Aim: For many years suicide rates have been higher for men than women and research has failed to explain this difference. More recently, the effect of gender role has been explored and offers a promising explanation, although the nature of this effect remains unclear. This study aimed to incorporate gender role into a well-established model of suicide (The Integrated Motivational-Volitional (IMV) model) (O’Connor, 2011). More specifically the present study tested whether two variables related to gender role moderated the relationship between defeat and entrapment in the IMV model. These variables were Gender Role Conflict (GRC), measured using the Gender Role Conflict Scale (GRCS) and Androgyny, measured using the Bem Sex Role Inventory (BSRI). Design: A cross-sectional design was utilised and participants completed anonymous online self-report surveys. The independent variable was defeat and the dependent variable was entrapment. Existing moderator variables outlined in the IMV model were rumination and coping flexibility. GRC and androgyny were tested as potential new moderators. General linear modelling was used to examine the moderating effect of the 4 variables. Participants: 231 men over the age of 18 completed the online survey. The majority of participants were White-British men in full-time employment. Results: Coping flexibility and rumination when entered jointly into the model were found to moderate the relationship between defeat and entrapment, with higher levels of rumination and lower levels of coping flexibility strengthening the relationship. This model explained 67% of the variance in entrapment scores. GRC and Androgyny were not significant moderators, however higher levels of GRC were correlated with higher level of defeat and entrapment. Conclusions: The clinical implications are discussed in relation to the clinician’s role in supporting men to identify patterns of rumination and adopt a more flexible approach to coping with defeat. Recommendations for future research are discussed.

Background: People with a borderline personality disorder diagnosis can require support from mental health services for managing risk behaviour. Evidence suggests current inpatient and community treatment can be unhelpful for this group, who usually require specialist approaches. Positive risk taking has been developed to help community teams manage risk with people with a borderline personality disorder. Aim: To understand how positive risk taking is experience by people with a borderline personality disorder diagnosis. Method: A qualitative study using Interpretative Phenomenological Analysis (IPA) to analyse transcripts from semi-structured interviews. Nine adults with a diagnosis of borderline personality disorder and experiences of positive risk taking approaches were sampled from one NHS Trust. Participants were either currently or had previously been under the care of a community mental health recovery service. Results: Participants’ engagement in positive risk taking was coloured by earlier negative experiences of the healthcare system (including previous risk management), interpersonal complexity in professional relationships and experiences of isolation. When participants were engaged in positive risk taking or with approaches using positive risk taking principles, these were experienced as a helpful alternative to traditional risk management. This seemed contingent upon collaborative and trusting relationships with professionals who created an emotional ‘safety net’, which appeared to empower participants to connect with outside agencies and challenge recovery-relapse patterns of service use. Conclusions: Positive risk taking seems to have the potential to benefit others with a borderline personality disorder based upon participants’ experiences. Participants’ experiences compliment those of service users in other studies emphasising the importance of interpersonal factors, such as compassion and empathy, when working with personality disorder. Positive risk taking itself was relatively unfamiliar to participants though findings are clinically relevant. Participants’ experiences suggest more training and increased resources are required to implement positive risk taking successfully with borderline personality disorder.

Objective: Negative symptoms are a major cause of social and functional disability in psychosis and current treatment approaches are yet to meet this therapeutic need (Fusar-Poli et al., 2015). Attachment has been proposed to play a significant role in the development of psychotic symptomology, with mentalizing suggested as a potential pathway through which attachment may impact psychosis (Korver- Neiberg, Berry, Meijer, & 2014; Carr, Hardy, & Fornells-Ambrojo, 2017). This study set out to test this hypothesis by examining the relationship between insecure attachment (anxiety and avoidance dimensions), mentalizing, and the negative symptoms of psychosis in first episode psychosis and general population samples. Design: A quantitative cross-sectional design was used. The hypotheses were tested using correlation, regression, and mediation analysis. Participants: 32 participants experiencing first episode psychosis and 149 general population participants took part in the current study. Participants experiencing first episode psychosis were recruited from Early Intervention in Psychosis services and general population participants were recruited via social media and university networks. Results: Insecure attachment dimensions (anxiety and avoidance) were associated with increased levels of negative symptom severity, distress resulting from symptoms, and mentalizing impairment (hypomentalizing). Mentalizing impairments (hypomentalizing) were linked with increased levels of negative symptom severity and distress. Mentalizing was found to mediate the relationship between insecure attachment and negative symptom severity and distress. These findings were significant across both samples tested. Mediation models were non-significant for social anhedonia. Conclusions: This study’s findings support an aetiological model of psychosis where, mentalizing, specifically hypomentalizing impairments, constitute a pathway through which insecure attachment impacts on the development of negative symptom frequency and distress. Clinical implications and future research directions are discussed. Keywords: Psychosis, Schizophrenia, First-episode, Negative symptoms, Attachment, Mentalizing, Mentalization, Distress, Social Anhedonia, Mediation, Cross-sectional design.

