Dr Bob Patton
Academic and research departmentsSchool of Psychology.
Dr Bob Patton is a lecturer in Clinical Psychology at the University of Surrey. He is a Chartered Psychologist (Health, Research), Associate Fellow of the British Psychological Society, Fellow of the Software Sustainability Institute, Fellow of the Higher Education Academy and a Chartered Scientist. During the 1990s he worked for the Home Office Drugs Prevention Initiative as a consultant, and then as a research associate in health promotion for the University of Northumbria, before moving to London where he has worked for Kings College London (medical education), Royal Holloway (violence prevention), London School of Hygiene & Tropical Medicine (cancer communication), Imperial College London (alcohol) and for King's Health Partners where he was the Health Services Research Coordinator for Addictions between 2004 - 2011. Bob has recently worked at Surrey as Research Tutor on the PsychD Clinical Psychology Training programme and an Academic Advisor on the MSc in Counselling Supervision & Consultation. He has also served as the Vice-Chair (Research) for the BPS Division for Teachers and Researchers and been a member of the BPS Research Board.
His current academic interests include the development of mental health smartphone Apps, Alcohol Identification and Brief Advice, physical health needs of IDUs, Health Professionals training in alcohol interventions, Hepatitis immunisation and the relationships between drug misuse and sexual health / risk taking. His PhD thesis explored brief interventions for alcohol misuse, and his book based on that and related studies is available here. Academia aside, Bob is the Director of Short Term Solutions Ltd. (Recruitment agency), plays keyboards in a variety of musical collectives, manages two studio based bands and has also worked as a nurse, youth worker, mystery shopper and IT consultant. He no longer lives on a boat.
Accident and Emergency departments need to do more to identify young people with alcohol problems
In the media
Use of software in research
King’s College London, University of Newcastle, Predicticare (USA)
Indicators of esteem
Editorial Board member PeerJ. April 2013 – Present.
Editorial Board member BMC Emergency Medicine January 2011 - Present
Editorial Board member BioMed Research International April 2013 – April 2015
Editorial Board member BMC Research Notes January 2005 - April 2015
Postgraduate research supervision
I teach on the PsychD Clinical Psychology programme, coordinating the Service Related Project and supervising PsychD and PhD research.
an alcohol health worker (AHW) on levels of
alcohol consumption, A&E attendance,
psychiatric morbidity and quality of life among
patients identified as hazardous drinkers
Design: Single Blind Pragmatic Randomised
Methods: 5240 patients attending the accident
and emergency department (AED) over a oneyear
period were screened using the Paddington
Alcohol Test (PAT). Participants randomised to the
Treatment condition were given an AHW
appointment and the HEA leaflet ?Think about
drink?. Control participants were given the leaflet,
but no appointment. At six months alcohol
consumption (PAT and Form 90 AQ) and
psychiatric morbidity (GHQ-12); at 12 months
alcohol consumption and quality of life (EQ-5D)
were assessed. Hospital data was used to
determine re-attendance. An analysis of costs
associated with screening patients, attending an
AHW session and AED attendance was
Analysis: 599 of 1167 hazardous drinkers met
inclusion criteria and were randomised. Thirty-six
per cent were lost to follow-up. Data was
analysed on an intention to treat basis.
Participants in the Treatment condition had
significantly lower levels of consumption than
Controls at six-month follow-up. Treatment
participants attended the AED significantly less
often than Controls; a number needed to treat
analysis found that every two patients referred to
the AHW prompted one less re-attendance. There
were no significant differences between groups
on the GHQ-12 or EQ-5D.
Conclusions: Screening and brief intervention
for alcohol misuse in the AED is feasible and
results in lower levels of alcohol consumption
over the following 12 months. Reduced alcohol
consumption is associated with lower levels of reattendance in the AED, which in turn offsets the
costs of screening and providing brief
Hangxiety ? a term that?s seen a recent renaissance ? happens because your body thinks it?s going into panic mode. Dr Bob (as he likes to be known), lecturer in Clinical Psychology at the University of Surrey and general alcohol Yoda, explained to me how it happens. Because you?re already experiencing anxiety-like symptoms (shakes, nausea, headache, elevated heart rate, sweating) caused by a drop in your brain?s happy-chemicals, alongside dehydration, your body gets all confused and has a hard time differentiating between the hangover and naturally occurring anxiety.
