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Main Research Project: Investigating perceptions of disgust in older adult residential home residents As able-bodied people often become increasingly physically-dependent as they make the transition into older age, they may lose the ability to contain bodily fluids as they once had. Contact with bodily fluids is linked with feelings of disgust and, given the necessity of receiving assistance with intimate care activities, it has been suggested that self-focused disgust, and concerns over the disgust of others, may be important preoccupations in older people. This mixed-methods study therefore investigated feelings of disgust in fifty four physically-dependent older adults living in residential homes. Participants completed measures of disgust sensitivity, mood, and two new scales pertaining to feelings of self-disgust and perceived other-disgust when being assisted with intimate care activities. Results indicated that disgust was uncommon, although where present, self-disgust was related to perceptions of others’ feelings of disgust and disgust sensitivity. These results were benchmarked against twenty one community-dwelling older adults, who reported believing they would feel significantly more disgusting if they were to start receiving assistance than those receiving assistance already did. Six of the residents who reported high levels of self-disgust also participated in semi-structured interviews. The thematic analysis was consistent with the quantitative results, with participants reporting that underlying protective factors, the use of strategies and carer characteristics reduced any feelings of disgust. The overall results are discussed with reference to the disgust literature, with recommendations being made for ways in which self-disgust can be minimised in residential homes. Service Improvement Project: Profiling the psychological training and support needs of oncology staff, and evaluating the effectiveness of clinical psychology provision, in a general hospital department The importance of training non-psychology healthcare professionals to offer psychological support to people with cancer is becoming increasingly recognised. Semi-structured interviews with five members of multidisciplinary oncology staff identified that training needs were primarily around communication skills, recognising and dealing with emotions, offering support and empathy, and self-care. Pre and post-training questionnaires developed with these themes in mind revealed that the Level 2 Training Programme workshops run in this network of hospitals are effective in increasing participants’ levels of perceived knowledge and confidence across each of these domains. Recommendations are made for further enhancing this effectiveness. Critical Literature Review: An evaluative review of the relationship between empathy and posttraumatic stress disorder There is a small but growing body of evidence suggesting that PTSD may affect, and be affected by, an individual’s level of empathy. This review identified and examined 20 papers investigating these relationships, exploring them with reference to the cognitive model of PTSD outlined by Ehlers and Clark (2000). The first finding suggested that level of empathy may either increase or decrease following traumatic experiences, depending upon the way in which an individual responds to their trauma. The second finding suggested that higher levels of empathy may either predispose or protect an individual from developing PTSD, depending upon their ability to use protective coping mechanisms. Finally, a third finding suggested that higher levels of empathy facilitate recovery from PTSD. It is recommended that empathy-enhancing work be included in PTSD treatment protocols, and that effective coping skills are taught to those likely to experience traumatic events.

Main Project: This study aimed to 1) investigate if adolescents and young adults with autism spectrum disorder (ASD) who are high in social anxiety underestimate their social performance when compared with those low in social anxiety, and 2) investigate the association between social motivation and social anxiety. Participants (n=20) aged 14-21 years completed measures of social anxiety, loneliness and social satisfaction before taking part in a video-recorded group discussion. Self and observer ratings of social performance were analysed. Results revealed that participants high in social anxiety rated themselves significantly poorer than did observers. The interaction between social anxiety group and rater was non-significant. Loneliness significantly correlated with social anxiety. This study highlights how cognitive factors may be involved in social anxiety for young people with ASD and discusses implications for psychological intervention. Service Improvement Project Objective: Chronic illness, such as Cystic Fibrosis, can make adolescence and young adulthood challenging. During this time, young people must move on from using paediatric to adult healthcare services. This transition is a current research focus, acknowledged to require careful preparation and planning and be considered within a developmental context. This study aimed to explore the experiences of some young people with Cystic Fibrosis and their parents during this transition in order to inform a transition pathway. Method: Five young people and three parents who were either approaching or had experienced transition were interviewed about their experiences. Transcribed interviews were analysed using thematic analysis. Results: Four key themes emerged: moving on from the familiarity and security of children’s services; changes in the nature of relationships with healthcare professionals; transition as a condensed process in the context of adolescence; and changing roles in healthcare. Conclusions: Results highlighted the strong attachment to paediatric team and the anxiety about change for both patients and parents. Themes are discussed along with service recommendations which aim to reduce this anxiety for patients by supporting the establishment of new relationships and increase familiarity and confidence with the new setting and processes. Literature Review: Family members often become significantly involved in obsessive compulsive disorder, changing their lives to accommodate the symptoms. Relatives can experience distress, and feel a great deal of burden relating to the OCD. Families are recognised as a key factor in treatment effectiveness and therefore understanding their burden and how they cope is essential. The aim of this review was to synthesize studies concerned with family burden and coping in OCD to build on the understanding of family experiences and help inform treatment. A search was conducted of Pub Med, Web of Science and APA Psych NET using terms OCD, burden, coping, family, relatives etc. Thirteen articles were included in the review. Burden was found to be a far-reaching and complex construct associated with increased severity of OCD, dysfunction, family accommodation and depressive symptoms. Families have been reported to struggle to know how to cope. Avoidant coping has been associated with decreased hope, negative affect and accommodation whereas active reframing and social support appear to have the opposite associations. Results are discussed along with implications for treatment and further areas of research.

