Post by Tori Sasaki, MSc student and Peer Link Worker with PsychUP for Wellbeing and Students’ Union UCL

Reading time: ~ 3 mins

PsychUP for Wellbeing and Students’ Union UCL have teamed up to pilot peer support sessions for students at UCL, as part of the Student Mental Health Partnerships projects funded by the Office for Students and led by UWE Bristol. Tori describes this new model of support and reflects on the experience of being a Peer Link Worker. Find out more about the sessions and book a slot with a Peer Link Worker here.

UCL has so many resources available to students who are struggling with a wide variety of issues, from Student Psychological and Counselling Services (SPCS) to International Student Support to the Students’ Union Advice Service, to Disability, Mental Health and Wellbeing (DMHW), and more. Navigating these services, however, can be overwhelming, and sometimes a more accessible and appealing first step is to seek support from someone who understands, on some level, what you’re going through. Someone who is a trained peer who can listen to what’s on your mind, share their own experiences when appropriate, and help direct you to the most useful further resources.  We know from the PsychUP for Wellbeing IMPACTS peer-led research that many students valued talking to a fellow student about their mental health experiences, and expressed a desire for more peer support at UCL. That’s where the Peer Link Worker programme comes in.

The Peer Link Worker pilot project is a collaboration between PsychUP for Wellbeing, Students’ Union UCL and the UCL University Clinic. It began in May of this year and will run until December, with the goal of using feedback from the pilot to inform a longer-term project. All newly-recruited Peer Link Workers receive training so they can support their fellow students effectively. Peer Link Workers offer remote one-to-one and group support sessions, as well as remote follow-up workshops to psychoeducational videos that Trainee Clinical Psychologists have made on topics such as assertiveness, perfectionism, and stress and relaxation. We recently ran a group session focused on students’ feelings about returning to campus this year and are working on creating group sessions based on other topics as well. Individual support sessions have been run every day during the pilot, Monday to Friday. Support is open to all UCL students. Students come to us for one or two sessions, during which they also learn about other types of support services offered that fit their individual needs.

As well as benefiting students who sign up to the service, Peer Link Workers are also trained in incredibly valuable skills.

I was particularly drawn to the Peer Link Worker project because it aligns both with my value of helping others and with my goal of going on to pursue a career in the mental health field. The project not only benefits students who sign up to the service by offering them much-needed emotional support and help navigating different situations and resources at UCL and beyond, but it also trains the Peer Link Workers in incredibly valuable skills. These skills include how to properly use self-disclosure of our own experiences, how to set and maintain appropriate boundaries, how to navigate different communication styles, and the best course of action to support a student who is in crisis. These are skills that will be useful in any individual’s personal and professional life, especially if one is pursuing a career as a mental health professional.

Peer Link Worker training at a glance¹: Boundaries

One of the special aspects about the student-peer relationship is shared experience. Of course, every student has elements of their university experience which are unique to them, and it is the Peer Link Worker’s job to truly listen to what the student is saying and to refrain from making assumptions. However, many students share similar struggles including dealing with mental ill-health on top of coursework, the pressure to get top marks, the financial burdens of being a student, and navigating friendships and romantic relationships. Therefore, another student is in a uniquely helpful position to support their fellow students. It is also notable that the relationship between the Peer Link Worker and the student seeking support is a non-hierarchical one: Peer Link Workers approach the conversation as a peer and not as a mental health professional.

I am grateful that this Peer Link Worker project has been able to continue into this academic year, especially as the start of the year can be a time of overwhelming amounts of information as well as new experiences and challenges. More than 50 students have been supported through the pilot to date. I hope that students continue to utilise this new resource, and that they come away from sessions feeling listened to, validated, and supported during their student experience.

More about the Peer Link Worker pilot and evaluation

You can find out more about the peer support pilot and book a session on the Students’ Union UCL website here.

PsychUP for Wellbeing are carrying out an evaluation of the pilot to see how it helps students. When you book a support session with a Peer Link Worker, you can opt into the evaluation and give us feedback on how you found it.