Kings College Hospital is a busy inner-city A&E with a turnover of 105,000 patients per year. Based on the data from the alcohol strategy, at least 40,000 of these patients are hazardous drinkers and would benefit from some intervention to reduce their alcohol consumption. Following the example of good practice set at St Mary?s Hospital, Paddington described by Crawford et al (Lancet, 2004), we have started to implement an alcohol screening policy in our department.
In a department that has no previous history of targeting alcohol related presentations, we wanted to explore how best to introduce such a policy. Our aim is to develop a set of guidelines that will inform other departments seeking to introduce such policies themselves.
Data on screening has been collected using the A&E computer system and the impact of teaching sessions for clinical staff (Drs and Nurse Practitioners) as well as the introduction of a paper-based system has been assessed. Interviews with clinical staff illustrate the barriers and facilitators to implementing this policy. Additionally our substantive baseline data also allow for a rapid review of the impact of changes to licensing hours on alcohol related attendances.
and how drinking is often a defence mechanism against psychological distress.
interventions to reduce harm.,
of referral for brief intervention by an alcohol
health worker (AHW) on levels of alcohol
consumption, psychiatric morbidity and quality of
life among patients attending an accident and
emergency department (AED) with alcohol
Design: Randomised controlled trial.
Methods: An AED doctor using the Paddington
Alcohol Test (PAT) screened patients who
presented to the AED. All those identified as
misusing alcohol and meeting the inclusion
criteria were asked if they would accept help
aimed at assisting them to reduce their alcohol
intake. Those randomised to Treatment were
given a card which detailed the time and place of
an appointment to discuss alcohol consumption
with an AHW. Participants were also given a copy
of a leaflet ?Think About Drink? Those randomised
to Control were given the leaflet but no
appointment. At baseline demographic details
were collected together with details of current
level of alcohol consumption. At six months a
telephone interview was conducted in order to
assess alcohol consumption and psychiatric
morbidity (GHQ-12). At 12 months alcohol
consumption (using PAT and Form 90),
psychiatric morbidity and quality of life using
Euroqol EQ-5D were measured.
Results: 5242 patients screened, 1159 identified
as hazardous drinkers (22 per cent), 659
consented and randomised. Data collection at
six-months completed (77 per cent). Data
collection at 12 months is ongoing.
Conclusions: This pragmatic study should
provide evidence of the worth of screening and
brief interventions for alcohol misuse applied in
the AED and offer guidance on the conduct of
psychological research within busy hospital
Emphasises the use of several approaches including CBT, psychodynamic and systemic and family treatments, and consideration of the wider picture of addictions
As well as the theories, gives a clear overview of the application of these models
Reflects the very latest developments in the role played by psychological perspectives and interventions in the recovery agenda for problem drug and alcohol users
driving up A&E visits?, The Conversation
regarding presentations over a three month time period before and after the changes in the Licensing
Act (2003) which came into force in November 2005. The time periods reported are January ? March
2005 (the PRE period) and January ? March 2006 (the POST period). Our data indicated NO
significant change in the number of attendances that could be related to alcohol consumption (hereafter
referred to as ?attendances?) in the first two months following increased availability. In the third month
there was a significant decrease in ?attendances?. There was considerable variation in the changes in
?attendances? between participating AEDs. The pattern of ?attendances? on weekdays (Monday ?
