BU Research Blog

A series of posts featuring BU’s impact case studies for REF 2021. (These are edited versions of the final submissions – the full impact case studies will be published online in 2022.)

Emotional processing and its impact on mental and physical health

Research areas: Clinical Psychology, Health Care Statistics & Epidemiology

Staff conducting research: Professor Roger Baker, Professor Peter Thomas, Dr Sarah Thomas

Background: In the late 1970s, Professor Baker began to see a connection between physical symptoms and the way earlier stressful events were emotionally processed. Emotional processing is a type of natural healing that protects people from emotional distress. However, there are some styles of emotional processing that inhibit successful processing and which could contribute to psychological disorders or psychogenic conditions, i.e. physical illnesses which have a psychological cause.

Together with a project team and clinicians, Professor Baker began the development of the Emotional Processing Scale (EPS) in 2000. Research findings indicated that nearly every psychological disorder they studied revealed significant difficulties with emotional processing. In 2012, the team collaborated with 70 research groups globally to develop a wide range of cultural, diagnostic and healthy norms. The final EPS consisted of 25 questions, covering five different dimensions, and was published in 2015.

Emotional processing offers an alternative approach to diagnoses of psychiatric illnesses. Problematic ways of emotional processing are implicated in nearly every type of clinical condition, from psychological disorders to medical conditions with or without organic pathology. The development of EPS has enabled clinicians to identify patients for therapy and measure change in significant emotional dimensions during therapy. It has also led directly to the development of emotion-based therapies in post-traumatic stress disorder (PTSD), tinnitus and psychogenic epilepsy.

The impact:

Patient benefits in the UK

The EPS is used as a tool to diagnose and treat people with a variety of physical, behavioural and emotional pathologies. It has been employed by clinicians and in teaching, with examples including:

• a consultant clinical neuropsychologist at Dorset HealthCare University Foundation Trust;
• a psychologist working with the Dorset Youth Offending Team;
• Sheffield’s Specialist Neurology Psychotherapy Service, for the treatment of patients with non-epileptic seizures; and
• the Open University, which invited Professor Baker to contribute material on panic attacks – based on his Emotional Processign Model – for their new MSc in Psychology. The material has also been re-purposed for its OpenLearn Platform, where it has had more than 30,000 unique visits since March 2019.

Healthcare guidelines and policy

The British Psychological Society (BPS) awarded the EPS a 4/4* (Excellent) evaluation, describing it as “spearheading a revolution in thinking to overcome the limitations imposed by the ‘medical model’… [it] makes it possible to explore more fully the contributory role of key emotional factors in psychopathology and psychological therapy.” The Emotional Processing Scale now has BPS Registered Test status, which provides clinicians with reassurance that it meets the necessary quality standards.

A global resource

The EPS has been translated into 19 languages and been used by therapists, psychologists and teachers in France, Poland and Italy, while Professor Baker’s three self-help books – Emotional processing: healing through feeling, Understanding trauma: how to overcome post traumatic stress and Understanding panic attacks and overcoming fear – have sold more than 90,000 copies worldwide in total. They have been translated into French, German, Polish and Czech and continue to receive positive reviews, including: “Best book ever if you suffer from panic attacks” and “My doctor told me to buy this book. It certainly worked for me.”

Supporting trade policy: Brexit and beyond

Research area: Economics

Staff conducting research: Professor Sangeeta Khorana

Background: From 2008, Professor Khorana took the lead in a series of studies on trade agreements, which demonstrated how data and techniques can support trade negotiations. In 2015-17, she led research on the European Commission’s ‘Public Procurement Initiative’ project, developing a methodology to use contracts data for negotiating free trade agreements with third countries, and devising a template that uses statistical tools to analyse negotiating positions.

As co-investigator for the European Commission’s ‘Europe for Citizens’ programme in 2015, Professor Khorana carried out research on the Transatlantic Trade and Investment Partnership (TTIP). This led to her co-editing a book for EU member states to enable them to understand the implications of TTIP and how an agreement could affect the future of global economic governance.

