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There is a need to find better treatments for fibromyalgia and its primary feature chronic widespread pain (CWP), and to explore mechanisms by which current treatments work. This can be done by examining evidence from epidemiological studies and randomised trials. This thesis is comprised of five publications looking at behaviour and beliefs of people with CWP. It investigates alcohol consumption behaviour as a possible treatment for CWP by looking at population-level data. It also investigates current treatments, particularly how beliefs about treatments might affect outcomes, using data from a trial. The first paper looks at the association of alcohol consumption behaviour and CWP in an observational study. It found moderate consumption is associated with reduced risk of CWP and less pain-related disability in people with CWP. The next looks at the same association stratified by changes in alcohol consumption behaviour, as changes in drinking might be due to pain status rather than vice versa. It replicated the results of the first paper in people who had not changed their alcohol consumption behaviour. The third paper uses Mendelian randomization to determine the causal effect of alcohol consumption on the risk of CWP. This paper concluded observational study results do not represent a beneficial effect of alcohol consumption on pain. The fourth paper reports results from a randomised trial of cognitive behaviour therapy (CBT) and exercise for CWP to find out whether effects persist after completion of treatment. It found positive effects on self-reported health of CBT and exercise for people with CWP after treatment stopped. The final paper examined how patients' beliefs about treatment might affect outcomes. It found those with higher expectations for treatment effectiveness were more likely to report improvements. Findings show how studying beliefs and behaviours of people with CWP helps identify further research questions to improve treatment.

Psychotherapy process researchers seek to determine what mechanisms internal to the patient drive the improvement patients experience from therapy. Many of these studies focus on cognitive behavioral therapy (CBT) for depression. There are many unanswered questions remaining about CBT processes; this dissertation contains three papers that aim to provide evidence relevant to these questions. All three papers utilize session-to-session data collected from patients with a diagnosis of depression who received cognitive behavioral therapy. The first paper examines the alliance-outcome relationship and provides evidence suggesting that the alliance and depressive symptoms may have a reciprocal relationship. The second paper assesses positive affect and negative affect in CBT for depression. Results show that both positive and negative affect change over the course of treatment and predict depressive symptoms. The third paper is a study of clinician ratings of patients’ likelihood to respond to the active ingredients of CBT. Ratings of therapists following the first session, but not ratings of assessors at intake, moderated the relationship between each form of adherence and symptom change. Patients given lower ratings (easy patients) had a stronger relationship between adherence and greater symptom change, with this relationship reversing such that adherence was related to less robust symptom change for those with the highest ratings (challenging patients). Depressive symptoms, working alliance, and change in affect at the first session predicted therapists’ ratings. Taken together, the findings of these three studies are an initial step in answering key questions about how psychotherapy achieves its effects and for whom it is most effective. We conclude by discussing methodological considerations that we, and other researchers, can take into account in future studies of psychotherapy processes, such as operationalizing outcome using specific depressive symptoms to obtain results that are more specific and generalizable, and measuring a broader array of outcomes beyond symptom change.

Since Timothy van Gelder's 1995 paper “What Might Cognition be if not Computation?” there has been a growing distrust of representational accounts of cognition, most notably from proponents of relatively new programs like dynamical systems theory and ecological/embodied approaches to cognition. Some advocates of these programs have argued that the concept of “representation” is deeply flawed – does little explanatory work, prejudices what is researched and how results are interpreted, and loses sight of the complex interactions that hold between agents and their environments. In this dissertation, I will not try to challenge these claims. Instead, I will argue that responses from defenders of representational modeling often fail to adequately meet these challenges, underestimate their insights, and have a tendency to react by redefining “representation” in such a way that it loses its explanatory significance. Although I believe that the ultimate shape and utility of representational models of cognition will only be revealed in the course of doing science, I will advocate a new tack for defending representational modeling. I begin by acknowledging that representational terminology is indeed used inconsistently, and sometimes without warrant or explanatory power. Next, I examine cases from the cognitive neuroscience to try to show that we can distinguish between explanations whose representational features are closely tied to their explanatory ambitions and those that are not. I will argue that the representationalist should emphasize that information-processing solutions are contingent strategies available to organisms for producing adaptive behavior – as are varieties of synergistic agent-environmental coupling – and, therefore, there should be ways of marshaling evidence for or against the hypothesis that any particular cognitive/perceptual capacity is the result of a representational solution. She can then point out that explanatory representational models in neuroscience provide concrete examples of the kinds of empirical considerations and observations that can be used to motivate attributions of representational significance. They do so by bringing together disparate nervous systems and their components under reoccurring principles of anatomical organization, processing strategies, encoding methods, etc., and these produce testable empirical predictions, suggest interventions, unify phenomena as instances of a more general pattern, and exemplify other commonly lauded scientific virtues. A defense of representational modeling should demonstrate that some of our best explanations in cognitive neuroscience do make central use of representational theorizing for securing their explanatory goals. This can be done while also admitting that there may be many cases where organisms adopted non-representational solutions to navigating their environment. Adjusting metaphysical definitions of “representation” to include even apparently non-representational processes is unconvincing and fails to appreciate the reasons that animate representational explanations.

This paper explores mindfulness as a therapeutic tool in the field of psychology and its historical origins in Buddhism. Over the past thirty years, mindfulness has become an area of growing interest and the subject of much research in psychology. Mindfulness, as a method for providing therapeutic benefits, has a long history that dates back to at least the time of Siddhartha Gautama (563 B.C.E.), who later became known as The Buddha. The story of the Buddha is used to frame the origins of mindfulness. The relationship between Eastern thought and Western psychology has been discussed by several of the early authors in the psychological traditions, particularly in the post-Freudian psychoanalytic schools, and this is explored here. The later cognitive psychological schools of thought that arose from roots in behaviorism would ultimately give rise to the current wave of mindfulness-based therapies we see being applied today. Finally, ethical dimensions are discussed in order to better understand whether or not mindfulness-based therapies can be effectively applied outside of the normative framework of Buddhism.