The journey of a young researcher in the 21st century

 

 

By Line Caes

I’ve been part of the School of Psychology now for a full year and felt it was about time I wrote something about my research interests for this blog. In the past two years I’ve become more involved with social media and just love the Health Psychology blog running here at NUIGalway.

My research journey stared in 2008 when I started my PhD at Ghent University, Belgium, under supervision of Dr Liesbet Goubert. I always knew that I wanted to work with children and I had a particular interest in helping children who were ill. Only at this point though did this broad interest get a focus: paediatric pain!


My PhD research

Pain is a common, aversive experience in children, but it is vital to one’s survival as it is a crucial signal in directing attention to potential sources of injury and motivates actions aimed at reducing, escaping and avoiding pain (Eccleston & Crombez, 1999). Child pain not only impacts the child’s functioning, but may also be a strain for their parents.

When I started my PhD, there was not a lot of research on how parents respond when their child is in pain. I was motivated to understand parents’ experiences better. Several studies had indicated that parent behaviours such as providing reassurance and comfort are related to more child pain and distress. In contrast, distracting the child is related to less pain and distress (Blount et al., 2008). However, little was known about why parents choose particular behaviours when faced with their child in pain.

Catastrophic thinking about pain is an exaggerated negative attitude towards actual or anticipated pain experiences (Sullivan et al., 1995). Based on evidence demonstrating the importance of catastrophic thinking about pain, we thought that parents could also have catastrophic thoughts about their child’s pain. In turn, this could influence what parents feel or do in response to their child in pain. We investigated this in healthy schoolchildren undergoing a painful task such as the cold pressor task (see picture).

In a cold pressor task children put their hand in cold water for as long as they can (with a maximum of 4 minutes) – example Birnie et al (2011)

In a cold pressor task children put their hand in cold water for as long as they can (with a maximum of 4 minutes) – example Birnie et al (2011)

We also looked at families of a child diagnosed with leukemia (as part of their treatment children have to undergo a series of painful lumbar punctures and bone marrow aspirations, which are not only anxiety provoking for children but also for their parents).

Parents who catastrophized about child pain experienced higher levels of distress when confronted with their child in pain, which in turn was associated with a higher engagement in protective behaviour (e.g. tendency to stop their child performing the painful task, reassuring, comforting; Caes et al., 2011; Caes et al., 2012a,b; Caes et al., 2014a,b). This supported early findings showing that parents with catastrophic thoughts experience child pain as more distressing than low catastrophizing parents (Goubert et al., 2006; 2008). By using psychophysiological measurements of distress (Caes et al., 2012a), the results indicated that distress in parents is an automatic negative

Dr Liesbet Goubert, myself and Dr Tine Vervoort, my Ghent-pediatric-pain-buddies, enjoying the reception at a conference on pediatric pain.

Dr Liesbet Goubert, myself and Dr Tine Vervoort, my Ghent-pediatric-pain-buddies, enjoying the reception at a conference on pediatric pain.

emotional response when their child is in pain. The results of our prospective study in children with leukemia (Caes et al., 2014b) even indicate that this higher level of distress in parents who catastrophize about child pain does not necessarily lessen when the parent is repeatedly confronted with a threatening, painful experience in their child.

Distress in parents probably serves a protective function as it prepares the parent for dealing with the possibility of an approaching threat to their child (Hadjistavropoulos et al., 2011). It might therefore also have important implications for caregiving behaviour (i.e. higher engagement in protective behaviour). Our findings have also been replicated in children suffering from chronic pain: parents who highly catastrophize about child pain report a higher engagement in protective behaviours in response to their child’s pain experience (e.g. Hechler et al., 2011; Sieberg et al., 2011). Parents with catastrophic thoughts might be more likely to have a preference for protective behaviour primarily because it functions as a way to reduce their own overwhelming feelings of distress.


Life after my PhD… Taking the plunge and moving to Canada

I finished my PhD in June 2012 and was ready for a new adventure in research-land. I had the exciting opportunity to start a postdoctoral fellowship in Canada at the Centre for Pediatric Pain Research at the IWK Health Centre (Halifax, Nova Scotia). Although the first three years of my PhD I was convinced I would do a postdoc at Ghent University, in the last year it became clear that my chances to receive funding at the university where I had studied for the last 9 years were slim. This made me look beyond the borders of Belgium. I was quite fortunate to be part of an international training program of paediatric pain researchers (i.e. Pain in Child Health; Von Baeyer et al., 2015). Attending the yearly research institutes of this training program allowed me to establish close connections with trainees and established researchers interested in paediatric pain and ultimately to find my postdoctoral supervisor.

