The prevalence of Chronic Heart Failure (CHF) is increasing and recent studies outside of the UK suggest that psychological adjustment to this disease can be poor. The present study aimed to: - 1) Determine the prevalence of anxiety and depression disorders in a UK sample. 2) Explore the validity of the Hospital Anxiety and Depression Scale (HADS) against a structured clinical interview (SCID-I). 3) Identify the predictors of depression and anxiety. 4) Identify the predictors of hospitalisation and mortality. PARTICIPANTS AND MEmODS - A postal survey of 118 patients from a specialist CHF unit in the UK was followed by a face-to-face interview with 100 patients. Measures used included those of depression, anxiety, social support, cognition, biomedical status and previous physical and mental health history. RESULTS - Prevalence rates of anxiety ranged from 18.4 - 42.3% and depression ranged from 15.3 - 37.8% dependent on the type of measure used (HADS or SCID-I). The HADS had adequate discriminatory ability. Both psychosocial and biomedical predictors of anxiety and depression were identified, although these differed depending on the scale used as the dependent variable. Associations were found between depression, anxiety and hospitalisations although these were not significantly strong to survive in the regression analysis. CONCLUSIONS - Prevalence rates of anxiety and depression are high in this population. The results were discussed according to their contribution to theory, clinical practice and future biopsychosocial research with this population.

The portfolio has three parts. Parts one and two are conceptually linked by their focus on self-harm and the cessation of the practice. Part one is a systematic literature review. Each individual’s self-harm experience is unique to them but there has been research that has shown that there are similarities between each experience. The systematic literature review examines the views and experiences of those who practice the behaviour with a view to identifying any similarities and discrepancies. Part two is an empirical paper. The therapies that have been studied for their effect on self-harm behaviours have failed to yield results that show that any one approach is consistent in decreasing the frequency and/or intensity of the behaviour. The empirical paper reports a study that explored the experiences of 8 adults who had previously self-harmed but no longer did so. It was hoped that the themes and any commonalities between the experiences would provide insight into what is poignant for the individuals when stopping the behaviour and that this would contribute to the on-going work helping people to no longer use the behaviour. Part three comprises the appendices.

VOLUME 1 This volume comprises a review of the literature surrounding caring for family members with dementia and an empirical study investigating the impact of knowledge on carer burden and anxiety and also to investigate whether coping style affected the relationship between knowledge and anxiety or burden. The literature review examines the prevalence of dementia and the nature of the caregiving role. The theoretical basis for understanding the caregiving experience is considered and an overview of the extensive literature investigating emotional and physical health consequences to caregiving along with factors affecting caregiver stress is given. Furthermore, the information needs of carers and the effects of dementia knowledge on carer stress are considered and possible areas for further research are discussed. The empirical study aims to explore the impact of knowledge on carer burden and anxiety and also to investigate whether coping style affected the relationship between knowledge and anxiety or burden. Information about dementia is not always well delivered to caregivers despite the fact that a good grasp of knowledge is important for accurate appraisals. The possibility that increasing knowledge about dementia may increase carer anxiety needs to be investigated further. A cross-sectional, questionnaire-based design was used. Participants were 47 family caregivers of people with dementia living in the community. Pearson's correlations were used to examine the relationships between carers' knowledge of dementia, anxiety, strain and coping. Student's t-tests were used to compare levels of anxiety, carer strain and level of knowledge across demographic variables.No association between carer anxiety and knowledge were found. Use of avoidant coping strategies was positively correlated to carer anxiety and burden. Anxiety and burden were significantly correlated. Use of active behavioural coping was related to level of overall knowledge and is specifically related to biomedical knowledge of dementia The overall conclusions were that it is possible that the relationship between knowledge and carer outcomes does exist, but were not found due to methodological flaws in the main study. However, the predicted relationship between knowledge and carer outcomes may be more complex, insofar as, knowledge may inform carers' subjective interpretations of problem behaviours that have been consistently linked with carer distress. VOLUME ll Four Clinical Practice Reports (CPR) are presented in this volume. CPR 1 details the sleep problems of a 2 year old and formulates the difficulties from 3 different perspectives. CPR 2 describes a service evaluation of a self-esteem group. The obsessive compulsive symptoms of a 65 year old gentleman and the subsequent intervention is outlined in CPR3. CPR4 presents an anxiety management intervention for a man with moderate learning disabilities. An oral presentation was delivered for CPR 5 and an abstract is given.

