Imagined movements (MI) are a complex behaviour, borne of the neural circuitry and cognitions shared with real actions. They have been implemented in many clinical and elite performance programmes, although these programme outcomes are inconsistent. Applying current models of MI to understand these inconsistencies is confounded by an ineffective discrimination between effects of MI on performance and those of simple preparation for action (MP). Critically, empirical comparisons have yet to be drawn between MI and MP. This thesis presents the results of four behavioural studies and one electroencephalographic (EEG) study which attempted to resolve neurocognitive aspects of this confound. In Experiment 1 (n=18), participants prepared for a lower limb response, or imagined then responded in a repeated measures design. Response time congruency priming was significantly larger following MI than MP, driven by increased costs. Three follow-up experiments were conducted. First (n=16), it was shown that the enhanced priming effect did not depend on optimal temporal preparation. Second (n=13), these effects were also present following imagination and preparation of finger responses. Third (n=21), non-motor cognitive load was manipulated in an additional task, and indicated that the MI priming effects could not be explained more simply as a distracting secondary task. A hypothetical view derived from this data was proposed, suggesting that MI priming can interact with normal MP processes by amplifying the gain of information received from proprioceptive channels prior to response, thus enhancing the difference between correctly and incorrectly primed responses compared to MP alone. Using EEG, the final experiment (n=11) showed the MI priming effect held up when controlling for unwanted muscular activation, and that it may be due to stronger corticomotor activity following MI, supporting the hypothetical view. This thesis therefore provides an integrative neurocognitive perspective on the role of MI in enhancing real performance at short time-scales.

Heteronormativity is an ideology that presumes that heterosexuality is, and should be, the only, the dominant, or the taken-for-granted sexuality for all. In the present thesis, I aim to develop a cognitive understanding of romantic love, as a heteronormative construct. In Chapter 1, I explore a history of psychological research on romantic love to develop my argument that researchers have typically taken heterosexuality as the default in research on romantic love. In Chapter 2, I expand on this argument and postulate that concepts (particularly social concepts) can encode heteronormative ways of thinking about the world. The next four chapters focus on exploring the cognitive construction of romantic love, and explore if participants’ take heterosexual as the default when thinking about romantic love. Heterosexual participants were found to construct romantic love differently depending of task demands. When the task appeared difficult, participants responded with heterosexual as the default (Chapters 3 and 5). In contrast, when the task appeared easy participants responded equally across sexuality conditions (Chapters 4 and 5). Lesbians, gay men and bisexual individuals were found to construct very different understandings of romantic love from heterosexual individuals (Chapter 6). The following two chapters explore how different understandings of romantic love influence perceptions of romantic relationships. In Chapter 7, I observed that participants draw upon a cognitive construction of romantic love when developing an understanding of a romantic relationship. Building on this, in Chapter 8, I found that the prototype of romantic love only predicted the perceived validity of a heterosexual relationship. In the conclusion (Chapter 9), I propose that heterosexual people may construct an understanding of romantic love on the basis of heterosexuality, which biases the perceptions of same-sex relationships. However, this construct of romantic love is not absolute, and can change.

