The psychological and emotional processes present in both individuals affected by eating disorders and residential workers implementing Trauma-Informed Care (TIC)

Thomas, Jordanne 2025. The psychological and emotional processes present in both individuals affected by eating disorders and residential workers implementing Trauma-Informed Care (TIC). ClinPsy Thesis, Cardiff University. Item availability restricted.

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Abstract

Early adversities are evident in many children and young people’s lives who reside in residential care, therefore a trauma informed approach by staff teams are necessary to support them. Similarly, studies have shown the impact of traumatic experiences on the development and maintenance of an eating disorder. Mental intrusive imagery experienced by those with an eating disorder, has also been linked to early self-defining memories and associated core beliefs which may have developed during such times of adversity. The aims of this research were twofold, firstly to explore mental imagery in eating disorders. Secondly, to investigate the perceived impact on practice in residential care workers following Trauma Informed Care (TIC) training. The systematic review synthesises the current research regarding intrusive mental imagery within eating disorders (ED), to explore the characteristics of imagery experienced within ED populations, and in comparison to other control populations. Furthermore, any maintaining factors in relation to imagery in EDs were considered. Mental imagery is a cognitive process in which sensory experiences are perceived in the absence of external stimuli. The sensory properties can include visual, acoustic, organic, kinaesthetic, cutaneous, gustatory and olfactory. EDs have become a public health concern due to their increased prevalence rates, association with high mortality and relapse. It is crucial that effective interventions are used to support the recovery of individuals with ED. Recent interventions that target imagery in EDs, such as imagery rescripting, are being implemented to support established treatments such as Cognitive Behavioural Therapy- Enhanced (CBT-E). However, there has been no review to date that synthesises the research of imagery characteristics in ED populations, and in comparison to control groups. Four databases were searched (PsycINFO, Ovid MEDLINE, PubMed, and ProQuest). Articles that reported on imagery characteristics within ED populations were included. A total of 480 papers were screened using the inclusion criteria that was set. Six studies were included in the final review. Out of these six studies, two focussed on ED populations, and four investigated EDs in comparison to controls. The review found that the prevalence of imagery was apparent in ED groups, and were experienced similarly in terms of characteristics across ED subtypes. Control groups also reported experiences of imagery, although ED populations experienced imagery more vividly, negatively and anxiety inducing in nature. Recurrence of imagery was reported in both ED populations and controls, with ED participants experiencing higher rates of recurrence. Various characteristics of imagery were experienced by ED participants and controls, which included, vividness, anxiety inducing, negative valence and vantage perspective, as well as controllability and impact of imagery. Findings indicate that imagery is a key contributing factor to ED pathology, due to the distressing emotion they can evoke, resulting in maladaptive coping strategies such as restricting or purging seen in EDs. Intrusive imagery significantly impacts the experience of ED, which has implications on the maintenance and perpetuating cycle of the disorder. Additionally, imagery characteristics shared similar sensory modalities and emotional impact with memories and core beliefs. Implications for treatments means relapse is likely, unless characteristics and the emotionality of imagery is targeted to support individuals’ recovery. Further research is recommended of imagery characteristics, their links with memories and core beliefs, and how these contribute to the maintenance of eating disorders. The empirical paper aimed to establish the perceived impact on practise in residential care workers after receiving Trauma Informed Care (TIC) training that was adapted and delivered online. Children and young people (CYP) that reside in residential care have complex emotional needs that stem from adverse childhood and life experiences. These needs can result in behavioural difficulties shown at times by verbal/ physical aggression towards staff, themselves or others. Residential care aims to provide a safe place to support CYP. Trauma informed care (TIC) has received much attention to date, particularly, as many CYP have experienced trauma at some point in their lives. Trauma informed models are being implemented into healthcare, including residential settings. TIC training was delivered online, to a team of residential staff, ensuring accessibility during COVID-19 and accounting for changes of staff shift patterns. Eight residential staff participated in semi-structured interviews, exploring their experiences and perceived impact on practise following training. A constructivist grounded theory approach was used to analyse the data. The results showed the impact on practise was determined by two stances, embracing a new perspective, or staff continuing to work the way they have always worked. Emerging categories highlighted various system and staff factors which influenced the likelihood of residential staff embracing a trauma informed way of working. Values and qualities, prioritising of time, resource and staff wellbeing were identified as enabling factors. Barriers included lack of resources, placement allocation, staff expectations and emotional experiences. This had implications on outcomes for both staff and CYP. Adopting TIC created opportunities for relational safety to develop within the system, however when staff continued their usual practices, minimal changes were observed, impacting negatively on outcomes. Future research is recommended to explore broader systemic concepts and factors that determine whether staff embrace TIC. Finally, future research is recommended that considered the CYP’s perspective first hand, and outcomes that are important in terms of their quality of life.

Item Type:	Thesis (DClinPsy)
Date Type:	Completion
Status:	Unpublished
Schools:	Schools > Psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Date of First Compliant Deposit:	18 August 2025
Last Modified:	18 Aug 2025 14:07
URI:	https://orca.cardiff.ac.uk/id/eprint/180483

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