After the UK’s EU referendum in 2016, Professor Khorana’s research focus shifted to an examination of the likely economic impact of Brexit. Her expertise in this area fed into the Handbook on the EU and International Trade – used as a learning resource and reference guide – as well as an edited book on Brexit, produced in conjunction with the Commonwealth Secretariat. More specifically, she has utilised her computable general equilibrium techniques, which combine economic theory with real economic data to compute the impacts of policies or shocks in the economy, to conduct a series of economic impact assessments on Brexit.

The impact:

The Department for International Trade (DIT)

The DIT approached Professor Khorana to seek her expertise on trade negotiations post-Brexit. Her subsequent involvement included:

•  contributing directly to the ‘Market Access’ project, an ongoing initiative at the DIT, to support UK trade negotiators in trade talks with the USA and Australia;
• membership of the Expert Advisory group on Public Procurement and Expert Advisory member of the Department of International Development’s Trade and Development group;
• advising DIT officials on which sectors the UK could target for greater market access in a trade deal with the USA and Australia.

Welsh Assembly

The Welsh Assembly commissioned Professor Khorana and Welsh Assembly Adviser at Aberystwyth, Professor Nicholas Perdikis, to report on the economic implications for Wales of the UK’s departure from the EU. The 2017 study’s findings – that the Welsh economy would suffer under all scenarios – informed Senedd Cymru’s (the Welsh Parliament) decision to update its policy, stating that Wales “must maintain full and unfettered access to the Single Market” post-Brexit. This became the official policy position adopted by the Welsh Government at Westminster from 2018-2020.

Professor Khorana also gave oral evidence to the UK government’s Welsh Affairs Committee in September 2020, providing an updated assessment on Wales’ preparedness to leave the EU on 1 January 2021. The Welsh Parliament acknowledged Professor Khorana’s contribution and support in making a decision on future trading with the EU, noting that the 2017 report “systematically influenced” its analysis of the impacts of post-Brexit UK-EU trade agreements on the Welsh economy.

Scotch Whisky Association (SWA)

Between May and November 2018 Professor Khorana researched the impact of Brexit on Scotch Whisky exports, and utilised CGE modelling techniques to examine potential scenarios. The findings presented loss of market access for all Scotch whisky producers, and especially those making the more expensive single malt. The SWA used Professor Khorana’s estimates of potential costs of the different scenarios in its Position paper, aimed at defending the industry’s interests at Westminster, and recognised that it enabled it to prepare for the different Brexit scenarios and associated costs.

Dorset business sector

Professor Khorana also led briefings for the Dorset Engineering and Manufacturing Cluster, advising more than 70 local businesses on the effects of Brexit on exports and their workforce. These sessions enabled members of the Cluster to understand how to prepare to mitigate the effects of various scenarios on the UK’s departure from the EU.

A series of posts featuring BU’s impact case studies for REF 2021. (These are edited versions of the final submissions – the full impact case studies will be published online in 2022.)

Changing hearts and minds: how the stories of older LGBT people are changing attitudes, education and care

RUFUS STONE (2012)

Research areas: Performative Social Science & Social Care

Staff conducting research: Dr Kip Jones, Professor Lee-Ann Fenge, Dr Rosie Read, Dr Marilyn Cash

Background: In ‘The Gay and Grey’ and ‘The Gay and Pleasant Land’ projects funded by the National Lottery and ESRC respectively, Dr Jones and his team explored the experiences of older LGBT people. They discovered common themes of identity issues, isolation and exclusion and, in particular, a lack of participation from rural residents and limited understanding of participants’ life stories.

Working with an advisory group of older gay people and service providers, BU researchers looked at how older gay men and lesbians in rural areas interacted with their communities, while considering socio-economic and cultural effects and differing attitudes towards sexuality and ageing. Their findings showed: a lifelong impact on gay men who grew up when homosexuality was illegal (up to 1967); the struggle to be accepted in rural communities by many older LGBT people; difficulties negotiating with service providers; fear and loneliness; and the prevalent risk of suicide among older gay men.

