Psychosis is a highly prevalent mental health problem and has a high relapse rate following non-adherence. In the current study it was postulated that illness beliefs may be responsible for variation in adherence amongst clients diagnosed with psychosis in a forensic sample. Specifically. it was hypothesised that those who perceived their condition to be more controllable and more threatening would show more adherence to treatment; and that this relationship would be moderated by attitudes to treatment. mood. and apathy. 31 participants were recruited from two regional secure units. The measures used were the: Illness Perception Questionnaire for Schizophrenia; Drugs Attitude Inventory; Hospital Anxiety and Depression Scale; Self-report Quality of Life Measure for People with Schizophrenia; University of Rhode Island Change Assessment; Service Engagement Measure; Apathy Evaluation Scale; and the negative scale of the Positive and Negative Syndrome Scale. A cross-sectional correlational design was employed. The findings provide some support for the hyptotheses. although there was no support for the possible influence of moderators on the relationship between illness perceptions and engagement. The findings of the current study. when combined with indications from other research. indicate the need to continue research into whether illness perceptions influence treatment outcome in psychosis.

This thesis is presented in two volumes. In Volume I, the effectiveness of cognitive-behavioural therapy and graded exercise therapy in the management of chronic fatigue are reviewed. The impact of these treatments compared to no treatment and other active therapy is assessed using meta-analytic techniques. The findings indicate that both cognitive-behavioural therapy and graded exercise therapy are effective in reducing fatigue and increasing physical functioning in the short term. Neither approach significantly improved mood disturbance. The findings are discussed with reference to treatment models for chronic fatigue and future research directions are identified. The second paper in Volume I presents an empirical study examining information processing in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). Individuals with CFS/ME, rheumatoid arthritis and healthy controls completed measures of core schema and current mood, in addition to an emotional Stroop task and facial affect recognition task. Stronger core schema were reported by the CFS/ME group. The illness groups both displayed systematic biases in their processing of emotional information. The findings are interpreted with reference to cognitive models of CFS/ME. Volume II contains five individual clinical practice reports completed during Forensic, Child, Older Adult and Learning Disability placements respectively.

This thesis is divided into two Volumes, representing the research and clinical elements submitted to the University of Birmingham in partial fulfilment of the deg'ree of Doctor of Clinical Psychology (Clin.Psy.D.). Volume I (the research component) contains three papers relating to individuals with intellectual disabilities and their support staff. The first is asystematic literature review . of two areas of intellectual disability research; factors affecting the likelihood of residential placement breakdown, and the impact of staff cognitions regarding challenging behaviour. From the overlap in the two bodies of literature, a framework is proposed linking staff attributions about the causes of challenging behaviour and risk of breakdown. The second paper reports on an empirical study designed specifically to investigate the validity of this framework. Both of these papers have been prepared for submission to the Journal of Applied Research in Intellectual Disabilities. Whilst the required format for this journal has largely been adhered to here, to assist the reader, figures and tables have been embedded in the text. The third paper is a Public Domain Briefing Paper, summarising the main findings of the empirical study in order to aid dissemination to a wider audience. Volume II (the clinical component) comprises five anonymised Clinical Practice Reports , relating to work completed on the assessed clinical placements that form an integral part of the Doctorate in Clinical Psychology. The papers included are: the case of a 29 year old man experiencing generalised anxiety, considered from cognitive and psychodynamic perspectives; an analysis of the profile of referrals to a secondary care psychological therapies service for adults in terms of access, equity and fairness; the case study of a 71 year old man with Parkinson's disease, anxiety and anger directed at the NHS from a psychodynamic perspective; a single case experimental design evaluating the effectiveness of two interventions for a woman with severe intellectual disabilities and her staff team, and the case study of a 31 month old child with behavioural difficulties from psychodynamic, developmental, behavioural and systemic perspectives.

This thesis is submitted in partial fulfillment ofthe requirement ofthe degree for Doctor ofClinical Psychology at the University ofBirmingham. The thesis consists ofa literature review and empirical paper. The literature review focuses on evidence for a degree ofoverlap between autistic spectrum disorder and psychosis. Evidence suggests that ASD may be a risk factor for psychosis. There may also be a sub group ofindividuals presenting with psychosis who have ASD. It can be speculated that this sub group have an early onset ofschiZ<?phrenia, display severe pre-morbid . , impairments, and suffer with predominantly negative symptoms. Further research is urgently needed. The empirical .paper examines autistic spectrum traits and empathy in individuals at risk of devel<?ping psychosis. A gro\iP at high risk of psychosis scored significantly higher on a measure ofautistic spectrum traits, and significantly lower on a measure of empathy than a control group. Twenty-seven percent ofthe high risk group scored above the cut off for a diagnosis of Asperger syndrome. Preliminary analysis suggested that autistic spectrum traits or empathy were not associated with particular psychotic symptoms. Clinicians need to be mindful ofautistic spectrum traits in psychosis samples.

