The experience of a heart attack (MI) can be an event that causes distress severe enough to satisfy DSM-IV criteria for trauma in some individuals. However, research has shown that positive outcomes can also follow traumatic events; this has been defined as Posttraumatic Growth (PTG). This cross-sectional study compared the level and pattern of PTG reported by a post-MI sample (n = 97) with that of a healthy control sample (n = 86); and examined demographic, disease-related, social and psychological correlates and predictors of growth. Post-MI patients reported greater PTG than healthy controls in the areas of 'relating to others' and 'appreciation for life'. Post-MI patients' growth was associated with greater support from family, and was unrelated to distress. Perceived severity of the event had a significant effect on PTG, but objective severity largely did not. Although less overall growth was reported than that following other life-threatening illnesses such as cancer, practitioners should be aware of the possibility for growth. Additionally, the meaning that patients ascribe to their MI has been shown to be more important for psychological adjustment than biological markers because perceived severity of MI had more impact on PTG than objective severity.

Background: Emotional expressivity has received recent research attention in studying behavioural outcomes, in non-clinical samples and clinical samples alike. However, it has not been tested with chronic fatigue syndrome patients, to see if positive expressivity predicts better social relationships. Secondly, dysfunctional attitudes concerning attainment and achievement, and poor everyday routine, have been associated with poorer functioning in different clinical conditions, such as cancer and diabetes. These have not been examined in chronic fatigue syndrome, for whether they predict worse patient functioning in their home duties. This study primarily aims to explore these relationships. The relationship between attainment/achievement attitudes and routine in this patient group was also explored. Method: This explorative, cross sectional study measured 57 patients' levels of positive expressive behaviour, attainment and achievement attitudes, routine, and levels of social relationship functioning and home functioning via self-report measures. Levels of CFS symptoms and depressive symptoms were also controlled for in each question. Results: Hierarchical regressions indicated positive expressivity did not significantly predict worse or better relationships with friends. Increased positive expressivity did predict worse relationships with family members. Attainment and achievement attitudes did not predict better home functioning, but better routine did. No relationship was found between attitudes and routine. Depressive symptoms predicted greater variance than CFS symptoms in the regressions. Conclusions: Depression appears to be of importance in relationship and home functioning difficulties. Positive expressivity also appears to have a special role for CFS patients, reducing quality of family relationships. Increased routine may help patients to manage their home duties better, but attainment and achievement attitudes appear to make little difference. Such attitudes do not appear to influence routine. Implications of findings for present theory and clinical treatment for patients are discussed, with further research following these findings suggested.

Erectile dysfunction (ED) is defined by the World Health Organisation as "a continuous or repetitive inability to achieve or maintain an erection sufficient for satisfying sexual activity". It is a sexual disorder that affects many men and is particularly prevalent in cardiac populations. Since the release of Viagra in 1998, there has been an increased awareness of ED and arguably with it a reduction in the stigma attached to the condition. Despite this, ED remains significantly undertreated. Sexual dysfunction is an important determinant of a person's quality of life and subjective well-being. Left untreated sexual dysfunction can have an adverse effect on a person's mood, well-being and interpersonal functioning. Some have proposed ED to serve as a marker for occult cardiovascular disease and it is therefore vital that men with ED seek treatment promptly in order that they can be assessed for further cardiac risk factors so that preventative or corrective measures can be put in place as necessary to minimise the chances of chronic illness developing. Researchers have proposed that men's reluctance to seek help is due to masculine attitudes and beliefs they hold. It has been suggested that help seeking may conflict with men's socialization of what it is to be a man i.e. being self-reliant, physically tough and emotionally inexpressive. The extent to which masculinity affects men's help seeking for ED is not yet clear. In order to increase the number of men coming forward for treatment of ED, we must understand the help seeking behaviour associated with it. Whilst there has been much research on the prevalence, aetiology, pathophysiology, diagnosis and treatment of ED, very little is known about help seeking for it. The primary focus of this research portfolio thesis is on men's help seeking for erectile dysfunction. The specific aim of the research activity is identifying common factors in cardiac patients' experiences of seeking help for ED; highlighting key drivers and barriers to help seeking for the disorder; and elucidating the extent to which masculinity influences such behaviour.