Twenty-first century workplaces have changed considerably, not least through technological developments which enable employees to engage in voluntary information and communication technology (ICT) use for work-related purposes during non-work time without contractual obligation. The overall aim of this thesis was to examine the concept of voluntary ICT use, its antecedents and consequences for employee recovery and well-being in order to develop an evidence-based conceptual model as a theoretical basis to advance future research in this area. One systematic review and three empirical studies were conducted. In the systematic review, literature on voluntary ICT use (i.e., 73 studies) was systematically identified and synthesised in order to establish the existing evidence base. This resulted in an operational definition and conceptual model of voluntary ICT use which provided a framework for the subsequent empirical studies. In Study 1, a two-part cross-sectional questionnaire study, antecedents of voluntary ICT use at the social-normative organisational level (Study 1a, N = 157) and at the individual level (Study 1b, N = 165) were examined. Study 1 identified the supervisor’s availability expectations and colleagues’ ICT use during non-work time as the most influential antecedents at the social-normative organisational level, and lack of psychological detachment at the individual level. In both parts, autonomous ICT use motivation explained a considerable amount of variance in voluntary ICT use. In Study 2, a daily diary study over five consecutive workdays (nbetween = 197, nwithin = 823), voluntary ICT use during workday evenings was found to negatively affect recovery and affective well-being reported at bedtime by impeding psychological detachment; these indirect effects were also observed regarding well-being the following morning, but were less pronounced. Study 3 comprised an experimental field study which evaluated the effectiveness of a three-week intervention that encourages an active boundary management in relation to voluntary ICT use. It was found that participants reported a short-term reduction in voluntary ICT use at the weekend, as well as delayed increases in ICT-related self-control and decreases in need for recovery in comparison to a waitlist control group (T2; N = 55). In summary, this thesis contributes to the establishment of voluntary ICT use as a concept and to existing theories of boundary management and work-related recovery by highlighting their interrelations with voluntary ICT use. Drawing on the findings from the empirical studies, evidence-based, practical guidance is provided, encouraging a more conscious, purposeful management of voluntary ICT use. Directions for future research are suggested in relation to the extension of the conceptual model, the added value of person-centred research and the practical implementation of lessons learnt in a holistic way, aiming to progress in informing policy-makers, employers and employees effectively.

This portfolio contains my doctoral research, clinical work and reflections on my journey of personal and professional development during my training as a counselling psychologist. In the initial introduction, I briefly offer some information about my personal history, my philosophical world view and highlight some important learning experiences. The introduction is followed by my therapeutic practice dossier which offers an overview of each of my 3 training placements, encompassing almost 500 hours of clinical practice. My 3 clinical placements across my 4 years of training consist of working one year at a University student counselling centre, one in IAPT services and two years in primary care as part of a Community Mental Health Team (CMHT). In my first year I had the opportunity to work using the person-centred model. In my second placement in IAPT I worked using brief psychodynamic therapy and in my final two years I employed a more integrative approach with a strong emphasis on traditional and third wave CBT. A number of anonymised case studies together with placement reports and agreements can be found in the signposted digital appendices. My research dossier begins with a brief introduction to three self-contained projects; a literature review and two qualitative studies. My literature review attempts to disseminate the literature regarding the differences between religious and secular individuals on psychological health and well-being. The second project draws on Interpretative Phenomenological Analysis to explore how Atheist clients experience psychotherapy. My final research project attempts to explore how religious fundamentalists exit their religion and abandon their religious beliefs. The final part of the portfolio includes a reflective paper on my identity development as a counselling psychologist. This piece of work includes key learning experiences and anonymised case studies which are interweaven with reflections on the four pillars of my professional training; Clinical, research, academic and personal and professional development.

Emergency laparotomies in the UK, and internationally, have a high risk of death, with accompanying evidence of suboptimal care. The emergency laparotomy pathway quality improvement care (ELPQuiC) bundle is a care bundle for patients undergoing emergency laparotomy, consisting of: initial assessment with early warning scores, early antibiotics, interval between decision and operation less than 6 hours, consultant-led intra-operative care, goal-directed fluid therapy and postoperative intensive care. The primary aim was to determine if implementation improved patient mortality after emergency laparotomy. Methods: The ELPQuiC bundle was implemented in four hospitals, using locally identified strategies to assess the impact on risk-adjusted mortality. Comparison of risk-adjusted 30-day mortality rates before and after care-bundle implementation was made using risk-adjusted cumulative sum (CUSUM) plots and a logistic regression model. Results: Risk-adjusted CUSUM plots showed an increase in the numbers of lives saved per 100 patients treated in all hospitals, from 6.47 in the baseline interval (299 patients included) to 12.44 after implementation (427 patients included) (P < 0.001). The overall risk-adjusted risk of death decreased from 15.6 to 9.6 per cent (risk ratio 0.614, 95 per cent confidence interval 0.451 to 0.836; P=0.002). There was an increase in the uptake of the ELPQuiC processes but no significant difference in the patient predicted risk of mortality profile as determined by the mean Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) risk (0.197 and 0.223 before and after implementation respectively; P=0.395). Conclusion: Use of the ELPQuiC bundle was associated with an increase in compliance to the majority of elements of the care bundle. Introduction of the ELPQuiC Bundle was associated with a significant reduction in the risk of death following emergency laparotomy.

