Monitoring others’ actions, and our control over those actions, is essential to human social reciprocity. One such everyday social interaction is joint attention when one person follows another’s direction of gaze to a referent object. When initiating joint attention (also known as “gaze leading”), reciprocal gaze responses must be processed rapidly. Therefore, we need to detect and sense agency over these social outcomes. If we cause an outcome, a compression of perception of time occurs between our action and its outcome. This phenomenon is termed temporal binding (also called intentional binding), believed to evidence an implicit sense of agency. Using a temporal binding paradigm, Experiments 1-5 evidence an implicit sense of agency for gaze shift responses to gaze leading. Using an old/new recognition paradigm, Experiments 6-7 evidence equal, high performance for recognition of unfamiliar faces for both previously encountered congruent and incongruent gaze responses to gaze leading. Experiment 8 employed electroencephalography to explore whether the neural system differentiates congruency of gaze shift elicited by gaze leading, finding, for the first time, N170-like evidence of this. Combining previous literature and the new findings in this thesis, a new neuro-cognitive model of joint and shared attention is proposed. This encapsulates the processes at work for both the gaze leader and gaze follower, the associated neural mechanisms and the subsequent social cognition processes which can ensue.

Cognitive behavioural models propose the way in which people with chronic fatigue syndrome (CFS) perceive and respond to symptoms and other illness-related information, contributes to the maintenance of fatigue and disability. Self-report studies exploring a number of these factors have proved fruitful. However, data regarding cognitions and behaviours that may occur at earlier, more implicit levels of processing is lacking. This thesis presents a series of experimental studies to investigate the manner in which people with CFS process information. The main work in this thesis is based on a large cross sectional cohort of people with CFS, compared to healthy controls; followed by a nested longitudinal study of the patients who underwent cognitive behavioural treatments for CFS, namely cognitive behavioural therapy (CBT) and graded exercise therapy (GET). Study 1: A systematic review of attention and interpretation biases found mixed evidence for information processing biases in CFS and highlights methodological issues in experimental design. Study 2: A published article addresses one of the key methodical issues highlighted in the review, the lack of illness-specific materials, by detailing a step-by-step process of comprehensive/robust stimuli development for experimental research. Study 3: A published quasi-experimental study indicates that, when using illness-specific materials, people with CFS (n=52) demonstrate attention and interpretation biases, compared to healthy individuals (n=51); which are associated with unhelpful responses to symptoms, but independent of comorbid mood disorder and attentional control deficits. Study 4: A replication study with a Dutch cohort of CFS participants (n=38) indicates that cognitive biases are a robust finding across cultures and CFS populations, and confirms that these biases are independent of attentional control. Study 5: A nested longitudinal study (n=26) found that, pre-existing attentional biases, as well as a high capacity to develop an attentional bias (i.e. attention malleability), predicts better functioning, but not fatigue post treatment for CFS. Pre-treatment interpretation biases do not appear to predict treatment outcomes in CFS. Study 6: A small follow-up up study (n=20) found that attentional control capacity significantly improves following treatment for CFS. Whilst attention and interpretation biases did not significantly change across this treated sample, the degree to which they changed was associated with more helpful cognitions and behaviours. By exploring the more implicit factors within the cognitive behavioural model of CFS, this body of experimental work has added another dimension to the CFS literature and contributes to a more comprehensive and nuanced understanding of information processing in CFS.

Background. There is strong evidence that supportive social relationships are associated with positive outcome variables in individuals with a long-standing psychotic disorder. Furthermore, evidence suggests that the social relationship deficits characteristic of psychosis are already apparent in the very early stages of the disorder. However, so far no comprehensive answer has emerged to the question of whether supportive social relationships have similar positive effects at psychosis onset, and which qualitative and functional aspects of support are attributed to these effects. A systematic review of the literature was therefore conducted to establish what is currently known about the relationship between perceived social support and outcomes in early psychosis. Method. Medline, Embase and PyschINFO were searched for studies investigating perceived social support in ‘ultra-high risk’ (UHR) and first episode psychosis samples using the expressions (‘schizophreni*’ or ‘psychosis’ or ‘psychotic disorder’) and (‘first episode’) and (‘ultra high risk’ or ’UHR’ or ‘clinical high risk’ or ‘at risk mental state’ or ‘ARMS’) and (‘social support’). Findings were synthesised using non-quantitative approaches. Results. At total of 3006 citations were screened and 11 studies were identified that met inclusion criteria. There was marked methodological heterogeneity, which limits the capacity to draw direct comparisons between the studies. Nonetheless, the existing literature suggests perceived social support has protective effects on service user outcome. These effects may be a function of support from friends and confidantes rather than from family members, and emotional support may be more important than practical support. Conclusion. Perceived social support appears to have beneficial effects on symptom severity, functioning, and levels of remission and quality of life in early psychosis. There is a need for more robust and comparable studies that employ valid and reliable measures of perceived social support and its multidimensional domains to evaluate the effects further and determine the specific mechanisms responsible for these effects. Future studies should also address possible mediating and moderating effects of perceived social support on known risk factors for psychosis.