Thursday) was unchanged. Following increased availability ?attendances? on Saturday fell, but
increased on Fridays and Sundays. There were no changes in the pattern of ?attendances? across the 24
hour period, with most patients presenting at around Midday. Rates of ?attendances? for Assault and
Head Injury fell significantly following the change in availability. The number of ?attendances? where
alcohol was specifically mentioned increased significantly during the POST period. Prior to the
increase in availability, the number of ?attendances? where alcohol was specifically mentioned peaked
sharply around Midnight. Following the change in the law, there was a general increase in such
?attendances? from 11PM through to 3AM. Although there was a general increase in alcohol specified
?attendances? across the week, there was a significant increase in such ?attendances? on a Sunday. Data
from one Northern and one Southern Local Ambulance Service was provided to complement the data
obtained from individual AEDs. The number of alcohol related ambulance call outs for the LAS and
NEAS increased following the change in the law.
electronic alcohol intervention for adolescents: findings from the
SIPS jr trials, Addiction Science & Clinical Practice 12 BioMed Central
To characterize England?s alcohol assertive outreach treatment (AAOT) services for people who frequently attend hospital due to alcohol-related reasons according to their concordance with six core AAOT components.
A cross-sectional national survey using structured telephone interviews with health professionals examining 6 essential AAOT components. High-level AAOT services were those that delivered 5 or more components, mid-level 3 to 4 components, low-level AAOT services 2 or less.
The analysis included 37 services that were classified according to their concordance with the 6 AAOT components. Six were identified as high-level AAOT services, 13 as mid-level AAOT services and 18 as low-level services. Extended support covering housing, mental and physical health over and above alcohol consumption was the most commonly delivered AAOT component provided. Having a multidisciplinary team was the least observed component, delivered in 33% high-level AAOT services and in 15% mid-level AAOT services. None of the low-level AAOT services had a multidisciplinary team.
Access to AAOT services developed to support high-cost and high-needs frequent hospital attenders varies across the nation. Further research, service evaluation and AAOT implementation should focus on essential AAOT components rather than self-defined labels of AAOT.
The study investigated alcohol assertive outreach treatment (AAOT) services in England. The study found variability in service provision across AAOT services when measured against six essential AAOT components. Improvement of AAOT in England?s hospitals should focus on the implementation of essential AAOT components.
To estimate and compare the optimal cut-off score of Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-C in identifying at-risk alcohol consumption, heavy episodic alcohol use, ICD-10 alcohol abuse and alcohol dependence in adolescents attending ED in England.
Opportunistic cross-sectional survey.
10 emergency departments across England.
Adolescents (n = 5377) aged between their 10th and 18th birthday who attended emergency departments between December 2012 and May 2013.
Scores on the AUDIT and AUDIT-C. At-risk alcohol consumption and monthly episodic alcohol consumption in the past 3 months were derived using the time-line follow back method. Alcohol abuse and alcohol dependence was assessed in accordance with ICD-10 criteria using the MINI-KID.
AUDIT-C with a score of 3 was more effective for at-risk alcohol use (AUC 0.81; sensitivity 87%, specificity 97%), heavy episodic use (0.84; 76%, 98%) and alcohol abuse (0.98; 91%, 90%). AUDIT with a score of 7 was more effective in identifying alcohol dependence (0.92; 96%, 94%).
The 3-item AUDIT-C is more effective than AUDIT in screening adolescents for at-risk alcohol use, heavy episodic alcohol use and alcohol abuse. AUDIT is more effective than AUDIT-C for the identification of alcohol dependence.
Results: Method of survey completion (paper vs. online) was found to represent different sub-populations of the sample and to have a significant impact upon findings. Well-being (both life satisfaction and scales of psychological well-being (total, environmental mastery and self-acceptance) was significantly higher for older adults in the nostalgia condition comparative to control (for those who completed the questionnaire online). Nostalgia was found to buffer against loneliness to protect well-being (for those who completed the questionnaire on paper).
Conclusions: This research partly supports the beneficial effects of nostalgia specifically in older adult populations. Future research can build upon the findings of this study, in particular, recruiting older adults experiencing high levels of threats to well-being such as loneliness. Should a body of literature begin to form around the benefits of nostalgia in older adults, this population could be supported to not just be living longer, but also to be living a better quality of life.
Most published research utilizes an AUDIT score of >8 as the threshold for hazardous drinking. Recent research suggests that this limit should be amended for younger drinkers (aged 18?35 years). This study aimed to explore the effect of a revision to AUDIT cut scores.
