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Staphylococcus aureus is a major pathogen, causing significant morbidity, mortality, and healthcare-associated costs, complicated further by increasing antimicrobial resistance. Macrophages, the resident tissue phagocyte are essential for bacterial clearance. S. aureus is rapidly internalised by macrophages, but phagosomal maturation is subverted to establish an intracellular population. Phagosomal maturation after bacterial ingestion normally involves sequential fusion with endosomes and lysosomes with reducing luminal pH, facilitating degradation of bacteria. In response to phagocytosis and phagosomal maturation, S. aureus gene expression adapts to the intracellular environment with up-regulation of multiple genes involved in resistance to oxidative stress and global regulation. A greater understanding of intracellular persistence is required to develop more effective treatment of S. aureus. The first aim of this project was to confirm that S. aureus USA300 strain JE2 demonstrates this phenotype. Using an in vitro differentiated macrophage model, phagosomes containing the USA300 strain JE2 progress to a late phagosome state but fail mature to a phagolysosome state and to acidify appropriately. The second aim was to develop a high-throughput microscopy protocol to screen intracellular bacterial acidification in macrophages. This enabled the final aim of assessing a USA300 strain JE2-derived library of transposon-mutated non-essential genes to identify genes associated with phagosomal acidification subversion. This novel screening tool can also be repurposed to investigate other pathogens to broaden knowledge of host:pathogen interaction. A total of 15 genes were identified, including the regulators agr and saeR, and oxidative stress enzyme catalase. The protease ClpP, the terminal oxidase complex genes qoxA and qoxC, and the cytochrome assembly complexes ctaB and ctaM were novel findings in context of phagosomal acidification subversion. A greater understanding of these genes and their regulatory pathways will offer insight into the mechanisms utilised by S. aureus to subvert the host macrophage immune response and aid novel therapeutic target development.

Gamma-rays are known to be emitted from some of the most extreme sources in the known Universe. Many of these objects are volatile and variable, and understanding them is the focus of the work contained in this thesis. One such class of objects which are highly variable in gamma-rays are blazars, which are known to be variable on ~ minute timescales at TeV energies. We present a macroscopic emission model to investigate whether magnetic reconnection is a feasible mechanism which can cause this rapid variability, assuming the primary emission mechanism to be synchrotron self-Compton (SSC). We show that in this case reconnection produces synchrotron-dominated flares so in general cannot fit broadband observations, although rapid flares can be produced. Underlying physical processes occurring in astrophysical sources are believed to relate to the functional forms of the probability distribution function (PDF) of their time-series. Gaussian and lognormal PDFs correspond to linear and multiplicative processes, respectively. By simulating artificial light curves of known PDF functional forms, we prescribe a method for calculating the likelihood that the PDF has been correctly measured, applying this to the blazar PKS2155-304. In recent years, observations made using the Fermi Large Area Telescope (LAT) have revealed classical novae (CNe) as gamma-ray sources, yet not every optically discovered CNe is a gamma-ray source. Here, we present simulations of an artificial Milky Way population of CNe with optical properties based of those detected in M31 and gamma-ray properties based on the observed sample. We show that observations are consistent with all CNe being gamma-ray sources and predict that all CNe at distances < 8 kpc will be detected in gamma-rays.

Dopamine (DA) neurons of the substantia nigra pars compacta (SNc) have a key role in regulation of voluntary movement control. Their death is a hallmark of Parkinson’s disease, characterised by inhibited motor control, including muscle rigidity and tremor. Excitatory input to SNc-DA neurons is primarily from the subthalamic nucleus, and in PD these afferents display a higher frequency firing, as well as increased burst firing, which could cause increased excitatory activity in SNc-DA neurons. NMDA receptors (NMDARs) bind the excitatory neurotransmitter glutamate, and are essential for learning and memory. In SNc-DA neurons, NMDARs have a putative triheteromeric subunit arrangement of GluN1 plus GluN2B and/or GluN2D. Wild type (WT) mice, and those lacking the gene for GluN2D (Grin2D-null), were used to explore its role in various aspects of DA neuronal function and dysfunction using patch-clamp electrophysiology, viability assaying, and immunofluorescence. Pharmacological intervention using subunit-specific inhibitors ifenprodil and DQP-1105 on elicited NMDAR-EPSCs suggested a developmental shift from primarily GluN2B to GluN2B/D. Activity dependent regulation was assessed by high frequency burst stimulation of glutamatergic afferents: in comparison to controls, significant downregulation of NMDARs was observed in SNc-DA neurons, though no differences were observed based on genotype. This regulatory function may be a neuroprotective or homeostatic response. Ambient extracellular glutamate elicits tonic NMDAR activity in SNc-DA neurons, which may be important for maintaining basal levels of excitability: the role of GluN2D was assessed by recording the deflection in baseline current caused by application of competitive NMDAR antagonist D-AP5. There was a significantly larger NMDAR-mediated current in WT vs Grin2D-null mice, indicating that GluN2D has a role in binding ambient glutamate. Dysfunction of glutamate uptake could be a secondary pathophysiological occurrence in the SNc, leading to increased ambient glutamate: the effect of this was explored by application of the competitive glutamate transporter blocker TBOA. Here, the NMDAR-mediated portion of this current was significantly higher in WT mice in comparison to Grin2D-null. Interestingly, dose-response data obtained from bath application of NMDA showed significantly larger currents in Grin2D-null animals vs WT, but only at the top of the response curve (~1-10 mM), which may indicate a capability for larger conductance in Grin2D-null animals at high NMDAR saturation due to replacement of GluN2D with GluN2B. GluN2D may therefore be neuroprotective, by attenuating peak current flow in response to very high agonist concentrations. Lastly, GluN2D has been found to decrease NMDAR open probability under hypoxic conditions, potentially conferring resistance to hypoxia / ischemia related excitotoxicity. Therefore, low (15% O2 / 80% N2 / 5% CO2) vs high (95% O2 / 5% CO2) oxygen conditions were used along with immunofluorescent propidium iodide cell death assaying and immunofluorescent labeling for DA neurons in order to compare levels of DA neuronal death in the SNc based on oxygen status and genotype. Whilst there was a significant submaximal effect based on O2 status, genotype did not confer a practical resistance under these conditions. In summary, NMDARs have diverse roles in SNc-DA neurons which may both serve to maintain normal function and protect the cell against potentially pathological conditions.

There exists a growing and tenacious challenge in the medicine supply chain, to manage the consequences of supply chain disruptions. Hospitals experience frequent shortages, in a European based study, 45% of respondents indicated that life preserving drugs were affected by shortages (Pauwels 2015). This research seeks to augment theoretical understanding underlying this significant issue and provide advice in the management of shortages which is a critical issue within the pharmaceutical industry. Previous research has focused on the antecedents of supply chain disruptions; what happens after a disruption has received scant attention. This research acknowledges that gap and seeks to build on the Bode et al. (2011), model of organisational responses to supply chain disruptions. This study uses a research onion design as a stencil to guide the pluralistic methodological approach chosen to release the multifaceted dimensions of the problem under consideration. Data collection instruments were interviews, an online survey, and focus groups. It was based on 318 acute care hospitals in the UK and Ireland. Findings indicate there are patterns of responses, and shortage performances vary depending on the length of time since the disruption and response mixture chosen. This research gives new insights into the impact of supply chain disruption response behaviour and supply chain performance in shortage management. It provides additional empirical tests to the Bode et al. (2011) normative model, providing insights into the underlying balanced theories, through examination of three constructs: supply chain disruption orientation; supply chain disruption performance and organisational response. It extends the concept of supply chain disruption orientation and highlights how response behaviour can feed back into the dynamic decision-making process, augmenting the Bode et al. (2011) framework. It provides insights to managers taking a system-wide view on drug delivery performance.

The aim of this thesis is to explore the experiences of people, with current or past mental health difficulties, participating in a community-based mass participation running event. The research also aims to explore the benefits of supporting psychological wellbeing through community involvement and physical activity. Paper one provides an overview of the current literature examining the psychological and social impact of community-based exercise projects. Nine studies were reviewed. The studies were critically appraised and the findings synthesised. Despite previous research evidence that physical activity is beneficial to mental health and that community-based projects can improve both social inclusion and mental health, the review did not find strong evidence in support of the social and emotional benefits of community-based exercise projects, however research specifically exploring this was limited. The studies reviewed provide only weak evidence that community-based physical activity is socially and psychologically beneficial, but demonstrate potential for such projects to be helpful. Paper two examined parkrun; a free, weekly, worldwide, five-kilometere running event facilitated by volunteers. Research evidence suggests that many elements of parkrun may be beneficial to mental health such as: physical activity, increased community involvement, being outdoors and volunteering opportunities. This study explored the mental health impact of parkrun on people with an experience of mental health difficulties. Twenty participants were interviewed. A thematic analysis was conducted and three themes identified: “sense of achievement,” “connecting with others” and “it’s for everyone.” The themes identified that participants valued the inclusive and supportive community environment of parkrun. Running was seen as a means of facilitating this, and of giving participants a sense of achievement. Participants universally felt that parkrun was beneficial to their mental health. Paper three provides a personal reflective account of the process of conducting this research project and writing this thesis. Attention is paid to the background 9 to the project, the process of writing paper one and paper two, and the context in which the thesis was written.

Background Coronary artery disease (CAD) is the leading cause of death in the world. Physiological lesion assessment with indices such as fractional flow reserve (FFR) is now accepted as the invasive gold-standard for diagnosing the significance of CAD and for guiding treatment. Patients undergoing percutaneous coronary intervention (PCI) guided by FFR have better clinical outcomes than those undergoing standard assessment. Furthermore, FFR-guided PCI is associated with decreased stent implantation and reduced long-term cost. Only a minority of patients undergoing invasive coronary angiography are currently afforded these benefits due to a number of procedure, operator, and economic related factors. There may be additional benefits from combined pressure and flow measurement. There is therefore a need for a technology that delivers the benefits of physiological lesion assessment without the factors which limit use of the invasive technique. Hypothesis Computational fluid dynamics (CFD) modelling based upon invasive coronary angiographic images (ICA) can characterise and predict intracoronary physiology. Aims (i) To develop a CFD-based model capable of simulating and predicting clinically relevant intracoronary physiology and (ii) validate model performance using clinical data from patients with CAD. Methods A workflow, based upon 3-D CFD modelling, capable of predicting intracoronary pressure and ‘virtual’ FFR from ICA, was developed. The model was validated against in vivo clinical measurements in 35 unique arterial datasets. The model predicted physiological lesion significance with 97% overall accuracy. Computation was prolonged (>24hrs). Two novel methods for solving the 3-D CFD were therefore developed. These methods enabled accurate computation of results in clinically tractable timescales (<5mins), at least equivalent to invasive measurement. The critical influence of system boundary conditions was explored, characterised, and quantified. A novel approach to patient-specific tuning of the outlet boundary conditions was developed and evaluated. The workflow was adapted to compute the pressure-flow relationship from measured pressure boundary conditions within a fully patient-specific in silico model. Results were validated within a novel experimental flow circuit incorporating patient-specific 3-D printed coronary arterial phantom models. Conclusions It is possible to compute clinically relevant intracoronary physiology (pressure or flow) from ICA. Results can be generated in clinically tractable timescales. The CFD model can be tuned to individual patient characteristics. The developed tools may be commercially desirable. Prior to full clinical translation, the model must be evaluated in a clinical trial.