Impairment in social interaction is one of the defining characteristics of autistic-spectrum disorders. Three factors that may influence the pattern of social skills deficits in autistic individuals are explored in the present study. 1. Can the autistic individual pass theory of mind tasks? Baron-Cohen, Leslie and Frith (1985) suggested that the core impairments of autism could be explained by an inability to attribute mental states to oneself and others. The term 'theory of mind' is used to refer to this ability to represent mental states. 2. Does the autistic individual use logical/factual or mentalist strategies to solve theory of mind tasks? Happe (1994) suggested that if success on theory of mind tasks was due to the use of a logical strategy, this would explain why these individuals were still socially impaired. The underlying reasoning strategy about social situations may have an influence on everyday social interactions. 3. Is general social reasoning influencing theory of mind task performance and achievement of everyday social skills? Several suggestions have been made as to possible reasoning strategies that may be used by children with autistic spectrum disorders to solve theory of mind tasks or to circumvent a lack of theory of mind ability in everyday life. Children with high-functioning autism/Asperger's Syndrome were tested with a battery of theory of mind tasks (1st and 2nd order) and social reasoning tasks. Their performance on these tasks was compared to their everyday social skills as assessed by the Vineland Adaptive Behavior Scales (Sparrow et al, 1984) and other parentrated questionnaires. Results were reported and discussed in the context of the relevant literature. The effects of theory of mind ability, social reasoning skills and the central drive for coherence on the everyday social skills of autistic children were discussed. Implications for clinical interventions for social skills deficits in children with autistic-spectrum disorders were discussed.

This thesis explores mental health nurses’ perceptions of boundaries with service users in acute mental health inpatient settings. This is against a backdrop of notions of recovery implying a relaxation of boundaries, but with an increasing dominance of concerns with risk. This thesis is divided into two sections, with the first part containing a journal paper that is ready for submission. The second section, an extended paper, is required to be read alongside the journal paper. The extended paper contains more detailed information that could not be presented within the journal paper. The journal paper concentrates on the main literature about recovery approaches and service users’ views about the relaxation of boundaries as part of their recovery, alongside barriers to the relaxation of boundaries within the acute mental health inpatient setting. It highlights the gap in the current literature which the thesis aims to address. In order to build a theory about what mental health nurses within the acute psychiatric setting perceive as boundaries with service users, a grounded theory methodology was used. This was used to analyse transcripts of semi structured interviews carried out with the mental health nurses. Three descriptive categories were constructed from the analysis relating to how mental health nurses perceive boundaries: the socially constructed nature of boundaries; the perceived need for boundaries; and enacting boundaries. Theoretical categories were constructed to embed the analysis in the broader cultural setting. The extended paper sets the research against a broader background about recovery approaches and the dominance of the discourse about risk aversion. It specifically explores boundaries in relation to recovery principles and risk, as well as factors that may hinder the relaxation of boundaries, such as stigma and othering. It offers additional information about the methodology and analyses of the data. It has a detailed reflection and memos about the research process. The results section concentrates on factors that impact on mental health nurses perceptions of boundaries. The theoretical categories are presented which aim to account for the data gained, rather than to just describe it.