Main Research Project: Self-critical thinking and overgeneralisation in depression and eating disorders: an experimental study. This study investigated the hypothesis that self-critical thinking plays an important role in ‘overgeneralisation’ where specific negative experiences result in more global negative self-views (sometimes known as ‘core beliefs’ or ‘schemas’). Two experimental tasks, one involving word puzzles of varying difficulty, and one focused on body image, were used to elicit self-critical thoughts in participants with depression (n=26), eating disorders (Anorexia, Bulimia and ED-NOS; n=26) and nonclinical participants (n=26). As predicted, following failure experiences on the word puzzle task, the clinical groups showed greater global negative self-views, controlling for baseline scores, compared to controls. Both habitual and increases in state self-critical thinking was associated with overgeneralisation while negative perfectionism was not. As predicted from Barnard and Teasdale’s (1991) Interacting Cognitive Subsystems model, increased global negative self-views were more strongly associated with post-task lowering of mood than self-criticism. Unexpectedly, participants with eating disorders did not report significantly more appearance-related self-criticism or greater global negative self-views after the body image task than the other groups. Overall, the findings are consistent with the suggestion that self-criticism may play an important role in the activation of global negative self-views after a specific negative experience, and this overgeneralisation may in turn result in low mood. Keywords: Self-criticism, depression, eating disorder, overgeneral, failure, perfectionism Service Improvement Project: Service user perspectives on the use of outcome measures in psychological therapy Despite much research into the benefits of outcome measurement, service user opinions on this as part of the therapy process have not been investigated. This study aimed to assess service users’ experiences of completing measures during psychological therapy, with a view to exploring how therapists can maximise how helpful measures are in therapy. Fifteen participants completed surveys about the use of measures in their current episode of care. Results showed that despite mixed experiences in how measures were explained and used, service users showed generally favourable attitudes towards their use in therapy, with them being perceived as most helpful when well integrated into sessions by their therapists. Implications for clinical practice, service development, and further research are discussed. Keywords: outcome measures, service user views, questionnaires, therapy, routine outcome measurement Critical Literature Review: Hoarding among older adults: An evaluative review This article presents an evaluative review of the literature on hoarding in older adult populations. Interest in hoarding is growing rapidly, with significant media attention and the inclusion of ‘hoarding disorder’ in DSM-5. Studies are now beginning to examine the phenomenon within particular client groups. This article aims to synthesise and examine research findings regarding older adults with hoarding problems. Database and journal searching revealed a small but growing body of work in this area, which was reviewed with respect to a number of theoretical issues. The reviewed studies tended to rely on purely descriptive methodologies, meaning that typical case presentations and circumstances are well documented but underlying causal and maintenance mechanisms are less well understood. There is a clear need for longitudinal work and cross-sectional designs comparing age groups, utilising appropriate control groups where possible. Directions for future research in this area are suggested, along with consideration of how the current findings might inform generic theories and models of hoarding.