Based on these insights, Dr Jones wrote and produced a short film, RUFUS STONE, which tells the story of two young boys’ experience of anger and rejection from a rural 1950s community when they develop feeling for each other. The film sees the two reunited 50 years later, although one character has never revealed his sexuality and ultimately takes his own life. As well as the film, Professor Fenge collaborated with a group of older LGBT people to produce a card deck called ‘Methods to Diversity’ for care agencies and service providers. the cards detail activities and exercises to prompt staff to think about inclusivity and the diversity of the ageing population.

The impact: 

Changing attitudes

RUFUS STONE was screened around the world, attracting attention for both its style and subject matter. It won international accolades, including an award for Best LGBT Film at Rhode Island International Film Festival 2013, and was also featured in the New York Times. As well as prompting discussion around sexuality and marginalisation, the film demonstrably changed attitudes: evidenced by student-teachers in Kazakhstan planning to screen it to pupils to help them “understand… that some existing values are remnants of the older generation”.

The film was also shared online in 2016 and, by December 2020, had been viewed more than 17,800 times in 73 countries.

Educating future generations

Several universities in the UK and abroad use RUFUS STONE in their teaching, including: the University of Manchester, which features it in an undergraduate sociology module; Brighton University, which describes it as ‘inspirational’; Istanbul Yeni Yuzyil University, which has added it to its syllabus at the Faculty of Fine Arts; and the School of Communication and Media Studies in Lisbon.

Transforming frontline care

Hampshire County Council has used the film and the card deck since 2014 in training sessions with emergency services, residential care staff among others, instigating “changes in attitudes and awareness amongst council staff”. It adds that the resources indirectly inspired the county’s first Gay Pride.

The Help and Care UK charity used the film and card deck with its ‘wayfinder’ staff, who signposted older people to information and services. Watching RUFUS STONE challenged their attitudes and perceptions around homosexuality and led to greater awareness. In a 2016 wayfinders briefing document, they included their support for “freedom from discrimination” on the grounds of sexuality.

The Alzheimer’s Society has used the film since 2013 to improve its local and regional teams’ understanding of LGBT issues: “There is no question [it] was a catalyst for change. It was… raw and real so made us think outside the box”.

How our electrical stimulation devices have improved long-term medical conditions

Research areas: Clinical Engineering, Orthopaedics, Design Engineering & Computing

Staff conducting research: Professor Ian Swain, Dr Jon Cobb, Tom Wainwright, Professor Robert Middleton, Professor Paul Taylor, Choukri Mecheraoui

Background: Electrical stimulation is a method of controlling muscles using an external device, following neurological disease such as stroke or musculoskeletal problems. When used to provide a specific function, such as walking or hand grasp, it is known as functional electrical stimulation (FES). The results of Professor Swain’s first ever randomised controlled clinical trial of an ES device to rehabilitate patients with dropped foot after a stroke demonstrated significant advantages over traditional physiotherapy. In addition to providing support and immediate improvement, the device means people receive therapy as they walk, improving walking and quality of life.

Since 2006, Professor Swain has steered a collaboration between BU, Salisbury NHS Foundation Trust and Odstock Medical Limited (BU-SFT-OML), after taking the lead in patenting the first Odstock Dropped Foot Stimulator and helping establish OML. The clinical service has since expanded to include the treatment of people with multiple sclerosis (MS), spinal cord injury and Parkinson’s disease.

Clinical trials supervised by Professors Swain and Taylor showed that 43% of participants who had suffered a stroke improved their walking speed, while people with MS also demonstrated a highly significant improvement. Recent findings showed that such use of ES was the most effective assistive technology treatment, and that it is possible to use surface electrodes to restore useful hand function to people with tetraplegia.

Professor Swain’s move to BU’s Orthopaedic Research Institute (ORI) to work with Wainwright and Professor Middleton has enabled techniques developed for people with neurological problems to be applied to those with orthopaedic problems. Combining this expertise has led to the development of new stimulators and training courses.