A new conceptual approach to modelling peatlands, DigiBog, involves a Complex Adaptive Systems consideration of raised bogs. A new computer hydrological model is presented, tested, and its capabilities in simulating hydrological behaviour in a real bog demonstrated. The hydrological model, while effective as a stand-alone modelling tool, provides a conceptual and algorithmic structure for ecohydrological models presented later. Using DigiBog architecture to build a cellular model of peatland patterning dynamics, various rulesets were experimented with to assess their effectiveness in predicting patterns. Contrary to findings by previous authors, the ponding model did not predict patterns under steady hydrological conditions. None of the rulesets presented offered an improvement over the existing nutrient-scarcity model. Sixteen shallow peat cores from a Swedish raised bog were analysed to investigate the relationship between cumulative peat decomposition and hydraulic conductivity, a relationship previously neglected in models of peatland patterning and peat accumulation. A multivariate analysis showed depth to be a stronger control on hydraulic conductivity than cumulative decomposition, reflecting the role of compression in closing pore spaces. The data proved to be largely unsuitable for parameterising models of peatland dynamics, due mainly to problems in core selection. However, the work showed that hydraulic conductivity could be expressed quantitatively as a function of other physical variables such as depth and cumulative decomposition. DigiBog architecture was used to build a simple, vertical, ecohydrological model of long-term peat accumulation. As model complexity was increased under a self-organisation approach, model predictions of peat accumulation rates and surface wetness changed dramatically, revealing the importance of feedbacks between peatland hydrological behaviour and peat physical properties. This work may have important implications for palaeoclimatic reconstructions which assume peatland surface wetness to be a reliable climatic indicator. The expansion of the model to include horizontal space altered model behaviour in quantitative and qualitative terms.

It has long been recognised that some oceanic regions have persistently low chlorophyll levels, even though inorganic nutrients are plentiful. Studies have shown that these high-nutrient, low-chlorophyll (HNLC) areas are depleted in iron, which is an essential micronutrient for phytoplankton growth. In HNLC regions biological production can be enhanced with artificial mesoscale iron fertilisation. However, the ability of artificially induced phytoplankton blooms to efficiently sequester carbon to mesopelagic depths is still an open question. SubAntarctic islands in the HNLC Southern Ocean are a natural source of iron and thus fuel the annual phytoplankton blooms observed in their proximity. One such bloom, tied to the Crozet Islands (52ºE, 46ºS), provided the opportunity to examine particulate organic carbon (POC) export during the austral summer of 2004/5. This work was imbedded into the multi-disciplinary CROZEX project thus providing a rich context for data interpretation. Based on satellite imagery, a high chlorophyll region (max = 4 µg l-1) north and downstream of the Crozet Islands was distinguished from a low chlorophyll region (typically 0.3 µg l-1) south and upstream of the islands. POC export estimates, obtained with the naturally occurring particle reactive radionuclide tracer, 234Th, were initially D15 mmol C m-2 d-1 in the high chlorophyll region, compared with D5 mmol C m-2 d-1 in the low chlorophyll region. After a moderately small increase in chlorophyll in the south (max = 0.7 µg l-1) the spatial variability in POC export was lost, resulting in equally high levels of POC export (ca. 20 mmol C m-2 d-1) throughout the study area. After comparing the daily rates of POC export with temporally integrated new production calculated from nitrate budgets, a different spatial pattern emerged. New production (NP) presented consistently higher values in the north, when compared to the south. Two hypotheses were formulated to explain this, 1) dissolved organic matter (DOM) and suspended particulate organic matter (sPOM) produced from NP was stored in the mixed layer with this effect relatively greater in the north, 2) the export event in the north was longer resulting in greater seasonal POC export. Investigation of the DOM pool revealed that DOM accounted for 46±7% of NP and was consistent across the whole study area. In contrast, sPOM accumulated at differential rates of 18±7% in the north and 0±7% in the south. This suggested that differential storage of sPOM was responsible for the lack of a latitudinal gradient in POC export after the relatively small increase in chlorophyll in the south. After investigating the second hypothesis, the daily rates of POC export were scaled to seasonal integrals using a silicon budget, which allowed the formulation of a seasonal carbon budget. This revealed that over the timescale of the study the magnitude of NP and POC export were not the same with this difference greatest within the northern high chlorophyll region. This was the result of relatively greater storage of sPOM in the north and had the effect of reducing the amount of easily exportable POC to mesopelagic depths. Thus both hypotheses contributed to better understanding carbon export in the Crozet region.

This thesis documents the development of a novel fibre optic hydrophone, for the characterisation of medical ultrasound transducers and the measurement of ultrasound induced temperature rises. The transduction mechanism of the hydrophone is based on the detection of acoustically and thermally induced changes in the optical thickness of a Fabry-Perot interferometer deposited at the tip of a single mode optical fibre. The interferometer comprises a layer of Parylene-C sandwiched between two thin gold mirrors. The design of the sensor was optimised using a numerical model of the interferometer transfer function. Through the use of vacuum deposition techniques, a fabrication procedure has been developed which enables batch production of the sensors. A self contained sensor interrogation system has also been developed. The system uses a rapidly tuneable laser developed originally for the telecoms industry to interrogate the sensor and make acoustic and thermal measurement, Control of the system is achieved via a PC using software written in Labview 8.0.

The receptor tyrosine kinase Tie-2 is expressed predominantly in endothelial cells and is involved in blood vessel formation and maintenance. A missense mutation resulting in an R849 to W substitution in the kinase domain of Tie-2 has been reported to co-segregate with an autosomal dominantly inherited form of venous malformation (VM). In this disorder focal masses arise comprising of numerous dilated vascular channels lined with endothelial cells but largely lacking mural cell support. The mechanism whereby R849W mutant Tie-2 results in VM is not known. The aim of this study was to determine the functional effects of this mutant form of Tie-2 in order to gain insight into the mechanism by which it results in VM. To do this, wild type and VM (R849W) mutant Tie-2 were subcloned into mammalian expression vector pCR3 and stably expressed in endothelial cells. the VM mutant form of Tie-2 exhibited elevated constitutive tyrosine phosphorylation compared with wild type receptor in endothelial cells. expression of VM mutant Tie-2 caused a dramatic increase in endothelial cell survival during serum starvation. Under basal conditions VM mutant Tie-2 was found to be associated with a number of tyrosine phosphorylated proteins including Shp-2 and the adapter protein Shc. Consistent with effects on cell survival, endothelial cells expressing VM mutant Tie-2 had constitutively activated Akt. These data suggest the mutant form of Tie-2 may act to prevent regression of mural cell poor vessels via ligand-independent Tie-2 activation of Akt and endothelial survival.

Purpose: The principal aim of this project was to investigate the influence of clinical indices of injury severity and polymorphism of the apolipoprotein E gene upon the long-term physical, cognitive and emotional sequelae of traumatic brain injury and spontaneous subarachnoid haemorrhage. It was also intended to determine the extent to which changes occur in these sequelae beyond the initial six months post injury. Method: Sixty-two brain injury patients who had previously taken part in a neuropsychological assessment at six months post injury were traced and participated in a follow-up assessmens some 6-9 years subsequent to their injury. Separately, a group of 70 subarachnoid patients drawn from a consecutive series of neurosurgical admissions participated in a neuropsychological assessment at 14 months subsequent to their haemorrhage. In both studies, the assessment comprised a semi-structured interview and a battery of cognitive measures focusing principally upon memory and executive function tasks. A questionnaire including a range of standardised measures of anxiety, depression and quality of life was left with patients to be returned by post. Results: The ApoE e4 allele did not appear to influence recovery amongst these brain injury survivors, though there are suggestions that it may have an influence upon subgroups of patients. Amongst traumatic brain injury survivors, post-traumatic amnesia was a better predictor of functional or emotional outcome than consciousness based measures. However, consciousness based measures were more predictive of cognitive sequelae and low admission Glasgow Coma Scale was associated with continued improvement on information processing tasks. Other than on these tasks, there was little evidence of change between 6 months and 6-9 years post injury. Amongst the subarachnoid haemorrhage patients, Fisher Grade was found to be more predictive of subsequent Glasgow Outcome Scale and cognitive function than WFNS Grade or other clinical indices. Surviving aneurysmal patients had comparable levels of recovery to patients who had a negative angiogram. In both studies emotional sequelae, in particular anxiety-related difficulties, were found to be a principal factor in the functional outcome of some 40% of patients. Conclusions: Greater emphasis should be placed upon measures of post-traumatic amnesia as predictors of functional recovery in surviving patients. The use of an amnesia measure may also be warranted in studies of outcome following subarachnoid haemorrhage or other stroke. The ApoE e4 allele does not appear to have a strong influence upon functional recovery after brain injury across all patients, though it is possible that it interacts with other factors to influence recovery in subgroups. Greater emphasis should be placed upon the prevention and/or detection and treatment of mood disorders following brain injury. In the absence of intensive rehabilitative interventions, survivors of serious brain injury are more likely to deteriorate than to continue to recover beyond six months post injury.

Given the paucity of information with regards the micronutrient requirements of the currently expanding number of cultured marine species, a series of investigations was undertaken to examine the water-soluble vitamin nutrition of the gilthead seabream (Sparus aurata L.). A preliminary study identified the qualitative requirement of this species for ascorbic acid, the B complex vitamins and choline for the maintenance of health and optimum productivity. Based on the observations of the preliminary experiment, a study was designed which allowed the development of a semi-purified diet and illustrated the qualitative requirement of the gilthead seabream for thiamin, niacin, riboflavin, pyridoxine and pantothenic acid. Using the semi-purified diet, the requirement for niacin and biotin were also established. As one of the vitamins for which the seabream exhibited a strong requirement, pyridoxine was chosen as the focus for an experiment which evaluated the benefit of the incorporation of this vitamin within a practical diet at levels which exceeded the minimum requirement. Thiamin is a vitamin which is known to exhibit a distinct relationship with carbohydrate metabolism, hence this vitamin was chosen as the focus of an investigation of the potential for the modification of vitamin requirements in response to major nutrient supply. Finally, having illustrated the requirement of gilthead seabream growers for ascorbic acid, an experiment was carried out to evaluate the efficacy of a series of vitamin C derivatives as feed supplements for this species. The current series of investigations has not only served to expand the present knowledge of the vitamin nutrition of the target species but has highlighted the potential for novel and applied research which remains within the field of micronutrients.

