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Literature Review: Anhedonia, the loss of interest or pleasure in usually pleasurable activities, is a core symptom of depression and is associated with a reduction in positive affect (PA). Repetitive negative thought (RNT) is implicated in the development and maintenance of psychiatric disorders. It has been hypothesised that RNT causally contributes to anhedonia. The aim of this review was to explore this relationship to answer two questions: Is there a relationship between RNT and anhedonia? Does RNT causally contribute to anhedonia? Review inclusion criteria were: studies using standardised measures to report a relationship between RNT and anhedonia or reduced PA. Results suggest that cross-sectional and longitudinal studies identify a relationship between RNT and anhedonia. Preliminary evidence from experimental studies shows that RNT causally contributes to anhedonia. Limitations within the field are that anhedonia is rarely measured directly or behaviourally. Future research is warranted to explore the relationship between RNT and anhedonia with a particular focus on direct and behavioural measures of anhedonia. Empirical Paper: It is hypothesised that repetitive negative thought (RNT) causally contributes to anhedonia. There is cross-sectional and longitudinal evidence of this relationship, but it has not previously been investigated directly using experimental methods. In the present study, student participants were randomly assigned to an unresolved goal (RNT) manipulation (n = 43) or resolved goal (control) manipulation (n =41) prior to completing a reward sensitivity task. This task has been reliably found to train a response bias towards the stimuli that is differentially positively reinforced, with both depression and self-reported anhedonia associated with a reduced response bias. The unresolved goal versus resolved goal manipulation was effective, with the unresolved condition producing significantly higher levels of RNT during the reward sensitivity task relative to the resolved condition. Inconsistent with study predictions, there was no significant difference between the conditions on response bias, although there were trend findings, which tentatively suggest that RNT may influence anhedonia. Potential accounts for the null findings and future research are discussed.

Context: Formulation is considered a core skill for clinical psychologists (Division of Clinical Psychology, 2011) and is a central component in most therapeutic approaches. There is no universally agreed definition of formulation, and the purpose and use varies depending on the theoretical perspective taken. The definition used in the Division of Clinical Psychology Good Practice Guidelines (2011) is ‘formulation summarises and integrates a broad range of biopsychosocial causal factors. It is based on personal meaning and constructed collaboratively with service users and teams’. There is debate around the validity and reliability of formulation as an intervention; however, an alternative recommended way to explore formulation is to understand its usefulness, particularly whether it is felt to be useful to the service user. To date, research into service user experience of formulation is lacking. Aim: This thesis portfolio aimed to understand the service user perspective on, and experience of, psychological formulation and operationalise the factors that impact on this, with the hope that this knowledge will help to improve the overall experience of formulation. Design: The project is presented in a thesis portfolio format combining two main research papers; the systematic review explored service user experience of formulation developed with a psychologist as part of the therapy process. The qualitative empirical paper used Thematic Analysis to explore formulation developed with member of the Multi-disciplinary Team (MDT), who has not been psychologically trained, as part of the care co-ordination role, within a community mental health service. Results: The systematic review developed an initial four-phased process of formulation that service users progress through iteratively and in a non-linear fashion. The experience of each phase and overall formulation process were impacted by specific factors. The empirical paper identified six themes describing the service user experience of formulation with a non-psychologically trained member of the MDT and factors that impacted upon it. Conclusion: Findings are provided tentatively, and further research is required to develop findings from both papers. However, the findings from this thesis portfolio add to the literature base around service user experience of formulation and identifies potential factors that may inform clinical practice and service delivery.

Altruistic behaviours benefit others at a cost to the self. They can be motivated by valuing the lives and wellbeing of other people. However, this value can be inconsistent, creating biases in who is valued and receives help. In this thesis, a literature review differentiates motivations for prosocial behaviour and then studies using neuroimaging, physiology, and behaviour explore the situational and individual factors that determine the value of other people. Paper 1 uses fMRI meta-analysis to distinguish between altruistic decisions, driven by intrinsic value, and strategic prosocial decisions, which could be for extrinsic gain. Results demonstrate overlap in reward-related regions, activations unique to each context and differences between the two. Paper 2 presents a solution to an issue in fMRI meta-analysis. The following papers focus on altruistic contexts. Papers 3 and 4 identify the physiological (skin conductance) and neural (fMRI) correlates respectively of valuing lives at risk. Results show that this value can be biased by the number of people at risk, whether they are at home or abroad, and how many similar situations one has already seen. Papers 1, 3 and 4 suggest we are affected by events that happen to others and our ability to help them efficiently. Paper 5 tests whether this translates to curiosity and choices to find out about their fate or choices to avoid this knowledge. Results from a series of behavioural experiments show 'wanting to know' about an outcome depends on who it affects, who caused it, and whether it is positive or negative.

Nostalgia, a sentimental longing for the past, has several psychological effects. For example, it increases self-continuity, meaning in life, and optimism. Nostalgia also buffers the adverse impact of psychological threats, such as death thoughts or the potential meaninglessness of life. In this thesis, I have expanded upon this existing nostalgia research in three keys ways. In my first empirical paper, I conducted three studies to investigate the, previously undocumented, link between nostalgia and spirituality. In Study 1, nostalgia was related to greater spirituality. In Study 2, nostalgia was again related to greater spirituality, and this relation remained significant after controlling for key demographics and core personality traits. In Study 3, nostalgia fostered spirituality via selfcontinuity and meaning in life serially. Taken together, nostalgia is associated with, and fosters, spirituality through its effect on self-continuity and meaning in life. In my second empirical paper, I investigated an additional psychological threat against which nostalgia may buffer: life uncertainty. Specifically, I examined whether nostalgia buffers the negative effect of life uncertainty on self-continuity. The findings revealed that life uncertainty reduced self-continuity, but only for participants low in nostalgia proneness, not those high in nostalgia proneness. Furthermore, life uncertainty reduced selfcontinuity, but only for those who recalled a recent autobiographical event, not those who recalled a nostalgic event. Thus, nostalgia buffers the negative effect of self-continuity on life uncertainty. In my third empirical paper, I investigated the origins of nostalgic memories in three studies. In particular, I examined whether savouring is implicated in the formation of nostalgic memories. I also examined whether nostalgia for a previously savoured experience predicts optimism for the future. In Study 1, retrospective reports of having savoured a specific event were associated with greater nostalgia for it. In Study 2, retrospective reports of savouring a time period were associated with greater nostalgia for that time period. In Study 3, savouring an experience predicted nostalgia for it 4-9 months later. Lastly, in Studies 2-3, nostalgia for a savoured experience was associated with greater optimism. In all, savouring provides a foundation for nostalgic memories and an ensuing optimism.

Chapter 1. The first chapter of this thesis is a systematic literature review to explore the role of personality in the gender differences found in leadership. PRISMA guidelines were adhered to in order to structure the search and selection of papers. A total of 14 papers were included as meeting the criteria for the review. The quality of the papers was assessed using The Standard Quality Assessment Criteria of Evaluating Primary Research from a Variety of Fields (Kmet, Lee, & Cook, 2004). Findings from this review showed a complex and multi-faceted picture and methodological problems within the field of leadership research made drawing any robust conclusions difficult. In general terms, Role Congruity Theory provided a helpful framework to compare results. Many of the included studies supported this theory, indicating that pressures from adhering to social expectations regarding masculine and feminine behaviours impact on gender differences seen within leadership emergence, leadership style, leadership self-efficacy and others' perception of leadership effectiveness. Moderating factors to the general trend of gender differences are discussed. Chapter 2. The second chapter of this thesis is an empirical paper exploring clinical leadership within the clinical psychology career pathway. Within the NHS, good quality care for patients and their families, and staff wellbeing, is underpinned by good quality clinical leadership. Clinical psychologists enter into their profession at a fairly senior level once qualified. The British Psychological Society (BPS) recognised the importance of developing good clinical leadership skills within clinical psychologists during their doctoral training and adapted the competencies required to meet this (BPS, 2014). A study conducted by Channer, Ononaiye, Williams and Mason (2018) explored the clinical leadership experiences of Trainee Clinical Psychologists and Qualified Clinical Psychologists during training and upon qualification. They used the Leadership Framework Self Assessment Tool (LFSAT; NHS Leadership Academy, 2012) to quantitatively measure self-reported leadership skills. Data for Channer and colleagues' paper were collected prior to the BPS changes being rolled out to doctoral training programmes. They found that, whilst Qualified Clinical Psychologists reported clinical leadership as a key element of their role, the doctoral training did not necessarily build and develop Trainee Clinical Psychologists leadership skills. The present study replicated elements of the Channer and colleagues' paper, with the additional inclusion of Assistant Psychologists, in order to explore whether changes in training (following the BPS inclusion of leadership competencies) have impacted on experiences of leadership within their roles. Further, the present study used qualitative questions in order to gain a richer understanding of participants' leadership experiences. A total sample of 202 participants across the clinical psychology career pathway were recruited. Quantitative aspects were explored using group comparison and correlational methods. Qualitative aspects were explored using thematic analysis from a social constructionist perspective. Findings indicated a varied picture in leadership skills development throughout the clinical psychology career pathway since the BPS (2014) changes. Limitations regarding the LFSAT measure were discussed. However, the qualitative results of the present study provided helpful insights into leadership experience and development in the profession. They also highlighted areas that need further improvements. Assistant Psychologists would like earlier opportunities to develop and engage in leadership. Trainee Clinical Psychologists would like teaching on leadership to come earlier in the programme and for this to be supported by opportunities to practice leadership skills during placements. Qualified Clinical Psychologists reported a need for increased funding for training and development once qualified and a need for good quality, psychologically informed, training in leadership in order to support their continued professional development in this area.

This thesis explores psychological interventions for young people experiencing psychosis, with a specific focus on group interventions, across three individual papers. The first paper presents a systematic review comparing the efficacy of individual and group psychological interventions for improving symptoms and functioning in a sample of young people experiencing first-episode psychosis (FEP). The findings of 12 studies were synthesised narratively, with comparisons of interventions and studies being made. Results were inconclusive, with mixed findings for the efficacy of individual and group interventions for improving symptoms and functioning. However, there were promising findings that both modalities may offer some benefits for functioning. Limitations, clinical implications and areas for future research are explored. The second paper presents the findings from an empirical study exploring young peoples' experiences of engaging with an outdoor therapy group (OTG) run by an Early Intervention in Psychosis Service (EIPS). A total of six interviews were undertaken, and were analysed using Thematic Analysis. The analysis identified two main themes: "I was a bit nervous to begin with" and "Turn my life around for the better", which contained six subthemes: "We're all in the same boat", "My mental health has improved and improved", "I thought I'd have an adventure", "Makes me wanna change", "It just brought confidence/I ain't a waste of space" and "I hope it can help other young people". The findings are promising for the benefits of OTGs with EIPS populations. Limitations, clinical implications and areas for future research are explored. The final paper considers the clinical and theoretical implications arising from both papers, and personal reflections of the process are discussed. Recommendations include better quality EIPS group intervention studies, more research with FEP samples and feasibility studies of OTGs in EIPS to provide a basis for the development of the intervention within services.