Background: Attentional biases for trauma-relevant information are consideredto be a feature of post-traumatic stress disorder (PTSD). However, there has beenno systematic review of the published literature into attentional biases across arange of experimental paradigms.Methods: A systematic search of four key databases identified 30 papers meetingthe inclusion criteria. Methodological quality of selected articles was assessedusing an adapted checklist. The tasks employed in the studies were assigned arating of either �yes�, �no�, or �mixed�, depending on the reported evidence fora specific attentional bias effect.Results: A specific attentional bias was found in only 19 of 37 tasks. Whenattentional biases were found they tended to occur at post-recognition stages ofprocessing and to be interference effects, rather than facilitative effects.Limitations: There were common weaknesses across studies, includingunrepresentative participant samples and inappropriate comparison stimuli andparticipant groups. Furthermore, it is difficult to identify the relative contributionof automatic and strategic processes in ranging cognitive paradigms.Conclusions: Attentional biases in PTSD are not reliably found in publishedresearch employing a range of experimental tasks. Future research needs to becarefully designed to clarify the existence and exact nature of attentional biasesin PTSD.Keywords: Attention bias, posttraumatic stress disorder, emotional Stroop, dotprobe,visual search, affective Stroop.

Background: Choice constitutes a core element of the human experience. To deny this right can be seen as a denial of basic human rights and yet for people with learning disabilities this has often been a reality. Some argue that choice is different for people with learning disabilities for a variety of intellectually based reasons. The effect of choice on people with learning disabilities therefore is an important area of concern for researchers to establish the underlying meaning and drivers for increasing choice for this group of people. Method: A systematic literature review was conducted to bring together studies examining the effects of choice for people with learning disabilities. The review utilised three databases and selected reference lists to find relevant articles and these were brought together in a summary of findings. Results: Studies focused heavily on task behaviours and challenging behaviours and whether and how this would be altered by introducing elements of choice or preference. A large majority of studies demonstrated that the main basis for the improvement of tasks and behaviours was the introduction of preferred stimuli rather than the being able to actively choose between stimuli. Other studies demonstrated that choice has a positive effect on mood, quality of life and motivation during a self care exercise.

This portfolio thesis has three parts. Part one is a systematic literature review examining the theoretical, conceptual and empirical literature regarding the relationships between coping styles and distress in infertility. Part two is an empirical paper exploring the relationships between emotional intelligence, coping styles and distress in women attending a subfertility clinic. Part three comprises the appendices.

This paper is a systematic review of empirical papers investigating preventative strategies and interventions for burnout among healthcare workers. The idea was borne out of a recommendation in the independent NHS Health and Well-being Review (Department of Health, 2009a) commissioned by the Department of Health and led by Dr Stephen Boorman, that is that there should be access to effective interventions for mental health problems faced by NHS staff in all NHS Trusts. 11 studies were included in the review which covered interventions ranging from brief psycho-education, peer-support, intensive residential courses involving individual counselling sessions and whole team-based interventions. Participants both within and between studies included a wide variety of healthcare professionals who worked in a variety of specialities and settings. Intensive residential courses for self-referring nurses and medics produced long-lasting reductions for those with initially high levels of burnout. Peer-support interventions were also valuable. The interventions reviewed tended to include more than one component and so future research should concentrate on determining which components of the interventions are most useful for which groups of healthcare professionals. This portfolio thesis comprises three parts: Part I is a systematic literature review of empirical papers investigating preventative strategies and interventions for burnout among healthcare workers. The idea was borne out of a recommendation in the independent NHS Health and Well-being Review (DoH, 2009a) commissioned by the Department of Health and led by Dr Stephen Boorman, that there should be access to effective interventions for mental health problems faced by NHS staff in all NHS Trusts. Part II is an empirical paper that has also arisen from a recommendation of the Boorman Review (DoH, 2009a), namely that the NHS should adopt a prevention-focused health and well-being strategy for staff. To help enable this, a clearer understanding of how healthcare professionals come to experience difficulties in the course of their work is required. To further this understanding a quantitative test was applied to the Positivity Negativity Ratio Model of the development of Compassion Satisfaction and Compassion Fatigue proposed by Radey & Figley (2007) as applied to mental health workers. Part III comprises the appendixes with additional information relevant to the systematic literature review and empirical paper, and a reflective statement of the research process.