Nesbitt (1973) identified the paradox that smokers report that smoking has both a stimulant and a sedative effect, but the vast majority of physiological studies of smoking find that smoking has only a stimulant effect. It has been suggested (Ashton and Stepney, 1982) that the physiological effects of smoking vary as a function of context. This hypothesis was investigated in the thesis by an examination of the effects of smoking on physiology, smoking behaviour and task performance in a variety of situations. Smoking behaviour was measured very precisely using a purpose built smoking behaviour analyser. The data from these studies should give conclusive evidence for or against the arousal modulation theory. Physiological data should tell us if arousal modulation is taking place. The exact description of smoking behaviour should tell us how the different physiological effects are being achieved. The performance data should tell us the functional significance of the physiological changes observed. Experiment One: a comparison was made between the effects of real smoking and sham smoking (puffing on an unlit cigarette) on electrodermal activity (EDA) in a neutral environment. The effect of smoking in this environment was found to be stimulant. Smoking caused increased EDA activity as compared to a baseline and as compared to activity in the sham smoking condition. A relationship between puffs and physiology was also revealed, a skin conductance response (SCR) occurring immediately prior to puff onset. As the SCR occurred prior to puff onset it was hypothesised that the SCR was related to the decision to puff rather than the SCR occurring as the result of a puff. Puffing behaviour in the two conditions was found to be highly correlated. We were measuring a stable phenomenon in a reliable way. Experiment Two: it has been suggested (Knott, 1980) that smoking has a sedative effect during complex cognitive processing tasks. In the second study the effect of smoking on EDA activity, smoking behaviour and performance was examined. There was unequivocal evidence that smoking sedated physiology during a complex cognitive processing task. No clear performance effects were revealed and no coherent account of how smoking was bringing about the different effects on physiology could be developed from the smoking behaviour data. However it was revealed that smoking behaviour was affected by environmental factors, the distribution of puffs being powerfully influenced by task performance. Experiment Three: Wesnes and Warburton (1983) have found that smoking improves vigilance performance. This type of task was thought to provide the best chance of producing measurable performance changes as a function of smoking. Smoking was found to have a marginal effect on performance. The effect of smoking on physiology in this context was stimulant. Again no clear explanation of how the different effects were being achieved emerged from the smoking behaviour data. It was concluded that smoking did have a variety of physiological effects but the motivation for smoking could not be attributed to these physiological changes as they seemed to be of no functional significance. Thus although the physiological effects of smoking observed in the studies seem powerful support for the arousal modulation theory, it is not clear why such changes should be desirable to the smoker. However the studies revealed many other interesting results. Smoking behaviour is incredibly stable, correlations of .9 or over on retest being commonplace. Thus laboratory investigations of smoking behaviour may have high ecological validity as compared to other laboratory studies. It was also revealed that smoking behaviour is powerfully influenced by environmental factors.

Despite growing research on human-nature interaction, there remains a lack of understanding of the impact of physical engagement in nature and whether nature-based intervention is effective in improving mental wellbeing, mindfulness, sleep quality, and mood in adults. The aims of this thesis are to deepen our understanding of the psychological effects of human-nature interactions in relation to gardening and keeping houseplants, and to test the effectiveness and mechanisms of a targeted nature-based intervention on mental health outcomes. The thesis investigated the psychological effects of human-nature connection from home settings to the community and to wider public nature environments. Firstly, the psychological effects of houseplants care behaviour on health and wellbeing community gardening, and the experience of engaging in community gardening amongst Chinese adults in urban areas were examined. Next, there is an examination of the effectiveness of greenspace-based walking intervention on mental health - a systematic review was carried out, and then a randomised control study of nature-based mindful walking was conducted in the UK with the design based on the findings of the systematic review. A review of the literature on the impact of nature on mental health indicated that research on this topic has been done mostly in developed countries, especially in the Western world. A few studies regarding the human-nature connection in psychology have been investigated in China, which is now facing growing urbanisation, and environmental problems, and increasing levels of mental health concerns. A research gap has also been identified regarding the effectiveness of walking in nature (i.e., greenspace) on mental health in the UK, especially for university students' mood disturbance and sleep difficulties during the COVID-19 pandemic. As many Chinese adults living in urban environments do not have ready access to outdoor gardens, the first empirical work was to investigate the impact of houseplants on mental health. Using a questionnaire-based survey, two empirical studies regarding the care of houseplants (n = 421) are reported. The first part of this research revealed that houseplants carers reported significantly higher levels of mental well-being and mindfulness compared with non houseplants carers. Additionally, taking care of houseplants was positively related to greater levels of mental wellbeing and mindfulness, and the Universalism value was found to significantly relate to various houseplants care behaviours. The second study highlights the importance of one's attitude, perceived behaviour controls (i.e., self-efficacy), and intentions on behaviours around keeping houseplants. Moving to community settings from the house, a grounded theory study (n = 21) of Chinese community gardeners found participants perceived that community gardening activities benefited their physical health, mood, sense of connection with nature, communication, spirituality, and personal growth, but that Chinese gardeners believed they needed more support from the government to construct more gardens. This study bridges the gap of understanding Chinese city residents' experiences of outdoor gardening activities with respect to health and wellbeing. These findings imply that positively interacting with nature through gardening and indoor houseplants leads to a better human-nature relationship and improved mental health outcomes for adults in urban China. The subsequent chapters (5-6) of the thesis present an evaluation of the effectiveness of greenspace-based walking interventions on mental health in the UK. A systematic review of the literature reviewed 17 studies to provide new insight on the effects of greenspace-based walking interventions through a narrative synthesis of existing evidence. The findings revealed that nature-based walking was associated with benefits such as positive mood, wellbeing, anxiety-reduction, rumination, and mindfulness. However, only four of the included experimental studies in the systematic review employed a randomised control design. To address this gap, a novel randomised control study was conducted, using a pre-test, intervention, post-test, and delayed post-test design, where participants (N = 104 UK university students) were allocated to nature or urban walking conditions. Self-reported online assessment questionnaires were used as an evaluation tool. Participants were randomly assigned to either a nature or an urban walking environment, and they followed a prescribed route involving walking for around 35 minutes daily for seven consecutive days with instructions on how to engage in the walk mindfully. The results revealed no difference between nature and urban walking conditions but indicated that outdoor mindful walking improved the participants' mindfulness and sleep quality, and decreased mood disturbance. The improvement of sleep quality was linked to the relationship between the mindful walking intervention and the improvement of mood amongst university students, suggesting that mindful outdoor walking enhances mood through improving sleep. This thesis highlights the importance of human-nature connections, and the mental health benefits of engaging in various nature-based activities and interventions in China and the UK. It also addresses gaps in psychological research on ways to promote human-nature interaction through gardening and planting; and deepens our understanding of how nature-based walking interventions can enhance adults' wellbeing, mood, mindfulness, and sleep quality. The findings of this thesis have implications for practice and policy and will impact public health (e.g., investment in community gardens for urban residents; encouraging people to grow indoor plants), and the impact on clinical practice of encouraging organisations (e.g., university mental health service) to deliver effective interventions to young adults with their sleep and mood problems.

Open prisons play a unique role in the preparedness and resettlement of prisoners nearing the end of their sentences such that graduated exposure to the community has been associated with lower recidivism rates. Yet the nature of these institutions increases the hazard that harmful behaviours spill out into the community. In 2014, prisons in England and Wales adopted the Enhanced Behaviour Monitoring framework to provide assurances that the risks - of abscond, recidivism, and temporary release failure - were managed. The purpose of this thesis was to evaluate the impact of Enhanced Behaviour Monitoring on the rate of failures in open prisons. To achieve this aim, Study 1 employed meta-analysis to identify risk factors associated with failure in the immediate years following release from custody (i.e., exposure to the community). Study 2 utilised these variables to build a model upon which to predict 'failure' in open conditions. Study 3 was an evaluation of Enhanced Behaviour Monitoring to compare the failure outcomes of those allocated to the intervention with a control group matched on the variables associated with failure identified in Study 2. Seventeen risk factors for recidivism were identified, six of which were associated with recall from open to closed conditions. Indeed, these recall rates were disproportionate to the rate of serious recidivistic outcomes such as abscond, and both custodial and community re-offending, which were rare. Enhanced Behaviour Monitoring had a null effect on reducing failures; those allocated to Enhanced Behaviour Monitoring were overall at higher risk of recall to closed conditions. This thesis contributes to the literature by advocating for longitudinal, individualised assessments of risk in open prisons, based on behavioural aggregation, to inform community risk management plans. Effective risk management in open conditions is best achieved through procedural change and cultural enhancement, rather than scrutiny of individual-level risk factors.

Background: Rates of psychological distress are rising, pressure on mental health services is increasing and currently there is a section of the population who experience psychological distress but are not accessing traditional mental health services. It has been proposed that nature-based interventions can play a role in mental health care. Aims: This thesis firstly aimed to conduct a systematic review to identify, and review randomised controlled trials that measured the effect of a virtual nature intervention on attention and distress. The second part of the thesis consisted of an empirical study that investigated the association between watching a virtual nature video and changes in positive and negative affect, anxiety, and mindfulness in older adults. The study aimed to see if this association could be further enhanced with mindfulness instruction. A correlational relationship between improvements in positive and negative affect, anxiety and nature connectedness aimed to be investigated, as was state mindfulness as a potential mediator in the relationship between contact with virtual nature and improvements in affect and anxiety. METHOD: The systematic review searched four databases using relevant key words for research papers and judged these against inclusion and exclusion criteria. The quality of the final papers was assessed. A three-arm randomised empirical study was conducted recruiting older adults from the general population. Results: The systematic review revealed twenty papers relevant to the research question. A narrative synthesis found evidence for associations between virtual nature contact and improvements in attention and psychological distress. The evidence for attention appeared to be stronger for certain measures. The quality of papers was good however limited by unclear reporting. Findings from the empirical study found support for an association between negative affect and watching a nature video, with no association with any other variables. Mindfulness instruction did not enhance any changes, neither was nature connectedness correlated with benefits. No mediation analysis was conducted as the data did not meet the assumptions of a mediation. Conclusions: The systematic review suggests that virtual nature is associated with improvements in psychological distress and attention in the general population. When it comes to attention this association seems to vary depending on the measurement used. This association of improvements in psychological distress was not replicated in the empirical project which used an older adult sample. Previous established associations seen in the general population using real nature did not extend to this older adult population and virtual nature, suggesting that virtual nature may not hold the same benefits as real nature.