The impact:

Health benefits

The findings from the BU-SFT-OML partnership have helped develop the National Clinical FES Centre in Salisbury, the largest clinical service in the world. As of February 2020, more than 7,700 people have been treated, primarily for walking problems, although the service is expanding to treat upper limb weakness, facial problems such as Bell’s Palsy, and constipation.

The FES devices developed with BU research input have radically improved people’s lives, increasing their functional ability and their participation in society.

Further FES centres, using equipment from BU-SFT-OML, have been established in the West Midlands, London and Sheffield, treating more than 2,600 patients in total.

Policy impacts

In 2016, NICE focused on the PACE device system, developed by BU-SFT-OML, in one of its Medical Innovation Bulletins. Professor Swain also contributed to the development of new NICE guidelines on the use of electrical stimulation in non-neurological long-term conditions.

Since 2014, OML has also trained more than 1,000 staff in total in the UK and abroad on how to implement the devices and treatments developed with BU for people with both lower and upper limb restrictions.

A series of posts featuring BU’s impact case studies for REF 2021. (These are edited versions of the final submissions – the full impact case studies will be published online in 2022.)

Understanding and helping to minimise the effects of terrorism on tourism destinations

Research areas: Quantitative Finance, Tourism Management, Retail Management, Quantitative Research Design and Analysis

Staff conducting research: Dr Anna Hillingdon, Professor John Fletcher, Professor Stephen Page, Dr John Beavis, Dr Gregory Kapuscinski

Background: Associate Professor Hillingdon is a leading expert in the area of terrorism and its impacts on tourists and tourism destinations. Her work, funded by both the World Bank and the United Nations World Trade Organisation, has offered a number of key insights:

• Analysis of international tourism arrivals across the USA, Bali, Spain, UK and India showed that terrorist attacks seem to have a larger effect in developing countries than in large European capitals. Where there is a greater dependence on tourism in GDP terms, it is important to restore tourist confidence through efficient and effective post-crisis communication.
• Demonstrating infrastructure which can quickly restore safety and order can help restore tourist confidence more quickly.
• International incidents including terrorism do not necessarily have a long-lasting economic impact on tourism.
• The willingness to travel to a destination after a terrorist attack differs according to personalities.
• BU researchers conducted an analysis of 250 case study ‘hybrid threats’ (those which combine conventional military aggression with non-conventional means such as cyber-attacks, espionage and terrorism) and found a key area of threat is ‘economic leverage’. They found governments needed to take measures to counter their susceptibility to this threat by building strong, adaptive infrastructures.

The impact:

Enabling better communication for travellers after terrorist attacks

With global online travel company Travelzoo, Dr Hillingdon worked on the design and analysis of a survey of 6,000 consumers worldwide to investigate consumer perception of safety and security on holiday. Combined with her previous findings about tourists’ risk perceptions, this informed a major media campaign in 2015-2017. In more than 100 interviews with national and international media, Dr Hillingdon conveyed that, while terrorist attacks might contribute to a decline in tourism in a specific region, demand would simply go elsewhere. The research was also published in the White Paper, “State of Play: the Impact of Geopolitical Events on International Tourism in 2017”, which concluded the tourism industry and governments should unite to provide clearer information on the safety and security of tourism destinations. In 2017, the UK Foreign Office announced the removal of the terrorism threat level descriptors used at the time, to be replaced with more information about the predictability, context and mitigation of any threat.

Encouraging countries to invest in tourism after terrorist attacks

Dr Hillingdon worked with the World Bank in 2018 to investigate the effects of terrorism on tourist development and growth in Central Asia. As a result of data collected from a survey of tour operators, as well as her own comparative research on the actions governments can take to mitigate the impact of terrorist activities on their tourism sectors, Dr Hillingdon was able to provide evidence which led to a full risk analysis. The project concluded the impact on tourism of specific terrorist attacks was likely to be negligible unless further attacks took place. The tourist sector in Central Asia was encouraged to continue its development, and it was noted this would reduce the likelihood of future attacks as it would decrease the poverty that makes countries like Tajikstan an easy recruitment target for groups such as ISIS.