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¹ The UCL peer support training was adapted from the Health Education England Competency Framework and Care City training.

Post by Phoebe Barnett, PhD student and Research Assistant. You can follow Phoebe on Twitter.

Reading time: ~3 mins

Clinicians delivering psychotherapeutic treatments to students may choose to adapt their interventions, to try and account for their unique context. In this post, Phoebe Barnett outlines the findings from her recent systemic review, which investigated whether current adaptations to treatments for students are working.

Student counselling services have reported considerable increases in the number of students accessing care. Alongside this, they report that their clients are presenting with more severe mental illnesses. While this is likely to be at least partly caused by widening access to university, recent reports have highlighted that student-specific concerns, such as academic pressure, financial distress, substance misuse and family upset are rising ^1,2.

Many of the current psychological therapies delivered to students were originally designed for the general population, and may therefore miss important factors related to student distress. One possible way in which student mental healthcare could be improved is by designing specialised treatments for students; for example, by targeting the prevention of suicide and self-harm ^3,4. As students are easy to recruit, previous research has often included them in their samples. However, the research rarely aims to establish what works best for them specifically. It is important to understand how to support mental health needs in this specific population, and how we can further adapt evidence-based treatment so students feel the support available to them is relevant to the difficulties they are facing. 

I therefore systematically reviewed the evidence from randomised-controlled trials of psychological therapy conducted in student populations. In doing this I aimed to establish if a specific focus on adaptation would work better than generic approaches.

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Our findings

In general, psychological treatments are effective in reducing students’ symptoms of depression, anxiety disorders and eating disorders. This result, although unsurprising, is important because depression and anxiety disorders are the most common in students. There is also overrepresentation of eating disorders in students, compared with non-students. Unfortunately, few investigations into treatments for PTSD in students have been conducted, and, despite recent reports of suicide rates in students increasing^5,6, we did not find any studies which focussed on either self-harm or suicidal ideation.

Only a small number of studies, 13 out of 84, specifically adapted their intervention for students. When we compared  studies looking at adapted and non-adapted treatments, adapted interventions did not lead to better outcomes or greater adherence to treatment. Those who received adapted treatments actually fared worse in most cases.

Those who received adapted interventions actually fared worse in most cases. Concerns about students dropping out would be better addressed with interventions focused on motivation, rather than reducing treatment length.

These results seemed counterintuitive at first, however when we looked into this in more detail, some of the adaptations did not fully encompass what students may need from mental health support. For example, a common assumption was that students lack the motivation to attend longer treatment programmes (although this point is disputed and contradicts some recent qualitative research I have conducted). Three studies sought to achieve better outcomes by reducing the treatment intensity: one delivered web-based sessions, one reduced the total number of sessions and the final study provided a single session of low-intensity treatment. But our review found no evidence that reducing treatment intensity in this way benefitted patients in terms of symptom reduction and treatment tolerability. It was not clear whether the shortening of previously evidence-based treatment models removed key “ingredients” which, in turn, hindered the effectiveness. We suggest that concerns about students dropping out would be better addressed by focussing on motivation, rather than potentially sacrificing important elements of therapy by reducing treatment length.

Positive effects were seen in two studies who provided more sessions alongside evidence-based adaptations, suggesting a potential avenue for further research.

Conclusion

In sum, psychological treatments can be beneficial for students, but so far they have not been fully optimised for them. There remains a lot of uncertainty over how we can provide interventions to students in a way that suits them best. A greater understanding of context-specific causes of mental health problems and distress could lead to more promising treatments for students.