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Data visualisations can be effective for communicating scientific data, but only if they are understood. Such visualisations (i.e. scientific figures) are used within assessment reports produced by the Intergovernmental Panel on Climate Change (IPCC). However, IPCC figures have been criticised for being inaccessible to non-experts. This thesis presents a thematic analysis of interviews with IPCC authors, finding that a requirement to uphold scientific accuracy results in complex figures that are difficult for non-experts to comprehend, and which therefore require expert explanation. Evidence is subsequently presented showing that figures with greater visual complexity are associated with greater perceived comprehension difficulty among non-experts. Comprehension of complex data visualisations may require readers to make spatial inferences. When interpreting a time-series graph of climate data, it was found that non-experts did not always readily identify the long-term trend. Two experiments then show that linguistic information in the form of warnings can support spatial representations for trends in memory by directing visual attention during encoding (measured using eyetracking). This thesis also considers spatial inferences when forming expectations about future data, finding that expectations were sensitive to patterns in past data. Further, features that act on bottom-up perceptual processes were largely ineffective in supporting spatial inferences. Conversely, replacing spatial inferences by explicitly representing information moderated future expectations. However, replacing spatial inferences might not always be desirable in real-world contexts. The evidence indicates that when information is not explicitly represented in a data visualisation, providing top-down knowledge may be more effective in supporting spatial inferences than providing visual cues acting on bottom-up perceptual processes. This thesis further provides evidence-based guidelines drawn from the cognitive and psychological sciences to support climate change researchers in enhancing the ease of comprehension of their data visualisations, and so enable future IPCC outputs to be more accessible.

This research was an idiographic investigation of the first-hand accounts of mature undergraduate students with depression. Participants were drawn from one Institution of Higher Education in Ireland. The number of mature students entering Higher Education in Ireland is increasing annually. The number of individuals with a diagnosis of depression is increasing also. To date, very little research has examined the experiences of mature undergraduate students with depression, in the Irish context. The focus was on undergraduate studies as the research aimed to examine an individual's first experiences of Higher Education. As the study aimed to provide a description of an individual's experiences of studying with depression, the participants had a current diagnosis of depression and were taking antidepressant medication. It is routine in Ireland to prescribe antidepressants for mild depression (e.g. HSE, 2016). Data were collected via in-depth semi-structured interviews with eight students aged between twenty-six and fifty years. Data were examined using Interpretative Phenomenological Analysis (Smith et al, 2010), which is an approach that facilitates a hermeneutic phenomenological enquiry into the unique lived experience, as well as convergences among participants. Based on the analysis of the material, the students' experiences were organised into three main themes: Journey through Academia with Depression; Managing Depression; and Altered Self. These themes indicated that the experience could be characterised as a journey through academia, with the journey getting increasingly more difficult as students entered their third and fourth years of a four-year undergraduate degree. Findings revealed that individuals had a complicated relationship with medication, and that they sought other ways in which to manage their depression. They also revealed the changes to their sense of self that they expressed as taking place during their academic journey. Individuals' accounts communicated the stigma around depression, the distinct dynamic among mature undergraduate students in relation to why they have come back into education, the difficulties in engaging in group work for individuals who experience depression, feeling isolated or disconnected, the challenges of receiving feedback on academic work, and a self-critical voice. The extent of suffering articulated by the participants leaves no uncertainty about the gravity of depression and the implications for their academic experience. Findings, which have implication for counselling psychologists working with mature students in HE, are discussed.

