Background: Chronic post-traumatic stress disorder (PTSD) occurs frequently and is characterised by an unremitting course (Kessler et al. 1995). Despite the availability of effective treatments a significant proportion of clients remain symptomatic following intervention (Cahill & Foa, 2004). Existing approaches seem inadequate to tackle this growing problem. Metacognitive therapy (MCT) is a novel approach and has demonstrated efficacy (Wells et al. 2008). This research compared MCT with Exposure therapy and a waitlist control condition (WL). Method: Participants (N=32) with symptom chronicity of~ 3 months were recruited for this . randomised controlled trial (RCT) from four Clinical Psychology Departments across the North West of England. Following an initial assessment those opting into the trial were randomly assigned to one of the three conditions, eight sessions of therapy (MCT v. Exposure) or an eight week wait period (WL) followed by a second randomisation to receive one of the active treatments. It was hypothesised that both active treatments would lead to significant reductions in PTSD, depression and anxiety symptoms compared with the WL and MCT would generate a faster rate of change compared with Exposure. The Impact of Events Scale (IES) was the primary outcome measure. Evaluations were conducted at pre-treatment and post-treatment time points. Results: Both MCT and Exposure resulted in statistically significant reductions in symptoms of PTSD, anxiety and depression compared with the WL control. MCT led to greater reductions than Exposure across symptoms of psychological distress and physiological arousal. Eighty-two percent of those completing MCT and 64% of the Exposure group met clinical significance criteria for recovery at post-treatment. In conclusion, MCT appears to be a highly effective treatment for PTSD when compared with traditional approaches. The clinical implications and suggestions for future research are discussed.

Submitted by Victoria Wardman for the Doctor of Clinical Psychology (Clin.Psy.D) and entitled Physical Disabilities: Pictorial Representation and Self-Perception, June 2008. Background: Adults and children with physical disabilities are known to be vulnerable to stigma, abuse and psychological distress. 'In My Shoes', an existing computer assisted interview, was designed to help vulnerable children communicate about their feelings and experiences. In order to develop 'In My Shoes' to meet the needs of those with physical disabilities, evidence needed to be gathered for the ways in which people with physical disabilities would choose to be represented pictorially and to examine factors which would influence this. The physically disabled population is under researched, with no previous studies having examined this field. Objectives: The aim of the research was to explore how adults and children with physical disabilities would choose to be shown in pictures, specifically examining whether a persons' mobility aid becomes incorporated into their pictorial selfrepresentation. A factor hypothesised to be related to pictorial representation was selfperception. Therefore, the differences in self-perception scores of those who included their mobility aids and those who did not were analysed. Design: Two exploratory studies using non-experimental single group designs were utilised. Study One examined pictorial representation in adults with physical disabilities through the use of an Image Selection task and compared those who included their aid in their image selection and those who did not on their Adult Self-Perception Scale (ASPP) scores. Study Two examined pictorial representation in children with physical disabilities using a Self-Portrait task and Image Selection task. The scores on the SelfPerception Profile for Learning Disabled Students (SPP-LD) were compared for those who included their aid in the pictorial representation tasks and those who did not. Methods: For Study One, 78 adult participants were recruited from discussion groups on the internet. Adult participants completed an Image Selection task and the ASPP. For Study Two, 28 children and young people were recruited from a specialist database, sports academy and educational organisations. The children completed a Self-Portrait task, Image Selection task and the SPP-LD. Results: For Study One, the majority (77%) of adult participants included their mobility aid in their choice of image to represent them. There were no significant differences in ASPP scores between those who included their aid and those who did not on the Image Selection task. For Study Two, the majority (70%) of child participants did not include their mobility aid in the Self-Portrait task, but the majority (75%) did include it in the Image Selection task. There were no significant differences in SPP-LD scores between those who included their aids and those who did not on the pictorial representation tasks. For both studies, no clear trends emerged to reveal which factors predicted the inclusion of a mobility aid in the pictorial representation tasks. Conclusions: These two studies revealed that the majority of people with physical disabilities would choose to be represented pictorially by an image which contains their mobility aid. Self-perception was found not to be related to how people would choose to be represented pictorially. The findings have demonstrated that tools such as 'In My Shoes' need to ensure that people with physical disabilities are considered in their development in order to make them accessible and relevant to the users.