References

1. Doerr, J. M., Ditzen, B., Strahler, J., Linnemann, A., Ziemek, J., Skoluda, N., Nater, U. M. (2015). Reciprocal relationship between acute stress and acute fatigue in everyday life in a sample of  university students. Biological Psychology, 110, 42–49.back
2. Murray, A. L., McKenzie, K., Murray, K. R., & Richelieu, M. (2015). An analysis of the effectiveness of university counselling services. British Journal of Guidance & Counselling, 44, 1309139.back
3. Gawrysiak, M., Nicholas, C., Hopko, D.R., 2009. Behavioral activation for moderately depressed university students: randomized controlled trial. Journal of Counseling Psychology 56 (3), 468-475back
4. McIndoo, C., File, A., Preddy, T., Clark, C., Hopko, D., 2016. Mindfulness-based therapy and behavioral activation: A randomized controlled trial with depressed college students. Behaviour Research and Therapy, 77 118–128. https://doi.org/10.1016/j. brat.2015.12.012.back
5. Horgan, A., Kelly, P., Goodwin, J., Behan, L., 2018. Depressive symptoms and suicidal ideation among Irish undergraduate college students. Issues in mental health nursing 39 (7), 575–584.back
6. Read, J.P., Griffin, M.J., Wardell, J.D., Ouimette, P., 2014. Coping, PTSD symptoms, and alcohol involvement in trauma-exposed college students in the first three years of college. Psychology of addictive behaviours 28 (4), 1052. back

Post by Dr Chloe Campbell, Deputy Director of the UCL Psychoanalysis Unit

Reading time: ~ 6 mins

The remote therapy experiment brought about by the pandemic has had a silver lining, as therapy has become more accessible to many people. Keeping some form of online therapy is desirable for this reason, but it does raise new challenges for communication. Chloe Campbell reflects on how a psychological understanding of trust can help us understand online communication better.

Psychological therapy is not new or special: that is why it works. Humans beings have – for as long as we have had language – sought out other people’s minds, thoughts and perspectives in order to regulate their own state of mind.

Infants do it all the time and perhaps most obviously – a baby or young child is not only dependent on their caregivers for physical survival, but also to restore their sense of comfort, safety or to help them make sense of the world together.

This joining of minds, known as ‘joint intentionality’, is crucial to human development. Recent evolutionary thinking has suggested it underpins the sophisticated social cognitive skills that make the human species unique. It enables teaching and learning, sophisticated planning and collaboration – in essence it makes social cohesion and the development of culture possible. 

To be able to do all these complicated and demanding social cognitions, we need to be able to think about the mental states of other people and ourselves, an ability known as ‘mentalizing’. But mentalizing requires imagination – we cannot know for certain what is going on in other peoples’ minds, and even thinking about our own mental states is a highly abstract undertaking.

The human imagination allows us to do extraordinary things – from being able to think sensitively about someone else’s pain or distress, to being able to write and read great literature, to being able to make the abstract leaps in ideas that lead to ground-breaking scientific breakthroughs.

We all need to access to other people’s thoughts to help us manage our own – to moor our imaginations to something more  helpful for us, or indeed with reality

The flipside of our marvellous imaginative capacities is that sometimes our ability to think in such ways can, when unregulated, lead to intense psychological distress. Many forms of anxiety and depression can be understood as being, in some way, the product of our minds working away at great abstract capacity but with insufficient alignment with our social reality. 

This is where other people’s minds come in. We all need, at times, to access to other people’s thoughts to help us manage our own – to moor our imaginations to something more in line with what is helpful for us, or indeed with reality.

This is the power of joint intentionality and cooperative thinking. But a further complication in all this arises from another downside of human social complexity: not all humans can be trusted and opening up to the wrong person could leave you vulnerable.

As a result of this, we have also evolved the capacity to be highly sensitive to cues from other people that might suggest whether or not they (a) have something useful to say and (b) have our best interests at heart.

And it is here that the communication that is relevant to effective psychotherapy comes in. The kinds of cues that we are sensitive to are often highly interpersonal.

If we feel the other person is truly interested and capable of recognising us – even those parts of us that are hidden, perhaps even partly to ourselves – then that is a powerful cue that the other person is sufficiently invested in us for us to be able to think with them, to learn from them, and to use their mind to regulate our own.

Once we have had some practise accepting this in the therapeutic relationship, we can go on to build on what we have learnt in our daily lives. With a bit of luck, a virtuous circle might be activated – and treatment has become “effective”.

