would be perceived as critiques of thin body ideals, would elicit photo-based activity in the form of "likes", and would positively affect women's body image. Results showed that both body positivity and humorous parody images elicited more "likes" and were perceived as critiquing thin body standards more than body ideal images. Moreover, women's body satisfaction and positive mood were higher after exposure to body positivity and humorous parody compared to exposure to body ideal images. Women exposed to humorous parody also reported a lower drive for thinness. These findings demonstrate that both body positivity and humorous parody can be considered critiques that improve body image.

Physical appearance and well-being in adults with incurable cancer: a thematic analysis.

OBJECTIVES: Existing research has established the importance of appearance concerns for individuals with cancer and identified appearance as an important factor in dying with dignity. No research, however, has explored in depth the role of appearance in the experiences of individuals who have incurable cancer. This research aims to explore patients' experiences and perspectives in relation to the role of appearance issues in adults with incurable cancer. METHODS: Semi-structured interviews were conducted with 24 adults with incurable cancer (20 women, 4 men; mean age 54.5, SD 11.32). RESULTS: Thematic analysis generated three themes: 'Identity: Embodying Cancer', 'Communication: Wearing your illness' and 'Support: Holistic Care'. Appearance was felt to be an important element of identity, which was often dominated by cancer, leading to feelings of separation from the participant's previous self. Appearance changes also influenced the way in which individuals communicated with their external world, forcing discussion of their diagnosis, and increasing focus on their cancer, with participants having to manage the emotional impact of this on loved ones, as well as the impact on their legacy. Finally, participants highlighted the positive impact of appearance-related support in their well-being and identified peer connections and refocusing on the self as key elements of such support. CONCLUSIONS: Appearance changes play an important role in the experiences of individuals with incurable cancer with regards to both identity and communication and challenged participants' ability to maintain normalcy. Further psychosocial support relating to appearance concerns was considered necessary to promote dignity and provide truly holistic patient care.

The patient-practitioner interaction in post bariatric surgery consultations: an interpersonal process recall study.

PURPOSE: The patient-practitioner relationship is fundamental to rehabilitation practice and patients' health and wellbeing. Dissonance between patients who have had bariatric surgery and health care practitioners about what supportive care and good outcomes are can undermine care. To address the mechanisms of this process, we conducted an Interpersonal Process Recall study. MATERIALS AND METHODS: We interviewed patients (11), video recorded consultations (10), conducted video-assisted individual interviews with patients (10) and practitioners (11) and a dyadic data analysis. RESULTS: We identified relational states and shifts in the clinical encounter 2-3 years post-surgery, described in themes: a) Playing by the Book - Making it Easier for Each Other, b) Down the Blind Alley - Giving up on Each Other, and c) Opposite Poles - Towards and Away from Each Other. CONCLUSIONS: The post-surgery consultations facilitated responsibility for health and self-care but did not invite dialogues about the psychosocial burdens of living with obesity and undergoing bariatric surgery. Patients and practitioners tried to avoid creating conflict, which in turn seemed to foster distance, rather than human connection. This limits the encounter's benefit to both parties, leaving them frustrated and less willing to either meet again or take any gains into their future lives.IMPLICATIONS FOR REHABILITATIONIllness evokes feelings of stress and uncertainty and is experienced very differently from the perspective of patients and health care practitioners (HCPs), who encounter each other in a field fraught with tension.Bodily changes and difficult emotions related to food and eating are to be expected when undergoing bariatric surgery, and to explicitly "notice, name and validate" emotions can promote the patient's capacity to sustain self-care, lifestyle change, weight loss and health gains.Making interpersonal connection and interaction between patient and HCP the centre of bariatric aftercare can enhance engagement in and outcomes of the post-surgery clinical encounter.

To what extent is circadian phase predictive of subjective jet lag in long-haul cabin crew pre- and post-trip?