This study explores the therapists' experience when managing safeguarding concerns about their clients' children, with the aim of raising awareness and bringing the child into the therapists' mind. A review of the literature indicated that this is an undeveloped area, with existing research lacking attention to the impact of the therapeutic relationship on this ethical dilemma. IPA (interpretative phenomenological analysis) was used to analyse the findings from six semistructured interviews with a mix of psychological therapists who had experienced concerns for their clients' children while working in non-NHS settings. This approach allows for an in-depth exploration into the subjective experience of the participant, while also recognising the reflective role of the researcher. The findings indicate that therapists are struggling with a lack of confidence and experience in managing their child protection concerns, with an indication of a training need. This lack of confidence, combined with a range of complex emotions evoked in such work, increased the participants' need for support and supervision. Participants felt the need to alter their therapeutic practice and become more directive in order to ascertain clearer details about their concerns. The findings have implications for the training and continued professional development requirements for psychological therapists. There is an indication for training focused on managing concerns in the context of the therapeutic relationship, more training around assessing the level of risk and the development of a prompt sheet with reflective questions to aid therapists in their thinking. An identified limitation of this study is the range of participants in terms of gender and ethnicity; further research could explore more thoroughly whether these factors influence how concerns are managed. There is also scope to explore more specifically the impact of the therapeutic placement, to identify whether those working within large organisations, such as the NHS, feel more supported and contained in this type of work than those working more independently.

The aim of this thesis was to use kinematic analysis to further our understanding of tool Use. We wanted to investigate whether there were similarities in how people picked up objects with their hand and with a tool, and whether these remained when we manipulated the ratio and motor equivalence of the tool. This allowed us to investigate the concepts of end-effector control and internal tool models. Participants compensated for the ratio of the red 1.4:1 tool to the same extent when only cued with tool colour as when having all of the information. This shows that information about the tool must have been stored in memory, supporting the idea of internal tool models. Participants produced qualitatively similar movements with our tools and the hand, showing no difference in the peak velocity and altering peak end-effector aperture based on tool ratio. Further to this, participants displayed similar adaptive mechanisms in response to visual uncertainty with the hand, the blue 1:1 tool and the red tool, but not with the yellow 0.7:1 tool however. Throughout the thesis participants also compensated less for the ratio of this tool than the red one. Whilst attempting to investigate the imperfect compensation seen with both tools we understood this issue more. Participants overestimated object size with the yellow tool and performed more poorly at a size discrimination task as well. This pointed towards a biased internal tool model, tending towards the aperture of the hand. This accounted for the asymmetric compensation seen between the red and yellow tools. We concluded that the imperfect compensation for tool ratio was caused by noise in the internal tool models and that the yellow tool model was then biased as well, further reducing compensation. Our findings support the idea that the precision with which we can use a tool could be modulated by prior experience with that transformation. We also believe that the degree of motor equivalence of the tool contributes to precision of use, with tools that are not directly equivalent taking longer to develop a robust internal model for. However, even tools without direct motor equivalence display some of the hallmarks of reaching and grasping with the hand, suggesting that grasping movements could be encoded in end-effector units.

Working memory predicts children’s academic achievement at school and future prospects. Working memory training may offer generalised improvements; however, evidence has been mixed and is a source of controversial debate. Training has been shown to improve performance on working memory tasks, but it is unclear if this reflects increased capacity or a change in strategy. Training has been found to improve children’s attention, maths, and reading, but rarely in studies with appropriate control groups. Very few controlled studies have investigated the neural correlates of working memory training in children, obscuring inferences about neural mechanisms. Chapter 2 presents the most comprehensive investigation of the neural correlates of working memory training to date. Training is found to improve children’s working memory performance, increase recruitment of the middle frontal gyrus, and increase connectivity within the posterior parietal cortex, but not change grey matter volume. It is concluded that repeated coactivation of fronto-parietal regions during training may increase executive or attentional control. However, strategy change may influence task-related brain activation. Chapter 3 presents a randomised controlled trial of ‘MetaCogmed’, a novel working memory and metacognitive strategy training programme designed to facilitate transfer to academic outcomes. Working memory training alone is found to improve children’s performance on tasks of working memory and mathematical reasoning. However, only the improvements in working memory were maintained three months later. MetaCogmed did not improve academic outcomes more than working memory training alone. It is concluded that working memory training may improve children’s maths ability in the short-term when offered in addition to school, and that metacognitive training may require more time and activities to promote generalisation. Chapter 4 presents a novel neuroimaging investigation of memory strategies in children. Grouping is found to be associated with decreased recruitment of the left middle frontal gyrus and increased recruitment of the left premotor cortex. It is suggested that grouping may afford an organisational advantage and more efficient use of working memory capacity compared to sequential rehearsal.