Of course, if the outside world does not support these developments, then it is much harder, and in some circumstances perhaps impossible, for the virtuous cycle to really keep rolling. After all, if we live in a hostile environment, where other people’s minds aren’t capable of investing benignly in each other’s, it would be a mistake to adopt such cooperative openness to others’ mental states.

So, where does this leave us with remote therapy?

The task of the remote practitioner is the same. Their work depends on their capacity to evoke in the client the same sense they have been recognised, that the practitioner is interested and invested in the client’s mental state, and is able to tolerate and accommodate the complexities this might involve.

Remote therapy can create particular challenges for this – but also perhaps offer some advantages.

Returning to an evolutionary perspective, the initial challenge arises from the fact that we adapted the capacity to read these signals in small, face-to-face social groups.

Working remotely creates challenges but more than ever it should focus us on the value of thinking together and communicating thoughtfully.

The role of signals such as eye contact, responding to body language and contingent responsiveness – the back and forth quality of shared conversation – are liable to be distorted in online communication. The person you are talking to may cut out for a minute and the conversational flow may be disrupted by time-lags and audio difficulties.

However, some individuals, including those who may feel others are not benign or well-intentioned towards them, may find another person’s attention overwhelming. For them, the buffer of online remoteness may provide some space to assess cues at a safe distance. The remote practitioner needs perhaps to work that bit harder to think about the cues, and to show that they have understood.

An example of this is the formulation, common at the beginning of therapy. We argue that the reason a skilfully done formulation is so important is that it is a thoughtful and explicit demonstration of the therapist’s interest in the client’s state.

In remote therapy, formulation is perhaps even more important given that other cues may be harder to convey remotely.

The need to work remotely creates challenges but perhaps more than ever it should focus us on the value of thinking together, of communicating thoughtfully and attempting to recognise and acknowledge mental states in all their complexity. And of course this includes the practitioners who themselves need to be appreciated and recognised for their efforts to connect with their clients, under conditions of such uncertainty.

Post by Verity Sutcliffe, PsychUP for Wellbeing student (historic post from Spring 2020)

Reading time: ~ 5 mins

Ever wondered what UCL students were talking about when the pandemic first hit? Verity, a final year student at UCL, discusses the results of her thematic analysis of UCLove posts from the first two weeks of the pandemic. (We didn’t want to lose this blog, which was posted on our old site in Spring 2020.)

The COVID-19 outbreak has triggered changes in the way we communicate. With lockdown regulations enforcing we stay in our homes, online communication is playing an essential role in many people’s daily lives.

Focusing on the student population specifically, some are turning to online forums to express their anxieties about the pandemic. This can be seen as an efficient way to gain insight and support from fellow students. Sharing problems online can provide an opportunity for students to communicate how they are feeling to a responsive and sympathetic listener.

One student-run outlet for discussing such anxieties has been Facebook confession pages. Created by students, these pages have gained popularity at several universities, as they have facilitated mass-scale student-to-student communication – with UCL’s UCLove amassing over 23,000 followers and 17,000 likes in the three years it has been operating.

We can all sometimes focus on specific concerns when there are deeper feelings underlying these

These pages began with a sort of ‘hive mind’ framework, where students can submit confessions and queries, to which other students can collectively respond to. With posts anonymous, yet public for followers to interact with, students from every demographic (i.e. students from all sectors of the university, and potentially other universities also) can offer advice and sympathy to their peers.

Recently, over 10% of posts have touched upon anxieties related to COVID-19: a potential source of insight into how students are feeling during this time, and how these feelings may change as the situation evolves.

As a final-year UCL student, I started my undergraduate degree around the same time UCLove was created, so I have followed its progression into the successful platform it is today. Therefore, I am interested in how it is currently being used by students to express their worries and concerns.

I extracted posts on the UCLove page during the two weeks straddling the day a pandemic was declared by WHO (4-18 March), and thematically analysed them (see text box for how).

During this fortnight, COVID-19-related posts quadrupled. I identified six main themes in the posts which outline the explicit content of the anxieties that were raised (e.g. travel). However, there are also potential latent meanings that can be explored (e.g. a feeling of powerlessness).

