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Background: There is evidence that culturally adapted psychotherapies (CAPs) are more effective for treating mental illnesses than standard therapies, but further research is needed to evaluate efficacy of CAPs focusing on the treatment of depression. Behavioural Activation (BA), an existing evidence-based treatment for depression, has been culturally adapted for depressed Muslims in the UK (BA-M; Mir et al., 2015). BA-M has the potential to be beneficial for the treatment of depression in Turkey, which is a Muslim majority country, but this has not yet been evaluated. Aims: The primary aim of this thesis was to examine the feasibility of conducting a full Randomised Controlled Trial (RCT) of BA-M for depressed Muslim adults in Turkey. A secondary aim was to compare findings of the feasibility study in Turkey with those obtained from the UK pilot study. Research design: Three studies were conducted: (1) a systematic review and meta-analysis of face-to-face CAPs; (2) a mixed methods parallel group feasibility study of BA-M compared to Cognitive Behavioural Therapy (CBT); and (3) a comparison study based on findings from the pilot study of Mir et al. (2015) with findings from the feasibility study. Results: The meta-analysis found that CAPs result in a statistically significant reduction in depressive symptoms for depressed adults compared with control conditions with a standardised mean difference of 0.63 standard deviations. Quantitative and qualitative findings from the feasibility study provided evidence about acceptability of BA-M among depressed clients and their therapists in Turkey and that the feasibility study was partially successful, thus an RCT of BA-M could be feasible if issues regarding clients' recruitment and data collection are addressed. The comparison study found some similarities and differences between treatment acceptability and outcome of BA-M among Muslim clients and therapists in Turkey compared to those in the UK.

There is strong evidence of inequalities in mental healthcare access, experiences and outcomes for service users belonging to Black and Asian Minority Ethnic groups experiencing psychosis. Clinicians and academics have speculated that culture-specific conceptualisations of psychosis, alongside inequitable service provision may explain disparities. There is, however, a dearth in literature exploring this in a South Asian population, despite this ethnic group being the second largest in the UK. The present study aimed to explore how people from this minority group have experienced and made sense of First Episode Psychosis (FEP). A qualitative approach was used to explore the lived experience and sense-making of British South Asians experiencing FEP and accessing early intervention services. Eight people were interviewed using a semi-structured format. The data were analysed using Interpretative Phenomenological Analysis. Three superordinate themes were identified in the group analysis: 1) Disconnection from self and others 2) Doubt and dispute 3) Power and shame. Participants characterised psychosis as a terrifying and uninvited intrusion and a fundamental shift in sense of self. Distinctive ethnic, cultural and systemic influence was strongly evident in how people conceptualised their experiences, how they managed their sense-making and where they sought support. Experiences were discussed in the context of power and shame, and this research proposes that socio-cultural/political context and racialised discourses have an impact on self-concept, the experiences of help-seeking (formal and informal), and fundamentally how services help them. Implications of this study for practice, policy and research are discussed.

Background: High levels of shame are frequently reported in individuals with experiences of paranoia, and recent literature suggests that shame is an important factor in the development of paranoia following stressful life events. Psychological therapies that involve the development of self-compassion are designed to address high levels of shame, and emerging evidence suggests promise for the effectiveness of these interventions for individuals with paranoia. However, there have been no studies to date that examine the specific relationship between shame, self-compassion and paranoia. Method: A randomised group comparison design was used to investigate the efficacy of a web-based intervention designed to increase self-compassion in reducing levels of shame and paranoia when compared to a control intervention. Results: The experimental intervention did not increase levels of self-compassion in participants, and therefore it was not possible to assess the impact of this on levels of shame and paranoia. However, the self-compassion intervention did reduce general psychological distress in participants randomised to that condition. Cross-sectional analyses revealed a number of significant correlations between self-compassion, shame and paranoia. Conclusions: The results suggest that a brief online intervention may not be sufficiently intensive to increase self-compassion, but that such interventions may be of use in reducing more general psychological distress. Self-compassion, shame and paranoia all seem to be related, but further experimental research is needed to better establish the processes through which self-compassion interacts with shame to influence experiences of paranoia.

Introduction: There has been a wealth of literature that has looked at social functioning in individuals with experiences of psychosis. Most of this has been quantitative research and has tended to suggest that social difficulties may be due to a social cognition deficit such as an impaired Theory of Mind. The present study aimed to give voice to people with experiences of psychosis and explore their own understanding of their relationships with others, including how they make sense of any difficulties they might experience. Method: A qualitative approach was used to explore the experience and meaning of relationships for people with psychosis. Five participants recruited from a local Rehabilitation service were interviewed using a semi-structured format. The data were analysed using Interpretative Phenomenological Analysis. Participants also completed The Hinting Task, a test to measure Theory of Mind ability. Analysis was done on an individual and group level. Results: Three superordinate themes emerged from the group analysis: 1) Feeling connected to important others 2) Having psychosis can get in the way of relationships 3) Being cautious around others. Discussion: The participants seemed to make sense of their relationships in terms of what the relationships provided; this included support and recovery but also a sense of belonging. Negative experiences with important others, for example, experiencing stigma, were blamed on important others’ difficulties in understanding experiences of psychosis. In relation to the existing literature, the present study suggests that it may be too simplistic to suggest that difficulties interacting with others are due to a social cognition deficit. Clinical implications for improving service user’s experiences and further research are discussed.