This thesis explores the experience of the working relationships for clients and their non-therapist workers who are marginalised from main stream health and social care in the third sector. Addressing psychological and emotional problems is traditionally the domain of trained psychotherapists, psychologists and counsellors - professions that draw upon clinical and practice based evidence. Third sector workers are often less qualified yet still provide psychosocial support to others, particularly the more vulnerable in society. Little research has explored the subjective experience of client and worker using brief therapy approaches in non-clinical third sector settings which support those who do not have access to mainstream health and social care services. This thesis explores the subjective experience of clients and their workers within the charity sector in three studies. Study 1 and 2 used thematic analysis and continued into study 3, using grounded theory methodology. Study 1 (n=8) explored the experiences of young people who were marginalised from mainstream education and mental health services and were accessing a workshop and manualised programme utilising brief therapy tools. Study 2 (n=5) explored the experiences of workers who had used the manualised workbook and programme to help these young people to manage their behaviour, with a view to returning to mainstream education. The findings of study 1 and 2 informed the development of a grounded theory exploration with an adult age population in study 3. This population were being supported by workers in a veterans Post Traumatic Stress Disorder (PTSD) charity. In addition, study 3 (n=11) also explored workers experiences in a veterans’ homeless charity and two addictions charities. The workers were using a range of brief therapy interventions from a range of approaches: Brief Solution Focussed Therapy, Cognitive Behavioural Therapy, Motivational Interviewing and Neurolinguistic Programming. The data from all 3 studies in this thesis were then synthesised to develop a middle range grounded theory. The findings of the thesis suggest that a therapeutic working relationship based on self-maturational models develops between worker and client. Both the workers and their clients have had disrupted attachment histories and see similarities in each other as part of their own healing journey. The relationship is sometimes uncontained with the workers lacking aspects of self-reflective functioning that would normally be supported through training, personal therapy and supervision of the qualified worker. The charity sector is an increasingly important economic contributor to the health and social care system. This thesis recommends a quality commissioning process that enables education and supervision of non-clinically trained workers to help develop and support their reflexive functioning.

Purpose – This study explores the lived experience of having a significantly larger body and how this influences the way people manage their identity in a world where their appearance exposes them to stigma. The paper has a focus on permissive discourse which is defined as the discourses and strategies participants use to show the way in which they respond to cultural messages about obesity to enable them to continue to live in a larger body. The purpose of this study is to help researchers understand the causation and maintenance of obesity beyond the medical model and inform effective intervention to improve health and wellbeing of people with obesity. Methodology - This study used a qualitative research design, conducting semi-structured interviews with seven participants who self-identified as being significantly larger than average. The interviews were analysed thoroughly using Interpretative Phenomenological Analysis (Smith & Osborn, 2008; Smith, Flowers & Larkin, 2009). Results – Three main themes emerged that were relevant to the purpose of the study; 1.0 the larger identity is dominant and contaminating, 2.0 identity shifts and identity processes and 3.0 permissive strategies that enable living with a spoiled identity. The final theme encompasses seven related subthemes describing different strategies. These strategies varied depending on factors such as internalisation of stigma, acceptance of larger bodies and whether their identity was undergoing a profound shift. Within these strategies permissive discourse narratives were identified. Conclusion – This study provided a fresh understanding of the effect of having a larger spoiled identity, and the coping strategies individuals used to manage this. Identify Process Theory (Breakwell, 1986) was considered a helpful theory to understand the ways in which the individuals used and transitioned between strategies. Further research could explore the phenomenon of identity shift, to see whether it could be used to produce more positive discourses.