How did it happen?!

It took a lot of courage but during one of the institutes I just went up to the famous Dr Christine Chambers to introduce myself and express my interest to do a postdoctoral

Me and Dr Christine Chambers, my postdoc supervisor.

Me and Dr Christine Chambers, my postdoc supervisor.

fellowship under her supervision. To my surprise she knew about my research and she was really enthusiastic and open to supervise me. Although it meant leaving everything I knew behind, especially my husband and doggies, I was really excited to start this new adventure.

The goal of my postdoctoral fellowship was to broaden my research perspective and experience. My main study investigated the role of family functioning in understanding parental responses towards their child in pain, in children with inflammatory bowel disease (IBD). IBD is a chronic condition of the gastrointestinal system with uncontrolled inflammation of the intestinal mucosa as its hallmark (Hanauer, 2006). I was interested in the finding that children with IBD reported a lower quality of life when living in a family with more difficulties (Herzer et al., 2011). However, no research had looked at why this was the case (Lewandowski et al., 2011). Therefore, we investigated the influence of family warmth or togetherness and flexibility on parental behavioural responses to child pain. In turn, we wanted to see how these parental responses impact the child’s pain experience and quality of life. The results are still being analysed, so stay tuned for a next blog to learn more about our findings!

 

Me enjoying one of many double double coffees at Tim Hortons

Me enjoying one of many double double coffees at Tim Hortons

Moving to another country not only meant that I broadened my research experience, but I also learnt a lot of new things on a personal level: Tim Horton’s coffee, Timbits (sort of mini donuts) and SNOW (lots of it 🙂 ).

 

My first winter storm!

My first winter storm!

I had a good time during my postdoctoral fellowship and can advise everybody to take the plunge and change institutes (even countries!) for an exciting and extremely valuable experience on both personal and academic level. I won’t lie, making the personal sacrifices was hard, but I was lucky enough to have a very understanding and flexible supervisor and a long-distance buddy in a lab member who also had the Atlantic Ocean separating her from her husband. To ease the pain a little more, we also flew our Newfoundland over to meet her roots in Canada:

Hera arriving at Halifax airport after 24h of traveling!

Hera arriving at Halifax airport after 24h of traveling!

Hera enjoying the snow in the backyard!

Hera enjoying the snow in the backyard!


The dreaded “REAL JOB”

However, after 2 years my funding ended and it was time to continue growing up and take the step to a ‘real job.’ Although I would have loved to stay in Canada, I didn’t want to limit my chances or opportunities and therefore adopted an equally flexible attitude as when I was looking for a postdoc. My only condition was that pain-related research should already be present in some form as during my postdoc I discovered that this facilitates integration in a new institution immensely!

Often people ask me how I ended up then in Galway, well by coincidence actually. One of my UK paediatric pain colleagues, who had done her masters of Health Psychology at NUI Galway, forwarded me the job application for a lecturer at NUI Galway. She put me in touch with some people to find out more about the school and one thing let to another. Before I knew it I was invited for an interview and then also got the job. The day before my interview I had taken the opportunity to meet with a couple of other faculty members with similar research interests, which was really helpful to get a feeling of the school as an outsider. This had made me extremely enthusiastic about the possible opportunities at the school and helped me in preparing for the interview! If applying for a position in a university you’re not familiar with, I would definitely recommend this.

After 1 year at NUI Galway, I can honestly say I feel settled in. Everybody had warned me that the step to a permanent position is something you never feel ready for and I can now confirm: it is a real rollercoaster! ‘Being busy’ has taken on a whole new level. But it is a great experience: I really enjoy working with the students, especially the one-on-one supervision, and it is great to think about research projects you want to conduct without the need for them to fit with your supervisor’s research line!

My main research focus will be on investigating the mutual associations between children and parental responses to child health conditions, such as pain, and how these impact the quality of life of parents and their child. I want to investigate this across development: from pre-schoolers to adolescents. I was very fortunate to receive my first grant (2015 IASP Early Career Research Grant) to start this research line in pre-schoolers. The project will take the first step in developing a method for home-based observation of everyday painful events (e.g. falling) to allow observation of parent-child interactions in a natural environment.