Long-haul cabin crew regularly report misalignment between their circadian phase and the external world (i.e. jet lag). The extent to which changes in circadian phase relate to reported levels of jet lag remains unclear. The main aim of the present study was first to evaluate the relationship between objective (circadian phase) and subjective jet lag and second to explore the relative role of both subjective and objective psycho-behavioural factors in predicting the subjective experience of jet lag. Twenty-eight long-haul cabin crew completed questionnaires measuring diurnal preference, trip characteristics and subjective jet lag as a single and as a multidimensional measure. Sleep was monitored using actigraphy and urinary melatonin peak time was measured, at baseline (T1), e.g. before a long-haul trip and post-trip on the crew's first recovery day (T2). Subjective jet lag was also measured at both time points. At T1, later circadian phase related to increased unidimensional jet lag, however, a post-trip discrepancy was found between objective and subjective uni- and multidimensional jet lag measured at T2 and change from T1 to T2. After controlling for direction and size of circadian phase, increased uni- and multidimensional subjective jet lag was predicted by depressed mood states. The regression models including phase, diurnal preference, departure time on the outbound sector and arousal levels accounted for 28% of the variance in unidimensional jet lag and 53% of the variance in multidimensional jet lag. It was concluded that there is a discordance between objective and subjective jet lag post-trip. Further, subjective jet lag in long-haul cabin crew is better explained by mood impairment than circadian phase. The results are discussed with reference to the gap between subjective and objective jet lag and the role of psychology rather than just biology in the jet lag experience. The implications for improving health and safety in the workplace, through a better understanding of the role of human factors in the management of jet lag, are discussed.

Assessing feeder motivations and behaviour within couples using the Feeder Questionnaire.

This study first aimed to provide additional validation for a new tool to measure Feeder Motivations and Behaviour. Second, it aimed to evaluate how feeder motivations and behaviour are enacted within romantic relationships and whether this reflects a reciprocal or linear dynamic. Participants completed the Feeder Questionnaire composed of six motivational subscales (affection; waste avoidance; status; hunger avoidance; offloading; manners) and one subscale to measure feeder behaviour, measures of eating behaviour (restrained, emotional and external eating) and their BMI. Participants were analysed as individuals (n = 190) and within couples as dyads (n = 76 couples). In terms of validation of the measure, analysis using the non-dyadic data showed good internal reliability for all subscales and moderate correlations between feeder behaviour and motivations and measures of eating behaviour. In terms of couple dynamics, dyadic data analysis indicated evidence for reciprocity within couples for BMI, feeder behaviour and feeder motivations relating to waste avoidance, affection, manners and status but not for hunger avoidance or offloading. Dyadic analysis also indicated evidence for a more linear relationship with one participant's feeder behaviour and motivations relating to their partner's emotional and external eating. This study therefore provides further support for the usefulness of the Feeder Questionnaire. The study also indicates that feeder behaviour is complex within couples and may function in a reciprocal way but also with one partner's behaviour impacting upon their partner in a more linear fashion.

Animal obesity: What insights can a one health approach offer when it comes to veterinarians 'making every contact count'?

There is an overweight/obesity crisis in both human and companion animal populations globally. Veterinarians have an ethical obligation to protect animal welfare and, therefore, have a duty to intervene by supporting their clients in changing care plans to mitigate and prevent pet overweight/obesity. Currently, there is limited evidence in veterinary contexts for when and how this can be done effectively. In contrast, a more comprehensive body of literature has been developed on how human healthcare practitioners 'make every contact count' (MECC). This review begins by briefly exploring the cross-species multifactorial causes of overweight/obesity, before considering the literature regarding whether veterinarians reliably address overweight/obesity and the obstacles they encounter. The review then explores the evidence from human healthcare contexts in terms of how person-centred and health 'coaching-style' MECC interventions have supported weight management in adult and child populations and the barriers practitioners face when implementing these interventions. The final section interprets this literature to provide a fresh 'lens' through which veterinarians' concerns can be understood. Recommendations are made for enhancing veterinarians' capacity to develop the knowledge and skills needed for successful outcomes when MECC. Opportunities for developing local multi-stakeholder/agency teams taking a 'one health' approach are considered.

How communicating a diagnosis of polycystic ovarian syndrome (PCOS) impacts wellbeing: a retrospective community survey.