Evidence is reviewed linking specific early abusive experiences (sexual abuse, physical abuse and emotional abuse) with the occurrence of eating disorders and this is interpreted in light of two conceptual models - self-trauma theory (Briere, 1996) and schema theory (Young, 1990). These models are used to consider a potential vulnerability to further victimisation, more specifically, being bullied at school. The impact of these repeated traumatic experiences on the development of a secure sense of self and emotional regulation skills is considered and examined in light of offering an aetiological understanding of eating problems. Research is then reviewed examining the prevalence of negative self-beliefs in the eating disorders. Alexithymia has been documented as being common in individuals with eating disorders, however this is reconsidered in light of a lack of emotional expressiveness as a result of particular childhood experiences. This clinical group seem to have particular difficulties with anger and disgust, however there is a lack of concise research measuring all of the basic emotions and comparing an eating disordered group to a psychiatric control group. This study aims to examine the association of abusive experiences both at home and at school with eating disorder symptoms, as compared to a control group suffering from depression and a non clinical student group. Comparisons were also made on levels of all of the basic emotions across the three groups. The eating disordered group were found to have significantly higher levels of sexual abuse than the depression control group suggesting that this may act as a specific risk factor for eating problems. The higher level of bullying experienced by the eating disorder group, compared to the depression group, was only approaching significance; however the ED group did report higher levels of being left out or ignored by their peers. Although the prediction that the eating disorder group would report higher levels of anger was not observed, the eating disorder group did report higher levels of disgust.

No description available.

Previous studies have found that mothers of overweight children report low levels of concern and consistently underestimate the weight of their child. A significant limitation of these studies is that they have failed to offer an explanation as to why this underestimation may occur and how it might be linked to maternal perceptions of overweight in children. The aim was to develop a theoretical framework for understanding maternal perceptions of overweight and obesity in children. Semi-structured interviews were undertaken with twelve mothers recruited via the paediatrician or local weight management group both in the North-West of England. Interviews were transcribed and analysed using grounded theory methodology. A theoretical understanding of maternal perceptions of overweight and obesity in children was developed using five related categories: 'feeding practices', 'minimising severity', 'concerns about weight', 'control' and 'resilience'. Results support findings uncovered in previous research and also expand on these findings by offering explanations about the psychological mechanisms that may mediate maternal misperceptions of overweight.

Caring for a loved one with anorexia nervosa has been demonstrated to be a stressful experience. There is a growing literature attempting to understand the experiences of parents who are carers; however, to date the views of fathers have been underexplored relative to those of mothers. In addition, theories of AN discuss or imply the importance of interpersonal factors, but have progressed without sufficient data on the involvement of fathers. This study sought to explore the experiences of fathers caring for a daughter with AN, using a qualitative approach. Method: A constructivist grounded theory methodology (Charmaz, 2006) was used to generate a new explanatory model from fathers' descriptions of their experiences, whilst openly considering the influence of context. Ten fathers were interviewed about their experiences caring for an adult daughter with AN; nine were recruited from a specialist regional eating disorder unit and one was recruited via a voluntary organisation, b-eat. Results: Fathers from the unit reported being involved in care-giving, and experiencing significant levels of distress, on a par with what has previously been reported for mothers. Fathers' distress appeared particularly linked to their daughter's loss of ability to reason clearly, leading her to resist family and expert treatment advice. This distress was associated with fathers' models of AN as a mental illness involving a failure of logic, which appeared heavily influenced by the unit's prevailing 'medical model'. In contrast, the father from b-eat viewed AN as a struggle with control and resisted hospital authorities. He was distressed at being left out while his wife did most of the care-giving. All fathers expressed significant distress, but also concealed or minimized their emotional experiences, either more or less deliberately. Conclusion: Since some fathers are highly involved in caring for daughters with AN, clinicians should not assume this role is adopted predominantly by mothers. Fathers regularly conceal the extent of their emotional distress, and may require special consideration by services to enable them to be more candid. Fathers' methods of involvement in care-giving appear derived from the model of AN they adopt, so it is important to understand fathers' illness beliefs and to include fathers' perspectives in theories of care-giving and of AN. Since fathers initially feel ignorant of AN and are very anxious, they can be heavily influenced by the views of those regarded as experts. This has consequences for the way they attempt to help their daughters recover, which has the danger of forming part of an emotionally invalidating system involving the family and services. A systemic perspective on adult AN appears important if the best care is to be delivered.