Our flat-coated retriever Iachi enjoying Blakes Hill

Our flat-coated retriever Iachi enjoying Blakes Hill

You might wonder what happened with the long distance relationship in the mean time. Well, there is no ocean separating us anymore, but it is still ongoing as my husband made a similar exciting jump for his postdoc by moving to Belfast, UK. Living closer together has allowed us to reunite the dogs! Both are now enjoying each other’s company again and the (Northern) Irish countryside. Yes, they are equally well travelled :).

 

I hope that sharing my journey made it more fun to read about my research interests, but also inspires people to not be afraid to leave their comfort zone. Talking to other people about my journey made me realise that this seems to be more and more a common trajectory for academics of this century and sharing experiences helped me a lot along this exciting journey!

Dr Line Caes joined the School of Psychology and the Centre for Pain Research at NUI Galway in July 2014 as a Lecturer of Psychology.

Dr Line Caes joined the School of Psychology and the Centre for Pain Research at NUI Galway in July 2014 as a Lecturer of Psychology.

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Reflecting on the Stress and Anxiety Research Society conference in Israel

By Páraic Ó Súilleabháin

The conference was the 36th Stress and Anxiety Research Society (STAR) annual conference which was held this year in Tel Aviv, Israel. Prior to the conference I travelled to Jerusalem from Tel Aviv to do some

Street in the Old City of Jerusalem

Street in the Old City of Jerusalem

sightseeing of the main religious sites such as the Western Wall. On the way to the Wall, I passed through a maze of streets in the old city of Jerusalem. These streets were a welcomed rest from the blistering heat. The Western Wall itself which surrounds the Temple Mount is the holiest site in Judaism. Hundreds of people attend in prayer every day. I found it fascinating watching people interact with one another, and especially while in prayer there.

Western Wall (Wailing Wall)

Western Wall (Wailing Wall)

Attending the conference was an excellent opportunity to view one of the most historically rich places in the world. Having heard and learnt about many of the places during my childhood in a catholic national school in rural Ireland, it was fascinating to pass places like Bethlehem and the Garden of Gethsemane. While I am not religious anymore, I certainly appreciated the history, beauty and relevance of these sites.

Professor Brian Hughes President of STAR opening the conference

Professor Brian Hughes President of STAR opening the conference

The conference itself was held in Tel Aviv University. The current president of STAR is Prof. Brian Hughes from the School of Psychology at NUIG. I was quite surprised at the size of the conference with hundreds of attendees with presenters from approximately 40 international universities. One of the aspects I enjoyed the most about the conference was while it was in my broad area of stress research, topics covered ranged widely from the joys and struggles with welcoming a new baby into the family to coping, resilience and trauma in conflict zones. It was very interesting listening to various other researchers speaking about stress research in such diverse ways.

Amanda Sesker’s presentation on conscientiousness and cardiovascular reactivity

Amanda Sesker’s presentation on conscientiousness and cardiovascular reactivity

Fellow School of Psychology PhD candidate Amanda Sesker also attended. Amanda presented on cardiovascular reactivity and the role of conscientiousness in recurrent stress exposures in female university students; a report on her initial findings for study 1 of her PhD. This was her first international conference and she reported it as being a unique opportunity; not only by visiting a different continent but also meeting many of the esteemed researchers involved in stress and anxiety research. Her presentation and work was very well received by the attendees.

Páraic presenting his own work

Páraic presenting his own work

Having surprisingly quickly acclimatised to the heat (I am designed for artic conditions!), I was looking forward to present on the opening day of the conference. I presented the first completed study of my PhD titled openness to experience and cardiovascular stress responsivity which is currently being submitted for publication. In recent years, research has reported that this personality trait has a large effect on mortality, with an even greater impact than common mortality risk factors such as socio-economic status and alcohol consumption. More recently, openness to experience has been found to impact the onset of a variety of cardiovascular health associations, such that a one unit increase in openness to experience decreases the onset of stroke by 31%, high blood pressure by 29%, and a host of other conditions by 17%. While the exact underlying biological mechanisms remain unclear, my PhD revolves around attempting to shed some light on why this may be happening.

