Does Trauma-Related Training Have a Relationship with, or Impact on, Mental Health Professionals Frequency of Asking About, or Detection of, Trauma History? Objective: Traumatic exposure is prevalent, with the impact of trauma and its relationship with other conditions widely documented. Research suggests that clinicians do not routinely ask about trauma history in clinical settings and trauma-related training has been recommended as a means of addressing this. The impact of such training on clinician behaviour (i.e. frequency of asking about or detection of trauma history), or the relationship between these variables, has not been formally reviewed. Method: A systematic literature review was conducted using PsychINFO, Scopus and Web of Science. The grey literature and reference lists of included articles were consulted. Nine articles met the eligibility criteria for inclusion. Results: Two-thirds of the studies reported either a statistically significant correlation between trauma-related training and detection of trauma history, or provided statistically significant evidence to suggest the following; (1) an increase in asking about, (2) more frequent asking about, and (3) greater detection of trauma histories, in mental health professionals who have received trauma- related training. Effect sizes ranged from very small to medium. Conclusions: Whilst acknowledging the limited number and variable quality of studies, as well as the failure to detect statistical significance in all studies, this review provides some evidence that trauma-related training has a relationship with or impact on clinician behaviour with regards to trauma enquiry or detection. However, further high quality research is needed. Training programmes should balance skill and educational components and consider the potential for variation in enquiry behaviour across trauma subtypes, as well as the barriers to clinician enquiry. A Survey on the Use of Trauma History Measures. Objective: Research has highlighted the role of trauma history measures in assessing traumatic exposure, as well as the limitations associated with these measures. With such an array of measures available, the extent to which trauma history measures are used and considered most useful is unknown. Method: An online self-report survey enquiring about the experience of trauma history measures was completed by 528 clinicians, researchers and clinician-researchers working in the field of traumatic stress. Results: Participants identified accessible language and clear presentation as the most important feature of trauma history measures. Trauma history measures appear to be used “often” and “very often” by 56.3% of participants, with evidence suggesting that trauma history measures are used less frequently by clinicians in comparison to clinician-researchers and researchers. Trauma history measures were considered useful in research and clinical practice. Participants reported using measures due to the impact of trauma and its relationship with other presentations, and to provide a comprehensive assessment of trauma. Despite well-known measures (e.g., CTQ; Childhood Trauma Questionnaire) being used by participants in the past year, the majority of participants reported infrequent use of these measures. However, the Life Events Checklist (LEC) and CTQ were identified as the most frequently used measures and were considered most useful. Conclusions: Clinicians should be skilled in assessing trauma history and encouraged, supervised and trained to use trauma history measures when appropriate. Further research is needed to establish a consensus as to the most used and useful trauma history measures in the field.