The present research consists of a number of studies which sought to examine the psychological processes associated with negative adjustment outcomes for adults with inflammatory bowel disease (IBD) and considered the potential benefits of a novel psychological intervention for improving outcomes in this population. The first study in this thesis (Chapter 2) systematically examined the evidence between psychological factors and adjustment outcomes in adults with IBD. Emotion focused coping strategies, perceived stress, IBD related cognitions (such as illness perceptions), emotions and emotional control (such as hostility, aggression and alexithymia), interpersonal traits (such as anxious attachment style) and personality traits (such as neuroticism and perfectionism), were linked to negative adjustment outcomes for adults with IBD after controlling for the influence of sociodemographic and disease related factors. The second qualitative study (Chapter 4) found that adults with IBD described concerns pertaining to underperformance at work and preventing an accident in public as linked to their symptoms of anxiety. Low mood was reported to be associated with a perceived lack of understanding of IBD from others and stigma. Distinct cognitive and behavioural responses were described by participants in each of these domains. Participants in this study stated a desire for psychological support delivered by a professional with specialised knowledge of IBD to evaluate and build their coping strategies. The third quantitative study (chapter 5) found that unhelpful cognitive, emotional and behavioural responses (assessed at baseline), after adjusting for sociodemographic and disease related factors, were associated with negative adjustment outcomes at baseline (cross sectional) and 3 month follow up. The final clinical, pilot study found that transdiagnostic cognitive behaviour therapy (TD-CBT) had clinical benefits for adults with IBD who were distressed. Uncontrolled effect sizes were superior to those of a previous RCT. This series of studies consistently identified unhelpful cognitive, emotional and behavioural responses that are associated with and predictive of negative adjustment outcomes for adults with IBD. Further, TD-CBT was found to be of benefit. These findings provide insight into how psychological interventions should be designed and delivered to be helpful and acceptable for people with IBD and disturbance to mood and quality of life.

Stranger sexual violence remains a matter of public concern. A key challenge which confronts criminal justice personnel dealing with such crimes is to understand the causes of the attacks and their meaning for the perpetrator. This thesis presents a portfolio of published works which address this challenge. Firstly, the diverse nature of some very rare and distinctive sex offender sub-types is explored. These include those with a mental illness, a personality disorder and/or those who sexually assault adult female strangers, including rape and sexual homicide. This is achieved by examining case files from high and medium secure forensic services, official data held by the National Crime Agency, and the latest research in this area. Using quantitative and qualitative research methods, important difference in relation to offender previous histories, offence behaviours and offence motivation are highlighted, as well as the differing contexts and circumstances in which stranger sexual violence occurs. These findings suggest that although rare, sex offender types have many similarities to other offenders, knowledge and understanding of these important ‘within-group’ differences are required by criminal justice personnel. Secondly, a new development in forensic clinical practice is presented. Referred to as ‘index offence analysis’ this is a formal and structured analysis of a crime, which helps to capture different offence behaviours and motivations, to ensure they are included in the assessment process and the final case formulation This thesis therefore suggests important ‘within group’ differences exist among men who engage in similar types of stranger sexual violence and such differences can be identified by a detailed analysis of their offending. Consequently, knowledge of such violence is required in order to understand how and why an offence occurred where and when it did. The findings of this thesis have important implications, not only for clinical practice but criminal investigations.