No description available.

Although much research has been carried out with regard to those who stigmatise, little has been conducted from the standpoint ofthose exposed to stigmatisation. With the aid of questionnaire measures, the present study aimed to look at stigma from the prospective of participants who believed that they had a stigmatising mark (a temporary facial scar), which in some cases was removed surreptitiously prior to a social interaction with a confederate. While several hypotheses were explored, none were supported fully. Nevertheless, several elements pertaining to stigma produced significant results, suggesting that participants who believed that they had scars not only found their own appearance to be stigmatising, they also thought that the people they interacted with found their appearance to be stigmatising. Secondly, there were gender differences with regard to feeling of stigmatisation, males who believed that they had stigmatising marks reported feeling more stigmatised than their female counterparts, a result that was contrary to what had been hypothesised. Finally, there was evidence to suggest that participants with higher trait anxiety scores rated some images of disfigurement images as more anxiety provoking and more stigmatising than those who rated themselves as less anxious. Although it was hypothesised that felt stigma would be experienced by participants in both the scar and the scar removed conditions, no evidence was provided to support this. It is possible however that the type of stigma reported by participants in the present study may have been a precursor to felt stigma, but further research is needed to explore any possible links.

The studies presented in this thesis aim at investigating how young children acquire and develop the inflectional system of Polish nouns. The perspective adopted here is a usage-based, constructivist one and the first two chapters motivate this decision. In Chapter 1 the constructivist approach to language acquisition is introduced in general terms and contrasted with the more traditional nativist standpoint. Within the constructivist fr-amework no sharp distinction between words and grammar is maintained and it is proposed that children learn all aspects of their language gradually, by drawing upon general cognitive abilities. Evidence supporting this approach with respect to early syntactic development of English speaking children is reviewed. Chapter 2 focuses on morphology. First, it introduces the inflectional system of Polish nouns, and then, reviews various accounts of both the development of morphology in children and morphological processing in adults. In the end, based on the description of the system and the literature review, it is concluded that morphology is best viewed as an emerging interface between form and meaning, that morphological patterns emerge gradually, and that effects of similarity and frequency are crucial for this process. The following empirical chapters are set to test these claims. The goal is also to find answers to some 'open questions concerning the application of the usage-based model to complex inflectional systems, in particular: whether early inflectional patterns are restricted in their specifications of use, and whether their generalization is based on pairs of inflections, rather than single inflections. Chapter 3 presents a corpus study of a two-year-old child's speech. The main aim is an analysis of productivity in the use of inflections by the child and a critical discussion of various attempts at measuring morphological productivity in naturalistic data is offered. A series of carefully controlled comparisons of the child with her mother permits the conclusion that the child's use of inflections was indeed lexically more restricted than that of the adult. Chapter 4 offers a continuation of naturalistic analyses, focusing on syntactic diversity in the use of noun inflections. A measure of contextual diversity based on a computational approach to corpus psycholinguistics is applied and some issues concerning this application are discussed. The measure indicates that the child's use of inflections is also contextually restricted as compared to her mother. Chapters 5 and 6 report experimental studies, both involving a nonce word elicitation task and two age groups: 2;6 and 3;6 year oIds. The first study shows that the production of a particular inflectional form may be easier or more difficult depending on which other form serves as a departure point. The second study supplements these results, showing that whether a given form is an easy or difficult departure point may be partly determined by which form is the target. Similarity between various inflections seems to play an important role when children attempt to switch between forms. Also, effects of contexts (constructions) in which departure point forms were introduced and in which target forms were elicited were identified. Chapter 7 summarises the main findings, their theoretical implications and considers some directions for future research.

No description available.