Enhancing the UK government’s and NATO’s understanding of hybrid threats

Dr Hillingdon contributed to a major NATO research project aimed at deepening understanding of so-called hybrid threats and exploring how to assess them. This work, together with her focus on the need for a strong, resilient economic infrastructure, fed into a handbook on the most effective ways to counter hybrid warfare, now in use by the UK and 13 other governments worldwide.

Reading on Screen: enhancing the benefits of reading through engaging with digital technologies

Research areas: English, New Media, Communication, Literature

Staff conducting research: Professor Bronwen Thomas, Dr Julia Round

Background:

Researchers at BU have challenged the negative perceptions around digital reading, providing insights into how and why people read on digital platforms. This has led to the development of innovative methods which capture how technology has enriched reading, enabling new social and cultural benefits.

The research was prompted by Thomas’s early work on fanfiction – a form of narrative which has exploded in popularity on the internet, and which enables fans to create their own stories about characters or plots. Thomas applied theories and methods developed by media and cultural studies scholars, revealing how fanfiction challenged boundaries between authors and readers, creation and interpretation. She also extended this approach to the study of online literary communities, using a combination of interviews and analysis to show a thriving, productive virtual culture.

An AHRC-funded project in 2012 investigated how people read online, as well as the insights and opportunities digital platforms provide for education and the creative industries. Some of the findings were that a preference for printed or e-books depended on genre, and that posting creative work in online forums boosted confidence.

The AHRC Research Network Award (2013-2015) brought together 29 academics and consultants from multiple disciplines to review existing scholarly models for researching reading practice. From this, the network developed innovative techniques adapted to analysing digital reading and prioritising engagement with readers both on- and offline. Building on the findings from the network, BU analysed activities in literature forums, detecting behavioural patterns to understand how users interacted with each other. They found that groups connect users with shared interests, allowing them to shape discussions themselves, and that moderators play a crucial role in shaping group identities and maintaining community bonds. Collectively, this work demonstrated how digital platforms have altered yet enriched reading.

The impact:

In 2017/18 Thomas established the Reading on Screen project, with the University of Brighton, the Reading Agency and DigiTales, a participatory media company. Readers from a diverse range of backgrounds aged 18-87 created digital stories capturing their experiences of reading in the digital age. The project demonstrated how engagement with the digital, far from being confined to younger generations, is in fact also delivering extensive benefits for the older population. It also highlighted how both digital and print reading practices and preferences are shaped by local cultures and environments but that these can change through life experiences and intergenerational interactions. The project achieved the following impacts.

Policy change

Thomas worked closely with the ‘Axe the Reading Tax’ campaign led by the Publishers Association, with the Book Trust and the National Literacy, to develop a new campaign strategy based on highlighting how the tax affects the most vulnerable. The Chancellor announced that VAT on digital publications would be removed from December 2020, although it was ultimately removed earlier, on 1 May 2020.

Benefits to organisations and charities

The Reading Agency delivers a range of programmes to more than 1.4 million people a year and applied the insights from BU’s research – particularly how and why people read on digital devices – to their own work. DigiTales runs digital storytelling workshops with young people, refugees, and the homeless. After working on the Reading on Screen project, they adapted their facilitator training and workshop model to reflect the requirements of working alongside academics with specific research questions in mind. The project also directly led to the organisation working with other universities and provided traineeships for two participants.

Enriching lives

For the participants who created the Reading on Screen stories, finding their voice was a transformative experience. An unforeseen impact is the beneficial effect workshops have on participants with complex social/health issues in terms of social inclusion and emotional resilience. They had no prior experience of using digital technologies in creative contexts and described how the project increased their feelings self-worth and achievement, with some developing resilience and others enjoying increased social interaction.