INTRODUCTION: Seizure disorders are common and disabling neurological conditions diagnosed in people presenting to neuropsychology services. The two main forms of seizure disorder are epilepsy and functional seizures. 'Illness representations' refer to the beliefs an individual has about their condition and are thought to be related to how people respond to and manage their condition. Many psychological interventions work explicitly with these representations; however, little is known about the illness representations of people with seizure disorders. Although seizure disorders can start at any age, even less is known about the illness representations of people whose functional seizures start after the age of 40 (so called patients with later-onset functional seizures). It has been proposed that these individuals constitute a clinically separate entity to people with earlier-onset functional seizures. For example, health-related traumatic events may be more salient causal factors for this group. However, there has been minimal research in this area. AIMS: The over-arching aim of this thesis was to improve current understanding of illness representations in people with seizure disorders through a) a systematic review of factors associated with illness representations in people with seizure disorders and b) a qualitative investigation of the illness representations of people with later-onset functional seizures. METHODS: A systematic review identified 17 studies examining factors associated with illness representations in people with seizure disorders, which were synthesised narratively. A qualitative investigation using Template Analysis was employed to understand the illness representations of people with later-onset functional seizures. Themes were interpreted according to the dimensions of Leventhal's Common-Sense Model (identity, causes, cures/control, and consequences). RESULTS: The results of the systematic review demonstrated moderately strong evidence for associations between illness representations and outcomes including seizure-related characteristics, distress, stigma, coping styles, and health-related quality of life, although the evidence base was weaker for people with functional seizures. Based on the available literature, it was unclear if illness representations differed between the two patient groups. The Template Analysis study revealed illness representations across the themes of 'identity', 'causes', 'triggers', 'cures/controls' and 'consequences' with half of the sample reporting health-related events or trauma as causal. Illness representations were characterised by uncertainty, contradiction, and distress, although for some, increased age of onset was viewed as advantageous for acceptance of the condition. CONCLUSIONS: Illness representations appear to be related to biopsychosocial outcomes in people with seizure disorders, however, further work is needed to assess for any between-groups differences or establish any modifiable factors. The illness representations of people with later-onset functional seizures arguably reflect their confusing and distressing experiences. Patients' accounts provide some support for the proposition that health-related traumas are relevant precipitators for this group, although a quantitative study would be required to test this hypothesis. Both studies open avenues for research and psychological treatment in people with seizure disorders.

PURPOSE: The systematic review aimed to explore whether there were significant differences between patients' illness perceptions and their spouses' or partners' illness perceptions and on what specific illness perception dimensions these differences exist. The empirical study aimed to explore the relationships between threat-related illness perceptions, optimism, problem-focused coping and demographic variables. The particular illness perception dimensions of interest were the illness consequences, illness identity and illness timeline dimensions. Specifically, the empirical study aimed to understand if optimism moderated the relationship between threat-related illness perceptions and problem-focused coping when controlling for age. METHODS: A systematic literature search was conducted across multiple electronic databases in order to identify studies that reported results from quantitative statistical analyses analysing the differences between patients' and their spouses' or partners' illness perceptions. Methodological quality of the included studies was assessed by the application of quality criteria and the results from the studies were discussed in the context of methodological quality. For the empirical study, 93 participants were recruited from an NHS Cardiac Rehabilitation service. They completed self-report measures assessing illness perceptions, optimism, problem-focused coping and demographic variables online or by telephone. Correlational and moderation analyses were used to explore the relationships between variables. RESULTS: Twelve studies met eligibility criteria and were included in the systematic review. There were significant differences between patients and spouses/partners, particularly on the illness control dimension. This finding was supported by the most consistent and methodologically strong evidence. Across the remaining illness perception dimensions, the consistency and methodological quality of the evidence was mixed. The empirical study highlighted from correlational analyses that perceiving more severe illness consequences and greater optimism were both associated with greater problem-focused coping. However, illness timeline and illness identity were not significantly correlated with problem-focused coping. A moderation analysis demonstrated that optimism did not moderate the relationship between illness consequences and problem-focused coping when including age as a covariate. CONCLUSIONS: Both chapters illustrated the important role of illness perceptions in the context of long-term health conditions. The systematic review highlighted that further research is needed to understand impact of different illness perceptions on coping responses, physical and psychological outcomes. The empirical study outlined the importance of routinely assessing for illness perceptions within cardiac rehabilitation as this could inform the development of problem-focused coping. It also illustrated that optimism could be assessed as part of routine clinical practice within cardiac rehabilitation and targeted through intervention strategies that aim to increase optimism.

Background: Bariatric surgery is a recommended treatment for people with morbid obesity. Patients who seek or undergo bariatric surgery experience a range of psychosocial difficulties which affect their quality of life, including interpersonal difficulties, maladaptive eating patterns and psychological distress. This thesis aims to investigate how weight-based bias was associated with maladaptive eating patterns in this patient population, and how the interpersonal psychotherapy model of eating disorders (IPT-ED) could be extended to consider the quality of life in those seeking bariatric surgery. Method: A systematic review of quantitative studies (n = 11) was undertaken to examine the relationship between internalised weight bias and eating behaviours in bariatric surgery patients. Also, a cross-sectional empirical study examined a pre-existing dataset of routinely collected clinical data from bariatric surgery candidates (n = 193). Drawing on the IPT-ED model, the study used mediation and moderation analyses to explore the relationships between interpersonal vulnerability, anxiety, depression, emotional eating and quality of life. Results: The systematic review found internal weight bias was associated with maladaptive eating behaviours, irrespective of whether patients were seeking or had completed bariatric surgery, and demonstrated medium to large effect sizes. The observational study found emotional eating partially mediated the relationship between interpersonal vulnerability and quality of life in bariatric surgery candidates. Moderation analyses found depression did not moderate the relationship between interpersonal vulnerability and emotional eating in those seeking bariatric surgery, however when anxiety was low interpersonal vulnerability and emotional eating were significantly related. Conclusion: Both the systematic review and empirical study demonstrated the strong association between interpersonal vulnerability and eating behaviours (e.g. emotional eating) in bariatric surgery patients. By introducing quality of life to the IPT-ED model and applying it to bariatric surgery candidates it provides clinicians and researchers with an enhanced theoretical foundation to understand how interpersonal factors, eating behaviours and psychological distress combine to affect the psychosocial wellbeing of bariatric surgery patients. Until recently application of theoretical frameworks with this clinical population has been limited. The current study has for the first time shown how an enhanced interpersonal framework featuring quality of life might be applied to those seeking bariatric surgery. Given bariatric surgery is a significant life transition future research would benefit from investigating how this enhanced model evolves at different stages along the patient journey, from pre-surgical assessment through to long-term follow-up.

Background: Acute coronary syndromes (ACS) are one of the leading causes of hospitalization and death. Patients with non-ST elevation ACS (NSTE-ACS) undergo coronary angiography (CAG). However, identifying the lesions which are physiologically significant is difficult based upon CAG alone. Fractional flow reserve (FFR) measured with a pressure wire is used in a few and produces a 25% change in management compared with visual assessment. Virtual (computed) FFR (vFFR), which uses a 3D model of the coronary arteries constructed from the invasive angiogram, and application of the physical laws of fluid flow, has the potential to be used more widely. Its practicability and impact in the acute setting need to be tested. Hypothesis vFFR leads to a change in planned treatment in >10% cases compared with angiographic assessment. Methods: This was a prospective, observational study of patients with NSTE-ACS undergoing coronary angiography. Clinical data, demographics, CAG result and the initial management (medical therapy, PCI, coronary artery bypass grafting (CABG) or multidisciplinary team (MDT)) were recorded. The vFFRs were calculated and the cardiologist was asked for any change in decision. Study meetings were also convened, and their decisions recorded. The primary endpoint was the number of patients in whom management changes. Results: Two hundred and ninety-four patients were screened, 208 were recruited and 335 vessels were processed. vFFR resulted in an hypothetical change of management in 22% [95% CI: 15% to 25%, p < 0.001] and increased the confidence level of the decisions in 126/208 (61%) cases and reduced it in 12/208 (6%). At six months, 6/208 (3%) of patients experienced a MACE; one death, two MIs, two unplanned revascularisations and one bleed. Conclusion: vFFR is feasible and leads to an hypothetical change in management in 22% of cases. It may have the potential impact to augment simple, angiography-based decision making in ACS.

Background: A systematic review was conducted to examine whether combined Applied Behaviour Analysis (ABA) and Mindfulness-Based Interventions (MBIs) are effective in increasing the psychological wellbeing and quality of life of carers of people with intellectual and developmental disabilities, and to determine whether combined interventions achieve more positive results than interventions delivered alone. Methods: Using the Ovid search software, systematic searches of Ovid MEDLINE, APA PsychInfo, and Embase were conducted in November 2020. The review included studies that combined ABA and MBIs in interventions with both paid and unpaid carers, working and living in any setting, and caring for people of any ages. Results: Thirteen studies involving 322 paid care staff and 195 parents of people with intellectual and developmental disabilities were included. Seven studies examined staff caring for adults, while the remaining six studies focussed on parents caring for their children (under 18 years old). Studies varied considerably in terms of design, sample size, diagnosis, and methodological quality. Within the context of these limitations, results tentatively suggest that combined ABA and MBI interventions are effective in decreasing carer stress and challenging behaviour, and that they can be more cost-effective than ABA interventions delivered alone. Conclusion: While there is emerging evidence that combined ABA and MBI interventions are beneficial to carer wellbeing, it is not possible to draw firm conclusions on the basis of the existing literature. Future studies should aim at evaluating the effectiveness of combined interventions further using high quality randomized controlled trials.

Background: Fractional flow reserve is the 'gold-standard' method for the measurement of coronary artery stenosis physiological significance. FFR-guided revascularisation has a positive impact on mortality and morbidity. However, FFR is under-used owing to its invasive nature and because of patient and physician factors. Computational fluid dynamics modelling has been validated as method of calculating a virtual (v)FFR without the need for a pressure wire, hyperaemic agents, additional contrast or radiation. Hypothesis: Disclosure of vFFR in patients with stable angina undergoing elective invasive coronary angiography will result in significant changes in patients' management strategies. Methods: VIRTUheart™ was applied to patients with stable angina at four hospitals in South Yorkshire. Patients' management plans were classified as optimal medical therapy (OMT), percutaneous coronary intervention (PCI), coronary artery bypass surgery (CABG) or more information, based upon the angiogram and again after vFFR disclosure. A management strategy change of 10% or more was considered significant. Changes in cardiologists' confidence levels in their original strategies were also recorded before and after vFFR disclosure. Results: 223 patients were screened and 112 patients were recruited. Median vFFR was 0.83 (IQR 0.15) and calculation time was 15 minutes (IQR 8). vFFR disclosures lead to an observed change in 22.3% (95% CI: ± 8.12%, p < 0.013) of patients' management strategies driven by a 39.5% relative increase in patients being reassigned to PCI and or invasive FFR measurement. The mean confidence levels in the original strategy before and after vFFR disclosure were 8.90/10 (SD 1.28) and 9.22/10 (SD 1.39) respectively (p = 0.026). Conclusion: The addition of vFFR to the coronary angiogram has the potential to significantly change management strategies in up to 22.3% of patients providing a detailed and specific 'all-inone' anatomical and physiological assessment of coronary disease. However vFFR health related outcomes and cost-effectiveness have yet to be determined.