Introduction: Cognitive difficulties are evidenced in opiate-dependent populations, whether they are caused by drug use per se, or other associated life-style factors. To date no research exists which explores the subjective experience of cognitive impairment in opiate-dependent populations attending drug and alcohol services. In comparable fields such as brain injury and dementia, the subjective experience of cognitive impairment has been explored with important and beneficial results. Method: Using a qualitative design, data were collected from in-depth interviews with six working-age adults with a diagnosis of opiate-use disorder, attending a service for opiate-substitution therapy, who self-identified as experiencing memory and thinking difficulties. Transcripts were analysed in accordance with Interpretative Phenomenological Analysis. Results: Three superordinate themes emerged: “a damaged brain and mind” which included the extent of the impairment and how participants made sense of such difficulties; “perceptions of the self as spoiled” which explored the perceived changes in independence and dependence and resultant negative feelings about the self; and “coping with a lesser self” which included acceptance and adaptation, and familiar but maladaptive coping strategies. Conclusions: Participants’ understanding and experience of their cognitive difficulties contributed to their sense of well-being, and further impacted on chosen coping strategies. Consideration of cognitive impairment is important to effectively support individuals attending drug and alcohol services.

Objectives: Colouring books for adults have become increasingly popular. Some of these books are marketed on the basis that they improve mindfulness and promote wellbeing. Using a randomised design, this study aimed to empirically explore whether the provision of guidance on how to colour mindfully is necessary to increase mindfulness, and to reduce worry, perceived stress and work-related rumination. Moreover, the study aimed to assess whether changes in mindfulness predicted changes in worry, perceived stress and work-related rumination. The extent to which trait perfectionism might impact on possible beneficial effects of colouring was also explored. Design: Sixty-four participants (49 female, 15 male, 84% Caucasian, mean age 36) were randomly assigned to either a mindfulness-instructed condition (MI) or non-mindfulness instructed condition (NI). Participants were instructed to colour in designs in a book on 10 occasions over a two-week period. Mindfulness, worry, perceived stress and work-related rumination were measured pre and post the colouring intervention and at one-month follow up. Perfectionism was measured once, prior to the two-week colouring period. Results: Analysis of Covariance indicated no significant differences between conditions in post-colouring and follow up levels of mindfulness, perceived stress, worry or work-related rumination whilst controlling for pre-intervention scores. Oneway Repeated Measures Analysis of Variance for the whole sample indicated significant increases in acting with awareness and nonreacting mindfulness subscales, and a significant decrease in worry, affective rumination and problem-solving pondering pre-to post intervention. Changes in the nonjudging mindfulness facet pre-to post intervention were found to predict changes in worry from pre-intervention to follow up. There was little evidence of a relationship between perfectionism and change in wellbeing variables. Conclusions: Colouring, with or without mindfulness guidance, appears to increase aspects of mindfulness and improve wellbeing. Replication of these results, and further research exploring whether colouring is intrinsically mindful is warranted.

Background: Comorbid borderline personality disorder (BPD) in psychosis is poorly understood, despite research suggesting that it contributes to poorer outcomes at 5 and 10-year follow-up. Mentalizing (the ability to attribute thoughts and feelings to self and others) is thought to be a transdiagnostic factor that contributes to core impairments in BPD and symptoms of psychosis. This study aimed to explore the relationship between mentalizing, positive and negative symptoms of psychosis, and traits of borderline personality disorder, in a sample of patients with first-episode psychosis, and in a non-clinical sample. Method: 32 adults with first-episode psychosis (FEP) and 149 non-clinical participants were assessed using the reflective functioning questionnaire (RFQ). The RFQ measures two dimensions of mentalizing, certainty (RFQc) and uncertainty (RFQu) about mental states. Traits of BPD and symptoms of psychosis were measured using the self-report version of the Zanarini rating scale for BPD, the Community Assessment of Psychic Experiences (CAPE), and the Green et al, paranoid thought scale. Results: Patients with FEP were significantly more impaired on the RFQ compared to the non-clinical sample, showing significantly lower certainty, and higher uncertainty about mental states. Regression analysis showed significant associations between higher scores on the RFQu and negative symptoms of psychosis in both groups. Significant associations were also found between higher RFQu and increasing BPD traits in the non-clinical sample. Conclusions: The present research provides evidence that impairments in mentalizing may be a core component of the process underlying negative symptoms of psychosis across both clinical and non-clinical samples. Mentalizing impairments may also be associated with BPD traits, but this finding was only confirmed in the non-clinical sample. Mentalizing should therefore be considered in the early assessment and treatment of patients experiencing these difficulties.

This portfolio comprises a culmination of research work spanning three years of full- time training on the Practitioner Doctorate course in Psychotherapeutic and Counselling Psychology (PsychD) at the University of Surrey. The research comprises three research reports: a literature review, and two qualitative studies. The literature review explores the psychedelic renaissance, focusing on the resurgence of studies into utility of psychedelic drugs as an adjunct to psychotherapy. The first empirical study is a Thematic Analysis of therapists who have worked with clients when they were under the influence of a psychedelic during a research trial. The study seeks to explore how they experienced the interplay between the drugs and psychotherapeutic practice. The analysis revealed three master themes: i) ‘The Facilitation of Process ii) ‘The Therapeutic Relationship’ iii) ‘The Power of a Transcendental Experience. The second empirical study used Interpretative Phenomenological Analysis (IPA) analysis to explore the lived experienced of having MDMA assisted psychotherapy to treat people with a diagnosis of PTSD. Analysis revealed three major themes: i) ‘Existential Freedom’, ii) ‘Beyond the Cartesian Split’, and iii) ‘A Journey Back in Time’.