This thesis examines the use of psychological therapies adapted for adults with intellectual disabilities (ID). The systematic review identified that four third-wave therapies had been adapted for use with adults with ID: mindfulness-based approaches, Dialectical Behaviour Therapy, Compassion Focused Therapy, and Acceptance and Commitment Therapy. These therapies were found to significantly improve challenging and offensive behaviour, smoking, and mindfulness and acceptance skills. Third-wave therapies appeared to improve mental health problems for some but not all participants. While these findings are promising, they must be interpreted with caution due to the 'weak' quality of included studies. The empirical study explored the views of six sex offenders regarding the adapted Sex Offender Treatment Programme (aSOTP) using Interpretative Phenomenological Analysis (IPA). Analysis revealed three themes: choice, disclosure and 'It's like being back at school'. This study identified that sex offenders with ID learn to deny their sexual offences to avoid experiencing shame. The disclosure process requires them to drop this defense mechanism. Participants either experienced relief or shame after disclosing, determined by the level of group safeness. Low levels of safeness appear to be associated with experiences of shame. Recommendations are put forward for aSOTP developers and facilitators based on findings from the empirical study. The final paper integrates findings from the systematic review and empirical study to discuss implications for clinical practice and future research in greater depth. The final paper ends with a personal reflection on the whole research process.

This thesis explores different dimensions of perinatal psychopathology across three individual papers with the aim of furthering our understanding of psychological distress experienced by women around the time of childbirth. A systematic review in chapter one examined the prevalence of eating disorders in women during the perinatal period. The review synthesised findings from 15 studies in multiple cultural and international settings. Wide-ranging prevalence estimates were found, with studies utilising self-report questionnaires reporting the highest prevalence estimates. Studies utilising more stringent diagnostic criteria in the context of clinical interviews yielded more conservative estimates. Collectively, the results suggested that the perinatal period can be a time of vulnerability for experiencing difficulties associated with disordered eating. Areas for further research are discussed and recommendations are made for routinely screening women for eating disorders as part of a mental health assessment in pregnancy and after birth. An empirical study in chapter two explored the characteristics of mothers admitted to psychiatric units in Wales within the first postpartum year using data covering an 18 year period. The principal aim was to investigate associations between postpartum psychiatric admissions and socioeconomic deprivation. Using multilevel modelling methodology, results indicated that socioeconomic deprivation, measured at the area-level, was significantly associated with psychiatric admissions after birth. This relationship was found to be significantly stronger for mothers age 40 and over. The implications and limitations of this research are discussed. The third chapter considers the theoretical, research and clinical implications that arose from the first two papers, in addition to a short reflective summary to conclude.

This thesis explored two areas important to professionals working within the National Health Service (NHS): working under special measures, and interventions to manage occupational stress and burnout. A systematic literature review with a narrative synthesis explored workplace interventions designed to reduce or prevent occupational stress or burnout for NHS staff. Eighteen studies met the inclusion criteria of the systematic search and were narratively reviewed. Three overarching categories of mixture of intervention types were identified which included nine studies examining 'individual support' interventions, four studies examining 'individual support interventions' and five studies looking at 'organisational and team-based interventions'. The review identified a minimal number of interventions which significantly reduced or prevented burnout in NHS staff, with none evidencing long term effectiveness. Areas for further research into interventions are suggested and recommendations made for managing this within the unique context of the NHS. The second paper shows the results of an empirical study, which utilised a qualitative approach to explore Inpatient Mental Health (IMH) nurses' perspectives on how special measures has impacted on their experience of working in an organisation in special measures. The principles of Thematic Analysis (TA) directed the analysis of semi-structured interviews conducted with ten IMH nurses. The analysis produced a singular main theme showing the confusion of special measures process, which influenced the three key themes with related sub themes. Implications for clinical practice and future research are discussed. The final paper examines the theoretical and clinical implications of the first two papers, as well as providing personal reflections of the main author's experience of conducting this research.

There is growing evidence, mainly from research with adult populations, that being kind predicts increased well-being for the giver. Adolescence is a sensitive period for the development of relevant systems such as moral reasoning and perspective-taking skills. Furthermore, adolescents are at high risk for the onset of mental health problems as well as declining well-being. Thus, kindness-based interventions may be a useful method to promote well-being in this age group. However, there is little understanding of kindness among adolescent populations, and very few experimental investigations have tested the impact of kindness on adolescent well-being. This thesis includes three papers designed to identify adolescents' conceptualisations of kindness, the impact of kindness on adolescent well-being, and the mechanisms that may explain how, why, and when kindness is most effective. Participants were aged 11 to 15 years in all papers. The first paper reports on a qualitative study designed to document and understand adolescents' conceptualisations of kindness. The paper identified a range of behavioural and psychological manifestations of kindness. Papers 2 and 3 used randomised, experimental methods to test the impact of kindness on well-being. For Paper 2, this consisted of a single kindness-based reflective writing task, whereas Paper 3 reports the findings from a four-week kindness-based intervention. Analyses for both studies revealed no significant overall effects of the kindness tasks on well-being.However, in each case, a positive indirect effect of kindness on subjective well-being via eudaimonia was observed. Paper 3 also identified a positive indirect effect of the intervention on general levels of kindness and flourishing. Together, the findings demonstrate that kindness is a multidimensional construct, consisting of both behavioural manifestations and specific other-focussed motivations. Furthermore, the findings highlight the challenges of designing kindnessbased interventions to raise well-being in adolescents and suggest the importance of eudaimonic experience in fostering a positive impact of kindness on adolescent givers. This has important theoretical implications for future research and practical implications for the way in which kindness-based initiatives are designed and implemented.

Several prominent theories claim that humans possess specialised socio-cognitive skills that emerge early in ontogeny and are attributable to selective histories not shared by other hominids. The generally poor performance of nonhuman primates on tasks designed to measure skills of joint attention, such as the Object Choice Task (OCT), is a key evidence base for these theories. Similar claims are made for domestic dogs, whose apparent proficiency in following pointing cues is taken as evidence for the idea that domestication selected for advanced socio-cognitive skills. The aim of this thesis is to extend current reviews which highlight methodological differences in OCT studies that compare across species, by first analysing the prevalence and the effects of such confounds in the existing literature, and then by conducting a series of systematic experiments to further investigate how these differences may affect behavioural responses. This thesis presents six papers, beginning with a meta-analysis of 71 published OCT studies with nonhuman primates and dogs, which finds between-groups differences in subjects' pre-experimental histories, the use of a barrier in the form of a test cage, and the types of cues presented. Effects of performance associated with these differences were also found. Following this are four papers which present the results of empirical studies manipulating the presence of a barrier in the testing environment and the spatial configuration of the test set-up distinguishing between central and peripheral versions of the task with human children and dogs. For both taxonomic groups, there were differences in the behavioural responses elicited, and some performance effects for dogs. A further paper finds no effect of manipulating food reward type in an OCT with children. This demonstrates that failing to match testing environments represents an experimental confound and challenges the validity of phylogenetic theories based on studies which use incommensurate test protocols.

Background: There is now meta-analytic evidence in support of the efficacy of group therapy on symptoms and functioning for people with psychosis. However Medical Research Council guidelines also highlight the importance of establishing the feasibility of complex interventions. Adherence is an important indicator of feasibility, and this is an essential first step in supporting the development of the evidence base for group interventions. Objective: This study aims to: a) estimate adherence to psychotherapeutic groups, and b) assess adherence barriers and facilitators. Method: Embase, Ovid MEDLINE and PsycINFO databases were searched cross referencing terms related to group therapy and psychosis. Studies were assessed against inclusion criteria and a methodological quality assessment was undertaken. Relevant data was extracted from each paper including the average session attendance, demographic, clinical, study, and group-related factors. Quantitative analyses were conducted to assess the impact of each factor on adherence (attendance level). A narrative synthesis of studies which specifically commented on intervention adherence was also completed. Results: Fifty-eight original research papers were included, reporting on 51 independent studies which included 65 therapy groups (2097 participants). Participants average adherence was 76.4% (SD = 17.6). Adherence was improved by receiving incentives and participants being of older age. A larger sample size was associated with lower reported adherence levels; when the mean was weighted according to sample size the rate was 70.9%. Study quality was variable with approximately 61% found to be at risk of bias. Conclusions: The results support the feasibility of group therapy in terms of adherence for people with psychosis, with figures similar to those for people experiencing common mental health difficulties. These findings, alongside efficacy evidence, support the use of group interventions in people with psychosis and suggest the need for further high-quality research to consolidate emerging evidence.

Bulimia nervosa (BN) and binge eating disorder (BED) are psychiatric disorders characterised by recurrent loss-of-control binge eating behaviour, which is associated with the consumption of an objectively large quantity of food for the circumstances. BN is additionally characterised by recurrent inappropriate compensatory weight control behaviours. Both BN and BED cause significant distress and detract from quality of life in affected individuals. To date, however, current treatments do not support full recovery in a considerable portion of individuals with BN or BED, thus highlighting the need for novel treatment approaches which target critical maintenance factors. The current thesis synthesises current evidence for the maintenance of recurrent binge eating behaviour through neural processes related to reward dysregulation and addiction. Based on previous and original evidence, I will go on to propose a new maintenance model of BN and BED and apply this model to a multi-modal investigation of exogenously-administered intranasal oxytocin in adult women with BN and BED. Paper 1 presents a narrative review of empirical literature relating to the dysregulation of reward processes in bulimia nervosa and binge eating disorder. Within this paper, I propose a new theoretical maintenance model of recurrent binge eating behaviour: the "addictive appetite" model. Paper 2 presents an additional narrative review of evidence for the novel elements of the addictive appetite model, including evidence for tolerance and withdrawal effects in BN and a central insulin- and dopamine-mediated mechanism underpinning heightened craving. Paper 3 tests hypotheses stemming from the addictive appetite model, which predicts that craving and reward-motivated eating are central to the maintenance of BN and BED. Paper 3 presents a cluster analysis demonstrating that food craving, reward-motivated eating, and eating for coping purposes significantly distinguish women with BN and BED from age- and weight-matched comparison women. Oxytocin, a neuropeptide and hormone, has previously been found to modulate anxiety and reward processes, which are central components of the addictive appetite model. Paper 4 presents a systematic review and quantitative meta-analysis of the effects of oxytocin on feeding behaviour in both animal and human samples. This meta-analysis demonstrates that a single dose of central or peripheral oxytocin significantly attenuates subsequent feeding in animals, while the effects of oxytocin decrease with chronic administration. The evidence for the effects of oxytocin on feeding in humans is mixed, and moderated by factors including eating disorder status, sex, and food type. Paper 5 tests the functional significance of exogenous oxytocin in altering palatable food intake, subjective stress, and salivary cortisol in women with BN or BED and healthy comparison women without history of an eating disorder. Contrary to our hypotheses, oxytocin did not significantly affect palatable eating behaviour, 24-hour calorie intake, subjective, stress, or salivary cortisol. Paper 6 investigates the influence of oxytocin on attentional bias to palatable food images. Contrary to our hypothesis, we found that oxytocin increased vigilance towards palatable, versus neutral, food images. Paper 7 tested the influence of oxytocin on risk-taking behaviours in a computerised task. Contrary to our hypotheses, women with BN and BED did not demonstrate significantly different risk-taking behaviour on the task in the placebo condition. We detected a significant interaction such that oxytocin decreased risk-taking behaviour to a greater degree in women with BN and BED. Paper 8 presents the preliminary outcomes of a study investigating the effect of 40IU intranasal oxytocin on the neural processing of visual and gustatory food stimuli. We did not observe significant differences in neural activation between women with BN or BED, versus healthy control women, in response to the anticipation or receipt of chocolate taste, versus water taste in the brain regions analysed. We did not find a significant effect of 40IU intranasal oxytocin, versus placebo, on BOLD response to the anticipation or receipt of chocolate milk, versus water. The results of these original experiments testing the influence of oxytocin indicate that a divided 64IU dose of oxytocin was not effective in reducing calorie consumption in women with BN and BED, although there is preliminary evidence that oxytocin may reduce risk-taking and attentional bias to food in women with BN and BED. Future doseresponse studies in women would be helpful in ascertaining whether a different regime of oxytocin treatment may be more effective in treating the symptoms and sequelae of BN and BED. Future research targeting the maintenance factors of BN and BED identified by the addictive appetite model via different treatment methods would be useful to advance treatment for affected individuals and further refine this theoretical model of recurrent binge eating.