Applying Foxcroft et al.?s [(2015) Accuracy of Alcohol Use Disorders Identification Test for detecting problem drinking in 18?35 year-olds in England: method comparison study. Alcohol Alcohol50, 244?50] suggested cut off scores of nine for males and four for females to the most recent Adult Psychiatric Morbidity Survey (2007) data.
This more than doubles the prevalence of female hazardous drinkers, and significantly increases the overall rate for that age group when compared with the standard threshold of >8.
The prevalence of hazardous drinking among females ages 18?30 may be significantly higher than current estimates.
To explore adolescents? experiences of consenting to, and participating in, alcohol intervention trials when attending for emergency care.
In-depth semi-structured interviews with 27 adolescents (16 males; aged 14?17 years (Mage = 15.7)) who had taken part in one of two linked brief alcohol intervention trials based in 10 accident and emergency departments in England. Interviews were transcribed verbatim and subject to thematic analysis.
Research and intervention methods were generally found to be acceptable though confidentiality was important and parental presence could hinder truthful disclosures regarding alcohol use. Participants discussed the importance of being involved in research that was relevant to them and recognised alcohol consumption as a normative part of adolescence, highlighting the importance of having access to appropriate health information. Beyond this, they recognised the benefits and risks of trial participation for themselves and others with the majority showing a degree of altruism in considering longer term implications for others as well as themselves.
Alcohol screening and intervention in emergency care is both acceptable and relevant to adolescents but acceptability is reliant on confidentiality being assured and may be inhibited by parental presence.
Objective: Previous work suggests that diabetes stigma may be associated with poorer psychological wellbeing in people with type 2 diabetes. However, no study has determined whether social support might moderate this association. The primary aim of this study was to examine the association between diabetes-related stigma and symptoms of depression and anxiety. The secondary objective was to determine whether different forms of social support (i.e. generic social support or diabetes-specific social support) moderated the relationships between stigma and symptoms of depression and/or anxiety.
Research design and methods: An online survey was distributed through diabetes-related charities, social media and diabetes forums. Participants were 108 adults, aged 18 or older diagnosed with type 2 diabetes who lived in the United Kingdom (mean age 58.4 years old, 63.9% female). The survey asked about diabetes stigma, depressive symptoms, anxiety symptoms, generic social support and diabetes-specific social support. Data was analysed using linear regression; firstly, to determine the direct association between diabetes-stigma with depressive and anxiety symptoms, and then to examine whether generic and diabetes-specific social support moderated those associations.
Results: Type 2 diabetes-related stigma predicted depressive symptoms after adjusting for all covariates (² = 0.284, p Â .05). Type 2 diabetes-related stigma predicted anxiety symptoms when sociodemographics were controlled for (² = 0.249, p Â .05), but this relationship was attenuated by the inclusion of diabetes characteristics (² = 0.188, ns). Neither form of social support functioned as a moderator in these relationships.
Conclusion: This study lends support to previous research which has found an association between type 2 diabetes-related stigma and psychological wellbeing. This indicates the need for interventions to reduce type 2 diabetes-related stigma and to improve psychological wellbeing amongst individuals with the condition.
Introduction: Teachers are often faced with incidences of young people who self-harm but can feel ill-equipped to offer support. The United Kingdom (UK) government state that all staff working in schools should be trained on how to deal with self-harm, yet a large proportion of teachers identify a lack of training as a barrier to supporting students. Barriers to receiving training are a lack of time and resource in schools.
Aim: This study seeks to investigate whether a bespoke eLearning module, designed for UK secondary school teachers, helps to increase knowledge and confidence in supporting young people who self-harm.
Method: Twenty-one schools across the West Midlands and South West of England were contacted via email and invited to complete a 30-minute web-based eLearning module on self-harm in schools. Participants were also invited to complete pre-and post-intervention measures and a follow-up questionnaire. The data was analysed using non-parametric statistics and the free-text comments using Thematic Content Analysis.
Results: 173 teachers completed the eLearning and pre-and post-measures and 16 completed a follow-up questionnaire. The eLearning significantly enhanced participants? perceived knowledge, actual knowledge and confidence in talking to and supporting young people who self-harm. 90.7% of participants felt that eLearning was a good way to receive training. The following themes emerged from the qualitative data: Learning about self-harm is important; eLearning is convenient and accessible; eLearning is less engaging than other modes of training delivery; Training improved my confidence and understanding; The module could be enhanced with further detail and guidance; Wanting ongoing support.