This portfolio thesis comprises of three parts: a systematic literature review, an empirical report and appendices. Part one is a systematic literature review in which literature relating to the empirical paper is reviewed. Insufficient studies into hope in cardiac populations exist so the search was broadened to hope in chronic physical illness. The review attempts to determine what the strongest and most consistent correlated variables with hope are in chronic illness populations. Links to theory and recommendations for future research are then made. Part two is an empirical paper which includes two complementary studies. Study one aimed to test the hypothesis, what are the statistical predictors of hope. A range of variables were assessed to allow regression analysis with hope as the predicted variable. Study two explored the experiences of individuals living with cardiovascular disease and what made them hopeful about the future. The results of the two studies were formulated together to propose an understanding of the predictive processes present in hope. Part three comprises appendices and a reflective statement which draws on personal experience of and reflection on the research process.

This study explores aspects of the future in adolescents' choices to continue or terminate pregnancy. Future orientation (FO) (e.g. Seginer, 2005) and reasons for pregnancy resolution were investigated using a researcher constructed and administered questionnaire. Three groups were included: termination of pregnancy (ToP) (n = 19), ante natal (AN) (n = 9), and never pregnant (NP) (n = 23). Participants were 13-18 years-old. Statistical and content analyses reveal groups differ in aspects of FO and reasons for pregnancy resolution choice. Future factors are shown to be important in teenagers' pregnancy resolution decisions. The impact of negative discourses about teenage pregnancy and parenting is discussed. Suggestions are made for conducting research that can advance understanding of this complex issue.

Objectives: There appears to be growing evidence that living with acquired hearing loss (AHL) results in people experiencing increased psychological distress. However, there is currently a dearth of research examining psychological adjustment to AHL. The available models assume that psychological adjustment to AHL is a sequential process. Personal accounts of AHL and evidence regarding other disabilities suggest that psychological adjustment is a far more complex process. Consequently, the present study aimed to explore individuals‟ experience of the process of psychological adjustment to AHL. In addition, individuals‟ understandings of the concept of adjustment were also explored. Method: Ten semi-structured interviews were conducted with individuals who had acquired a moderate, severe or profound hearing loss in adulthood. These were transcribed and analysed for recurrent themes using Interpretative Phenomenological Analysis. Results: Data analysis revealed that 9 super-ordinate themes represented participants‟ experience of adjustment to AHL. Findings indicated that AHL resulted in participants experiencing identity loss and changes in the dynamics of their relationships. Participants suggested that acceptance was a difficult but vital process that reduced psychological distress. Acceptance was hypothesised to be a multi-dimensional continuum along which participants moved back and forth. Identity negotiation appeared to be an important psychological process associated with acceptance. Participants believed that there was a “right” way to “adjust” but none felt their experiences matched this ideal. Consequently, it appeared that there was a discrepancy in the way participants and the researcher understood the concept of “adjustment.” Discussion: The findings suggested that psychological “adjustment” to AHL was a complex dual-directional process. Participant narratives appeared to be consistent with the recurrent model of acceptance and adjustment proposed by Newsome and Kendall (1996). It was suggested that findings regarding participants‟ perceptions of “adjustment” had important implications for clinical practice and these were described. It was recommended that future qualitative research should attempt to explore individuals‟ assumptions regarding “adjustment” in more detail.