Empirical Paper. Objective: Exposure to nature has been found to improve mental wellbeing. Biophilia suggests because we evolved with nature, natural features that supported survival are perceived positively. Stress Reduction Theory proposes these features subconsciously reduce stress and improve affect. However, little research has investigated whether features being perceived as survivable is actually necessary for improvements to occur. Study 1 explored which features of a natural environment affect people's perceptions of how survivable it is. Study 2 aimed to operationalise this to investigate the impact of differentially survivable nature on stress and affect. Restoration ratings were also compared to explore whether survivability may be important in Attention Restoration Theory. Design: Study 1: A focus group with a card sorting task. Study 2: a between-subjects design with three conditions: high survivability nature, low survivability nature and urban scenes. Participants: Study 1: A self-selected sample of twelve people aged 18-54 (1 male). Study 2: A self-selected sample of 111 people aged 18-81 (87 female). Results/Findings: Study 1 discovered twelve themes of environmental factors that impact perceptions of survivability. Study 2: survivability had a significant positive impact on stress and positive affect scores but not on negative affect scores. Survivability also had a significant impact on some ratings of the perceived restorativeness of the environments. Conclusions: The results suggest nature should contain features indicative of survival to reduce reported stress and possibly improve positive affect. Such features include water, visibility and refuge opportunities. Survivability may also play some role in ratings of perceived restorativeness. Implications: It seems not all nature is equal when it comes to improving mental wellbeing. If planning therapeutic interventions involving nature, particularly for improving stress and positive affect, it may be important to consider utilising nature that has high levels of the factors found here that increase perceptions of survivability. Literature Review. We live in an increasingly urbanised society with decreasing contact with nature. Much research suggests contact with nature has a positive impact on our mental wellbeing. There is evidence that incorporating nature into therapy can have positive outcomes for various populations. This systematic literature review aimed to investigate: how Psychologists are currently incorporating nature in therapy, the patient groups they are using it with and the efficacy of such interventions. Nine papers were found that incorporated nature into psychological therapy and spanned four intervention types: Wilderness Therapy, Horticultural Therapy, Nature Based Therapy and Forest Based Cognitive Behavioural Therapy. Commonly, the role of Psychologists was to deliver psychological therapy in outdoor nature settings alongside other professionals who supported people to actively take part in activities that involved engaging with nature. The exception was Horticultural therapy where traditional talking therapy was not incorporated and the Psychologists' therapeutic engagement was predominantly planning or supporting people to engage in horticultural tasks. The research studies included here were carried out with young people experiencing psychological distress, adults with chronic schizophrenia, depression, stress-related illnesses and veterans with PTSD. Positive short-term effects for interventions that incorporated nature into therapy were found although the quality of the small research base was medium to low. Study designs meant the direct effect of nature in the therapeutic process could not be drawn out. At present there is not enough evidence to impact therapy guidelines, but the findings suggest incorporating nature into practice is something Psychologists should consider and research further.

Literature Review Background: Mathematical and reading abilities are predictive of academic achievement. To date, limited research has examined the relationship between processing speed and academic achievement in typically developing children. Greater insight into this relationship could help to identify the impact that reduced processing speed may have on long-term academic achievement. This review aimed to explore the relationship between these variables in typically developing children. Method: Studies conducted in the past twenty years measuring mathematics and/or reading abilities and processing speed in typically developing children using a standardised assessment measure were included in the review. In total 1278 studies were screened, which led to the identification of eight eligible studies that were included in the review. Results: No relationship was found between processing speed and reading ability. The findings on mathematics abilities were conflicting, with some studies identifying a relationship and other finding no significant association between these variables. Age appeared to be a moderating factor in studies that reported a significant relationship between mathematics and processing speed. Conclusions: The findings suggest that the relationship between processing speed and academic achievement is complex and the following review was unable to ascertain the direct relationship between these variables. It is recommended that future research examines the relationship between age and academic achievement in further detail. Empirical Paper Processing speed interventions have been found to be acceptable in children; however, there is limited evidence that they are effective in this population. This study investigated whether a processing speed intervention was effective in improving processing speed (PS) in children with suspected white matter disorders. The study hypothesised that children would demonstrate improvement on a daily outcome measure and between pre-baseline and post-intervention measures of PS. A single case experimental design utilising a multiple baseline approach was used to observe the effect of the intervention within and across participants. Three participants were recruited, each completing a choice reaction time (CRT) task three times a week that acted as the outcome measure. The processing speed intervention involved playing single player, multiplayer and iPad/android games. Overall there was no significant change in CRT between phases; however two participants demonstrated a medium effect size. There was no significant change in pre- or post-PS measures but there was evidence of reliable change in overall and cognitive fatigue. These findings suggest that the processing speed intervention was not effective in improving PS abilities. This paper highlights a number of challenges in implementing a processing speed intervention and explores the clinical implications of these findings.

Around 30% of sex offences against children are convicted by other children, a finding which is replicated across countries. Harmful Sexual Behaviour (HSB) refers to problematic behaviours such as risky sexual behaviour and using sexually explicit language but also encompasses behaviours including sexual assault and rape. It is the responsibility of social services, the police and the Crown Prosecution Service to determine whether the matter should be pursued criminally. Given the relatively high rates of young people demonstrating HSB it is important that there is a clear understanding of effective interventions. Unfortunately there is a lack of published research into HSB interventions and disagreement across services about which psychological model is the most effective. A literature review was completed to compare the available evidence. This was completed systematically to ensure all papers were similar enough to compare. Thirteen papers were included and all were assessed for quality although most papers were considered fair or poor. Six studies used Cognitive Behavioural Therapy (CBT), three studies used Multi-Systemic Therapy (MST) and four studies used an eclectic approach. The CBT and MST studies concluded these models were effective however there were a number of flaws with all studies so these results should be viewed with caution. Many studies used re-offending as an outcome, problems with this were discussed in the review. Studies did not seem to be following recommended guidance for working with HSB. There is no agreement in the academic field about how to assess effectiveness of HSB interventions which makes it difficult to conclude which methods are most effective and more stringent research is needed. A study was then completed to explore the experiences of mothers and fathers who have a son who has displayed HSB. The aim was to understand their experience and explore their journey through services. Seven mothers and one father were interviewed and a qualitative analysis called Interpretative Phenomenological Analysis (IPA) was used to analyse the results. IPA involves two layers of analysis, the initial stage requires the participant to make sense of their experience, providing the first level of interpretation, secondly, the researcher consciously and systematically applies meaning to their testimonies by drawing upon psychological theory. Themes shared across participants are then grouped together. There were six main themes; 'Lack of Formulation', 'Maternal Attachment', 'Affiliation', 'Escape', 'Emotional Toll' and 'Structural Issues'. Parents noted that HSB existed within a wider context of behaviour but services typically did not acknowledge or address the broader circumstances. Parental distress often related to being overlooked by services during decision-making and feeling blamed by others or blaming themselves for the HSB. There were significant consequences on the emotional well-being of parents and many experienced significant life changes after the HSB. Parents spoke about difficulties accessing services and the value of having someone on their side. Often parents seemed more affected than the young person who displayed HSB. Services are encouraged to develop collaborative ways of working with parents, focus more on parental-well being and consider how to increase fathers involvement.

Subjective wellbeing (SWB) has been defined broadly as "a person's cognitive and affective evaluations of his or her life" (Diener, Lucas, & Oishi, 2002, pp.63). Conceptualizations of 'wellbeing' can be broadly distinguished into 'hedonic' and 'eudaemonic' approaches. The former, encompasses satisfaction with life, and an emotional equilibrium between positive affect (e.g. happiness) and negative affect (Larsen & Prizmic, 2008), whereas the latter relates to optimal, psychological functioning and the fulfilment of one's own potential (i.e. "self-acceptance", "environmental mastery", "positive social relationships", and "purpose in life") (Ryff & Keyes, 1995, pp.720). Acceptance and commitment therapy (ACT) is a trans-diagnostic psychological therapy, which focuses on the cultivation of wellbeing through enhanced valued living and the promotion of psychological flexibility). A range of measures have been utilised within the ACT literature to measure SWB, including the Mental Health Continuum- short form (MHC-SF) that measures both the hedonic and eudemonic aspects of wellbeing. Elevated levels of subjective wellbeing (SWB) may be referred to as 'flourishing', and low levels of SWB may be referred to as 'languishing'. The main focus of the current thesis was to explore SWB in relation to ACT's theorised mechanisms of change. Psychological flexibility (purported to be the central mechanism of change in ACT) has previously been linked to SWB in clinical and non-clinical populations (e.g. Wersebe, Lieb, Meyer, Hofer, & Gloster, 2018). Additionally, ACT has shown promise for enhancing SWB in an increasing number of research trials (e.g. Grégoire, Lachance, Bouffard, & Dionne, 2018; Räsänen, Lappalainen, Muotka, Tolvanen, & Lappalainen, 2016). In particular, the current thesis aimed to explore ACT processes in relation to medical, other healthcare and veterinary students collectively referred to here as student practitioners (SPs); a group that frequently report high levels of psychological distress, and decreased wellbeing during professional training (e.g. Dyrbye, Liselotte, Thomas, Matthew , Shanafelt & Tait, 2006). Amongst a number of commonly cited stressors and contributing factors related to training (i.e. demanding workloads, frequent exposure to the suffering of others), 'maladaptive perfectionism' has been associated with poor adjustment, psychological distress, depression, hopelessness and reduced wellbeing in this group (Henning, Ey, & Shaw, 1998; Enns, Cox, Sareen, & Freeman, 2001; Stoeber & Corr, 2016). Further research is needed in this area in order to understand and support improved health and SWB in SPs. Two papers are presented within this thesis. Chapter 1 presents a systematic literature review which aims to synthesise and critically appraise published, randomised controlled trials (RCTs) of face-to-face and guided ACT interventions that have assessed SWB. Overall, 1108 participants were recruited on to the 11 included studies. The results of the risk of bias assessment highlighted the variable quality of the included studies across assessed domains. Methodological issues highlighted in the systematic review related to allocation concealment, handling of incomplete data, and small sample sizes. Five measures of SWB were utilised in the included studies, of which the most common measure used was the Mental Health Continuum-Short Form (MHC-SF). The findings indicated that guided, ACT interventions may be of benefit in enhancing SWB in clinical and non-clinical populations. The heterogeneity of included studies precluded metaanalysis. It was concluded that further RCTs that include standardised measures of SWB, are needed to facilitate a future meta-analysis of the research. Chapter 2 presents an empirical study "Exploring Acceptance and Commitment Processes as Predictors of Subjective Wellbeing in Student Practitioners". The study aimed to explore factors, and mediating processes (i.e. ACT related mechanisms of change, maladaptive perfectionism, and self-critical thoughts) as predictors of SWB in SPs. Furthermore, the study aimed to explore relationship between maladaptive perfectionism and SWB, and the potential mediating roles of psychological flexibility (the purported central mechanism of change targeted by ACT) in this relationship. Two hundred and seventy four SPs took part in the online study. Four out of every ten SPs who participated in the study met clinical caseness for psychological distress, and less than half the sample reported experiencing the highest level of SWB ('flourishing'). Psychological flexibility was found to be the strongest predictor of SWB, followed by values-based action. Psychological flexibility (AAQ-II) was found to mediate the relationship between maladaptive perfectionism and SWB. Based on these findings, further research (pilot studies, RCTs) is merited in order to evaluate the efficacy of contextual behavioural science approaches (e.g. ACT) in this group, and to explore how interventions aimed at improving SWB in SPs might be best integrated into university curricula. As both the systematic review and empirical paper will be submitted to The Journal of Contextual Science, both chapters are formatted in line with recommendations from this journal (See appendix A).