Presenting at the conference was an amazing opportunity for me. Many of my peers and people I greatly admire attended my presentation from various international universities. Apparently they didn’t attend specifically to hear my presentation! While it was slightly nerve wrecking presenting to begin with, I assured myself I was correctly responding to the stressor with habituation to hopefully follow (see what I did there!!).

Attending the conference would not have been possible without travel bursaries from the School of Psychology, the Centre for Research on Occupational and Life Stress, and the College of Arts, Social Sciences, and Celtic Studies. I am extremely grateful for their assistance and support.

Páraic Ó Súilleabháinis currently in the third year of his PhD studying "Cardiovascular responses and adaptation to recurring stress – a psychophysiological investigation of personality" at the National University of Ireland, Gawlay - with assistance from a Galway Doctoral Research Scholarship from the College of Arts, Social Sciences, and Celtic Studies, National University of Ireland, Galway. He is supervised by Prof. Brian Hughes & Dr. Siobhán Howard

Páraic Ó Súilleabháin is currently in the third year of his PhD studying “Cardiovascular responses and adaptation to recurring stress – a psychophysiological investigation of personality” at the National University of Ireland, Gawlay – with assistance from a Galway Doctoral Research Scholarship from the College of Arts, Social Sciences, and Celtic Studies, National University of Ireland, Galway. He is supervised by Prof. Brian Hughes & Dr. Siobhán Howard

Follow Páraic on Twitter 

2015 Health Promotion Conference. Health Literacy: Research, Policy & Practice

By Milou Fredrix0608_health_promotion

There are 53 different ways of saying, ‘take 1 tablet a day’. This seemed to be the catchphrase of the NUI Galway Health Promotion, 19th Annual Summer Conference held on 18th of June 2015. This year, the conference focused on the research, policy and practice of Health Literacy. Not sure what to expect, I went to the conference open minded, and ready to learn more about this rather novel concept. Armed with my fellow health-psychology colleagues, we marched over to Áras Moyola, where we found ourselves outnumbered by many other disciplines.

Welcoming us and impressing us with the conference programme, Tony O’Brien, Director General of  HSE Ireland kicked off the conference. A good start was learning that health literacy is “the ability to obtain, read, understand and use healthcare information to make appropriate health decisions and follow instructions for treatment.” 

So how did this concept of health literacy come about?

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Dr Rima Rudd, Senior Lecturer on Health Literacy, Education, and Policy at Harvard T.H. Chan School of Public Health.

With her mesmerising way of speaking, the first keynote speaker, Dr Rima Rudd from Harvard T.H. Chan School of Public Health, was able to explain this quite clearly. In the nineties, 20 predominantly developed countries including Ireland participated in national surveys of adult literacy skills. These were in in-depth interviews looking at how well people were able to use everyday materials to accomplish everyday tasks. An example item would be using a bus-timetable to plan one’s journey. When the findings came out, the researchers and participating countries were shocked. It turned out that the literacy skills of the majority of adults in most countries, including Ireland, were not adequate to meet the needs of the current society.

This moment was the beginning of the field of health literacy as people began to wonder if this could have consequences for health. Many research projects were undertaken and results showed strong links between literacy skills and health outcomes. People with limited literacy and numeracy skills have lower adherence to medical regimens, are more likely to be hospitalised, are less likely to make use of screening and report poorer overall health. However, in this talk Dr Rudd highlighted that while these studies show very important findings, there has been a missing perspective to this picture. Health Literacy has kept its eye focussed on the patient. It has been putting the burden of finding, understanding, evaluating and using information on the patient. But literacy does not take place in a vacuum. Researchers have not been focussing on the context in which patients function. We should also be looking at our health system, the communication skills of health care professionals and the availability of information. We need to ensure that health materials are developed and piloted with rigour before they are given to patients.

Dr. Graham Kramer, GP and National lead for self-management and health Literacy in Scotland provided us with a fantastic analogy in the following keynote speech. He reminded us of the first home computers in the early 80’s. As some of us may remember, some serious programming skills were necessary to operate these old-fashioned beasts. Being a toddler at the time, I only seem to remember ‘<Dir> Pacman.exe’. Instead of burdening people with an extensive information or computer skills, companies such as Apple chose to simplify their interface to the point where toddlers can now operate iPads before they can speak. The same should happen with health information.