This thesis evaluated paranormal belief measurement. Particularly, it considered the weaknesses of existing published measures. An extensive literature review identified frequently used paranormal scales and common associates. Consideration of identified measures produced a comprehensive pool of items (see Dagnall et al., 2010a and 2010b). Analysis of these items assessed the factorial structure of paranormal belief. Research progressed through four discrete phases that evaluated measurement of paranormal belief. Phase I: Exploratory factor analysis: Respondents completed a 64-item scale. Analysis supported a conceptually coherent and internally reliable 8-factor solution (haunting/ghosts, extra-terrestrial, superstition, religious beliefs, psi [premonition/psychokinesis], extra-sensory perception, astrology, and witchcraft). Phase II: Confirmatory factor analysis: Tested the emergent structure (47-Items) further. Respondents completed items retained from phase I alongside additional items (indexing astrology and witchcraft) to create a 50-item scale. Following removal of items sharing excessive variance, analysis confirmed an 8-factor solution. The emergent measure demonstrated good internal reliability and validity (content and face). Phase III: Alongside the emergent scale, respondents completed established paranormal measures (Revised Paranormal Belief Scale and Australian Sheep-Goat Scale), a series of probabilistic reasoning tasks and a measure of proneness to reality test deficits. Results revealed the new measure was psychometrically sound, contained coherent subscales, assessed construct breadth and correlated positively with established measures. In addition, non-believers perform less well on perception of randomness reasoning tasks. Finally, belief in the paranormal correlated positively with proneness to reality testing deficits. Phase IV: Further examined the newly constructed measure alongside mental toughness to assess validity and reliability in a real world context. Findings were in line with previous phases, suggesting excellent levels of consistency, while correlational analysis produced ideas for additional development of paranormal items and subscales. Measurement of the current MMUpbs, psychometric performance and subscale coherence, reveal improvements for future item design.

Irritable Bowel Syndrome (IBS) is a common, chronic bowel illness involving the presence of unpleasant bodily sensations and pain. In the current research the ‘stories’ women living with IBS had to tell were studied as part of a multi-layered narrative ‘bricolage’ (Kincholoe, 1991) analysis. The language used to discuss women living with IBS in a primarily scientific and deductive literature, was argued to be problematic, and reinforce gendered notions of IBS as a ‘women’s disease’ (Dixon-Woods and Critchley, 2008). Informed by the researcher’s positioning as a feminist and a woman living with IBS based in the UK, this feminist-narrative study was carried out and placed women’s standpoints (Harding, 1991) at the forefront of IBS research. Participants who volunteered to take part were women living with IBS and who were based in ‘Western’ countries, such as the UK, USA and Australia. Each of the participants completed a diary for one-week, completing at least one entry per day by writing or drawing about what was meaningful to them, reflecting upon their everyday lives and experiences of IBS and illness. Diaries were used a means of conducting narrative inquiry, which takes human experiences seriously as the phenomena of interest (Clandinin and Connelly, 2006). The diary method also facilitated adopting a stance on illness as ‘embodied’ experiences, transcending a divide between the mind and body (see for example, Bendelow, 2009). The research aims were to explore stories the women had to tell about their lives, whilst also considering if Western ‘cultural scripts’ (Miller, 2005) of femininities and of chronic illness informed the personal story constructions. The interpretations presented how the diverse and nuanced accounts explored embodied experiences of bodily shame, suffering, hope to ‘be positive’, and efforts to keep going when faced with the challenges of living with a chronic illness. Consistent with past literature (Björkman et al., 2013) illness was emplotted into the women’s stories in gendered and culturally meaningful ways, such as by drawing upon narrow Western feminine body-ideals. Whilst the women could not contain their ‘leaky bodies’ (Shildrick, 1994), this did not prevent them constructing stories about trying to keep up an appearance of normalcy and able-bodiedness. In addition to providing valuable new knowledge about stories of IBS, illness and gendered embodiment, this research showed the promise of adopting a creative and playful approach to conducting feminist research. The thesis itself was conceptualised by the ‘insider’ researcher as having been symbolic of what it was like to complete a PhD when experiencing intermittent illness. Poetry-as-method thus provided a valuable vehicle for the research during the interpretative process, but also in realising the potentials of artful research in creating space for innovative and politicised social action.