This thesis includes three papers; a systematic review, an empirical paper and a critical appraisal reflection paper. Paper 1 presents a systematic review examining the effect of attachment style on caregiving behaviour in couples. Caregiving behaviour was observed by videotaped interaction in laboratory settings. Ten studies met the inclusion criteria. Data was extracted and the quality of each study was assessed. Findings generally suggested that not all people are easily able to provide responsive caregiving to their partners, and this may be partly based on their attachment styles, however there were inconsistencies. Measurement issues, sampling biases and low-quality ratings rendered tentative conclusions that cannot be generalised beyond young people in relationships of a relatively short duration. Paper 2 presents an empirical paper examining the effect attachment training on compassion satisfaction, compassion fatigue, knowledge, confidence and worries in frontline staff in social, health and education services, working with children and young people with attachment and developmental/complex trauma. Compassion satisfaction and fatigue did not change significantly before and after the training. Knowledge and confidence significantly increased and worries significantly decreased before and after training. Factor analyses suggested further work is required for validation of the knowledge, confidence and worries questionnaire. Theoretical and clinical implications of the findings are bespoke to the service facilitating the training. Paper 3 presents a critical appraisal of papers 1 and 2, and of the research process as whole. This paper includes a reflection on strengths and weaknesses of each paper, the methodologies used, implications of the findings and suggestions for future research, with personal reflections and what I have learnt in terms of my professional development throughout.

Self-efficacy refers to our belief in our ability to complete tasks successfully or overcome the obstacles we face. It is a topic of considerable research with regard to familial dementia caregivers and the challenges they encounter. The subsequent three papers aim to provide more clarity of the topic of self-efficacy in paid dementia caregivers. Paper One presents a literature review that demonstrates that previously little research has been dedicated to self-efficacy in paid dementia carers compared to familial caregivers. Whilst the quantitative evidence base investigating paid carer self-efficacy is growing, there has to date been only one qualitative study exploring this topic. The strengths and limitations of the evidence base are also discussed. This indicates that further clarity is needed to better understand the factors and experiences that might influence or impact on dementia care worker self-efficacy. Paper Two details a piece of empirical research completed in response to gaps identified in the research literature. Fourteen people working in care homes registered for people living with dementia were interviewed to better understand the factors, approaches and experiences that influence self-efficacy. Transcripts were analysed using thematic analysis. Four themes were identified, (1) Maintaining wellbeing and self-care, (2) Support from others, (3) Values and attributes and (4) Demands of the role including subthemes of unpredictability, the emotive nature of the work, negotiating family issues and complex decision making. Implications for clinical practice were discussed including the opportunity for Clinical Psychology to support care staff in their role through the development of reflective practice and self-compassion interventions. Paper Three presents an executive summary of the research. The paper is written in an accessible style for individuals working in the care sector such as Care Home Mangers and dementia Care Assistants.

Paper one is a narrative literature review of nine studies. It reviews the current evidence base regarding what is known about the relationship between body modification and mental health. Four main categories were reported: associations between body modifications and mental health; associations between number of body modifications and mental health; associations between body modifications and past abuse; and associations of body modifications with risk behaviours. The findings of these studies were mixed. All included studies had some methodological flaws but were regarded as of fair to good quality. All reviewed studies were cross-sectional making it impossible to determine the direction of the relationship between body modifications and mental health. Paper two is an empirical study which explored the experiences of body modification in eight UK women with experience of self-harm behaviours. There are similarities between these behaviours, but associations between them has received little attention in the literature to date. Interviews were conducted using instant messaging services and telephone. Interpretative Phenomenological Analysis was used to identify two superordinate themes linking body modifications and self-harm behaviours: Coping Strategies and Body Modifications as Protective. The findings are discussed, along with clinical implications, limitations and suggestions for further research in this area. Paper three is an executive summary. This has been written as an accessible document intended for dissemination of the findings to the general population. The research method, findings, clinical implications and suggestions for further research have been summarised within this report.

The thesis aims to review the current literature about why it is that kinship care may provide more favourable outcomes for Looked after Children. It then moves on to begin exploring the experiences of carers granted special guardianship orders (SGOs). Chapter one is a literature review which examines factors thought to contribute to more favourable outcomes for Looked after Children in kinship care placements. Factors including longer lasting placements, positive attitudes of the carers, increased contact with biological parents, being placed within a familiar social class and culture, high levels of carer wellbeing, and good levels of support were all thought to be linked to more favourable outcomes. Limited research has been carried out in this area however, and the majority of research is based on samples from the United States. It was therefore recommended that further research is completed, with a particular emphasis on samples in the United Kingdom. Chapter two is an empirical paper which set out to retrospectively explore carers' experiences and perceptions of SGOs from the point of applying for the order, to the point at which the SGO was granted, and finally to the present day. Ten participants were recruited to complete the research using Q-methodology. Five common viewpoints were identified and include 1) The child is part of the family: a positive experience despite limited knowledge, 2) In the dark, obliged and unsupported, 3) Lots of training opportunities and managing well, 4) Giving up the caring role is not an option ... but having a supportive family is helpful, 5) Confused, angry and don't know who to trust. Clinical implications and areas for future research are discussed. Finally, chapter three is an executive summary of the empirical paper. It is intended for use by both service users and professionals, and aims to present the key findings of the research in a more accessible format.

This thesis was completed as part of the academic requirements for the degree of Doctorate in Clinical Psychology. The research was based on the author's prior clinical experience of supporting people who self-harmed. Self-harm is seemingly on the rise among young people, and support is often provided by parents or professionals. Chapter 1 of this thesis is a review of the literature exploring parental beliefs about the functions of self-harm. Using a systematic search, 8 papers were found and evaluated using a structured appraisal tool, the Critical Appraisal Skills Programme (CASP). Most papers were of good quality. Synthesis of the findings indicated that parents hold a range of views about self-harm, with some misconceptions identified. Parents should be provided with accurate information on self-harm to ensure they are in the best position to support their children. Parents would also benefit from being provided with support for the feelings evoked by discovery of their child's self-harm. Chapter 2 is an empirical study using Q-methodology to explore Child and Adolescent Mental Health Service (CAMHS) staff beliefs about why young people self-harm. Twenty-five staff members from a range of professions completed Q-sorts, where they ranked 65 statements about self-harm in terms of relative agreement and disagreement. A large overlap in beliefs was found between all staff. Beyond this, two distinct accounts were identified; 'self-harm is a private experience used for coping' and 'self-harm seeks connection with others'. Overall, CAMHS staff appear knowledgeable about self-harm. Future studies could aim to use Q-methodology with other populations such as alternative staff groups or young people who self-harm to explore their beliefs. Chapter 3 is an executive summary of the empirical paper, written in a more accessible style. This paper is aimed to be disseminated amongst CAMHS staff in the NHS Trusts where the research was undertaken.

The aim of this review was to examine research investigating links between adult attachment style and conflict resolution in intimate relationships. A relationship has been demonstrated between these variables in the research literature, but a critique of the methodology employed to gather such data, consideration of clinical implications from a clinical psychology and mental health perspective, and recommendations for future research has not been presented in a structured, systematically generated review, which is what this review report sets out to do. In May 2018 seven databases were searched and a hand search undertaken, which resulted in nine papers for review once inclusion and exclusion criteria had been applied. All papers were quantitative in design, with exploration of the relationship between adult attachment style and conflict resolution in intimate relationships, as main areas of focus. The evidence consistently suggests that those individuals who have a more secure attachment style demonstrate more displays of positive behaviour, less displays of negatively construed behaviour, use more mutually focussed conflict resolution strategies, and report having increased confidence in resolving conflict. For example, those participants with a more insecure attachment orientation demonstrated less of these behaviours, however there was some variation in the results with regards to the type of insecure attachment these results applied to. For example, those with a more secure attachment orientation demonstrated more positively perceived behaviour, compared to those categorised as having a dismissing or preoccupied attachment. Clinical implications and future research recommendations are discussed.

With internet use prominent in daily life, research investigating how adults with learning disabilities are accessing and using the internet is increasingly relevant. Three papers are presented in this thesis which aimed to provide additional understanding about this research topic. The first paper outlines a review of the literature regarding what factors influence how adults with intellectual disabilities access and use the internet. The existing literature suggests a shift in the technology used to access the internet, from computers to smartphones. It also shows a shift in the purpose of internet use, from only using the internet for emails, to multi-platform usage, mainly social media. Significantly, it highlighted how important it is for some adults with learning disabilities to have access to support to assist with using the internet; in addition, the perceptions of those supporting impacted on how much support a person would receive. The second paper details the empirical research that was undertaken in response to findings from the literature review. Eight support workers took part in this qualitative study which looked at how support workers understand their role supporting adults with learning disabilities to use the internet for personal and sexual relationships. Interviews were transcribed and analysed using thematic analysis. The themes of 'Social and Organisational dilemmas' with subthemes 'Role and Moral positioning', 'Expectations of Support' and 'Protected and Reflective space; 'Policy dilemmas' and 'Power and position' were found and discussed. This research highlighted the current gap in training and guidance available for support workers regarding supporting people to use the internet for personal and sexual relationships - suggesting more must be done to develop these training opportunities. The final paper is an executive summary which condenses the empirical research and presents it in a format accessible to adults with learning disabilities, support workers, and organisations employing support workers.