In the past it was assumed that psychotherapy with the dementia population was not possible. There currently exists a growing evidence base for the use of a variety of psychotherapeutic models with individuals diagnosed with dementia. Less research, however, has focused on the actual subjective experiences of psychotherapy or the therapeutic process, including the therapeutic relationship. The current qualitative study therefore aimed to gain an in depth understanding of the subjective experiences of psychological therapists working psychotherapeutically with individuals diagnosed with dementia including experiences of the therapeutic process and relationship. Semistructured interviews were carried out with nine psychological therapists regarding their experiences of working psychotherapeutically with individuals diagnosed with Alzheimer's disease. Verbatim transcripts were analysed using Interpretative Phenomenological Analysis which resulted in the generation of three super-ordinate themes: Considering the Psychotherapeutic Work; Bridging between Two Worlds; and The Detrimental Effect of Dementia on the Therapist and the Therapeutic Work. These super-ordinate themes along with sub-themes are expanded into a narrative account of participants' experiences. Of particular interest, the concept of identity arose from the narratives. Dementia was conceived to act as a threat to participants' sense of identity preventing them from sustaining their usual roles or preserving their existence as therapists. This finding and additional results from the analysis were considered in light of existing theory. The implications of the findings for clinical practice, service provision and training were highlighted. Limitations of the current research study were outlined and recommendations were put forward for future research

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This thesis is concerned with responses to metastereotype activation amongst members of devalued groups. Metastereotypes are impressions that group members expect an outgroup to have of one's group (Vorauer et al., 1998). Until recently, research has focused primarily on establishing the content, accuracy and conditions that are necessary for activating metastereotypes, often from the perspective of dominant groups. Conceptualised as a form of social identity threat this thesis examined three responses to metastereotype activation derived from social identity theory (SIT; Tajfel & Turner, 1979). These are: identity distancing, identity re-negotiation (i.e., improvement) and defensive derogation/reciprocity. Findings across the four empirical chapters presented in this thesis suggest that use of the three responses to metastereotype activation were consistent with identity improvement needs. Specifically, the four studies presented in Chapter 2 showed that group members distanced themselves from their social identity when negative metastereotypes were activated (Studies 1-4): this effect was fully mediated by self-esteem (Study 4). Because identity distancing implies apathy towards group-serving behaviours, Chapters 3 and 4 examined the implications of negative metastereotype salience on identity improvement actions.· These were collective action (Chapter 3) and outgroup helping (Chapter 4). The moderating roles of identification and cognitive appraisals (i.e., the perceived likelihood of identity improvement actions achieving the desired ends) in seeking identity improvement were also examined in the studies presented in Chapters 3 and 4. Results showed that activating Vlll negative metastereotypes led to greater orientation towards identity improvement (e.g., collective action [Studies 5-6] or outgroup helping [Study 7]) but only when group members were strongly convinced that the strategies they adopt can improve outgroup's perception of the ingroup. Importantly, this effect was only evident amongst high, but not low identifiers (Studies 5-7). Given that group members seem primarily motivated to manage the perception that the dominant outgroup has of the ingroup, the studies presented in Chapter 5 sought to establish how judgements of a dominant outgroup may be affected by negative metastereotype activation. Because negative metastereotypes could elicit anger feelings among group members, it was reasoned that those who activate these beliefs may evaluate the outgroup negatively in line with reciprocity norm. However, such reciprocity should only be evident in situations where group members' judgments will not reinforce outgroup's negative opinions of the ingroup (e.g., in public). Results confirmed these expectations. Group members reflected the valence of the activated metastereotypes in their evaluation of the outgroup only when the audience was ingroup (Studies 8-9): an effect that was fully mediated by anger. However, the reciprocity pattern observed across these two studies was particularly evident amongst high but not for low identifiers. In line with a need to manage the outgroup's perception of the Ingroup, high identifiers reciprocated the valence of the activated metastereotypes privately (before an ingroup audience [Studies 8-9]) but not publicly (before an outgroup audience [Study 9]). Finally, Chapter 6 (general discussion) presents a summary of the results and discusses these with respect to some key theories of intergroup relations.

The present thesis examines psychological outcomes following stroke. Psychological distress is common following stroke and post-stroke depression has most frequently been studied. Associations between post-stroke depression and further adverse outcomes have been evidenced, including impaired physical recovery and even mortality. A need is highlighted for psychological factors associated with post-stroke distress to be identified that are modifiable and amenable to intervention. Associations between illness perceptions, or subjective beliefs regarding illness, and a range of health outcomes have been demonstrated across multiple chronic conditions. As such, illness perceptions are proposed as psychological constructs with the potential to further understanding of the subjective experience of stroke and psychological outcomes. The self-regulatory model (SRM), which theorises the dynamic relationship between illness perceptions and coping strategies in determining health outcomes, is advanced as an integrative framework for research examining post-stroke psychological adjustment. Research regarding cognitions compatible with the SRM is limited. However, promising findings are reviewed regarding the relationships between psychological outcome and perceptions of control, treatment and achieving a sense of meaning regarding stroke. On the basis of identified needs in the evidence base, a questionnaire-based study was undertaken employing the Illness Perception Questionnaire-Revised, a measure assessing all cognitive domains of the SRM, in a sample of people who had experienced stroke. Consistent with the SRM, coping strategies were also assessed, as were anxiety, depression and positive affect. It was hypothesised that illness perceptions and copingvariables would explain additional variance in psychological outcomes over that explained by previously implicated clinical and psychosocial variables. Illness perceptions or coping variables contributed significantly to each of the regression models of measured outcomes and the hypothesis was generally supported. The clinical implications of the research are discussed and the critical review expands on relevant issues, including situating illness perceptions in the context of existing psychological models

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