Background: Eating disorders are most commonly diagnosed in adolescence and when left untreated cause serious psychological and physical harms. Early intervention is most effective at reducing negative outcomes, however there are delays to adolescents recognising a problem and seeking help for eating disorders (Beat, 2017).
Aims: The present study aimed to address a gap in the literature by investigating the gender differences in how young adolescents recognise early signs of eating disorders in their peers, and their intentions to seek help for the problem. The study also aimed to investigate whether a brief film intervention that is focused on adolescent males? experiences of body image concerns had a positive impact on problem-recognition and help-seeking intentions.
Methods: Participants (N=194, 12-13 years, 57% female) from two secondary schools in the UK completed online measures of their recognition of a mental health problem and help-seeking intentions at three time points: before and immediately after watching the film intervention, and at one-month follow up.
Results: Females recognised a mental health problem in a vignette at a higher rate compared to males. Recognition of a mental health problem improved for males and females after the film intervention but more so for males. Help-seeking intentions also improved after the film intervention. However, at one-month follow up much of the gains in recognition and help-seeking intentions were lost.
Conclusions: Adolescent males are poorer at recognising and intending to seek help for eating disorders compared to females, but males can catch up with females following a brief film intervention. More investigation is required into whether gender-sensitive interventions can help maximise the effectiveness of interventions particularly toward gender-related mental health inequalities.
Adolescents in the UK are among the heaviest drinkers in Europe. Excessive drinking in adolescents is
associated with increased risk of accidents, injuries, self-harm, unprotected or regretted sex, violence and
disorder, poisoning and accidental death. However, there is lack of clear evidence for the most clinically
effective and cost-effective screening and brief interventions for reducing or preventing alcohol
consumption in adolescents attending emergency departments (EDs).
Objectives: To estimate the distribution of alcohol consumption, alcohol-related problems and alcohol use
disorders in adolescents attending EDs; to develop age-appropriate alcohol screening and brief intervention
tools; and to evaluate the clinical effectiveness and cost-effectiveness of these interventions.
Design: The research has been conducted in three linked stages: (1) a prevalence study, (2) intervention
development and (3) two linked randomised controlled trials (RCTs).
Setting: Twelve EDs in England (London, North East, and Yorkshire and The Humber).
Participants: A total of 5376 participants in the prevalence study [mean age 13.0 years, standard
deviation (SD) 2.0 years; 46.2% female] and 1640 participants in the two linked RCTs (mean age
15.6 years, SD 1.0 years; 50.7% female).Interventions: Personalised feedback and brief advice (PFBA) and personalised feedback plus electronic
brief intervention (eBI), compared with alcohol screening alone. These age-appropriate alcohol
interventions were developed in collaboration with the target audience through a series of focus groups
and evaluations during stage 2 of the research programme and following two literature reviews.
Main outcome measures: Total alcohol consumed in standard UK units (1 unit = 8 g of ethanol) over the
previous 3 months at 12-month follow-up, assessed using the Alcohol Use Disorders Identification Test,
Consumption (3 items) (AUDIT-C).
Results: In the prevalence study, 2112 participants (39.5%) reported having had a drink of alcohol that
was more than a sip in their lifetime, with prevalence increasing steadily with age and reaching 89.5% at
the age of 17 years. The prevalence of at-risk alcohol consumption was 15% [95% confidence interval (CI)
14% to 16%] and the optimum cut-off point of the AUDIT-C in identifying at-risk drinking was e 3.
Associations of alcohol consumption and early onset of drinking with poorer health and social functioning
were also found. In the RCT, the analysis of the primary outcome (average weekly alcohol consumption at
month 12) identified no significant differences in effect between the three groups in both trials. In the
high-risk drinking trial, the mean difference compared with control was 0.57 (95% CI ?0.36 to 1.70)
for PFBA and 0.19 (95% CI ?0.71 to 1.30) for eBI. In the low-risk drinking trial, the mean difference
compared with control was 0.03 (95% CI ?0.07 to 0.13) for PFBA and 0.01 (95% CI ?0.10 to 0.11) for eBI.