Paper one is a literature review of eight published studies. It reviews research on the experiences of young people who have a sibling experiencing mental health difficulties. The findings identified that young people would like more information on their sibling's difficulties and highlighted the lack of research with this population. This is despite clinicians and researchers identifying a need to better understand young people's experiences. Furthermore, generalisability of the findings was often limited by the fact that data was gathered from parents and not the young people directly. Paper two is an empirical study using the qualitative methodological approach, Interpretative Phenomenological Analysis. It explored the experiences of young people who had a sibling admitted to a mental health inpatient unit. 5 brothers of adolescent females were interviewed. Interviews were analysed using interpretative phenomenological analysis. Findings suggest young people experience changes in their family relationships as a result but have trouble expressing their own emotions and may use avoidance strategies to manage this. They also worry about not being able to support their sister enough and what their future may look like with mental health difficulties. Paper three is an executive summary. This was written as an accessible document for clinicians working in Child & Adolescent Mental Health Services to help disseminate the findings from the empirical study. The rationale for the research, method, findings, limitations of the research and recommendations are summarised.

This research thesis examines the influence of maternal employment on both mothers and their preschool infants (aged 0 to 4 years). Paper one is a literature review, examining twelves studies on the relationship between maternal employment and the attachment of preschool infants to their mothers. Maternal employment was measured by the timing of return to employment, employment hours per week and employment status. The findings suggest that maternal employment may have limited influence on the attachment of preschool infants to their mothers. However, the timing of returning to employment was found to be associated with infant-mother attachment although more research is needed to understand the direction of this relationship. Clinical and future research implications are discussed, which include consideration of the overreliance on white, middle-class American samples. It is recommended that future research is needed with diverse samples from different socioeconomic and ethnic backgrounds. Paper two is an empirical study on internet-mediated research which investigated whether marital (cohabiting) status, number of preschool children, perfectionism, perceived social support and number of employment hours per week were predictors of mood and anxiety in employed mothers of preschool infants. The study explored whether perfectionism significantly moderated the relationship between two of the variables, perceived social support and marital status, and mood and anxiety. Perceived social support and perfectionism significantly predicted mood and anxiety, accounting for 40.6% and 31.6% of the variance, indicating that they may be risk factors for poorer mood and higher anxiety. Perfectionism was not a significant moderator. Employed mothers reported better mood, lower anxiety and perfectionism than anticipated. The implications of the findings, clinical and research implications, limitations of the study and suggestions for future research are discussed. Paper three is an executive summary that summarises the main points, findings and recommendations found in the empirical paper, 'Predictors of Mood and Anxiety in Employed Mothers with Preschool Children.' It is written to disseminate the findings of the empirical study to employed mothers and the general population.

Background: Endings are considered an important part of the therapy process, however, the empirical literature on the topic is sparse, and clinical guidelines supporting practice are limited. In particular, there is a lack of evidence derived from service users' subjective experiences that warrants further exploration. Aim: The key aim of this research was to explore service users' experiences of endings from NHS community Personality Disorder services. Method: Semi-structured telephone interviews were conducted with eight individuals discharged within a three-month period from one of four NHS community PD services. Interview transcripts were analysed using a deductive-inductive approach using an adapted version of Braun and Clarke's method of thematic analysis (2006). An additional 'refutational' stage was incorporated into the steps of analysis to ensure contrasting data was considered. Results: During the analysis, it became apparent that there were two distinct over-arching themes: service users' experiences of the process of ending and their clinical reactions and responses to the ending. It was therefore decided that two journal papers would be written, each focussing on their respective parts. Three main themes relevant to the process of ending were reported in paper one; 'Service users' experiences in the context of Reflective versus Reactive practice', 'Endings held in mind' and 'What next?' A further three themes emerged in relation to service users clinical experiences of endings, 'Loss', 'Responses to loss' and 'Boundaries'; these are discussed in paper two. Conclusions: In summary, service users experiences highlight the importance of taking a reflective approach to the management of endings: in particular, explicitly acknowledging the ending from the start, mentioning it throughout and 'marking' the ending of therapy were considered key features of service users' experiences. The findings also highlighted service users' readiness to end therapy as a potential area of intervention. The findings from the second paper emulate previous literature suggesting that endings are experienced as a loss and that endings evoke a dynamic range of emotional responses. Boundaries were also highlighted as having an important role in determining how service users' experience the loss of endings. Clinical recommendations are provided within each paper on how health professionals and services may manage endings within clinical practice. Suggestions for future research are also discussed.

This systematic review investigates the links between literacy difficulties, dyslexia and the self-perceptions of children and young people (CYP). It aims to further understanding by building on Burden's (2008) review and explores how the additional factors of attributional style and the dyslexia label may contribute to the self-perceptions of children and young people. 19 papers are included and quality assessed. Quantitative papers measured the self reported self-perceptions of CYP with literacy difficulties and/or dyslexia (LitD/D) and compared these with the CYP without LitD/D. Qualitative papers explored the lived experiences of CYP with LitD/D, including their self-views and how these were affected by receiving a dyslexia diagnosis. Results suggest that CYP with LitD/D may be at greater risk of developing negative self-perceptions of themselves as learners, but not of their overall self-worth. Factors found to be relevant in supporting positive self-perceptions include adaptive attributional styles, good relationships with peers and parents, and positive attitudes towards dyslexia and neurodiversity. In some cases, CYP with LitD/Dfelt that others perceived them as unintelligent or idle; for these CYP, a diagnosis led to more positive self-perceptions, as it provided an alternative picture of themselves. There is a need for further research to explore the impact of attributional style and the potential for intervention, as well as CYP's experiences of diagnosis and the associated advantages or disadvantages. There has been ongoing debate around the use of the term 'dyslexia' to describe the literacy difficulties of certain individuals, however, CYP's perceptions of the advantages and disadvantages of the use of the term have not been directly sought. This study aims to explore the views of young people (YP), with and without experiences of dyslexia, with a particular focus on the impact of labels. A qualitative methodology is used to explore the views of a range of individuals currently in secondary education (aged 13-19). The views of 36 YP (12 with self-reported dyslexia, 12 with self-reported literacy difficulties and 12 with no reported literacy difficulties) were gathered using an online survey. In depth one to-one interviews were also carried out with six YP who reported having dyslexia. Results show that YP saw the dyslexia label as an important factor in gaining appropriate support for difficulties, and highlight the potential for discrimination in terms of access to diagnosis and therefore access to support. The dyslexia label led to changes in perceptions and helped to remove the sense that a YP may be to blame for their difficulties, as dyslexia was seen as having a biological origin. This was beneficial for those individuals who had the label, but led to more negative judgements being made in relation to individuals with literacy difficulties but no dyslexia label. Furthermore, the label was associated with permanence, which is discussed in terms of attribution theory. Implications for Educational Psychologists and school staff are discussed in terms of ensuring that YP, and their teachers, have a good understanding of their literacy needs and are empowered by the way their needs are described, and are not subject to selective stigmatisation.

Volume One Volume One presents three papers. The first paper reports a meta-analysis exploring the prevalence of autism spectrum disorder (ASD) in rare genetic syndromes. Further analyses consider sources of variance in the data, evaluating the influence of methodological factors and sample characteristics on ASD prevalence estimates. The second paper is an empirical study examining the developmental trajectory of early social cognitive skills in children with ASD. The third provides a summary of the reported research, for dissemination to research participants and professionals in clinical and educational services. Volume Two The second volume consists of five Clinical Practice Reports (CPRs). CPR one presents two formulations, using cognitive-behavioural and systemic models, exploring anxiety experienced by a 50-year-old man presenting at a community learning disability service. CPR two describes a service evaluation project evaluating staff attitudes towards the use of the 'Friends and Family Test' feedback tool. CPR three presents a case study, reporting a systemic intervention with a 44-year-old woman experiencing low mood. CPR four is a single-case experiment, evaluating the effectiveness of a cognitive-behavioural intervention for self-harming behaviour linked to low self-esteem. Finally, an abstract for CPR five is presented, summarising an oral case presentation describing an Acceptance and Commitment Therapy intervention for a 78-year-old man experiencing low mood following a stroke.

Volume I thesis consists of a systematic literature review, empirical research paper, and public dissemination document. The main finding of the systematic review was that sensation seeking is a significant predictor of alcohol use in adolescence, but does not always directly predict problem drinking and related problems. The empirical showed, among a sample of young males who have not attended university, impulsivity and negative consequences are directly related to alcohol use, but that it important to consider mediating and moderating variables that may impact the nature and direction of these relationships. The public dissemination document provides succinct and accessible summaries of both the systematic review and the empirical research paper. Volume II serves as a compilation of five Clinical Practice Reports (CPRs) conducted throughout the course of the Doctorate programme. This includes case studies, a single case evaluation design, a service evaluation and formulation of one case from two different models.

Parents can face many new challenges in bringing up children with many now accessing the internet for general parenting support and advice. Much is known about patterns of parenting that support children’s positive development and a lot of research has demonstrated the effectiveness of parenting programmes to support parents of high challenge children. These interventions teach positive parenting skills, including relationship building, play, positive reinforcement and emotional regulation generally taught through discussion, training in observation skills and positive role modelling. The growing evidence for the effectiveness of teaching parents positive parenting strategies has demonstrated the potential of such programmes to improve the mental health and well-being of both parents and children. However, there is relatively little evidence-based information on parenting available in general. Many of the available programmes target children at-risk of developing conduct problems or families living in high-risk areas (e.g. Flying Start areas), meaning that the majority of parents do not have access to evidence-based information. Universal parenting programmes have the potential to promote positive child well-being and prevent future mental health problems. Advantages of a universal provision include (1) providing support for parents whose children do not have problems but who are concerned to parent their children in ways that provide them with the best outcomes, (2) facilitating access to evidence-based information for parents who are facing common everyday parenting challenges, but not currently in receipt of services, (3) impacting on societal norms by promoting positive parenting more widely, and (4) encouraging positive child development. The COPING parent (COnfident Parent INternet Guide) programme is a web-based universal programme that presents evidence informed parenting principles to support all parents in establishing positive relationships with children and promoting their children’s Evaluation of the COPING parent programme well being and development. This thesis reports on the development and evaluation of the programme in a randomised controlled trial with intervention and wait-list control conditions. Chapter 2 is a review of universally available parenting programmes, based on social learning theory principles, that were either offered to a universal population or included universal goals i.e. development of parenting skills and promotion of child developmental outcomes. This review highlighted the need for more research to establish the effectiveness of universal programmes on promoting positive parenting skills and child development. This leads to chapter 3, which is a review of web-based interventions for behaviour change, both behaviour in general (such as weight-loss and smoking) and parenting behaviour are included. This review highlighted the need for further evaluations of web-based parenting interventions and associated attrition challenges. Chapter 3 discusses the many challenges, which parents can face, and how these challenges can compromise parenting, child behaviour and parent-child interactions. Chapter 4 contains a brief review of interventions created using the LifeGuide software and a detailed description of the development of the COPING parent programme. Chapter 5 is a published paper (Owen & Hutchings, 2017) reporting our feasibility study that was conducted to gain user feedback from an early version of the programme. Feedback suggested modifications that included adaptations to enable the programme to be accessed by tablet users; an option to look back over previously completed chapters, the inclusion of more video examples of positive parenting and text message reminders to address engagement. Chapter 6 is the published protocol paper (Owen, Griffith & Hutchings, 2017) providing details of the methodology of the main trial. Chapter 7 is the main outcomes paper, and reports the findings from the evaluation of the programme, limitations and suggested improvements. The COPING parent web-based universal programme was effective in increasing observed praise and reducing observed indirect commands for parents who completed at least one chapter of the programme, however trial Evaluation of the COPING parent programme challenges included low engagement, high attrition at follow-up and softare challenges. The final chapter of this thesis provides a summary of the research findings and discusses implications, strengths and limitations and future directions. This was the first evaluation of the COPING parent online universal programme, an intervention for all parents of children aged 3-8 years who have an interest in learning more about positive parenting strategies. Findings from the main trial were promising and suggest that an online universal programme can significantly increase the positive parenting skills that are associated with good child outcomes for some parents. This thesis has highlighted the importance of providing all parents with the opportunity to access evicence-based support and further develop their parenting competencies in order to promote children’s development.

