Expert insights: Diana Dubash, Assistant Psychologist, Pain Management, Birmingham City Hospital

Lorna: Can you just start off by telling me a little bit about yourself, what your background is and how you came to be where you are now?

Diana: I’m a psychologist. I did psychology A-Level. That’s where it all started. Then I did an undergraduate course in psychology in London. With psychology, it’s 50% clinical and 50% research-based. Stats was something that we’re taught right from the start, even at A-Level, we’re taught very basic stats. Then at uni, it progresses to a more advanced level, like, “Okay, how do you do it? What programs do we use? Why do we do it?” That type of thing.

Lorna: What’s your current position? Tell me a bit about what that involves.

Diana: I want to work in clinical psychology, which is where you work with people with some sort of mental health difficulties or maybe a physical health disability, or a physical health issue combined with a mental health issue. In order to do that, you need to get a doctorate in clinical psychology. In order to get the doctorate, you need a lot of experience. There’s a lot of different ways to get experience, but the post that I’m in right now – assistant psychologist – is the gold standard for getting into the doctorate so that’s what I’m doing at the moment.

Lorna: What is it that appeals to you about clinical psychology?

Diana: I was going to do medicine before, but the thing that appealed to me about psychology is that psychologists don’t really look at mental illness as a set of symptoms. You don’t just hold these symptoms in your head and then when you see them, you automatically think, “Okay, it’s this condition” or “It’s that condition.” The first thing you jump to in medicine is a medication. I never really agreed with that approach.

I think psychology appealed to me because you’re not just treating mental health with medication. So how do you use psychology to help people? There’s so many different theories and therapeutic approaches that you can choose to use with your patients. That really appeals to me, that flexibility around how I can approach each patient.

At the end of the day, everyone’s individual, and everyone responds differently to different things. If you come armed just with different types of drugs you’re really limiting the choices and you’re not really exploring that person as an individual. With psychology, you’re trained to hold all of this information in your head. The things that are important will jump out to you and suggest the most appropriate intervention or combination of interventions. I really like that flexibility around it. That’s what has drawn me to it.

Lorna: What’s the specific area that you’re working in at the moment?

Diana: I currently work in pain management. There are two types of pain; acute and chronic. Acute pain is short term pain, it’s medically classified as lasting less than three months. Any type of pain will start as acute pain and whether or not it draws over that three-month line and becomes chronic pain is highly dependent on the individual. I work with people that have been experiencing persistent pain for more than six months. In most cases it tends to be five years or more. Obviously, with people with pain, you have to check out the biological stuff first. If this is a new pain, is there something medically wrong? Do they need an operation? Do they need some blood work done? We have to leave that to the medical professionals.

Each patient comes into our clinic and sees four different professionals. They’ll see a medical doctor, they’ll see a nurse, and they’ll see a physio. Then if they think that it’s relevant, they’ll also see a psychologist. That’s our place in pain. It’s maybe not at the start, but it’s there (although, some would argue that the place of a psychologist should be at the start as well).

Obviously, if people are in constant pain there’s a lot of mental health and sociodemographic problems that can arise. Things like low mood, anxiety, stress then also things like relationships with family members and colleagues at work. There’s a lot of different factors that can affect your physical health. Mental health and physical health are very, very closely interlinked. Low mood can affect how you feel. Not only in your mind, but it can also affect your body. The same as stress. Stress can physically create changes in your body. Changes in your heart rate, and your blood pressure, and things like that. It can also create a lot of tension.

A lot of the time pain patients are quite tense. A lot of my work is about showing them the links between their mental health and their physical health and personalizing it for them. It’s about us showing them that, “Okay when your body reacts like this, your pain is increasing because of these factors.”

A big part of my role is also just general education, telling patients about the nervous system, telling them about stress response, telling them about low mood and anxiety, that type of thing. A lot of the time people don’t realize that their physical and mental health are so connected – you can’t be poor in one aspect and expect to be good in the other aspect.

Lorna: How are you using data and analytics? What are you using SPSS for?

Diana: Psychology is 50% research.

As a psychologist, you can’t really have any clinical input without having any research to back that up. We rely on evidence-based practice. In order for a psychologist to actually pick up a paper, read it, and understand it, then implement it into their intervention, you need to be able to understand research methods and stats.

That’s why we’re taught that right from the start and why we are trained to a doctoral level. If we didn’t have that background in research, we couldn’t base our interventions on anything. We’d be basing it off of gut feeling and that’s wrong because psychology is a science and you can’t base science off of a gut feeling.

Then on top of that, you need to also be conducting research to check that your service is meeting needs, is meeting expectations, and is being effective. In order to do that, you need a pretty solid understanding of how to conduct a research study. How to analyze the findings, the type of data that you’re collecting. Those types of things.

At the moment, I’ve been doing quite a lot of research projects. Because of COVID we had a few extra things planned that we couldn’t really execute. We’ve had to limit what we’ve done, but we still have managed to do a couple of projects which is good.

Lorna: Can you tell me a little bit about one or two of those projects then?

Diana: Yes. At the moment we’re writing a paper based on data that has been collected from patients from about 2009-2016. It’s about the effectiveness of one of our interventions. I have done all the data analysis for that and I’m currently in the stage of writing up the paper. We’re about halfway through on that I’d say.

Then one of the other research projects that we’ve done is a big service evaluation. We started this in about March. We initially decided to have just one phase, and we’d have one cycle of data collection and then a report. Then obviously COVID hit. Our main intervention is clinics. These clinics had to move from face-to-face to a virtual medium. We decided to carry on that service evaluation to see if there are any differences between the effectiveness of face-to-face clinics compared with the virtual clinics.

I’ve recently presented the findings of that to the team. Then the findings have been implemented into our clinics to actually create some positive change. It was a service evaluation, so we were looking to see if there were any problems within our clinics and we uncovered a few areas for improvement. To make big changes in NHS you need to go right to the top, to the administrators. The big changes have to come from the top down. It’s really good that the research that I did actually reached the top and the changes are slowly being implemented. That’s really positive.

Lorna: You’re using SPSS for your data analysis. How do you find that?

Diana: A lot of people don’t realize how heavily stats and psychology go together. Psychologists all tend to use SPSS. That’s what I was taught at uni.

At the start I really didn’t like stats but psychology stats aren’t really like very traditional stats and because we have SPSS, it’s so easy. You just click some buttons and it’s done for you, whereas if I had to do that in my head or by hand, it just would not happen. At first, I found SPSS very confusing because I’d never seen anything like that but I soon got used to it and by the time I was doing my dissertation, I found it relatively easy. The actual using SPSS is easy. The difficult part is deciding what tests you want to do and trying to understand why you’re doing those tests but obviously, that doesn’t necessarily relate to SPSS. If you run the wrong test even if you run it correctly in SPSS, it’s not going to give you the answer that you need.

Lorna: You wouldn’t necessarily have to be a statistician at the start? Is that fair?

Diana: Definitely. I’d stopped doing maths at GCSE. I had a good two and a half year gap of not really doing maths. I’ve never considered myself to be particularly good at maths, it took me a long time to understand maths especially for GCSE I remember. But once I started looking at it more from a psychologist’s point of view I found it made much more sense.

If I know the data type, if I know what I’m trying to find and if I know what the tests are going to give me then I’ve got everything I need. At that point it’s much easier. I definitely would not consider myself a statistician or anything like that at all. Statistics is just a useful tool. I understand the need for it in psychology and that’s why I don’t really have a problem doing it or using SPSS or anything like that or doing research at all because you can’t be a psychologist and not have the research element.

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