The health economic analysis showed that eBI and PFBA were not more cost-effective than screening alone.
Conclusions: The ED can offer an opportunity for the identification of at-risk alcohol use in adolescents.
A simple, short, self-completed screening instrument, the AUDIT-C, is an effective tool for identifying
adolescents who are at risk of alcohol-related problems. Associations of alcohol consumption and earlier
onset of drinking with poorer health and social functioning were observed in the prevalence study.
The trials were feasible to implement and exceeded the recruitment target and minimum follow-up rates.
However, PFBA and eBI were not found to be more effective than screening alone in reducing or
preventing alcohol consumption in 14- to 17-year-olds attending EDs.
Limitations and future work: Only one-third of participants engaged with the application program; this
is likely to have limited the effect of the intervention. We re
Social and occupational functioning are important for psychological health. However, quantitative research has suggested that these areas can be adversely affected by multiple chemical sensitivity (MCS). This systematic review therefore sought to explore what qualitative research has suggested about how people with MCS perceive it to affect their social and occupational functioning.
Journal articles were included if they were 1) peer reviewed 2) qualitative or mixed methods 3) published in English 4) reported qualitative findings relevant to the review. Studies were excluded if they were 1) descriptive only 2) primarily concerned with environmental intolerances other than chemicals or 3) focussed on specific populations such as veterans. Quality was assessed using the National Institute for Health and Care Excellence (NICE, 2018) qualitative quality criteria. However, quality was not used to determine eligibility for inclusion. Six databases (CINAHL, Medline, PsychArticles, PsychInfo, Scopus and Web of Science) were searched between the 24th of February 2019 and 2nd of March 2019.
Having removed duplicates, database searches identified 388 potential articles. Thirteen of these articles were eligible for inclusion. Following review, no more articles were included from the reference lists of these studies. Meta-aggregation of the findings identified seven categories. These were synthesised into three themes; ?limited access?, ?loss & anxiety? and ?seeking engagement?.
The findings suggested that MCS limits some people's social and occupational functioning. The results warrant further research, and, the development of prevention and intervention strategies. Studies predominantly recruited United States and Canadian females and had several limitations.
Objective: To identify areas in the English Criminal Justice System where the deployment of alcohol screening and brief interventions could reduce alcohol consumption and related harms.
Methods: A rapid literature review for the prevalence of alcohol use disorders and the effectiveness of screening and brief interventions in criminal justice settings as well as conducting telephone interviews of key informant interviews.
Conclusion: With young offenders, there is a lack of trials and none from the U.K. With AssestPlus screening it would appear more feasible to conduct a trial here than in other criminal justice settings which may offer an advantage than other settings.
Methods: Two data-sets were used. 7,848 participants from the Health Survey for England (HSE) 2016 (549 with T2DM) completed the General Health Questionnaire-12 (GHQ-12) and Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) and reported average weekly alcohol consumption in units. Sixty-one UK participants with T2DM were recruited through diabetes peer-support websites to complete a survey, comprising the Alcohol Use Disorder Identification Test (AUDIT), WEMWBS, Diabetes Self-Management Questionnaire (DSMQ), and Diabetes Distress Scale (DDS). Spearman?s rank correlations, Chi-squared, Mann-Whitney U, and Kruskal-Wallis tests were used to explore the relationships between alcohol consumption and mental wellbeing (WEMWBS) in both samples, psychological distress (GHQ-12) from the HSE, and diabetes-related distress (DDS) and self-management (DSMQ) from the online survey.
Results: From HSE data, people with T2DM were more likely to be non-drinkers (OR=2.087) and to have poorer mental wellbeing (p Conclusions: Alcohol consumption is less prevalent among people with T2DM than the general population but may be associated with difficulties in some aspects of self-management. Drinking is associated with lower psychological distress than non-drinking among people with T2DM. Tentative clinical recommendations are made based on these findings and areas for further research are suggested.
Keywords: type 2 diabetes, alcohol, self-management, distress, wellbeing