Poor childhood nutrition is a global phenomenon, contributing to obesity and the development of non-communicable diseases. The present thesis explores methods of improving child nutritional intake in a school setting. Here, we present four papers: • A methodological paper, describing the validation of a newly designed method of collecting nutritional data in a canteen setting. We find that it is possible to accurately estimate nutritional intake in a fast-paced free-living environment using digital photography; • An evaluation paper, exploring the impact of a school-based multicomponent intervention, the Food Dudes programme, on lunchtime nutritional composition. Results indicate that participation in the Food Dudes programme is associated with an increase in the consumption of fruit and vegetables, and a decrease in consumption of unhealthy food items; • A systematic review, describing those studies in the literature focussed on improving children’s eating behaviour through behavioural nudging. We report that, though many studies are successful, few studies use validated and reliable data collection methodologies, rendering results inconclusive; • An experimental pilot study, exploring the influence of behavioural nudges on the fruit and vegetable consumption of primary school children. Significant improvements in fruit, vitamin C, and fibre consumption were observed following a simple behavioural nudge intervention. The results presented in this thesis contribute to the literature investigating methods to measure, and promote childhood nutrition, and have implications for promoting research best-practice, and policy targeting poor childhood nutrition.

Children in foster care are at high risk of experiencing mental health problems and tackling this issue is a key priority. Previous research suggests that the transition from primary to secondary school can be particularly challenging, as well-being declines and mental health problems increase in early adolescence. However, there is insufficient understanding of variations in the well-being and mental health of this group of children, and particularly the role played by their social interactions, relationships, and psychological attributes. This thesis includes three papers reporting on a programme of empirical research conducted to address this gap in knowledge and better understand the risk and protective factors, particularly in the peer context, for changes in mental health and well-being. The first paper focuses on current provision and reports the findings from a national survey of Virtual Schools that support the education of children in care. The second paper presents the findings of a longitudinal study with children not in care (aged 10-13 years), to test our conceptual model in the general population. This demonstrated that peer factors predict changes in mental health problems and well-being over and above parental and other adult support. The third paper presents findings from a longitudinal study of children in foster care (aged 10-14 years), to test these key pathways in our focus population. This revealed a pattern of differentiated links from peer and adult support to mental health and well-being, and identified self-efficacy as a key longitudinal predictor of change, especially when moderated by peer relationship quality. The thesis demonstrates the importance of supportive relationships with both adults and peers for the mental health and well-being of children in care. This has important implications for future work where social activities and relationship quality with peers should be considered as potential protective factors, especially in school settings.

Forced displacement is the crises of our time as it has reached an unprecedented magnitude and rate, which exceeds the capacity of the international relief system and required efforts from global citizens, institutions, governments and communities. Social psychology has an important role in this needed mass response, to provide a better understanding of how the forcibly displaced people deal with their situation and how they are affected by it. Taking into consideration the sharp gap of resources available to the international relief system, it is especially important to understand the natural mechanisms of support the affected communities have, which can be an effective tool to build more efficient interventions and to empower marginalised communities and individuals. This research project aims to explore one possible mechanism underlining social support among refugees of conflict in developing countries, and sought to answer three main questions: how refugees help each other? Does sharing an emergent identity of being a “refugee” facilitate support among them, similar to people affected by disasters? Does this shared identity-based support impact their health? After conducting a systematic literature review (Paper 1) of psychosocial support among refugees of conflict in developing countries, we identified that the main challenge was the stressors arising from the exile environment (secondary stressors) and found indications of shared identity-based support among them. To do further exploration with social identity in mind, we conducted an 8-month ethnography (Paper 2) with Syrian refugees in Jordan that revealed an emergent shared “refugee” identity which seems to stem from a sense of common fate and motivates providing help to other refugees in addition to creating new social networks in exile that facilitates support efficiently. To better understand the secondary stressors (Paper 3), we conducted a survey (N = 305) and combined it with ethnographic data to find that Syrian refugees in Jordan suffer the most from financial stressors, due to loss of income and high living expenses; environmental stressors arise from exile and are either circumstantial (e.g., services and legal requirements) or created by this environment (e.g., instability and lack of familiarity); social stressors, directly related to social relations (e.g., discrimination & exploitation). In order to explore the process of support and the exact role of shared identity, we conducted two surveys (Paper 4) among Syrian refugees in Jordan (N = 156) and Turkey (N = 234) and used path analysis to build a model, which suggested that shared social identity is an important predictor of providing support and collective efficacy, which in turn has a positive association with general health of the refugees. We found indications that such positive associations could have a buffering effect in counter to the negative effect of stressors and stress on the health of refugees. We do acknowledge the stigmatic nature of a “refugee” identity and that there are other sources of support among the refugees. Nevertheless, we suggest that shared social identity can be a valuable resource in the field of psychosocial support among refugees of conflict in developing countries, especially if incorporated in the design of community level intervention.

This thesis investigates the identity and motivation processes involved in the association of well-being with consumer products (material or experiential). Through a series of four empirical studies looking at consumer spending behaviours, it both tests and extends some of the theoretical claims made by motivated identity construction theory (MICT, Vignoles, 2011), which postulates that the satisfaction of identity motives (such as self-esteem, distinctiveness or effectiveness) enhance well-being, and self-determination (SDT, Deci & Ryan, 2002), which postulates that the pursuit of the extrinsic goals (such as wealth, image and fame) leads to lower well-being. The current thesis suggests that it might not be so much what consumers buy (material or experiential purchases), but how consumer products are thought to transform or enhance one's extended sense of self by satisfying identity motives (MICT) (Paper 1 and 3), and why people are motivated to make a spending behaviour that drives the effects on well-being that consumers associate with a purchase (SDT: intrinsic or extrinsic goals; paper 2). As a result, the present research contributes to the literature on material and experiential consumption by providing a theoretically-driven explanation for the differences in well-being found between the different types of consumer products as identity processes mediate the relationship between what consumers buy and the well-being associated with a purchase, and that goal orientations predict both those identity processes and the initial choice of spending behaviour. Moreover, it provides a behavioural explanation for the extended body of literature that has found a negative relationship between extrinsic goals and well-being (i.e., Dittmar, Bond et al., 2014) as it fills in the gap between goals and well-being by suggesting that concrete behaviours concerning the allocation of economic resources mediatethe relationship between goals pursued and the well-being experience.

Through a series of four papers using experimental and correlational methods, this thesis investigates precursors to judging life as meaningful. This thesis extends and tests tripartite models that define meaning in life (MIL) as comprised of the three dimensions of purpose, coherence and significance, while integrating claims derived from the Meaning Maintenance Model and previous research on sources of MIL (e.g., relationships, personal control). In Paper 1, we showed that different kinds of coherence threat (self-uncertainty and general uncertainty) were perceived differently, with self-uncertainty being overall most successful at influencing felt uncertainty; however, neither of the two manipulations influenced MIL judgements. In Paper 2, against our predictions, we did not find evidence that the effects of belongingness and personal control additively increase sense of MIL. In Paper 3, across three studies, we tested whether fulfilment of the three dimensions of MIL (coherence, purpose, significance) predicts MIL judgments contemporaneously and over time. In Study 1, we improved previous measures to create distinct scales of the key constructs. In Studies 2 and 3, we showed that sense of significance was the most consistent predictor of MIL judgments across time, with the effects of purpose and coherence being moderated by religious belief (Study 3). Finally, in Paper 4, we used a multilevel approach to show that different meaning frameworks (i.e., propositions that one holds about oneself and the world; e.g., identities, values) are seen as more meaningful, the more they provide a sense of purpose, significance and coherence. This, in turn, predicted the perceived importance of meaning frameworks. Finally, I discuss implications for the future of the construct of MIL in terms of definition, operationalisation, theoretical utility and future directions.

We have learnt a lot about the development and maturation of colour vision in infants, but know comparatively little about the development and structure of colour perception once trichromacy has been established. This thesis aims to characterize infant colour perception in the first year of life over several areas which have previously been well documented in adults; colour categorisation, colour preference, perception of illusions, and infant sensitivity to natural scene statistics. Paper 1 (Skelton, Catchpole, Abbott, Bosten, and Franklin, 2017) systematically mapped infant colour categories revealing that infant colour categories are related to the retinogeniculate pathways of colour vision. Paper 1 also illustrates and quantifies the correspondence between infant colour categories and commonalities found across the worlds' colour lexicon. Paper 2 shows that infants look for longer at the colours which adults prefer, and provides evidence for an influence of low-level mechanisms on infant response to colour and adult preference. Paper 3 (under review) reopens the question perception of the Munker-White illusion in infants aged 4 to 8 months, through the replication of a previous study and the use of an alternative method, with discussion of the reasons for studying illusions in infancy. Finally, paper 4 provides the first substantive evidence that infants aged 4 months are sensitive to natural scene statistics, as evidenced though the presence of a blue-yellow discrimination bias commonly associated with the distribution of chromaticities found in natural scenes. Paper 4 also has critical implications for the use of psychophysical methods in infants and adults. The findings inform our understanding of infant colour perception and general perceptual processes by outlining some of the structure around which infants' colour perception is built. The early structure of infants' perception of colour is shown to often have commonalities with adult colour perception.