BACKGROUND: Polycystic ovary syndrome (PCOS) is associated with wellbeing. Many women report dissatisfaction with the diagnostic process. AIM: This study assessed the impact of aspects of the diagnostic consultation on subsequent wellbeing. DESIGN & SETTING: A retrospective community survey. METHOD: Females with PCOS (n = 147) completed measures of aspects of the diagnostic consultation (consultation satisfaction, language used in terms of framing and focus) and current wellbeing (body esteem, quality of life). RESULTS: Most diagnoses took place in primary care. The majority showed a medium degree of satisfaction with the consultation. Most diagnoses were framed using a neutral term 'raised' but many used the more judgemental term 'abnormal'. The majority focused on taking oral contraception and weight management. Poorer body esteem (body dissatisfaction and dieting behaviour) and poorer quality of life (self-identity, concerns about fertility, physical health, hirsutism, and overall quality of life) were predicted by lower communication comfort during the diagnostic consultation and greater use of the word 'raised'. Greater use of the word 'irregular' predicted greater concerns about fertility, greater focus on fertility predicted greater concerns about physical health, and greater focus on appearance predicted greater concerns about hirsutism. CONCLUSION: How a diagnosis of PCOS is delivered can impact subsequent wellbeing. The diagnostic consultation may take a few minutes, yet how these minutes are managed, what words are used, and how this makes the patient feel may change how the patient makes sense of their condition and influence the impact of the condition on their wellbeing for the longer term.

Global variations in preoperative practices concerning patients seeking primary bariatric and metabolic surgery (PACT Study): A survey of 634 bariatric healthcare professionals.

BACKGROUND: Bariatric and Metabolic Surgery (BMS) is a popular weight loss intervention worldwide, yet few scientific studies have examined variations in preoperative practices globally. This study aimed to capture global variations in preoperative practices concerning patients planned for BMS. METHODS: A 41-item questionnaire-based survey was designed and the survey link was freely distributed on social and scientific media platforms, email groups and circulated through personal connections of authors. The survey included eight parts: basic information; criteria for BMS; preoperative nutritional screening; preoperative weight loss; preoperative diets for liver size reduction; preoperative glycemic control; other laboratory investigations and preparations; decision making, education, and consents. Descriptive statistics were used to analyse data and graphs were used for representation where applicable. RESULTS: Six hundred thirty-four bariatric healthcare professionals from 76 countries/regions completed the survey. Of these, n = 310 (48.9%) were from public hospitals, n = 466 (73.5%) were surgeons, and the rest were multidisciplinary professionals. More than half of respondents reported using local society/association guidelines in their practice (n = 310, 61.6%). The great majority of respondents routinely recommend nutritional screening preoperatively (n = 385, 77.5%), mandatory preoperative diets for liver size reduction (n = 220, 53.1%), routine screening for T2DM (n = 371, 90.7%), and mandate a glycemic control target before BMS in patients with T2DM (n = 203, 55.6%). However, less than half (n = 183, 43.9%) recommend mandatory preoperative weight loss to all patients. Most respondents (n = 296, 77.1%) recommend psychological intervention before surgery for patients diagnosed with psychological conditions. Variations were also identified in laboratory investigations and optimisation; and in the aspects of decision making, education and consent. CONCLUSIONS: This survey identified significant global variations in preoperative practices concerning patients seeking primary BMS. Our findings could facilitate future research for the determination of best practice in these areas of variations, and consensus-building to guide clinical practice while we wait for that evidence to emerge.

Nostalgia, Gratitude, or Optimism: The Impact of a Two-Week Intervention on Well-Being During COVID-19.

Research indicates that brief 2-min positive psychology interventions (PPIs) increase well-being during COVID-19 lockdowns. The present study extended this to assess the effectiveness over two-weeks. Participants (n = 150) were randomly allocated to one of three PPIs; nostalgia, gratitude, best possible self (BPS), or control. The interventions were slightly adapted for the lockdown and were completed three times, every seven days over two-weeks. Well-being measures were completed immediately after the first intervention (T1), after the next two interventions (T2-T3) and at one-week follow-up (T4) (but no baseline measure of well-being was taken). At T1, participants in the nostalgia, gratitude, and BPS intervention had higher self-esteem than those in the control intervention. At T1 and T2, participants in the gratitude and BPS intervention reported higher social connectedness than participants in the nostalgia and control intervention. Then at follow-up (T4), participants in the nostalgia, gratitude, and BPS intervention had lower fear of COVID-19 than those in the control intervention. Overall, the results show the benefits of nostalgia, gratitude and optimism, compared to the control, during lockdown. Supplementary Information: The online version contains supplementary material available at 10.1007/s10902-022-00513-6.