This distinction between literal and interpretive analysis is important: we can all sometimes focus on specific concerns when there are deeper feelings underlying these, which we may not even be aware of.

If we are going to understand the impact of COVID-19 on people, this distinction could also be relevant for seeing how people’s concerns change. We might expect at least some explicit concerns to change as the situation does, but some of the deeper concerns might be more intractable.

For example, one theme draws upon the decisions being made by UCL regarding the academic year. One student writes, ‘Anyone else really nervous about online exams?? I find it so much harder to concentrate at home compared to in an actual exam hall, and I hate doing my exams from a screen rather than paper’.

This references an explicit concern towards the choice to move assessments to online platforms. It may also reflect an implicit fear about how changes to assessment affects the student’s grades, which will impact on their future.

The six explicit themes identified from the UCLove corpus data, with the % of posts that referenced each theme

Another identified theme is the anxiety towards daily-life changes. One student reports, “everything is changing for the way in which we lead our lives. It’s scary, difficult to concentrate…on work. There are so many unknowns…”.

This references nervousness towards the lifestyle adaptations that were being introduced around this time. These may include the UK-wide social distancing and self-isolating guidelines, as well as more university-specific regulations such as the closure of libraries and cancellations of face-to-face lectures.

This could imply the student is concerned about the unpredictability and longevity of the virus. These are new adjustments we have learned to adhere to, and the uncertainty of how long for may instil a sense of unease. This unease may manifest into latent anxieties that persist throughout the outbreak’s duration.

This preliminary look into UCLove and its content suggests that students benefit from the model that confession pages offer. Perhaps the relationship between the anonymous-poster and public-commenter gives it its unique appeal. The identifiableness of the commenters is what gives their responses a more genuine and sympathetic feel, while the anonymity of the original poster allows for the discussion of personal problems without compromising their identity.

Without such pages, there would be less of a cohesive safe space for students to come together to support one another. These confession pages are a useful tool for students to discuss their issues openly to an engaging and approachable audience – who offered responses such as “I agree 100%” and “so relatable…stay safe” to the previously mentioned posts, respectively.

Interview by Katie Trigg, Trainee Clinical Psychologist on placement with PsychUP for Wellbeing (historic post from Summer 2020).

Watch time: ~ 5 mins

Dr Chinea Eziefula explains how you can access professional support from your local healthcare team and IAPT service.

Meet Katie Trigg

How your healthcare team can support you

How can people access psychological therapy from IAPT?

Interview by Katie Trigg, Trainee Clinical Psychologist on placement with PsychUP for Wellbeing (historic post from Summer 2020)

Watch time: ~ 7 mins

If you have been finding it tough lately, you are not alone! Here, Dr Chinea Eziefula explores the benefits of community living.

Meet Katie Trigg

What can people who are struggling do? 

Community is key!

Interview by Katie Trigg, Trainee Clinical Psychologist on placement with PsychUP for Wellbeing (historic post from Summer 2020)

Watch time: ~ 6 mins

Learn some helpful tips from Dr Chinea Eziefula, Clinical Psychologist at iCope. In this post, she shares some of her self-care strategies and advice about where to find good self-help resources during the pandemic.

Meet Katie Trigg

Dr Chinea Eziefula introduces herself

Chinea’s self-care tips, strategies and resources

Interview by Katie Trigg, Trainee Clinical Psychologist on placement with PsychUP for Wellbeing (historic post from Summer 2020)

Watch time: ~ 4 mins

Katie talks to GP Dr Mo Ogunrinde about what it means to be ‘high risk’ and the support needed by this group.

Meet Katie Trigg

What does it mean to be high risk?

How can we support vulnerable individuals?

Interview by Katie Trigg, Trainee Clinical Psychologist on placement with PsychUP for Wellbeing (historic post from Summer 2020)

Watch time: ~ 7 mins

Don’t let your pre-existing physical health condition worsen during the pandemic. Meet Dr Mo Ogunrinde, a North London GP and Fellow at UCLPartners, and learn how to monitor your health remotely.

Meet Katie Trigg

Dr Mo Ogunrinde introduces herself

Monitoring your health remotely