The effectiveness of third wave therapies on neurodegenerative diseases. Objectives: Previous research has identified the effectiveness of third wave therapies in reducing the symptoms of a variety of physical and psychological presentations. This systematic review will assess the efficacy of third wave therapies for adults with neurodegenerative diseases. Methods: The selected electronic databases, Medline, PsychInfo, Embase and Cinahl, were used to search for studies that were published from the inception of each database to January 2018. Third wave therapies (e.g. Acceptance and Commitment Therapy, Dialectical Behaviour Therapy, Mindfulness-Based Cognitive Therapy) and neurodegenerative diseases (e.g. Alzheimer disease, Parkinson’s disease, Prion disease) were included as search terms. Results: The systematic literature search revealed 570 potentially relevant papers. From this number, seven studies were found to be eligible for inclusion in the narrative synthesis. These studies reported on four neurodegenerative diseases and five adapted third wave therapy interventions. There were found to be mixed results on the effectiveness of third wave therapies for improving both physical and psychological symptoms in a variety of neurodegenerative diseases. Conclusions: At this stage, it is not possible to deem whether third wave therapies are feasible in offering psychological or physical benefits to the neurodegenerative disease population. However, despite not being able to draw any firm conclusions, the use of third wave therapies has shown some potential benefits. Further randomised controlled trials to assess the effectiveness of adapted third wave therapies are required. Practitioner Points: + Three studies identified improvements in cognitive functioning in the intervention group in comparison with the control group. + Some studies also found improvements in anxiety, depression, quality of life, and mindfulness following third wave therapy interventions. - However, an increase in depression, stress and a reduction in quality of life found following third wave therapies. - As this is the first review of this population and third wave therapies, it has not been possible to focus more closely on just one specific third wave therapy or neurodegenerative disease. Further research on the effectiveness of third wave therapies in this population is required. LSRP: Defence styles, alexithymia, illness perceptions, and HRQOL in IBD. Background/aims: The role of psychological factors in the development and progression of Inflammatory Bowel Disease (IBD) is not completely understood. Several studies have suggested that defence styles, alexithymia and illness perceptions each individually influence the way a person experiences their disease, thereby impacting on health related quality of life (HRQoL). The study aimed to expand the knowledge base and assist in offering a better understanding of these variables. Methods: The study employed a survey design and used opportunity sampling to recruit participants with IBD from a Regional Crohn’s and Colitis support group and outpatient Gastroenterology clinics. Participants were given questionnaire packs containing measures and were asked to post them back to the researcher. One hundred and thirty-nine participants were included in the study, of these 73.5% were female and 26.5% were males. 53.6% of participants reported being diagnosed with Crohn’s disease, where as 41.3% were diagnosed with Ulcerative Colitis, 1.4% were diagnosed with both, and 3.6% had a diagnosis of IBD but did not have a clear diagnosis of either Crohn’s or Colitis. The majority of participants identified that they were diagnosed with IBD between the ages of 20 and 29. Most participants (60.4%) felt that stress and worry was the cause of their IBD. Results: The study found that defence styles, alexithymia and illness perceptions were all correlated with HRQoL. However, multiple regression analysis revealed that the alexithymia subtest, “difficulty identifying feelings” and the neurotic defence style were the only variables that had a significant relationship with HRQoL. It was also found that females and people that were recently diagnosed also had a worse HRQoL. Conclusion: These findings suggest that females who are recently diagnosed with IBD and have difficulty identifying feelings as well as a reliance on neurotic defence styles have a worse HRQoL. Therefore, screening of this population and the introduction of psychotherapy to assist with emotional care might be beneficial in improving HRQoL. Practitioner Points: + Gender, time since diagnosis, neurotic defence styles and difficulties identifying own emotional experiences found to potentially contribute to poorer HRQoL. + Therefore, therapy using emotional identification, especially when a person is just diagnosed, might be beneficial to people with IBD. - The study used a cross sectional design, therefore it is not possible to infer causation. Future research should use a prospective design.

The Association between Quality of Social Support and Symptom Severity in Individuals with Psychosis: A Systematic Review. To systematically review the research exploring the association between quality of social support and symptom severity in individuals with psychosis, a literature search was conducted on three databases (PsychINFO, Web of Science and PubMed). A narrative synthesis of twelve studies that met the inclusion criteria was conducted. Results of the review indicated relatively consistent findings, with greater symptom severity associated with lower quality of social support. The possible mechanisms underlying these findings are explored, including a hypothesis that social support is a protective factor that promotes resilience. The limitations of the review and clinical implications of findings are outlined with possible directions for future research suggested. Exploring Childhood Trauma and Social Capital as Predictors of Depression in Individuals with Psychosis. The exploration of depression in psychosis is essential due to the potential impact on the individual. Childhood trauma and social capital, comprised of measures of social support and neighbourhood cohesion, were explored as predictors of depression in individuals with psychosis. Using a cross-sectional design, 52 participants were recruited from mental health services in Northern Ireland. The Childhood Trauma Questionnaire, Multidimensional Scale of Perceived Social Support, Neighbourhood Cohesion Scale and the Beck Depression Inventory were administered. Whilst childhood trauma, specifically emotional abuse was predictive of depression in individuals with psychosis, the remaining subscales along with social capital were not associated with depression. These findings suggest a relationship between emotional abuse in childhood and depression in individuals with psychosis and are discussed in relation to attachment theory. Clinical implications, including the need for routine assessment of childhood trauma are highlighted along with limitations of the current study and recommendations for future research.