This thesis was initially designed to include two papers, both relating to the study of compassion: a review paper focusing on the effectiveness of Compassion Focused Imagery (CFI) and an empirical qualitative research project exploring self-compassion with adults who experience Dissociative Seizures. Due to Covid-19 outbreak the empirical research project was terminated before the completion of data collection. Therefore a third paper was included in the thesis, which presents a secondary analysis of an existing dataset from a qualitative project unrelated to compassion. Paper 1 presents a systematic review of the effectiveness of CFI on psychological outcomes across clinical and non-clinical populations. The aims of the review were to provide qualitative synthesis of existing literature and to provide effect size calculations for outcome measures relevant to compassion literature (self-compassion, self-criticism and shame). Sixteen records were identified and reviewed. Most of the studies reported improvements in self-compassion and positive affect, reduction in self-criticism, shame and paranoia. Effect sizes ranged between 0.19- 0.99 across measures of self-compassion, self-criticism and shame. Methodological weaknesses and heterogeneity between the studies make it difficult to draw strong conclusions regarding the effectiveness of CFI as a stand-alone intervention. Paper 2 presents the rationale and methods for the terminated empirical project on Self-compassion and Dissociative Seizures. Dissociative Seizures refer to paroxysmal events that resemble epilepsy without the epileptic activity in the brain. The qualitative project had intended to explore patients' views and experiences with Self-Compassion and their perceived barriers and facilitators to taking a self-compassionate stance. Even though it was not possible to complete the project, it was felt important to document the work undertaken so far for reasons of transparency and for demonstration of relevant research competencies. Paper 3 presents a secondary analysis on an existing dataset which was initially recruited as part of an MSc research project in 2018. This was a qualitative research project exploring the views of participants from deprived communities, about the perceived benefits, barriers and proposed solutions to increasing engagement with greenspaces. The dataset was considered suitable for secondary analysis since first wave of analyses indicated divergence of themes among the research team. Eleven unidentifiable interview scripts were analysed using a constructivist Grounded Theory approach. Since external factors impacting on engagement are already well discussed in literature, the analysis presented focused on less well-covered themes and themes relating to internal factors. The emergent themes were discussed in the context of existing literature to facilitate future interventions for improving engagement.

Despite enhancements in medical asthma treatments, the disparity in asthma outcomes remains a pressing issue in asthma care and represents a significant personal burden for individuals living with asthma. To further improve available care, it is crucial to better understand which psychological factors might account for such disparity and the mechanisms through which they operate. In two chapters, the current research portfolio aimed to explore the role of psychological factors in asthma morbidity outcomes in adults with asthma. The first chapter is a systematic review exploring the relationship between six emotion regulation strategies: acceptance, avoidance, problem-solving, reappraisal, worry/rumination and suppression and asthma outcomes: asthma control, health-related quality of life (QoL), health care utilisation and medication compliance in adults with asthma. A systematic search of four electronic databases resulted in 18 studies which met the inclusion criteria. The systematic review highlighted significant relationships between emotion regulation strategies and asthma outcomes. The direction of these relationships depended on the type of emotion regulation strategy and the asthma outcome studied. Findings from the current review highlighted that psychological interventions aimed at promoting more adaptive emotion regulation skills in adults with asthma might positively influence their asthma morbidity outcomes. Further research is needed, using improved methodological design and a clearer conceptualisation of emotion regulation construct. The second chapter presents an empirical study. It explored the role of generalised anxiety (GA) in asthma outcomes: asthma QoL, asthma control and short-acting asthma reliever medication use (SAARM) and the potential mediation role of experiential avoidance (EA) and asthma control self-efficacy (SE). A cross-sectional set of questionnaires was completed by 65 participants attending NHS outpatient respiratory clinics. Correlation and mediation path analyses were conducted. Higher GA was associated with poorer asthma outcomes, lower asthma control SE and higher EA. After controlling for covariates, both SE and EA were found to mediate the relationship between GA and both asthma control and QoL. Neither SE nor EA played a mediatory role in the relationship between GA and SAARM use. These results need to be replicated in research using a longitudinal design. However, they provide preliminary support that psychological interventions targeting asthma control SE and EA could promote better asthma control and QoL in adults with asthma and co-morbid anxiety.

Background: Palliative care professionals work with ongoing emotionally and practically challenging situations. These challenges may include dealing with complex symptomology, being unable to relieve suffering, patient deaths, and having to have difficult end-of-life conversations with patients and their family members. Despite these challenges, palliative care professionals appear to have similar or lower levels of occupational stress or burnout compared to other medical professional groups (e.g. oncology, medical-surgical, etc.). The current thesis had three main aims. Firstly, it was hoped that this research could lead to better decisions around measuring occupational stress in palliative care professionals. Second, this research aimed to describe and understand the experiences of palliative care professionals and the helpful and unhelpful ways they respond to stress or challenges at work. Thirdly, this thesis hoped to explore the role of psychological flexibility (i.e. ability to contact the present moment without judgment while persisting or changing behaviour in accordance with chosen values) in the wellbeing of palliative care and other healthcare professional wellbeing. Fourthly, this thesis also aimed at further investigating the psychometric properties of the Mindful Healthcare Scale (MHS; Kidney, 2017), a new measure of psychologically flexible helping. To address these aims the research in this thesis made use of multiple research methodologies including a systematic review, a qualitative framework analysis study, and a longitudinal survey design. Study 1 method and results: The first study was a systematic review of occupational stress measures used with palliative care professionals; it also aimed to investigate psychological predictors of occupational stress in this population. In this review, the COSMIN was used to rate the quality of the studies with respect to the psychometric properties being addressed in each study. The results indicated that Maslach Burnout Inventory, Professional Quality of Life Scale, and Nursing Stress Scale were the most widely used measures and had the most evidence to support their use with palliative care professionals. However, based on the COSMIN criteria the methodological quality of the studies was fair overall. In addition, a narrative review of the psychological predictors of occupational stress was provided. A number of psychological factors identified as protective (e.g. self-efficacy/competence, professional social support) and harmful (e.g. psychiatric morbidity, deathrelated anxiety) for palliative care professional wellbeing. Overall, this review implies that the methodological quality of studies in this area could be improved particularly by making hypotheses more explicit, reporting missing data information, and using more longitudinal designs to examine responsiveness and test-retest reliability of measures. Study 2 Method and Results: A qualitative framework analysis study was used to describe and understand the experiences of palliative care professionals and how they responded in helpful or unhelpful ways to challenges at work. Semi-structured interviews were conducted with 9 employed palliative care professionals. Participants identified being able to make a difference to the suffering of others and personal growth as sources of meaning and purpose in their work. Participants also highlighted emotional challenges in providing palliative care, difficult patient family dynamics, work environment factors (e.g. caseload), uncontrollability of patient symptoms, having goals blocked and public perceptions of palliative care work as stressful as frustrating aspects of their work. They also noted areas in which this work had a personal impact such as making them more clear about life priorities and being more comfortable with death and dying. In addition, a number of helpful (e.g. accepting of challenges, being present) and unhelpful (e.g. self-doubt, lack of self-care) responses were explored in relation to their wellbeing and performance at work. This study provides further understanding of the experiences of palliative care professionals and has some implications for the design of interventions/training programs for this population. Study 3 Methods and Results: This study was a longitudinal survey study of palliative care provision, general psychological flexibility (i.e. Comprehensive Assessment of Acceptance and Commitment Therapy processes [CompACT]; Francis et al., 2016), psychological flexibility in healthcare providers (MHS), self-compassion, self-as-context, and empathy in predicting wellbeing in healthcare professionals. Participants were recruited through social media (e.g. twitter posts with a link to the study), contacting Marie Curie Hospices in Scotland, and word of mouth. Participants who completed survey at time point 1 (T1; N = 163) were invited by email to take part in the survey at time point 2 (T2; N =83). Data from T1 were used to examine the structural validity of a new measure of psychological flexibility in healthcare work (Mindful Healthcare Scale [MHS]; Kidney, 2017) and to conduct a cross-sectional analysis of the relationships between the psychological predictors and the wellbeing outcomes. Data from T2 was used to examine the predictive ability of the psychological predictors measured at T1 and wellbeing outcomes measured at T2. A confirmatory factor analysis (CFA) approach and an exploratory structural equation modelling (ESEM) within CFA (EwC) approach were used to examine the structural validity of the MHS and its subscales (Engaged, Awareness, and Defusion) in healthcare professionals. ESEM is a less restrictive approach compared to CFA and allows for the cross-loadings of items. Of the 163 participants recruited at T1 one participant was excluded for having incomplete MHS response leaving 162 participants in the analysis. Two measurement models were tested: (1) The original MHS model [Higher order factor: PsychFlex. Firstorder factors: Engaged (5 items), Awareness (5 items), and Defusion (3 items)] (2) a one factor model [i.e. all items loading onto psychological flexibility], Results from these analyses suggested that the ESEM approach outperformed the CFA approach in terms of model fit for the original model but not for the one-factor model. Furthermore, the original model as analysed using the EwC approach was the only model that reached satisfactory fit; the CFA approach to the original model did not reach a satisfactory fit. The onefactor model was not considered to have satisfactory fit in either CFA or ESEM analyses. These findings suggest that the original model of the MHS is a robust measurement of psychological flexibility in healthcare professionals. It also suggests that the MHS may be best conceived as a multidimensional measure of psychological flexibility with items loading onto more than one factor. The cross-sectional survey data at T1 were used to examine the role of psychological flexibility in predicting wellbeing and burnout in healthcare professionals. Based on correlational analyses, psychological flexibility (both the generic and healthcare specific measure) appeared to positively correlate with general wellbeing and compassion satisfaction and negatively correlated with burnout and secondary trauma. However, the defusion subscale of the MHS only significantly and negatively correlate with secondary trauma. In hierarchical regressions, it was revealed that the subscales of the MHS added significant additional variance in the prediction of the outcomes over and above the subscales of the CompACT. However, the defusion subscale only contributed to additional variance in secondary trauma. Palliative care and non-palliative care providers differed on the fantasy subscale of the empathy measure but not on any other measures. The longitudinal data (including both T1 and T2) were used to examine the ability of psychological flexibility to predict wellbeing outcomes in healthcare professionals at a six-month follow-up. The MHS total score, engaged subscale, and awareness subscale positively correlated with general wellbeing and compassion satisfaction and negatively correlated with burnout. However, only the awareness subscale and total scale negatively correlated with secondary trauma. Defusion was found to only be significantly correlated with compassion satisfaction but in the negative direction (r = -.27, p < .05). Therefore, a revised MHS was explored in further analyses (Revised MHS = Engaged + Awareness; i.e. without defusion). The revised subscale correlated in expected directions with all outcomes. In terms of incremental validity across time, the revised MHS explained additional variance for compassion satisfaction and burnout over and above the CompACT. However, it did not add additional variance for general wellbeing or secondary trauma across the six-month interval These findings also suggest that psychological flexibility can predict future wellbeing and burnout outcomes in healthcare professionals. The longitudinal data was also used to examine the test-retest reliability of the MHS. Based on the Intraclass Correlation Coefficients (ICC) the testretest reliability of the original MHS (ICC = .77, p < .001), defusion subscale (ICC = .78, p < .001) and the revised MHS (ICC = .80, p < .001) were considered good; whereas the engaged subscale (ICC = .73, p < .001) and awareness subscale (ICC = .71, p < .001) were considered moderate. Therefore, the MHS appeared to have moderate-to-good test-retest reliability. Future research should extend this finding and examine the responsiveness or sensitivity to change of the MHS.