Through a series of four studies using qualitative, correlational, and experimental methods, this thesis identifies sources of identity threat in sexual and ethnic minorities in Turkey, where these identities are highly stigmatised and subject to ongoing prejudice, and examines coping strategies and their implications for well-being. In Paper 1, extending previous qualitative findings, I show using structural equation modelling that identifying as a ‘global citizen' helps gay men integrate their incompatible sexual (gay) and gender (male) identities in a traditional society, and this increased gay-male identity integration predicts higher well-being. In Paper 2, I substantiated these findings with an experiment, whereby participants primed with pro-globalisation worldviews increased their identification as global citizens, which then increased their gay-male identity integration. Here, I also found that access to gay-affirmative social spaces, where gay men can express their identity comfortably, also helps increase gay men's well-being. In Paper 3, I present findings from an interview study with Kurdish ethnic minority members from Turkey, identifying key sources of identity threat for this group as well as key coping strategies that might form a basis for potential interventions to improve well-being. Finally, in Paper 4, I tested one of these coping strategies–collective ethnic nostalgia–investigating its effects on identity motives at personal and group levels, and on well-being; here, discuss potential reasons why collective nostalgia may fail to serve as a psychological resource for coping in a highly threatened group. Together, these studies contribute to the developing social psychological literatures on identity threat and coping, multiple identities, identity motives, and nostalgia. Moreover, they provide practical implications regarding how the well-being of stigmatised minority group members could be improved with bottom-up coping strategies, in contexts where minority group rights are not ensured by legal protection.

Colour perception is formed of many different components, such as colour discrimination, colour constancy, colour term naming, and the dimensions of colour (hue, chroma and lightness). It is a 'toolbox' of processes, not one cohesive function. Some of the components of colour vision develop into adult-like function over childhood, but they do not necessarily mature at the same speed. The studies in this thesis investigate adult, child and infant colour perception and cognition. Paper 1 finds a relationship between colour constancy and colour term naming in three- to four-year-old children. This relationship has wider implications for the co-development of language and perception. Paper 2 (Rogers, Knoblauch & Franklin, 2016) uses the technique of Maximum Likelihood Conjoint Measurement (MLCM) in adult participants to investigate the interaction between lightness and chroma in perception. Paper 3 combines MLCM analysis with preferential looking methods to compare interaction of lightness and chroma in infant and adult participants. This study paves the way for the use of MLCM and eye-tracking for studying other dimensions in development such as face perception, language, surface and shape. Paper 4 investigates why discrimination is poorest along the blue-yellow direction of cone opponent space (also known as the daylight locus). We tested the theory that this is adaptive for colour constancy by comparing illumination discrimination to surface discrimination in adult participants. We found equally poor discrimination for blue-yellow in both conditions, suggesting colour constancy is not the only explanatory factor. Together, these papers add to our understanding of the key components of colour vision over the life span and how perception of colour depends on various contextual and individual factors. Furthermore, this thesis develops novel applications of experimental techniques, and paves the way for these methods to be used to study other cognitive and developmental domains.

Background: Fatigue is a complex, multifactorial and multidimensional phenomenon, which has been described as a persistent overwhelming sense of tiredness, weakness, or exhaustion. It is the third most common concern for patients with inflammatory bowel disease (IBD), experienced by 44-86% of patients with active disease and 22-41% of patients in remission. Fatigue can have a significant negative impact on patients’ quality of life (QoL). The aetiology of fatigue is not well understood. Interventions for IBD-fatigue are scarce, demonstrating limited benefit, and have not been implemented into clinical practice. The development of a theoretically-driven intervention to improve fatigue is a primary need for this population. Methods: The overall aim of the study was to develop a complex intervention for the management of IBD-fatigue and test its feasibility and potential efficacy. Guided by self-regulation theory and the Medical Research Council framework for development, feasibility and piloting phases, four steps were conducted in an iterative process. A systematic review study (Paper 1), identified aetiological modifiable factors which had already been or could be targeted by health interventions to improve IBD-fatigue. A quantitative cross-sectional study (n = 182) (Paper 2), evaluated the potential relationship between the identified modifiable cognitive-behavioural factors and IBD-fatigue. Patient and public involvement activities informed the adaptation of a cognitive-behavioural therapy (CBT) intervention for multiple-sclerosis fatigue to IBD-fatigue. Lastly, a two-arm pilot randomised controlled trial (RCT) with a nested qualitative study (Papers 3 and 4) assessed the feasibility and initial estimates of efficacy of a CBT manual with 8, weekly therapist telephone session (n = 15) vs. a fatigue information sheet without help (n = 16). Results: Initial estimates of efficacy with per protocol analysis showed a reduction in fatigue scores and an improvement in QoL scores at 3-months post-randomisation. The difference in change in scores between groups was significant for impact of fatigue. The intervention was acceptable to participants and feasible for therapists to deliver. Healthcare professionals working with IBD patients reported that the intervention would be broadly applicable but time, finance and training constraints may limit its implementation in routine clinical care. Conclusions: CBT for IBD-fatigue is feasible and has a potential for improvement of the impact of fatigue on daily activities. A large-scale RCT is needed to investigate the size and longevity of treatment gains and the cost-effectiveness of the therapy. Incorporating changes to the protocol and developing an online intervention may be an effective way to overcome the barriers to implementation identified by healthcare professionals and test the generalisability of the intervention to IBD-clinical practice.

Objective: To explore whether nostalgia, a bittersweet emotion characterised by sentimental longing for the past, can improve well-being in older adults and buffer against threats to well-being in this population. Design: A between-subjects experimental design was conducted with random group assignment for participants to recall either a nostalgic memory or an ordinary memory (control group). Ryff & Keyes (1995) Psychological Well-being factors and Life Satisfaction were measured post-intervention and potential threats to wellbeing: loneliness, time-limitedness, and activity levels were measured pre-intervention. Participants: 161 older adults (age 65 years and above) completed the questionnaire on paper or via an internet survey and 132 were able to be used in data analysis. They were recruited through opportunity sample from local community groups and residential homes in England with the majority being White British, retired and living independently alone or with a partner. Results: Method of survey completion (paper vs. online) was found to represent different sub-populations of the sample and to have a significant impact upon findings. Well-being (both life satisfaction and scales of psychological well-being (total, environmental mastery and self-acceptance)) was significantly higher for older adults in the nostalgia condition comparative to control (for those who completed the questionnaire online). Nostalgia was found to buffer against loneliness to protect well-being (for those who completed the questionnaire on paper). Conclusions: This research partly supports the beneficial effects of nostalgia specifically in older adult populations. Future research can build upon the findings of this study, in particular, recruiting older adults experiencing high levels of threats to well-being such as loneliness. Should a body of literature begin to form around the benefits of nostalgia in older adults, this population could be supported to not just be living longer, but also to be living a better quality of life.

Eating disorders are serious conditions that significantly damage psychological and physical health. If left undetected and untreated, eating disorders can become longstanding, debilitating and life-threatening conditions. To improve the prevention and treatment of eating disorders, factors contributing to the development and maintenance of eating disorder need addressing. This project aimed to inform the prevention and treatment of eating disorders by (i) exploring the association between eating disorder characteristics and fear of negative evaluation, and (ii) experimentally testing the use of surveys, a type of behavioural experiment, for improving body satisfaction and eating disorder characteristics. First, a systematic literature review was conducted to explore whether fear of negative evaluation, a central feature of social anxiety, is also associated with eating disorder characteristics. If an association is indicated, targeting fear of negative evaluation might improve the prevention and treatment of eating disorders. Through systematically searching three databases (PsycInfo, Medline and Web of Science), the review identified 19 eligible studies. Data related to the association between eating disorder characteristics and fear of negative evaluation were extracted from each paper. Overall, the evidence indicated a moderate association between eating disorder characteristics and fear of negative evaluation. Furthermore, the association was present for both clinical and non-clinical samples, and for different eating disorder characteristics. Potential reasons for the relationship are discussed within the review, and clinical implications are outlined. Study limitations and recommendation for future research are also made. Body dissatisfaction is suggested to be one of the most consistent predictors of eating disorders in females. Therefore, improving body satisfaction is considered an important factor in the prevention and treatment of eating disorders. Surveys are routinely used in clinical practice to improve body satisfaction. However, there is limited research evidence supporting this practice. Therefore, the second part of this project formed an experimental study investigating the impact of survey feedback on body satisfaction and eating disorder characteristics. Fifty-seven non-clinical participants were randomly assigned to one of three groups. Participants in the control group received survey feedback unrelated to appearance. In contrast, participants in the experimental groups received either moderate or strong survey feedback related to appearance. Survey feedback unrelated to appearance improved body satisfaction for non-clinical, female, undergraduate students. However, strong survey feedback related to appearance increased body dissatisfaction. Eating attitudes were improved for the full sample, but this effect was not dependent on the type of feedback received. Potential reasons for the results are discussed within the paper, and clinical implications are outlined. Study limitations are identified, and recommendations for future research are made.

The following commentary discusses the six papers submitted for evaluation for the award of PhD by Publication (chapters 1-6). To give context to my contribution to the field of animal welfare science, I have also included several published reviews and extended abstracts as appendices (appendices 1- 6). The research considered in this commentary examined the potential of ear postures, eye whites, and nasal temperatures as measures of both positive and negative emotions in cattle. Three papers focussed on measuring a positive, low arousal emotional state. The paper; "Can ear postures reliably measure the positive emotional state of cows?" (chapter 1, page 44), which was published in Applied Animal Behaviour Science, demonstrated that cows perform two ear postures for significantly longer when they are in a positive, low arousal emotional state, compared with before and after. The second paper; "Nasal temperatures in dairy cows are influenced by positive emotional state" (chapter 2, page 53), which was published in Physiology & Behavior, showed that cow's nasal temperature drops significantly when they are stroked to induce a positive, low arousal emotional state, compared with before and after. The paper; "Measuring positive emotions in cows: Do visible eye whites tell us anything?" (chapter 3, page 59), also published in Physiology & Behavior, revealed that the percentage of visible eye white is significantly decreased when cows are in a positive, low arousal emotional state, compared with before and after. Papers 4-6 focussed on measuring both positive and negative high arousal emotional states in dairy cows. The paper "Can changes in nasal temperature be used as an indicator of emotional state in cows?" was published in Applied Animal Behaviour Science (chapter 4), page 66), and showed a significant decrease in nasal temperature in cows, in response to stimuli intended to elicit positive and negative high arousal states, compared with a neutral stimulus. Paper 5; "Looking into the eyes of a cow: Can eye whites be used as a measure of emotional state?" (chapter 5, page 73), was also published in Applied Animal Behaviour Science, and found that visible eye white in cows increased significantly in response to the emotional states of excitement and frustration, compared with a neutral stimulus. Finally, paper 6; "Positive and negative emotions in dairy cows: Can ear postures be used as a measure?" (chapter 6, page 80) which has been submitted to Behavioural Processes, demonstrated that cows are more likely to perform certain ear postures in response to positive or negative, high arousal emotional states. Taken together, these findings show that there is potential for ear postures to be used as a measure of emotional state in cattle, although further research is required to explore the effects of other contexts and stimuli. In addition, nasal temperatures and eye whites are not purely the result of arousal levels, as they did not mirror the heart rate measurements, and so further research is needed to explore the complex relationship between arousal and valence. Throughout the whole of the commentary these papers will be referred to, and so it is recommended that the publications are read first.