Despite significant advances in both understanding and technology, complications of surgical care have become a major cause of death and disability worldwide. A substan- tial proportion of these complications are deemed preventable. It has been hypothesised that preparing surgeons to operate may improve performance and, by extension, pa- tient outcomes. This thesis is concerned with three fundamental investigations into the effect of preparation (described as preoperative simulation) on surgical performance. First is an investigation into the current understanding of preoperative simulation, which involves a systematic review of the literature. Broad support for preoperative simulation is demonstrated, however, the studies suffer from methodological shortcom- ings and lack theoretical grounding. Building on this, a laparoscopic sequence learning task was developed to allow the investigation of preoperative simulation under controlled conditions. This was used in three controlled, randomised crossover trials. These experimental trials demonstrated that a simplified, relevant preoperative simulation can improve simulated laparoscopic performance. Exactly what form the preoperative simulation should take is deter- mined by the nature of the task/operation being performed and is likely to reflect how that procedure was learnt. Additionally, preoperative simulation can alter an opera- tors approach to completing a task, overriding a suboptimal but preferred method, to condition them to use a better method of completing the procedure. Finally, the natural experiment of repeating a procedure during an operative list was used to explore the effect of preoperative simulation in clinical practice. An inves- tigation of approximately a half million operations was conducted, which demonstrated that the order in which procedures are performed has a predictive relationship with operative duration (a surrogate for operative quality). This finding was relatively con- sistent across the thirty-five most common operations, and reinforced by the finding that switching procedures leads to significantly increased operative times. These investigations support the view that preoperative simulation improves surgi- cal performance.

Colorectal cancer (CRC) is the second most common cause of cancer death in the UK. Since the introduction of the NHS Bowel Cancer Screening Programme CRC incidence and mortality rates have reduced, however, screening uptake in the overall population remains suboptimal and is disproportionately low among populations with low socioeconomic status (SES) and Black and Minority Ethnic populations. This thesis aimed to critically assess the available evidence of public health interventions to improve CRC screening and to examine the possible mechanisms of socioeconomic inequalities in CRC screening uptake within a UK setting. A systematic review and meta-analysis (Study 1) of randomised controlled trials (RCTs) to increase CRC screening uptake was conducted. Data from 102 RCTs including 1.94 million participants were analysed and intervention effectiveness was examined by level of SES. Interventions significantly improved screening uptake, especially among low SES populations, and helped reduce - but not eliminate - SES disparities. Specific intervention strategies were highlighted as effective among low SES groups. Study 2 used qualitative interviews (N = 27) to explore the views of different socioeconomic and sociodemographic population subgroups and identify the barriers and facilitators to CRC screening. Results highlighted both practical and emotional factors that influenced screening decisions and revealed both similarities and differences in the views of different subgroups. Study 3 used cross-sectional, observational, survey data (N = 206) to explore key sociodemographic and psychosocial variables as potential moderators and mediators of screening intention. Results indicated that psychosocial variables mediated the effects of past behaviour on screening intention and identified some differences by educational attainment and area-level deprivation. This thesis argues the importance of considering both sociodemographic and psychosocial factors in relation to improving CRC screening uptake and reducing inequalities. Results highlighted key determinants of CRC screening participation and identified specific pathways via which sociodemographic and psychosocial variables interact to affect screening intention. This thesis provides an evidentiary basis that can be used to inform future public health initiatives and/or interventions that aim to reduce the CRC inequality gap.

There is a growing need for the provision of mental health services for young people in schools. A number of evidence-based practices (EBPs) now exist for schools to choose from to address their pupils' mental health needs. However, when such EBPs are introduced into schools, their effectiveness can be lacking and weakened. Implementation science suggests that without effective implementation strategies, the success of EBPs in schools may be limited. The transfer of knowledge into practice is a difficult and challenging process, often referred to as the 'science to service gap'. To support the mental health of young people, there is a need not just for EBPs but also for evidence-based implementation. Mindfulness training (MT) is a promising intervention for young people that is currently being introduced to a number of schools across the UK, and internationally. The primary aim of this doctoral work was to understand and examine MT implementation experiences in order to identify the determinants of, and potential ways to promote, the early implementation stages of MT in schools. The first study in this doctoral work examined how far a knowledge broker, sharing implementation related knowledge, could impact the implementation decisions made by a steering group (SG) responsible for implementing a mindfulness program across schools in Cumbria, UK. SG meetings were attended for 14 months and meeting minutes, notes and audio recordings were recorded and analysed for "key moments" and "key outcomes". A second related analysis of this SG activity explored, via interviews and thematic analysis, the perceived opportunities and barriers for the SG to act as an implementation team. Study 3 aimed to identify the determinants of MT early implementation success in five secondary schools by using the Consolidated Framework for Implementation Research (CFIR). Interviews were conducted with school staff responsible for implementing MT at two time points across 6 months. The schools' implementation progress was recorded, and the CFIR was used to code the data for 38 implementation constructs. Usefulness of the CFIR was assessed. Finally, in Study 4 the findings of the previous studies were synthesised with the implementation science literature to inform the development of a preliminary implementation framework to promotes the successful implementation of MT in (secondary) schools in order to improve their usefulness in such complex settings. Findings from Study 1 and 2 suggested that SGs responsible for implementing school public health programs can learn about implementation and then apply this new knowledge to their program. Sharing knowledge with stakeholders responsible for implementing public health programs may be a viable and effective implementation promotion strategy. Having a strong engagement strategy and good relationships with schools can facilitate this process. SGs influence over general school capacity and external funding may be limited and hinder their ability to impact overall implementation. More work is needed to understand how SGs may be empowered to influence general capacity, funding, and have better linkages to other stakeholders involved in their program's overall provision. Findings from Study 3 indicated that there are a number of implementation related constructs which seem to distinguish between schools which implement MT well and schools which do not. The CFIR was a useful tool for identifying the barriers and facilitator to EBPs in schools and which barriers and facilitators seem to distinguish implementation success between schools the most. School leadership plays a pivotal role in ensuring implementation success. Who should be solely responsible for the successful implementation of EBPs in schools is less clear but it may be that a concerted effort on the part of program designers, program funders and school leadership might be required to ensure programs are implemented well. Study 4 indicated that implementation frameworks designed specifically for school leaders are likely to be useful but what motivates school leaders to use them is less clear. Further research into ways of promoting the use of implementation guidance by school leaders is needed.