Background: Unpredictability is identified as a major factor in Multiple Sclerosis (MS) and reported to be a “constant companion” for individuals living with MS. It is reported to be a factor of uncertainty, which is indicated to have a biopsychosocial impact on these individuals. However the impact of uncertainty is argued to diminish over time. Whereas, the lived experience of unpredictability is reported to be continual. Furthermore, unpredictability is argued to have a continual psychological effect on individuals with MS. However, unpredictability is an aspect that remains relatively unaddressed in the research. Qualitative research has been highlighted to be fundamental in exploring the individual experience of illness, providing rich detailed descriptions. In addition it has been instrumental in the development of services to meet the needs of these individuals. The significance of unpredictability in MS highlights the need for further exploration of lived experience of this aspect of the illness to support healthcare professionals and the development of services to meet the needs of these individuals. Aim: This study aimed to address the limited research examining unpredictability in MS, to develop a comprehensive understanding of how this aspect affects the lives of individuals with MS. Method: This study employed a qualitative design. Twelve participants were recruited through the MS Society, local advertisements and by a ‘snowballing’ sampling technique. All participants lived in England, had a diagnosis of MS, and were able to provide consent to participate. Individual interviews were conducted (7 face-to-face and 5 telephone interviews) using a semi-structured interview. Interviews were transcribed verbatim and analysed by the researcher using a thematic analysis (TA) approach. Results: Three main themes were derived from the analysis: 1) Challenges to meaning-making; 2) A wide picture of unpredictability; and 3) Surviving unpredictability. Each of the themes generated between two or three sub-themes. The themes told the participant’s story for living with unpredictability. Conclusion and recommendations: Unpredictability was reported to be a key factor of living with MS, yet it was challenging and difficult to understand. Participants described the wide reaching impact of unpredictability influencing them personally and socially. Pragmatic and psychological approaches were employed by participants to deal with unpredictability. The findings offer insight into the individual’s experience of living with unpredictability. It is argued the findings represent individuals who have reached a stage of acceptance with their illness and therefore may offer health professionals guidance around how to support individuals who have not been able to come to terms with the unpredictability of their illness. Furthermore, the findings highlight the wide reaching impact of unpredictability emphasising the importance of the family team. These findings may offer health professionals guidance around providing family education and support to help develop a cohesive network of support for the individual and the family experiencing the effects of unpredictability in MS.

Introduction: Diagnostic systems conceptualise different eating disorders as discrete entities, identified at a particular point in time. However, research shows there is much overlap between ‘anorexia’ and ‘bulimia’, and the most prevalent diagnosis is ‘Eating Disorder Not Otherwise Specified’ (EDNOS), when people fail to meet full criteria for other diagnoses (Fairburn & Bohn, 2005). When considered from a longitudinal perspective, eating disorder diagnoses and behaviours also tend to change over time, a phenomenon called ‘diagnostic crossover’. Although it is accepted that the prevalence of ‘diagnostic crossover’ in eating disorders is high (e.g. Eddy et al., 2002), the process through which it occurs is poorly understood. Authors have suggested that higher movement from ‘anorexia’ into ‘bulimia’ may represent an inability to maintain restrictive eating and have deliberated about a ‘natural course’ to the eating disorders. Although physiological and psychological effects of starvation suggest this may play a part (Polivy, 1996), some people avoid diagnostic crossover and others move from ‘bulimia’ into ‘anorexia’, which suggests additional factors are involved. Other researchers have proposed that clinical and personality variables such as low self directedness influence these transitions (Tozzi et al., 2005), but the results are inconsistent. Eating disorder therapies are underpinned by psychological models, but these are theorised on the basis of eating disorder diagnoses, which for the reasons above may be invalid, and ignore transitions between them. Although some theories acknowledge crossover (e.g. Fairburn, Cooper & Shafran, 2003), they fail to fully account for the process. Since anorexia binge-purge type, and therefore the acquisition of more eating disorder behaviours, is often associated with poorer outcomes (e.g. Carter et al., 2012, Favaro & Santonastaso, 1996, Herzog, Schellberg & Deter,1997), better understanding of the way eating disorders change over time could improve outcomes and quality of life for patients. Objectives:To investigate the experience of diagnostic crossover, which will be referred to as ‘eating disorder transitions’ to represent the phenomenon as a process rather than a discrete event. This aims to gain a better understanding of the process through which this occurs, and improve insight into the trajectory of eating disorders to further our understanding of them. Methods: Twelve people with a history of transitioning between ‘anorexic behaviours’ (more restrictive eating) and ‘bulimic behaviours’ (bingeing and/or purging) were interviewed about the experience. The results were analysed using ‘Thematic Analysis’. Results and Discussion: Participants’ eating disorders tended to focus on restrictive eating before cycles of bingeing and purging developed in a staged process. The effects of certain life experiences either triggered a change, or facilitated the emergence of these different eating disorder behaviours. When the expression of eating disorders was inhibited and underlying emotional difficulties remained, the eating disorder changed to a different form to compensate. Since participants continually valued being thin, bingeing and purging behaviours were evaluated much more negatively than phases of restrictive eating and led to risky behaviours. The findings suggest that attempts to change eating disorder behaviours without helping patients manage their underlying difficulties first should perhaps be avoided.