Assessing Knowledge, Beliefs, and Behaviors around Antibiotic Usage and Antibiotic Resistance among UK Veterinary Students: A Multi-Site, Cross-Sectional Survey.

Antimicrobial resistance (AMR) is a profound threat to human and animal health. Antimicrobial prescribing behaviours are influenced by psychological factors such as knowledge, beliefs, and emotions. As future antimicrobial prescribers, it is important to understand beliefs about AMR and stewardship among veterinary (vet) students. This cross-sectional online survey assessed vet students' self-reported behavior, knowledge, and beliefs in specific relation to antibiotic resistance (ABR) and antibiotic usage. Participants were early years (first- and second-year; n = 460) and later-years (third- and fourth-year; n = 113) undergraduate vet students from three UK universities. Self-reported antibiotic-related behaviors were responsible among most students. Knowledge about ABR and stewardship was moderate among early years students and good among later years students. Vet students typically believed that vets had less responsibility for both causing and preventing ABR than other groups (animal owners, human medics, and the public). This study offers evidence that vet students (along with other groups) tend to lay greater responsibility for ABR/AMR outside of their own profession, which may impact their future prescribing behaviors. It is vital that AMR and antimicrobial stewardship are embedded across veterinary curricula, and that the One Health nature of the challenge posed by AMR is emphasized to encourage shared responsibility across all stakeholder groups, thereby helping to reduce 'other-blaming' for AMR.

Patients' expectations of cancer treatment and their perceived link to subsequent experiences: A qualitative study.

OBJECTIVE: Whilst much research has addressed patients' expectations and experiences of cancer treatment, little research has explored the association between these factors. The current qualitative study aimed to explore patients' beliefs about the relationship between their expectations of cancer treatment and their subsequent experiences. DESIGN: Qualitative semi-structured interviews were conducted with sixteen individuals who had received cancer treatment. RESULTS: Data were analysed using thematic analysis and illustrated that cancer treatment was experienced as a challenge that could be understood in terms of two themes: 'investing in treatment' reflecting trust in treatment and health care professionals and a sense that treatment was a necessary evil and 'encountering tensions or disconnects' illustrating the mismatch between expectations and experiences with patient reporting feeling unprepared, pleasantly surprised or shock. Transcending these themes was the notion of 'searching for stability and certainty' in terms of a desire for normality and a shift in focus between treatment process and outcome. Overall, disconnects were apparent between participants' expectations and experiences. However, due to their trust in treatment, participants were able to shift their focus between the treatment itself and future outcomes, to regain a sense of certainty. CONCLUSION: Patients describe a complex relationship between expectations and experiences and are able to shift their focus between process and outcome to cope with the challenges they face.

Exploring the experience of Gamblers Anonymous meetings during COVID-19: a qualitative study.

Whilst much research has explored the possible causes and consequences of gambling, Gamblers Anonymous (GA) - one of the most accessed forms of support for gamblers - has been largely overlooked and, to date, only a few studies have explored how members experience this programme. Core to GA is the social interaction between members. From March 2020, however, the COVID-19 pandemic forced GA to move their meetings online. The present qualitative study therefore explored how GA members experienced these online meetings in the absence of actual face to face interactions with others. Individual telephone or video call interviews (n = 21) were carried out with members of GA in the UK and analysed using Thematic Analysis. The results described three main themes: (1) 'practicalities of GA in lockdown', which highlighted the practical benefits of online meetings such as more opportunity to attend different meetings, which in turn expanded participants' perspectives and social networks; (2) 'the importance of relationships in GA', reflecting strong and enduring social networks that were created, maintained, and strengthened by feelings of solidarity; and (3) 'therapeutic elements of the meetings', such as psychological contract making which helped participants to stay abstinent. Transcending these themes was a tension between individual versus group identity with interviewees reporting a shift to focusing more on their own needs rather than those of the group. Overall, whilst still providing a lifeline during COVID-19 and offering some practical benefits, the online GA meetings were not able to completely replicate the value individuals gained from face to face meetings. This transition also resulted in disruptions both to group dynamics and to individual interactions within each group, ultimately resulting in participants behaving more individualistically and less collectively than in face-to-face meetings.