Objective: To explore whether nostalgia, a bittersweet emotion characterised by sentimental longing for the past, can improve well-being in older adults and buffer against threats to well-being in this population. Design: A between-subjects experimental design was conducted with random group assignment for participants to recall either a nostalgic memory or an ordinary memory (control group). Ryff & Keyes (1995) Psychological Well-being factors and Life Satisfaction were measured post-intervention and potential threats to wellbeing: loneliness, time-limitedness, and activity levels were measured pre-intervention. Participants: 161 older adults (age 65 years and above) completed the questionnaire on paper or via an internet survey and 132 were able to be used in data analysis. They were recruited through opportunity sample from local community groups and residential homes in England with the majority being White British, retired and living independently alone or with a partner. Results: Method of survey completion (paper vs. online) was found to represent different sub-populations of the sample and to have a significant impact upon findings. Well-being (both life satisfaction and scales of psychological well-being (total, environmental mastery and self-acceptance)) was significantly higher for older adults in the nostalgia condition comparative to control (for those who completed the questionnaire online). Nostalgia was found to buffer against loneliness to protect well-being (for those who completed the questionnaire on paper). Conclusions: This research partly supports the beneficial effects of nostalgia specifically in older adult populations. Future research can build upon the findings of this study, in particular, recruiting older adults experiencing high levels of threats to well-being such as loneliness. Should a body of literature begin to form around the benefits of nostalgia in older adults, this population could be supported to not just be living longer, but also to be living a better quality of life.

Background: Auditory hallucinations (voices) in people with a diagnosis of borderline personality disorder (BPD) have traditionally been regarded as ‘pseudohallucinations’. However, recent research suggests that these voice hearing experiences can be highly distressing and share many of the same qualities as those found in diagnoses such as schizophrenia. Given these similarities, can any psychological therapies effectively treat distressing voices in the context of a BPD diagnosis? Aim: To add to the growing literature exploring voice-related distress in people with a diagnosis of BPD and to answer the unique question of whether brief psychological therapy is effective at reducing voice-related distress for people with a diagnosis of BPD. Methods: 37 people with a diagnosis of BPD and 49 with a diagnosis of schizophrenia received up to four sessions of Coping Strategy Enhancement therapy. The primary outcome measure at baseline and post intervention was the distress subscale of the Psychotic Symptoms Rating Scales (PSYRATS). The frequency, attribution and loudness subscales of the PSYRATS, the Depression Anxiety and Stress Scales (DASS21), the CHoice of Outcome in Cbt for PsychosEs (CHOICE), the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) and drop-out rates were secondary measures. Results: The BPD group reported significantly greater voice-related distress at baseline. The BPD group, but not the schizophrenia group, reported statistically significant improvements on voice-related distress at post-therapy. Only a small minority of participants (BPD = 15% and schizophrenia = 16.7%) showed reliable improvements in voice-related distress, with this not differing significantly between the groups. When controlling for baseline distress and other covariates, the BPD group reported statistically greater improvement in voice-related distress than the schizophrenia group. Withdrawal rates were low for both groups. When controlling for covariates, the attribution dimension of the PSYRATS, the stress subscale of the DASS21, and well-being were the only secondary measures that was predicted by diagnosis. Conclusion: Voices can be experienced as highly distressing for people with a diagnosis of BPD. Brief psychological therapy appears to be appropriate for helping people who experience distressing voices to engage with therapy as part of a stepped-care process, but it is unlikely to produce reliable and clinically meaningful improvements as a standalone treatment.

In the general population, confiding in others is typically related to a plethora of individual and interpersonal benefits. However, there is a lack of research which has examined how confiding may be experienced by young people who have been in the care system. The current study employed Interpretative Phenomenological Analysis (IPA) to guide the analysis of semi-structured interviews with eight young people, all of whom had care experience, on the topic of confiding in others. Five superordinate themes emerged from the data analysis. These included: difficulties negotiating an acceptable sense of self and ‘in-care’ identity that can be shared with others; the anticipation and expectation that confiding would lead to harm; subsequent internal conflict between being open or remaining closed; and the variable opportunities to develop trusted, confiding relationships across different environments. The findings suggest a need for young people in the care system to have safe, secure and stable environments, which can enable the development of trusted, confiding relationships within which one’s identity can be explored. The findings are considered in relation to existing theory and research. Implications for clinical practice and future research are discussed.