Best-practice guidelines, grounded in psychological theory, are important for interviewers who engage with a vulnerable group such as children who allege abuse (reviewed in Chapters 1-6). Prior to conducting interviews, Scottish investigative interviewers must complete a JIIT (Joint investigative Interviewing Training) course, where they interview an adult actor who plays the role of an abused child. Limited field work suggests child interviews in Scotland are of low quality. No empirical work on the quality of JIIT precludes an understanding of whether i) interviewers are trained to an appropriate standard, ii) gains made in training diminish over time (i.e. when compared against performance in the field) and iii) whether adults from acting companies respond in a manner that reinforces best practice questioning by the trainee. This thesis examines the line of questioning and responses of actors during JIIT. Specifically, whether JIIT outcomes differ i) in two different police jurisdictions with separate untrained actors (Chapter 7), ii) according to whether training sessions are scribed or recorded (Chapter 8) and iii) according to an actor‟s expertise in the psychological literature on investigative interviewing (Chapter 9). Across studies, trainees were poor at using both "ground rules‟ and closure rules. Lines of questioning did not differ between two forces and untrained actors/trainees responded-to/used invitations to the same extent as directives. Untrained actors provided more informative responses to focussed prompts and suggestive questions than they did to open prompts. Although a „trained‟ adult actor provided a more authentic training opportunity, trainees were not sensitive to this feedback and it did not encourage better lines of questioning. Scribed versus recorded accounts of interviews captured fewer ground rules and closure rules, shorter responses to invitations, incomplete and incorrect records in response to invitations and, on average, omitted two details per interview. By way of comparison, analyses of actual Scottish field interviews with children (Chapter 10) revealed no use of any ground/closure rules at levels greater than chance. Children provided more details in response to option-posing questions and relatively short but detailed responses to suggestive questions, only in comparison to „other‟ questions in both instances. Of note in relation to earlier chapters, children gave longer average responses to invitations than directives. Overall the findings of this thesis indicate that interviewers‟ training is inconsistent across jurisdictions in Scotland and that many aspects of the training are inappropriate. For example, the adult actors hired to role-play abused children do not reinforce the use of best practice open prompts selectively as we would hope and the use of scribing as a method to record interviews is unreliable and resulted in both loss and incorrect recording of information. Further, the field interviews conducted with children in Scotland are of a low standard (6% open prompts), therefore, practical recommendations are made (Chapter 11) in light of these concerning findings.