The Youth Justice and Criminal Evidence Act 1999 introduced a range of Special Measures to assist vulnerable witnesses whilst giving testimony. One of these was the use of Registered Intermediaries (RIs), who facilitate communication between the vulnerable witness and the practitioners of the Criminal Justice System (CJS). Using a mixed methods design, this research explored the experiences of RIs and police officers of working with each other and adult witnesses with intellectual disability (ID) and the attitudes of police towards ID. In Study 1, 12 RIs were interviewed on their experiences of working with the CJS and adult witnesses. Interpretative Phenomenological Analysis (IPA) revealed that while they are being gradually accepted by the CJS, they face several challenges such as lack of awareness about their role among the police and legal professionals. The RIs, themselves, often felt isolated, unsupported, and stated that they needed personal and professional support. Study 2 conducted semi-structured interviews with 11 police officers who work with RIs. IPA showed that the use of RIs is not widespread, mainly due to lack of awareness about them. When used, officers felt that the RI was beneficial in facilitating communication with vulnerable witnesses. However, waiting for long periods for an RI frustrated the officers, while some questioned the apparent contribution of the RI to the interview. Study 3 examined whether working with RIs led to a more positive attitude towards ID. The Attitudes toward Intellectual Disability questionnaire was administered to 126 police officers. The results showed that officers had a more negative attitude towards individuals with severe ID as compared to mild ID. While working with RIs had no effect on attitudes, those that had worked with RIs believed it had changed their practice. The three studies provide an in-depth understanding of the experiences of RIs and police of working with each other and with adult witnesses with ID. This research makes a significant contribution to knowledge, as it is the first empirical work that explores the experiences of RIs and police officers, while providing recommendations for future research and practice, such as training police on the role of RIs and IDs and supervision for RIs so that they feel supported.

Mindfulness is an ancient Buddhist tradition which has found a place in the West especially as a therapeutic intervention. The evidence base continues to expand but most of the previous work has been undertaken with adults, with relatively limited research involving children and young people. The study was conceived, devised and designed within a CAMHS setting and therefore much attention has been paid to this aspect. However circumstances necessitated change and the main mindfulness sessions were finally delivered in a special educational establishment. The young participants were vulnerable young people who were essentially similar to the clinical population for which it was initially envisaged. As such the study has some similarity to the mindfulness in schools programme but with a different population. The aim was to deliver a mindfulness-based intervention to no more than ten vulnerable young people in a group format giving consideration to how this might impact on them. The research was approached from a relativist social constructionist stance but was essentially one of mixed methods. The study was to be evaluated in a number of different ways. These were a focus group held with the young people, individual interviews with their parents and outcome measures delivered in the form of self-report questionnaires (mainly those in regular use in Child Mental Health). These questionnaires were completed before and after the sessions in a single case evaluation method. The pilot group was held within CAMHS and contributed to the format of the main group where eight sessions of mindfulness meditation practices and psycho-educational information were delivered to the young people. The study found that the process was well received by the young people with some favourable results and reports of less overall stress in some of the young people. The position of parents proved to be important in terms of their support and interaction with mindfulness. Those young people whose parents engaged with them in mindfulness did better. Future projects would do well to focus on more inclusion of parents. The findings also showed that not everybody would benefit and it would seem to be important for participants to opt in to the project. The eight sessions of intervention were comparatively short considering some other therapeutic interventions. Thus it can be cost effective and not too difficult to deliver providing that clinicians have the implementation skills. There would seem to be potential to develop the method in terms of treatment for future service delivery with vulnerable young people in a number of settings. The study will be of interest to clinicians and others working with vulnerable young people and also may draw the attention of service providers as a potential way to capitalise on a treatment initiative. Additionally it will be of interest to those within education settings, particularly those in special education seeking to promote the emotional health of their students.

This commentary aims to convey my publications on community based care and Quality of Life (QOL), in Learning Difficulties (LD), and Dementia care. My rationale through this journey aims to critique my earlier observation, assessments, and interview findings and theory, in research care practices and policy. I further argue for reconceptualising care and QOL research methodology, underpinned by phenomenological theory and research focussing on service user lived experience and open dialogue between care disciplines. My contributions to knowledge in LD focuses on service user life experiences and varying QOL in private sector care homes, and observation of differences in quality of interaction in day-centre settings. Life experiences in LD residential care significantly changes over time in relationships; opportunities and freedom of choice, comparing poorly with the general population. The LD residential care research and LD day-centre observation is critiqued drawing on Social Role Valorisation (SRV) theory, and objective and subjective QOL. My Dementia research compares traditional, enhanced traditional and social models of care by setting. The social model provides more choice, control, recreation, privacy and social interaction, than traditional and enhanced-traditional models. Further work shows significant gender differences in interactions with staff in Dementia care. A lack of implementation of policy concerning a normal community based life in LD, is noted in residential and day-centre care. The social model setting's policies and practice in Dementia care, is noted as more 'enlightened' and showing more positive interaction. Gender disparity findings in care interactions in Dementia is salient to practice and policy intervention, and my subsequent training program relates directly to practice by addressing quality of interaction training. My epistemic 'shift' escapes the 'natural sciences' method by proposing discursive and phenomenological enquiry into lived experiences of service users, in a practice and policy context of trans-disciplinary discourse promoting relational and compassionate care.