Self-esteem is a central research topic in psychology, but its measurement and definition have long been contentious topics. In this four-paper thesis, I investigate (1) the measurement of self-esteem in personality and social psychology, (2) the definition of self-esteem in personality and social psychology, (3) further explore the dimensionality of the Rosenberg Self-Esteem Scale (RSES; Rosenberg, 1965), and (4) construct and initially validate a new two-item self-esteem scale. The first two papers of this thesis are meta-research. In the first paper, I extract detailed measurement information from 371 recently published research articles. I find that the RSES dominates the measurement of self-esteem in personality and social psychology. In the second paper, I analyse 117 definitions of self-esteem extracted from the same corpus of articles. I find that, while there is a lack of consensus on the definition of self-esteem, researchers most often define self-esteem narrowly as one's overall evaluation of his or her worth and/or value-a definition that is narrower than that which guided the construction of the RSES. In the third paper, to extend the research on its dimensionality, I recount, for the first time, the RSES's largely unknown transformation from a Guttman-type to Likert-type scale and explore item-level associations with variables theoretically linked to self-esteem. I find that the items of the RSES are heterogeneously correlated with perceptions of agency, communion, social status, inclusion, dominance, submission, agreeableness and quarrelsomeness; but not attachment anxiety or avoidance. In the fourth paper, with the problems of the RSES in mind, I report on the development and initial validation of a new self-esteem scale-the Worth and Value Self-Esteem Scale (WAVSES). This two-item scale is intended, above all, to be maximally content valid for self-esteem as it is narrowly defined in contemporary personality and social psychology.

This thesis focuses on the psychology of men, and in particular the factors that are associated with their disclosure and help-seeking experiences in two particular contexts: following sexual abuse and when experiencing a psychological difficulty. This thesis consists of three chapters. Chapter 1 is a systematic review of the literature, investigating the barriers to disclosure and help-seeking for male survivors of sexual abuse. Five barriers were identified: unwillingness to acknowledge the abuse, the nature of the abuse and abuser factors, perceptions of sexual orientation, stigma and shame, and mistrust of others and services. These barriers are discussed within the context of masculinity. Clinical implications are discussed, such as the importance of training in the sexual abuse of men for professional staff groups. Chapter 2 is a vignette based empirical study which explores factors associated with help-seeking for psychological difficulties in men. The study used the theory of planned behaviour as a guiding framework in order to test a number of hypotheses. Data were collected using an online survey and participants were men aged 18-65, living in the UK, who were recruited via social media. Perceived behavioural control and attitudes toward seeking professional psychological help were significant variables within the theory of planned behaviour model. Men were most likely to endorse seeking help from their intimate partners and GPs and least likely from helplines and religious leaders. Clinical implications are discussed and areas of future research recommended. Chapter 3 is a reflective paper which discusses how the topic of the thesis originated. This paper reflects on the experiences of being a male trainee clinical psychologist in a predominantly female profession, as well as in relation to carrying out research on male psychology. The paper concludes with final thoughts about how the work started in this thesis can be continued post-qualification.

The experience of living with a chronic illness can impact on both the person receiving a diagnosis and those close to them. Experiences of diagnosis and any subsequent treatment are important as it allows individual, lived experiences to be better understood. Through exploring these experiences, it is hoped that services, treatment and support could be developed and improved. This paper consists of three chapters. Chapter one focuses on the experiences of partners of men with prostate cancer. A review of the literature identified twenty-two papers that are reviewed and synthesised into four overarching themes. Changes to the relationship and the unmet needs of partners are explored. Further ways in which services and professionals can support partners are identified. Chapter two involves a qualitative study exploring the experiences of seven men living with a diagnosis of Bipolar Disorder. Interpretative Phenomenological Analysis is utilised to understand men’s lived experiences. One theme identifies the battles men experience internally and externally in relation to vulnerability, masculinity, medication and stigma. Clinical implications and research directions are identified. Chapter three is a reflective account of the overall research process. It spans from the development of the research proposal through to conducting and reflecting on the research undertaken. Consideration is given to the role of a Clinical Psychologist in the research process.

There are two papers contained within Volume I of the thesis. The first is a systematic review which aimed to assess the efficacy of psychological interventions with adolescents with traits of Borderline Personality Disorder (BPD). A systematic search of three databases resulted in 12 papers, which were assessed against a quality framework. As there were limited papers which were of high quality and a paucity of evidence within each of the interventions assessed, it was difficult to draw conclusive results from the review. The second paper is a research study which sought to understand the experiences of females with BPD traits who had frequently been admitted to psychiatric inpatient services. Seven participants were interviewed using Interpretative Phenomenological Analysis. Four super-ordinate themes were identified: ‘BPD diagnosis is shorthand for untreatable and exclusion from services’; ‘Care-shaped gaps in services’; ‘Hospital as an illusion of escape, protection, safety, respite’ The importance of responsive and therapeutic relationships with clinicians was highlighted throughout the results as being fundamental to helping to develop better long term outcomes. A supportive transition from inpatient services to community, with a clear plan of support to empower the individual, was posited to be of utmost importance.

This dissertation investigates how the settings of drug use influence the affective and neurobiological response to heroin versus cocaine in addicts. Chapter 1 reviews the neuropharmacology of heroin and cocaine and the theoretical background for drugs-settings interactions, including a detailed discussion of findings from previous studies in animals and humans that show how the same settings can influence in opposite directions the reinforcing effect of heroin and cocaine. Cocaine self-administration, for example, was greatly facilitated when rats were tested outside the home environment relative to rats test at home. The opposite pattern was found for heroin. Translational studies in humans yielded similar results. Indeed, heroin and cocaine co-abusers reported using the two drugs in distinct settings: heroin preferentially at home and cocaine preferentially outside the home. The aim of this dissertation is to determine whether the setting could also influence in opposite manner the affective and neurobiological response to heroin and cocaine in human addicts. Chapter 2 illustrates the findings of a study aimed at testing the hypothesis that the affective state experienced under cocaine or heroin is the result of an interaction between central and peripheral drug effects and the surroundings of drug use. According to this hypothesis, when cocaine is taken at home there is a mismatch between the familiar environment and the peripheral effects such as arousal, increased heart rate, increased respiratory rate, and increased muscular tension (which are usually produced in stressful situations). This mismatch dampens cocaine-rewarding effects. A mismatch would also occurs when heroin (which produces sedation and decreases heart rate, respiratory rate, and muscular tension) is used outside the home in contexts requiring vigilance. We found indeed that co-abusers subjectively experienced opposite changes in arousal, heart rate, respiratory rate, and muscular tension in response to cocaine (increase) versus heroin (decrease). Most important, using a novel two-dimensional visual test, we found that in agreement with the working hypothesis the valence of the affective state produced by heroin and cocaine shifted in opposite directions as a function of the setting of drug use: heroin was reported to be more pleasant at home than outside the home, and vice versa for cocaine. Chapter 3 illustrates the results of in which emotional imagery was combined with fMRI to investigation the neurobiological underpinnings of drug and setting interactions in addicts. Heroin and cocaine co-abusers were asked to recreate real-world settings of drug use during fMRI. In agreement with the working hypothesis, we found that heroin and cocaine imagery produced opposite changes in BOLD in the prefrontal cortex and in the striatum, regions implicated in brain reward in humans. Furthermore the same pattern of dissociation was observed in the cerebellum, suggesting that that a fronto-triatal-cerebellar network is implicated in processing drug-setting interactions. Chapter 4 includes a summary of the results, a general discussion, and suggestions for future research and implication. The major finding is that the environment surrounding drug use can influence in opposite manner the affective and neurobiological response to heroin and cocaine, suggesting that therapeutic approaches to the treatment of drug addiction should take into account the distinctive effects of different classes of drugs as well as the contexts of drug use. The Appendix includes reprints of two papers reporting on additional studies conducted during the course of the Ph.D. program, which are not directly germane to the aims of the dissertation. Other three papers are in the pre-submission stage.

Background and aims: The aim of this study was to review whether (and which) impulsivity sub-domains are elevated in groups of non-dependent alcohol misusers (e.g., heavy/hazardous drinkers, binge drinkers, etc.), relative to healthy drinking comparison groups. It set out to answer this by reviewing studies comparing groups on impulsivity multi-dimensionally – that is, via more than one index (at least one self-report and at least one behavioural). Comprehensively profiling non-dependent alcohol misusers’ impulsivity may increase understanding of the potential mechanism(s) involved in the initial development to and maintenance of such misuse (and possibly to subsequent dependence). Methods: The search was performed via three scientific databases (Embase, Medline and PsycINFO) and was limited to empirical studies comparing non-clinical groups of drinkers aged 18-25 years and published in English language journals. The titles and abstracts of all non-duplicate returns were screened in order to determine eligibility. A subsequent ancestry search involved screening the (titles and abstracts of papers in the) references sections of all eligible papers. Grey literature was not included. The findings of the included papers were qualitatively reviewed, before each was rated using the National Institutes for Health quality assessment tool for observational cohort and cross-sectional studies. Results: Just eight studies were found to have compared impulsivity multidimensionally in groups of young adult (i.e. 18-25) non-clinical alcohol misusers, relative to comparison groups. Collectively, findings indicate that self-reported rash impulsivity is elevated in the quasi-experimental groups, whilst behavioural inhibitory control and delay discounting are not. Due to insufficient amounts of data, it is unclear whether response-initiation, risk-taking and reflection impulsivity may be elevated in non-clinical alcohol misusers. The quality of the eight studies included in the final review was generally rated ‘fair’, none being rated ‘good’, due to a range of potential sources of confound. Conclusions: Across all impulsivity sub-domains assessed in these studies, only selfreported rash impulsivity appears a reliable risk factor for the maintenance (and possibly, initial development) of non-clinical patterns of alcohol misuse, at least in young adults. However, the potential inclusion of dependent drinkers across the included studies represents a serious limitation, raising questions about findings/conclusions. Overall, more studies are needed that assess impulsivity multidimensionally in groups of alcohol misusers, relative to healthy drinkers; these studies should ensure better control of possible sources of confound.

The ability to form secure attachments shapes the experience of feeling safe in distressing situations. Dementia is often described as a distressing situation which activates the attachment system. Consequently, how people with dementia and caregivers attach to one another informs how safety may be experienced in such circumstances. This thesis has sought to understand how attachment influences the experience of both the person with dementia and their caregiver. Part one presents a literature review on the ‘interactive attachment dyad’ between the person with dementia and caregiver. Findings suggested that interactions within the dyad is a complex phenomenon. Conflicting results across papers highlighted difficulty in understanding how attachment influences the reciprocal interactions that take place between people with dementia and caregivers. Future research could include exploratory observational research of interactions that take place within the dyad, and explore the relevance of attachment theory. Part two presents an empirical paper which qualitatively explored staff caregivers’ understanding of their interactions with, and relationship to, residents in the mid to later stages of dementia in the care home setting. This sought to consider the relevance of attachment within the caregiving relationship. Findings highlighted that a care home setting shares many of the features usually associated with the concept of a secure base in attachment theory. The findings suggest that an attachment-focused model of care may be useful to consider across policies, clinicians and service-levels. Future research is considered.