Mangroves are among the most carbon-dense ecosystems in the world. However, it is unclear whether natural and restored mangroves will continue to sequester carbon in the face of global environmental change. I used both laboratory mesocosms and field experiments to investigate the effect of global changes (reforestation, warming and sea level change induced by climate change) on fine root production (chapters 2 and 3) and on soil organic matter (SOM) decomposition (chapter 4). In addition, I identify the controls on soil water regimes in mangrove soils (chapter 5). My research showed that warming from 27 to 31°C increased SOM decomposition by 21 %, though this impact was reduced in mangrove soils affected by rising sea levels. Drought conditions (simulated as a suppression of soil inundation) sharply increased SOM decomposition (+66 %) and acted with warming to exaggerate this effect. Rising sea levels (simulated as an increase of inundation duration from two to six hours per day), alone or combined with warming, did not affect SOM decomposition. Therefore, the persistence of mangrove to sea level rise by accumulating SOM is likely driven by mangrove root production, and not by reduced SOM decay as previously assumed. Root production might be altered by additional global change factors (chapter 3). I showed that following mangrove restoration the fine root production declines monotonically with mangrove stand ages. This age-related pattern has been observed in aboveground production, but has not previously been reported in belowground carbon. Forecasts of changes to mangrove carbon storage and the persistence of these ecosystems in the face of rising sea levels need to account for stand ages in reforested mangroves (chapter 3). Finally, I showed that clayey mangrove sediment does not drain during ebb tides, even in locations with high densities of animal burrows. Only mangroves with coarser sediments seem to be sensitive to animal burrows. A possible shift toward coarser sediment with rising sea levels may lead to changes in lateral water flows within mangrove soils and their associated carbon loss (chapter 5). Overall, my thesis findings have important implications for understanding both mangrove carbon dynamics and the persistence of mangroves and other coastal wetlands under current and future environmental conditions.

Crying accompanies a person's most important life moments, it is a new-born's primary mode of communication, and is found in all cultures at every stage of a person's life. Crying is thought to not only communicate emotions, but to act as a cathartic mechanism that reduces physiological arousal and improves mood. Whilst crying involves different behaviours, it is the visible shedding of tears, known as weeping, which is considered the main component. Despite weeping being the main behaviour, it has received little focus in the crying literature, primarily, due to the difficulty in inducing weeping in a controlled environment. The overarching aim of this program of research is to investigate the role of weeping on the intraindividual and interindividual functions of crying. In Chapter two, we reviewed the emotion induction literature and demonstrate how heart rate responses are dictated by how we induce emotions and not which emotion we induce. The results of this large review are consistent with predictions made by the intake-rejection hypothesis taken from the classic cognitive psychophysiology literature. The intake-rejection hypothesis suggests attending to external stimuli reduces heart rate, whereas, turning our attention to internal cognition, such as memory, increases heart rate. We found heart rate responses in emotion inductions were a product of attention and not affect. We suggest the primary reason for our findings is because laboratory induced emotions are mild. Moving forward, we propose developing induction procedures that will increase the intensity of emotions, this is especially important for laboratory induced weeping where intense emotions are a necessity. In Chapters three and four, we used an idiographic induction technique to induce weeping in the laboratory. We measured multiple psychological and physiological indices including facial thermography, heart rate, respiration rate, skin conductance and subjective affect. In Chapter three, we found episodes of weeping were associated with a large increase in facial temperatures and increased negative affect compared to non-weepers. These changes were in the absence of any major cardiorespiratory or electrodermal responses. In Chapter four, we showed how the suppression of tears led to a physiological stability, whilst, weeping was again associated with large facial temperature increase. The thermal response was influenced by increased sympathetic nervous system activity and was specifically tied to weeping and not underlying affect. Overall, we found no evidence weeping led to any psychophysiological restoration. In Chapter five, we explored the interindividual function of weeping and why tears signal sadness despite accompanying a range of both positive and negative emotions. Context is an important influence of how we perceive the emotion of others. The situational cues provided by setting a context can alter the way emotional expressions are perceived, the Kuleshov effect is a film editing technique creates meaning through the interaction of contextual scenes and actor expressions. We utilised the Kuleshov effect, to add emotional context to videos of weeping targets. We found that weeping was associated with increased attributions of both sadness and the contextual emotion. This suggests the context is having a top-down effect on the judge's perceptions of emotions; however, this effect was present in some but not all judges. Overall, this program of research shows not only the importance of weeping to our understanding of crying, but the importance of weeping in context. We suggest that weeping should be considered primarily as a social signal opposed to having any immediate benefit to the crier. Secondly, by using an idiographic induction technique we were able to generate strong emotions in the laboratory that may help inform the wider debates in the emotion literature.

Introduction: Functional neurological symptoms are commonly reported by people presenting to neurology services. Symptoms are diverse, and there is little published evidence to inform treatment guidelines. Idiopathic drop attacks are also seen within neurology services, but literature about them is sparse and it is unclear whether they should be considered within the spectrum of functional neurological disorder. Aims: The aim of this thesis was to assess cognitive behavioural therapy (CBT) as an intervention for functional neurological disorder (FND), through a systematic review and meta-analysis. A second aim was to look at idiopathic drop attacks and determine whether a psychological understanding of these would help to inform formulation and treatment. Methods: A systematic review identified 28 studies of CBT for FND, nine of which were included in meta-analysis. In addition, a grounded theory study of idiopathic drop attacks was conducted through the coding and synthesis of data from interviews and diaries of seven individuals with FND, with the aim of identifying predisposing, precipitating and maintaining factors. Results: In the systematic review and meta-analysis, random effects models revealed a significant advantage of CBT over control on daily functioning, and a significant improvement within CBT groups over time. CBT also had a significantly positive effect on anxiety, depression and functional neurological symptoms, both compared to control groups, and within CBT groups over time. Positive effects of CBT were maintained over six months. In the grounded theory study, themes relating to predisposing and precipitating factors for drop attacks, along with thoughts, emotions and behaviour both before and after a fall, were identified. A cognitive behavioural model was proposed, with a traumatic first fall and life stressors as predisposing factors, situational triggers and increased worry as precipitating factors, and a maintaining cycle of thoughts, emotion and behaviour. Conclusions: Meta-analysis suggests that CBT may be effective for FND, and that the positive impact of this persists over time. However, as the evidence base is currently small, larger trials are required. The grounded theory study proposed a cognitive behavioural understanding of the onset and maintenance of idiopathic drop attacks and noted considerable overlap between drop attacks and non-epileptic seizures. This understanding could help to guide formulation, and suggests a CBT treatment approach would be worth exploring in this population.

Introduction: The thesis had two objectives. The first was to explore the effects of paediatric traumatic brain injury (TBI) on non-injured siblings. A systematic review investigated psychosocial outcomes for young people with a brother or sister that had sustained a TBI. An empirical study explored the lived experience of being a sibling to a young person who has sustained a moderate or severe TBI. The second objective was to assess the validity of regression equations used to predict older adults expected (or premorbid) test performance on measures of executive functioning. An empirical study conducted external double cross validation of regression equations for three measures of executive function: the Trail Making Test, and the Hayling and Brixton Tests. Methods: Eleven studies were identified via systematic review using predefined criteria. The first empirical study recruited three young people who lived with their siblings who had sustained a moderate to severe TBI within the past five years. Participants engaged in a semi-structured interview and the transcripts were analysed in accordance with interpretative phenomenological analysis. The second empirical study compared observed test performance of 132 older adult participants to an estimate of their performance (as predicted by demographically-based regression equations). New predictive equations were generated. Results: The systematic review indicated that having a sibling who has sustained a TBI is a risk factor for experiencing problems with mood and self-esteem. Overwhelming emotion, ongoing emotional burden, altered family dynamics and resilience and growth were found to be pertinent themes in the empirical study. Caution is necessitated in generalising these results due to the small sample size. In the second study, existing regression equations did not generalise to a new sample and so were not recommended for further use. New predictive models indicate that age and estimated IQ predict performance on tests of executive function; and socioeconomic status and participant sex also influencing performance on the Hayling and Brixton tests respectively. Conclusions: Further high quality research which is adequately powered, has suitable control groups and incorporates child self-report in addition to parent report is needed to address the outcomes and experiences of siblings following paediatric TBI. Regression models for the prediction of test scores need to be validated in a further external sample prior to their application in clinical settings.

This thesis aimed to explore the applicability and effectiveness of the Acceptance and Commitment Therapy (ACT) model. The first chapter is a systematic review of the effectiveness of ACT in enhancing psychological flexibility in adults. The review found good evidence from the eleven included studies that ACT treatments are effective. There was preliminary evidence that ACT was more effective than other treatments, but results were not conclusive. Further research using theoretically-consistent measures is recommended. The second chapter is an empirical study exploring the role of ACT processes in retirement. A cross-sectional survey completed by 181 retired people explored value-directed living, cognitive defusion and psychological flexibility in predicting wellbeing, adjustment and distress. Correlation analyses and multiple hierarchical regression analyses were conducted. The psychological factors were found to explain unique variance in these outcome variables, even when the variance from known predictors such as physical health had been accounted for. Psychological flexibility was found to be the strongest predictor of wellbeing, adjustment and distress. These findings need to be replicated in longitudinal research, however they provide initial evidence that interventions aimed at improving psychological flexibility could be beneficial for people in retirement.