Dr Kramer highlighted that the key to addressing Health Literacy is not so much to get us to see the world from the perspective of health care but for healthcare to see the world from our perspective. Dr Kramer made us hopeful for change when talking about his work on Making it Easy – A Health Literacy Action Plan for Scotland. It aims to raise awareness of literacy needs, test series of health literacy improvements/ innovations and make successful communication at transitions of care a routine experience in Scotland.

Ms Inez Bailey from NALA- National Adult Literacy Agency then brought us back to health literacy in an Irish context. She highlighted the worrying statistics that about 1 in 6, Irish adults are below level 1 on a five level literacy scale. At this level a person may be unable to understand basic written information. Furthermore, it seems that only 1 in 5 Irish people fully understand the information that they receive from their health care professional. Luckily Ms Bailey stresses that Health Literacy is currently being addressed In the Healthy Ireland (HI) programme. This is a new governmental initiative to improve health in Ireland and it contains the first ever governmental commitment to improving health literacy.

Fig 1: PIAAC [2011]: Ireland Compared to Other Countries

Fig 1: PIAAC [2011]: Ireland Compared to Other Countries

After a quick coffee break to improve our own literacy levels, a series of parallel sessions were offered in which a variety of innovating research was presented. Studies included explorations of health literacy levels in the traveller community, exploring methods to measure health literacy in children, and many more. For a full list of the presented studies, see here.


After a delicious lunch and some time to digest the morning sessions, Dr Geraldine Doyle from UCD spoke about European projects highlighting the importance of health literacy. She particularly stresses that more efficient use of health services and chronic disease management requires improvements in health literacy.

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Dr Joanne Protheroe of Keele University highlights some of the health-related problems associated with low health literacy.

Dr Joanne Protheroe of Keele University subsequently presented her work conducted in Stoke-on-Trent. She found that the majority of patient leaflets in GP surgeries in Stoke-on-Trent would be too complex for 43% of population. Their plan for actions includes getting the community involved to raise awareness of health literacy in front-line staff.

In a following workshop with Dr. Saoirse Nic Gabhainn on engaging with policy makers, large discussion arose about how to best create collaboration, skill-sharing and communication between policy makers and researchers. The idea of a common language and think-tank seemed to dominate.

With a historical overview of Ireland’s Health Policy, Mr Owen Metcalfe, Chief Executive of the Institute of Public Health in Ireland, concluded the conference.

Overall it seems that the message of the day was that health literacy needs to be addressed and improved, but health care managers need to take more responsibility for the problem as well.

  • Health literacy needs to be recognised and linked to patient safety.
  • Institutions need to accept responsibility for making patients understand and for providing accessible information.

Walking back to the Arts Millennium building on this lovely sunny day, we couldn’t help but discuss where we as Health Psychologists come in. Can we collaborate, or is this field passing us by in improving health behaviour? If we enhance health literacy and make materials clearer, will we eliminate all health problems?

To end with Dr Rudd’s wise words:

“Health literacy is not a social and behavioural science, it is not involved in persuasion and it is not changing cultures and norms of health behaviour. Social sciences as psychology are needed to give insight into this. Health literacy focusses on dialog, discussion and dignity of exchange between provider and users of care. It does not necessarily always link to action, but is it a first step. There is dignity in understanding information. Whether or not people choose to do something with this information, is another story.” 

Milou completed a BSc. in Psychology and Neuroscience and a MSc in Health and Social Psychology at Maastricht University in the Netherlands. As part of her masters Milou conducted research on eating behaviour and the underlying psychological mechanisms. As a PhD student at NUI Galway, Milou will focus on ’understanding and managing health-related behaviours within the area of Diabetes’. She is the recipient of a four-year scholarship from the Health Research Board as part of Dr Byrne's HRB Research Leaders Award.

Milou completed a BSc. in Psychology and Neuroscience and a MSc in Health and Social Psychology at Maastricht University in the Netherlands. As part of her masters Milou conducted research on eating behaviour and the underlying psychological mechanisms. As a PhD student at NUI Galway, Milou will focus on ’understanding and managing health-related behaviours within the area of Diabetes’. She is the recipient of a four-year scholarship from the Health Research Board as part of Dr Byrne’s HRB Research Leaders Award.