Introduction: Numerous accounts have been developed which portray sex addiction and the sex addict. These in turn have led to screening tools, said to be capable of accurately distinguishing the sex addict from non-addicts. However, there are a wealth of various, diverse and conflicting understandings of addiction, sexuality and sex addiction. Sex addiction also carries moral implications, leading some to argue the term is used as stigmatising label for those who deviate from a socially constructed sexual standard. Despite the clinical significance of the growing use of the term, to date there has been a dearth of research which has critically reflected on sex addiction as a concept, and the meaning for those who identify as sex addicts. Objective: This study aimed to explore a seminal text and screening assessment’s description of sex addiction; as well as sex addicts and nonaddicts’ own descriptions of their sexual behaviour and perspectives on sexual addiction; using a qualitative methodology sensitive to the adaptable and social and historical contextual aspects of discourse. Design: A primarily Foucauldian Discourse Analysis approach was taken in the analysis of data from text and semi-structured interviews. Method: Data was collected from the book “Out of the Shadows: Understanding Sex Addiction” (Carnes’, 2001), and the “Sex Addiction Screening Test – Revised” (Carnes, Green & Carnes, 2010), as well as from nine interviews conducted with men identifying as sex addicts and non-addicts from both the UK and USA. Results: The findings demonstrated three main discourses: A Loss of Control, ‘Good’ vs. ‘Bad’ sex, and a Cultural Imperative to Intervene in Sex Addiction. The study demonstrated expert, addicts and non-addicts talk about sex addiction show a number of similarities and some select distinctions. The ways in which sex addiction was talked about were complex and at times inconsistent. Scientific, psychological and moralistic discourses were commonly drawn on to position sex addiction as distinguishable from ‘normal’ sexual behaviour. Health and biomedical discourses were also drawn on to manage accountability, and to construct the sex addict as sick, naïve and disempowered. Correspondingly there was a reciprocal-construction of experts as credible and impartial in being able to identify sex addiction. These experts and wider society were necessitated to identify and protect against a projected exponential rise in sex addiction, catalysed by the advance and accessibility of Internet pornography. Discussion: The study offers new understanding on the discourses of sexual addiction and the subject positioning, actions and subjectivities it creates and restricts for those identifying as sex addicts. Those discourses identified correspond with contemporary discourses surrounding addiction and sexuality; though offer novel permutations which invite further research. The results of this study ascertain that there is a need for healthcare professionals to reflect upon the risks of uncritical acceptance and practice using the sex addiction label, given the breadth and diversity of discourses it encompasses.

No description available.

<p> Money is generally assumed to be a good thing, but there is a downside to wealth. Research has shown that more money does not necessarily lead to greater happiness, but the reasons why remain unclear, and there is a paucity of studies comparing the wealthy to the non-wealthy. This study explored the effect of money on well-being, as well as the various problems associated with abundance. Having more money creates its own unique set of problems, as one must tend to one&rsquo;s money, protect it, and deal with the insatiable urge to accumulate more of it. It was proposed that those who have a lot of money exhibit more paranoia, higher levels of money addiction, and less quality of life, than those who have only have average amounts of money, which may explain why more money does not equal more happiness. Two groups, a wealthy &ldquo;target&rdquo; group and a non-wealthy &ldquo;control&rdquo; group, each completed the Narcissistic Personality Inventory (NPI-16), the Paranoia Checklist, the revised Workaholism scale, quality of life as indexed by the World Health Organization Quality of Life-BREF, the Flourishing scale, and a demographic questionnaire. On average, the wealthy in the target group were found to have greater quality of life than the control group, mostly due to greater reported physical health and environment than their less wealthy counterparts. The other variables did not demonstrate a significant relationship or difference; in fact, on the variables of narcissism and money addiction level, the two groups were found to be nearly identical. However, once age was controlled for, paranoia was found to have a statistically significant relationship with Income. In other words, as predicted in the hypothesis, those with wealth exhibited greater paranoia than those with only average amounts of income when their ages were held constant; paranoia predicted wealth. The present study suggests one possible explanation for why more money does not necessarily lead to more happiness &ndash; the wealthy are more paranoid and distrustful of others than the non-wealthy.</p>