Introduction: The objective of this thesis was to examine aspects of emotion regulation in Multiple Sclerosis (MS). A systematic review was carried out of studies investigating the prevalence of alexithymia in individuals with MS, and its relationship with anxiety and depression. An empirical study was conducted to explore whether there were differences in emotion regulation abilities in individuals with different variants of MS, compared to healthy individuals. Methods: Twelve journal articles were identified via systematic search utilising predefined criteria. Seventy nine individuals with relapsing-remitting type of MS, and 38 individuals with chronic progressive type of MS were recruited to the empirical study. Participants filled in self-report questionnaires measuring difficulties in emotion regulation, illness severity, illness representations and quality of life. Also, 55 healthy volunteers took part in the current study. Results: The estimate of prevalence of alexithymia in MS was approximately twice as high as in general population. Positive relationships between alexithymia and/or anxiety and depressive symptoms were found. Those with MS reported difficulties accepting emotional distress which, to some extent, were predicted by strong illness identity and negative emotional responses to having MS. These findings were independently of illness severity, and type of MS. Perceptions of negative consequences of MS were the only partial mediator of the relationship between illness severity and quality of life. Conclusions: Larger and more representative samples are needed to clarify the impact of alexithymia on the clinical presentations of patients with MS. Psychological interventions targeting non-acceptance of emotional distress and negative illness perceptions are warranted to support those with MS.

Purpose: The systematic review explored whether self-management interventions improve patient activation in long-term conditions, and if any improvements are greater than the amount of change experienced by patients in usual care or active control conditions. It also aimed to determine if positive effects on activation are maintained at follow-up. The empirical study sought to explore relationships between patient activation, psychological factors (depression and valued living), perceived clinician empathy, perceived symptom severity, self-management and demographic variables. It also examined whether depression, valued living and perceived clinician empathy are unique predictors of activation, and if activation is a unique predictor of self-management for MS, when relevant confounding variables are controlled for. Methods: For the systematic review, a comprehensive search of multiple electronic databases was conducted to identify intervention research reporting on patient activation outcomes, as measured by the short-form Patient Activation Measure (PAM-13), in people with long-term conditions. For the empirical study, a cross-sectional survey of 118 people with MS explored patient activation, MS symptom severity, valued living, depression, perceived clinician empathy, self-management for MS and demographic factors. Correlation and hierarchical regression analyses were employed to explore relationships between variables. Results: Twenty-five studies were eligible for inclusion in the systematic review, reporting a wide range of long-term conditions. Twenty-one studies (10 RCTs; 1 non-randomised study; and 10 uncontrolled studies) found an improvement in patient activation at post-intervention. Nine studies reported a significantly greater improvement in activation in self-management conditions compared with usual care or an active control at post-intervention. In six out of eight studies, gains in patient activation were maintained in the intervention group at follow-up. However, in four of these six studies, patient activation in the control group also improved over time. Findings from the empirical study suggested that only valued living was a significant predictor of patient activation after controlling for demographic variables and MS symptom severity. Neither depression nor perceived clinician empathy significantly predicted activation. After controlling for valued living, depression and perceived clinician empathy, patient activation independently predicted 5.5% of variance in self-management for MS. Both activation and perceived clinician empathy were significant predictors of self-management for MS. Conclusions: Self-management interventions improve patient activation in long-term conditions compared with usual care or active control. Patient activation gains appear to be maintained longer-term; however, the impact of self-management interventions on activation is unclear due to increases in activation in control groups over time. Valued living is associated with patient activation in MS, while patient activation and perceived clinician empathy are associated with MS self-management. Self-management interventions targeting valued living and the patient-clinician relationship may be effective for addressing low levels of activation in some patients with MS.

Clinical decision-making about psychological interventions is best supported by robust evidence and informed patient choice. Randomised controlled trials (RCTs) are the current gold standard in evaluating intervention effectiveness and identifying harm. At present, RCTs of psychological intervention are unlikely to include measurement of adverse effects and this is in part due to lack of consensus about this topic. A Delphi study was conducted with a panel of both professionals and people with personal experience of face-to-face psychotherapy across the spectrum of mental health difficulties to seek consensus on what to include on a measure of adverse effects. Fifty-four items derived from an initial list of 147 items generated by the panel, are included on the APTMOS outcome measure, which now in it's preliminary form now requires validation before use in RCTs. To date, the evidence for psychological interventions for psychosis and schizophrenia has not been synthesised, which is important to inform patient choice and decision-making. Network meta-analysis compares multiple interventions using direct evidence from randomised controlled trials (RCTs) and indirect evidence from the network. A systematic review of the literature identified 91 RCTs across 23 different intervention/control group categories. Psychological interventions were more effective at reducing total symptoms of psychosis than control groups. One intervention with a low risk of bias, mindfulness-based psychoeducation, was consistently identified as most effective, with large effect sizes. Subgroup analyses identified differential effectiveness in different settings and for different subgroups. Further high quality RCT evidence of the highest ranked interventions is required to inform updates to clinical guidelines of psychological interventions for psychosis.

As the name implies, indeterminate sentenced prisoners in England and Wales do not have a fixed release date. Instead, a panel of the Parole Board decides whether or not the prisoner can safely be released or moved to a lower security prison without presenting a significant risk of harm to the public. In order to make these decisions, the Parole Board panel relies on written and oral evidence from a range of professionals, including psychologists, who have assessed the risk of the prisoner committing further serious offences. As part of the risk assessment process, psychologists interview prisoners in order to inform their recommendations to the Parole Board. Despite the potential implications of psychological risk assessment, there has been little research focused on how it is experienced by those whom it affects. However, there is suggestion within the extant literature that psychological risk assessment carries substantial weight in Parole Board decision making. Additionally, relationships between prisoners and psychologists seem to be characterised by hostility and mistrust. This research aimed to gain greater understanding of the experiences of psychologists, indeterminate sentenced prisoners and Parole Board members in relation to psychological risk assessment. It also explored relationships between psychologists and prisoners and their experiences of the risk assessment interview. Data were gathered mainly from interviews with the three stakeholder groups and analysed using Grounded Theory methodology. The results reveal pressures and contextual influences on all three participant groups. The prison environment, the organisation and the high stakes nature of the task differentially affect psychologists, prisoners and Parole Board members. Consequently, taking a more systemic approach to understanding and conducting risk assessment is essential in reducing stress and improving the quality and utility of risk assessment. The results also suggest competing views of the legitimacy of psychological assessment. Psychologists and Parole Board members perceive it as valuable and justifiably influential in parole decision making. Prisoners perceive it as unfair and opaque, a view which contributes towards resentment and mistrust of psychologists. The risk assessment interview is an opportunity for differing perspectives to interact. Therefore, the interview is best understood in intersubjective terms, with participants' multiply and reciprocally influenced by their own and each other's attitudes and behaviour. The results also reveal a shared understanding between prisoners and psychologists about features of risk assessment interviewing that are most likely to promote trust, engagement and consequently legitimacy. These elements can be built on to improve risk assessment practice. Overall, this study has improved understanding of the experiences of the three participant groups. It has highlighted the importance of understanding context when trying to understand criminal justice practice. It has identified the unique intersubjective experience of risk assessment interviewing, and the inevitability of influence on the participants. Finally, it has revealed areas where psychological risk assessment can improve in order to promote legitimacy and procedural justice.

Water provision is a valuable ecosystem service that is of central importance to human well-being. Peatlands are potentially important to the sustainable provision of potable water because water draining from peatlands is often of good quality, other than being rich in dissolved organic carbon (DOC). However, there have been no attempts to date, to investigate the role of peatlands in potable water supply at a global scale. In this thesis, an improved global peatland map (PEATMAP) was developed, which is freely available as a potentially useful tool for peatland or wetland researchers. The new map provided a basis from which to estimate global hotspots of peatland-derived potable water use. The volume of annual drinking water delivered by these catchments was estimated, and the status of the water-supply peatlands were evaluated, being the first such estimates at the global scale. Application of PERSiST and INCA-C models across the nine catchments in the UK, which are among the most important peatland-derived drinking water supply catchments in the world, provided evidence of the potential changes in DOC concentration and DOC flux under 21st-century climate and sulphate deposition scenarios. The results show that total global peatland area is 4.23 million km2, approximately 2.84 % of the world land area. Water supply peatlands provide approximately 4.22 km3 yr-1 of peat-fed drinking water globally, equivalent to typical consumption of 71.4 million people, but only 28 % of water-supply peatlands are pristine or protected globally. Although DOC flux is largely insensitive to future climate change scenarios, DOC concentrations in UK water sources are likely to increase while discharges are likely to decrease under all 21st-century climate and sulphate deposition scenarios tested.

Mental time travel (MTT) refers to an individual’s ability to mentally travel through subjective time, autonoetically re-experiencing past events under the form of autobiographical memories (past MTT), and pre-experiencing events as future autobiographical representations (future MTT). MTT can occur voluntarily, whereby a past/future autobiographical event is subjectively experienced as an intended occurrence, or involuntarily, wherein such an event is subjectively experienced as an unintended outcome of which the individual is aware. Studies investigating MTT’s characteristics in dysphoria and depression show that dysphoric and depressed individuals produce more overgeneral and negative MTT events when compared to control groups. However, existing research has been limited to past and voluntary MTT events, with few studies investigating involuntary MTT and future MTT in dysphoria and depression. The overarching aim of the present research was to compare the phenomenological characteristics of MTT in dysphoric individuals vs. normal mood individuals (Study 1), and in clinically depressed individuals vs. never-depressed individuals (Study 2), with the purpose of furthering existing knowledge on MTT and its relation with dysphoria and Major Depressive Disorder. This aim was addressed by conducting two studies, using a 2 x (2 x 2) mixed-factorial design, with temporality (past vs. future events) and type of retrieval (voluntary vs. involuntary events) as within-subjects independent variables, and participant group as a between-subjects variable. In Study 1, Portuguese university students were categorised into a dysphoric (n=17) or a normal mood group (n=39) depending on their score on the Beck Depression Inventory (BDI-IA) – cutoff point (≥ 10). In Study 2, clinically diagnosed depressed patients (n=32) were recruited from a Portuguese hospital and matched for age and gender with never-depressed control participants (n=32) recruited from the community. The dependent variables tested were: level of spatiotemporal specificity, self-relevance, mood and physical impact, valence, and visual perspective of the MTT events produced. A diary methodology was used in both studies, with an open-ended time period that lasted for a minimum of two weeks, for participants to record their MTT events and grade them on the above mentioned variables using Likert-type ratings. Between seven and fourteen MTT events were produced for each of the four MTT conditions (past voluntary, past involuntary, future voluntary, future involuntary). Results showed that when compared to their respective control groups, depressed, but not dysphoric participants, exhibited a clear influence of mood on several of the phenomenological characteristics of MTT. In Study 1 there were no statistically significant differences in the specificity, negative valence, and mood/physical impact of the MTT events produced by dysphoric and normal mood participants. On the contrary, in Study 2, results partially supported a lower specificity and fully supported a greater negativity and mood/physical impact of MTT events in depressed individuals compared with never-depressed participants. Both studies supported the greater self-relevance of voluntary MTT events and partially supported the hypothesised effect of type of retrieval in specificity. These were the first studies to directly compare past and future, voluntary and involuntary MTT events in dysphoric and depressed individuals, addressing existing gaps in the literature. The key limitation is the relatively small sample size of both studies, however each participant was comprehensively assessed for at least two weeks, providing a rich set of reliable data. Despite limitations, this thesis provides novel pilot findings that help understand the similarities and differences between involuntary and voluntary, past and future MTT, as well as providing new information regarding the possible role of MTT in dysphoria and depression.