Background: There is growing evidence that individuals with Developmental Coordination Disorder (DCD) experience elevated internalising symptoms and executive function (EF) difficulties compared to their typically developing (TD) peers. Research also suggests that EFs are important for psychological wellbeing. Aims: This study aimed to explore whether adolescents with DCD experience greater levels of internalising symptoms and everyday EF difficulties than their TD peers. It also explored whether EF difficulties mediate the relationship between DCD status and internalising symptoms. Methods and procedures: Fourteen adolescents with a diagnosis of DCD and 29 TD adolescents (ages 12-15) participated. A cross-sectional survey was conducted to collect parent-reported EF difficulties and self-reported internalising symptoms. Outcomes and results: Self-reported internalising symptoms and parent-reported EF difficulties were significantly higher in the DCD group compared to the TD group. A bias-corrected, bootstrapped mediation analysis identified that the effect of DCD on internalising symptoms was mediated by parent-reported EF difficulties. Exploratory analyses identified that this indirect effect was greatest for symptoms of depression through behavioural regulation difficulties. Conclusions and implications: These findings support previous research indicating that adolescents with DCD experience greater levels of internalising symptoms and EF difficulties than their TD peers. This highlights the need for increased awareness, routine screening, and intervention for mental health and EF difficulties in people with DCD. The findings also highlight the potential benefits of targeting EF deficits in people with DCD to improve emotional wellbeing. However, larger scale, longitudinal research is needed.

Background: Psychological difficulties such as anxiety and depression are common post-stroke. Mindfulness-based interventions (MBIs), such as Mindfulness Based Stress Reduction (MBSR) and Mindfulness Based Cognitive Therapy (MBCT) have demonstrated effectiveness in alleviating such difficulties in other clinical health populations and show promise in stroke-related psychological difficulties. Objective and Outcomes: The study aimed to assess the feasibility of recruiting and retaining stroke survivors into a randomised waitlist control trial with an 8-week waitlist period and 3-month follow-up. We also aimed to assess the acceptability of an online mindfulness-based intervention for this population and the use of outcome measures relating to anxiety, depression, perceived stress, health status, quality of life and perseverative thinking. Methods: Stroke survivors were recruited at 6-month post-stroke in an NHS clinical setting. No criteria were set regarding minimum pre-existing psychological difficulties. Intervention: 10-session online mindfulness course, comprising elements of both MBSR and MBCT. Results: Fifty-four people were screened. Eighteen were deemed ineligible. Of the thirty-six assessed for eligibility, ten declined to participate. Twenty-four others considered participation but ultimately decided not to participate for reasons such as low confidence with computers. Two participants were successfully recruited and randomised (one to waitlist control). The intervention could be delivered as planned. The 8-week waitlist period was tolerated. No adverse effects were reported. Follow-up at 1 and 3-months was feasible. Reliable and clinically significant improvements were demonstrated in depression for one participant, certain mindfulness domains and quality of life scores. Where reliable deterioration was indicated to perseverative thinking and anxiety measures, low baseline scores prevent us from drawing any substantial inferences. Thematic analysis of interview data conducted with both participants and the recruiter indicated overall acceptability of the intervention and outcome measures used whilst highlighting difficulties in recruitment such as fears about safety online and the priority of physical rehabilitation. Conclusion: Despite the promise of MBIs for stroke-survivors, our poor recruitment rate indicates a larger trial of the proposed design is not currently feasible as planned.

Background: Parent programmes are a NICE (2017) recommended intervention for parents of children who have a conduct disorder and evidence suggests a number of benefits to paternal involvement in such interventions. However, on the whole fathers are often unrepresented at parenting groups. The present study aimed to understand the issues to which facilitators attributed paternal absence from parenting groups. Method: Thematic analysis was chosen to highlight salient ideas in facilitators' explanations. The participants were a volunteer sample of nine parenting group facilitators, from various child services in South East England. Semi-structured interviews were conducted in person and over the phone, and were up to 60 minutes long. Interviews were transcribed and analysed using an inductive approach. Results: The data revealed five main themes: "An uncomfortable topic", "Responsibility", "Our hands are tied", "Fathers are peripheral parents" and "What makes fathers more comfortable?". Facilitators appeared uncomfortable discussing this topic and tried to avoid generalisations or the appearance of sexism. They had differing ideas of who was responsible for paternal attendance and many felt they had done all they could. An important aspect of facilitators explanations of paternal absence was of parents adherence to traditional gender roles in relation to childcare. They also considered that greater familiarity with services and the presence of other men in groups might make fathers more comfortable attending parenting groups. Conclusion: Facilitators found this an uncomfortable topic but mainly explained absence in terms of parents adopting traditional gender roles and service constraints. Clinical implications and research recommendations based on this are discussed.