This thesis investigated cognitive biases in attention, interpretation, and memory and their role in symptom perpetuation of Chronic Fatigue Syndrome (CFS). The first empirical study presented in the thesis used a quasi-experimental design to explore the interaction of attention and a cognitive state of rumination in 33 people with CFS and 33 healthy controls, who were randomly assigned to undergo either rumination or distraction cognitive state induction. In these altered cognitive state participants have completed a visual probe task measuring attentional processes. The CFS group did not show attentional bias towards illness-related information following the rumination induction, compared to the CFS group in the distraction state or healthy controls. However, being in a state of either rumination or distraction led to greater mood volatility in CFS group than in healthy controls. The second empirical study similarly used a quasi-experimental design to investigate the interaction of attention and mood in a sample of 16 people with CFS, 25 people with asthma, and 28 healthy controls. The study explored later-stage conscious allocation of attention in neutral or depressive mood, under either low or high cognitive load. CFS, asthma and healthy control participants were randomly allocated to a depressive or a neutral mood induction. Then the participants completed two cognitive tasks, a visual probe (high load) and an exogenous cueing (low load), to measure allocation of attention towards health-threat. Attentional bias towards health-threat emerged under the condition of high cognitive load and neutral mood in CFS and healthy controls, but not in the asthma group. Depressive mood did not exert an influence on attentional bias towards health-threat in CFS. The third empirical study, using a quasi-experimental design, investigated later-stage conscious allocation of attention towards activity and exertion-related stimuli in the conditions of neutral and depressive mood, and low and high cognitive load, utilising the same method as the second empirical study, described above. The same sample of participants consisting of 16 people with CFS, 25 asthma and 28 healthy controls completed a visual probe and an exogenous cueing task to measure allocation of attention towards activity words and pictures. Under high cognitive load CFS group showed increased attentional avoidance of activity-related stimuli, compared to healthy controls. Empirical Study 4 investigated the process of interpretation of ambiguous information collecting and analysing the data from the sample of 33 people with CFS and 33 healthy control volunteers who also participated in Study 1. The study used a quasi-experimental design. The participants completed a lexical decision task, which measured their reaction times to the presentation of ambiguous information that could be interpreted either in a threatening or in a neutral manner. The CFS group did not demonstrate a tendency to interpret ambiguous information in a negative illness-related fashion, compared to the healthy control group. The fifth study, a survey conducted via the Internet, utilised a mixed methods design to investigate features of autobiographical memory, specificity and perspective, in 87 people with CFS, 56 people with asthma, and 60 healthy controls. Participants completed a memory task, where they were asked to recall four types of events (happy, pain, fatigue, physical activity), and questionnaires assessing symptoms, functioning, activity, mood, and coping. The CFS and asthma groups recalled more specific memories of activity, compared to healthy controls. For CFS and asthma groups general activity memories were associated with more personal, field memory perspective. The activity memories recalled by CFS group were rich and diverse in content, reflecting a complex multidimensional view of activity. Healthy controls viewed activity specifically as sport and exercise-related. Fatigue memories recalled by the CFS group reflected a stable, global, profound view of fatigue. The overall findings partially supported the hypothesis that people with CFS may cognitively over-process the information related to potential health-threat. Enhanced cognitive processing of health-threatening information may underpin increased monitoring and overperception of CFS symptoms. Methods that can address cognitive processing, for example reduce over-processing of potential health-threat or modify perception of activity, may be of benefit in treatments that aim to increase activity levels in people with CFS, such as Graded Exercise Therapy.

No description available.

In the literature and research on giftedness there are ubiquitous references to interpersonal problems. This project investigated this by comprehensively bringing such references together and analysing them (textual analysis), and by interviewing 20 gifted adults about their interpersonal experiences. A Constructivist Grounded Theory methodology was employed to build a theory grounded in research data that could explain how interpersonal difficulty in gifted individuals arises, is perpetuated, and can be overcome. A Psychosocial (Hollway 2016) interpretation of the data examined not just its explicit cognitive and behavioural content but also the more hidden nuances of intersubjective experience – termed ‘unconscious processes’ – that the giftedness literature neglects. An ‘Overview Model of Giftedness’ was constructed to organize the research findings, which emphasizes the importance of person-environment interaction, belonging, competition, and collaboration. Interpersonal difficulty was found to arise predominantly through relating categorized as naïve (‘Child’, including autism) or arrogant (‘Emperor’, including narcissism). It was demonstrated how interpersonal difficulty is perpetuated through unconscious processes such as transferences, valencies, and intersubjective complementarities. It was found that interpersonal difficulty was overcome by changing environments (gaining contact with more similar others); changing the level of self-expressiveness (‘hiding self’); or changing the nature of self-expressiveness (such as tempering naivety and arrogance through improving interpersonal understanding and skill). These findings were consolidated in an original model titled ‘Giftedness and Interpersonal Relating’ that shows the optimal movement away from being interpersonally inhibited, despairing, or provoking, towards thriving. Conclusion: Atypically efficient neural functioning, and minority status, make gifted individuals vulnerable to interpersonal difficulty. Recognising the individual differences involved, their impact, and their unconsciously perpetuating intersubjective patterns, and taking this into account when communicating with others, improves interpersonal relating and the actualizing of gifted potential. The project’s main products are a website offering services designed to “help high-ability adults thrive”, and a book proposal.