The physical and psychological health enhancing benefits of physical activity have been well established (US Department of Health & Human Services, 1996; Warburton, Nicol & Bredin, 2006) and reviews support the anxiolytic, antidepressant and stress reducing effects of physical activity, but it is unclear if group or solo physical activity is more effective in the reduction of these forms of psychological distress. A recent survey found that approximately a third of adults in Scotland do not engage in sufficient levels of physical activity recommended to achieve these benefits. The aim of this thesis was to investigate the effectiveness of group versus solo physical activity in the reduction of psychological distress (including stress, depression and anxiety) and factors involved in participation to promote greater engagement in physical activity. The first study issued questionnaires to members of the general population and university students. Inverse correlations were found between group physical activity and psychological distress in both samples. However a single positive correlation was found between anxiety and solo physical activity in the student sample, which suggests that group physical activity may be more effective in the reduction of psychological distress than solo physical activity. Low active individuals appeared to prefer solo physical activity to group, which may be due to lower perceived barriers. More active participants either preferred group activity or had no preferences between group or solo activity, despite also perceiving greater barriers to group than solo activity. The second study allocated university students to a group versus solo jogging condition intervention and found that psychological distress increased for those allocated to solo jogging, but did not increase amongst those allocated to group jogging, suggesting that group physical activity may protect against university related distress. Those allocated to group jogging engaged in (non-significantly) more jogging and engaged in significantly more moderately intensive physical activity throughout the intervention than those allocated to solo jogging. The final study compared group and solo physical activity using the Theory of Planned Behaviour and structural equation modelling. The model explained more variance in group physical activity than variance in solo physical activity. When the model was expanded, self-efficacy made a significantly greater contribution to intention in the solo physical activity model than it did in the group activity model, therefore promotion of group physical activity may not be as dependent on self-efficacy as solo physical activity. Perceived autonomy support (PAS) was included in the model, as guided by modification indexes, but only the group physical activity model was significantly improved by the addition of PAS; this may be useful for the development of group physical activity promotion. This thesis finds some support that group physical activity may be associated with reduced psychological distress and be more beneficial in protecting against psychological distress than solo physical activity. Promotion of group physical activity may benefit from reducing perceived barriers, developing PAS, and having less reliance on self-efficacy than required for the promotion of solo physical activity.

Psychological distress is common during pregnancy. The objective of this thesis was to evaluate the effectiveness of antenatal cognitive behavioural based treatments in reducing psychological distress in pregnant women. A systematic review was undertaken of randomised controlled studies utilizing antenatal cognitive behavioural based treatment in reducing anxiety and stress compared to treatment as usual. Eleven papers were identified through a systematic search of databases using predefined criteria comparing intervention groups to treatment as usual in pregnant women with anxiety or stress. The systematic review revealed preliminary evidence for the effectiveness of cognitive behavioural based treatment with several studies noting changes over time in anxiety and stress; however, only a few studies reported intervention effects when compared to control. While the systematic review results suggest that a small number of cognitive behavioural based interventions may be effective in reducing anxiety and stress during pregnancy compared to treatment as usual, confidence in these findings is limited due to methodological limitations such as lack of follow-up, high attrition rates and difficulties with generalisability. The evidence base is currently insufficient and further research which utilises a robust methodology is needed before any reliable conclusions can be drawn. An empirical study was conducted to examine the effectiveness of a brief, single-session stress reduction programme introducing cognitive behavioural techniques aimed at reducing general anxiety, other pregnancy related distress and improving general well-being and pregnancy outcomes. Twenty-nine participants with clinically significant levels of anxiety were recruited to the empirical study from the local maternity hospital. Participants completed measures of general anxiety, pregnancy related anxiety, general well-being and childbirth experience. The control was derived from a historical dataset where 37 participants were matched for baseline anxiety levels. The empirical study demonstrated significant reductions in general anxiety; however, similar findings were also observed in the control group. Significant reductions were observed with pregnancy related anxiety and women also reported their childbirth experience similarly regardless of delivery type. Although our findings were not significant when compared to control, our recruitment design resulted in good return rates following birth. Further studies using sophisticated study design with use of robust control group are required.

The purpose of this research was to enhance our understanding of the experiences of visiting Chinese students throughout the duration of their two-year postgraduate studies in creative programmes in a UK university. The specific areas examined were: one, the students’ perceptions of, and perspectives on, their academic and social experiences; and two, identifying how such experiences changed or developed as the students progressed through the two-years of their studies. The research involved a two-year longitudinal study of Chinese students who arrived in September 2009 at a well-known Art College in London. These students were enrolled on art and design postgraduate courses that placed a premium upon the ability to use their imagination to generate new ideas and then develop such ideas in an innovative manner. The study examined the possibility that as such courses do not base themselves on established bodies of knowledge or transmissive pedagogies, that it could possibly challenge the students’ prevailing epistemological concepts and pedagogical assumptions. The method of enquiry was via a qualitative methodology within an interpretative approach, utilising data obtained by audio-recorded, semi-structured interviews, following British Educational Research Association guidelines. Three sets of interviews were undertaken with each student: near the beginning, at the middle and at the end of their two-year courses, thereby fulfilling the longitudinal basis of this study. The approach to analysis was characterised by thematic coding with a focus on understanding the ‘themes of concern’ from the narrative accounts gathered from the interview data. Originally it had been anticipated that challenges arising from the nature of the programmes, specifically the focus on creativity and criticality, would be the main difficulty the students would encounter. However it ultimately emerged that their lack of colloquial English, pedagogical issues and socio-cultural difficulties would be their major problems. However, whilst these three main challenges were identified by all of the students there was significant variation in their perceived impact on individual students over the two year duration of the programme.

Domestic dogs (Canis familiaris) are ideal subjects for the comparative study of collaboration: they form stable social groups, engage in cooperative behaviour, and are characterised by human-like social skills. Moreover, dogs understand when human communication is intended for them, they obtain information about the emotional valence of human facial expressions and vocalisations, and readily form attachment bonds with humans. It has been hypothesised that, during the domestication process, dogs have been selected for collaborative activities with humans and evolved some human-like social skills as an adaptation to life with humans. However, collaborative interactions between dogs and humans are understudied and not well understood. The aim of this research is to explore dogs’ behaviour in contexts seen as the building blocks for successful collaboration: informative communication, reputation forming, and other regarding preferences. In the first chapter of the thesis I review the literature on these topics. In Chapter 2, I explore the applicability to dogs of an experimental method for the comparative study of informative communication. In Chapter 3, with a simplified protocol, I provide evidence that dogs have some level of understanding of the relevance of the target for a human partner. Chapter 4 investigates reputation forming in dogs, suggesting that they do not take into account their previous experience about a human partner’s skilfulness when they communicate to request human help. In Chapter 5, I use a novel apparatus for the study of other-regarding preferences, confirming that, in a food sharing situation, dogs do not act altruistically towards humans but are rather motivated by the expectation of obtaining the food reward. Finally, in Chapter 6 I discuss the findings in the light of the current literature. The research presented in this PhD provides evidence that dogs may possess some of the building blocks of collaboration but not others. Specifically, they may have some understanding of the relevance of a target of communication for a human partner. However, there is no evidence that dogs’ can use reputation judgments in collaborative contexts as flexibly as humans or chimpanzees, and in terms of other-regarding preferences, dogs do not appear to act altruistically towards humans when food is involved. Overall, the current results may be taken as a confirmation that dogs’ human-like social skills may represent a specialisation to receive human communication.

Provisional Question for the thesis to address: Indicated and selective prevention of common mental health problems in later life: Is there a theoretical rationale for an Acceptance and Commitment Therapy approach? Background The burden of late life depression and anxiety is significant. Even subthreshold symptoms result in great individual, community, economic and societal cost. However, common mental health problems in later life are under‐recognised and under‐treated despite evidence in support of pharmacological and psychological intervention. Previous research regarding psychological therapy for late life mental health problems has been dominated by cognitive behavioural therapy. However, the effectiveness of this approach has been questioned, leading researchers to explore alternative approaches. Acceptance and Commitment Therapy has received increasing attention from researchers keen to explore an alternative and some have argued that this approach is particularly suited to older people. In the context of demographic change and a significant increase in the proportion of community dwelling elderly there is a need to provide evidence to support the use of alternative management strategies for late life mental health problems, for example, focusing on prevention. Methods A systematic review will evaluate the current evidence for the use of ‘indicated’ and ‘selective’ prevention interventions for older people at risk of developing a major depressive or anxiety disorder due to the experience of subsyndromal symptoms or the presence of significant physical, socioeconomic, and psychosocial risk factors. This paper will be followed by an empirical article in which the relationship between psychological processes and ageing will be explored. Specifically, this study will explore psychological flexibility, the use of Selection, Optimisation and Compensation strategies, and the presence of psychopathology in a non clinical sample of community dwelling older people. Results Findings of the systematic review provide preliminary evidence for indicated and selective prevention of late life depression, however there is no clear evidence of benefits of these interventions in late life anxiety. The relationships between variables in the empirical study were explored using descriptive statistics, correlation analysis, and conditional process modelling. Although the study did not find age to be a specific predictor of variance in psychological variables explored, the study did provide empirical support for the potential to use Acceptance and Commitment Therapy with older people. Discussion The systematic review article provided preliminary evidence for the efficacy of selective and indicated prevention interventions for late life depression. However, further research is required to consolidate these findings. The empirical paper found significant relationships between the perception of positive health, reduced psychopathology and theoretical variables including cognitive fusion, engagement in valued living, and the use of Selection, Optimisation, and Compensation strategies. Cognitive fusion was found to mediate these relationships and as such, findings provide support for the use of an Acceptance and Commitment Therapy approach with older people. The theoretical and clinical implications of these findings are discussed in detail.