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The studies described in this thesis present a three-pronged approach into how services for individuals with personality disorder might be developed. The first two studies begin to examine constructs that appear related to features of borderline personality disorder which may potentially be targets of therapy. Study 1 (chapter 2.) examines the relationship between emotional dysregulation, cognitive dysregulation and features of borderline personality disorder. The findings suggest that both forms of dysregulation predict borderline personality disorder features, particularly depressed mood and a preoccupation with danger. Study 2 (chapter 3) examines the relationship between emotional intelligence, alexithymia and features of borderline personality disorder. The findings suggest that only alexithymia predicts borderline features and that alexithymia and emotional intelligence correlate only moderately. The third, fourth and fifth studies highlight a need for training as recommended by NIMHE's (2003b) 'Personality Disorder Capabilities Framework' for all staff and agencies that come into contact with individuals with personality disorder. In particular study 3 (chapter 4) investigates the reasons why patients are referred to a specialist personality disorder service, the problems that patients may present with to teams, how staff feel about and cope with such problems, what could be done to improve coping, and what training support and guidance staff feel they need from a specialist service. The findings indicate that many staff feel frustrated and stuck with this patient group, reporting high levels of negative behaviour such as self-harm and substance abuse. Although many staff feel confident most report the need for formal training and support. Study 4 (chapter 5) assesses Gwent Healthcare NHS trust nurses' attitudes towards patients with personality disorder. Here a sample of nurses who volunteered to undergo personality disorder awareness training is compared to those who did not volunteer. Both samples are combined and compared to samples taken from prison and high security setting. The findings indicate that nurses who volunteer to undergo personality awareness training display significantly more positive attitudes towards personality disorder than those who do not volunteer for the training. However nurses who work in prison and high security settings display significantly more positive attitudes towards personality disorder compared to Gwent Healthcare NHS nurse samples combined. Study 5 (chapter 6) comprises of a Delphi survey that elicits patients' views on their experiences of services en-route to a specialist personality disorder service. The findings indicate that patients value respect professionalism, and services that provide personal support that meets their needs. In general police, general practitioners and community psychiatric nurses are viewed positively whilst psychiatric hospital staff could improve. General hospital staff such as accident and emergency staff, and particular surgical wards are viewed unfavourably. Specialist personality disorder services are viewed favourably. The last two studies highlight that assessments need to be conducted on patients at the point of referral and that ongoing assessments are required over the course of a patient's contact with a specialist personality disorder service. Study 6 (chapter 7) investigates the differences between those who continue therapy for borderline personality disorder with those who discontinue therapy. The findings indicate that those who discontinue with therapy have more complex personality disorder profiles and are more externally motivated for therapy and were less internally motivated. A negative problem solving orientation predicts discontinuation of therapy. Therapy discontinues spend on average 3 times longer in hospital compared to continuers. Study 7 (chapter 8) begins to devise a method of assessing and measuring an individual's response to and progress in Dialectical Behaviour Therapy using single case experimental methods. The findings indicate that although effective methods exist they require tailoring to an individual patients' clinical functioning and ongoing monitoring.

Previous studies suggest that both genetic and environmental factors contribute to variation in Attention Deficit Hyperactivity Disorder (ADHD) symptoms and their continuation. Family relationship factors have also been associated with the disorder. However, whether these family relationship factors have a causal effect on ADHD symptoms is not clear. This thesis used two longitudinal community samples, to examine the effects of both genetic and family relationship factors on ADHD symptoms. The first sample included 1214 families (twins and a parent) from a population based twin register (twins aged 12-20 years). A longitudinal sub-sample of 833 families from data collected 8 years previously was also used. The second sample included 309 children (aged 11-14 years) and their parents who took part in a longitudinal study on two occasions 12 months apart. ADHD symptoms and their continuation from childhood to adolescence and young adulthood were found to be influenced by genetic factors (h2 = 64% genetic factors explained 78% of stability), however non-shared environmental factors were also significant. Father-child rejection was the only relationship factor to significantly impact on ADHD symptoms (y = .11 P = .15). ADHD symptoms were shown to have a negative impact upon mother-son hostility, mother-child rejection and family conflict (y = .13 to .22 P = .19 to .24). ADHD symptoms and parent-child warmth were not associated. The association of both mother- and father-child hostility with ADHD symptoms was genetically mediated (ra = .41 to .58). Importantly, the association between mother-son hostility and boys' ADHD symptoms was environmentally mediated as well (re = .20). The findings suggest the importance of establishing whether or not environmental factors, such as family relationship factors, have causal effects on ADHD symptoms. The majority of the results in this thesis suggest that ADHD symptoms have a negative impact upon family relationship factors.

Cancer is one of the leading causes of death in the UK. The Cancer Reform Strategy (2007) highlighted the need for integration of psychological services into routine cancer care. Previous research into psychosocial aspects of adjustment is, however, inconsistent This thesis opens with a background on cancer epidemiology and policy the psychological impact of cancer and, the shortcomings of previous intervention-based research. The Transactional Model is introduced as a potential framework for modelling adjustment. The thesis aimed to test this model for cancer patients in order to provide evidence to better inform the provision of psychological services for cancer patients. A systematic review summarised the literature exploring the extent to which personality, appraisals and emotions were associated with psychosocial outcome. 68 studies were included. A number of small meta-analyses were performed using the Hunter and Schmidt method. Findings demonstrated a lack of consistency, and a number of research questions still unanswered. A methodological critique was provided based on systematic quality assessment. The empirical study had two purposes: prediction of clinical outcome and theory development 160 recently diagnosed colorectal, breast, lung and prostate cancer patients were recruited. Measures of personality, appraisal, emotion, coping and outcome (anxiety, depression and quality of life) were collected at baseline, three- and six-month follow-up. Analyses demonstrated that the data generally fitted the model but adaptations were proposed. Clinically, between 47 and 74% of variance in psychosocial outcome was explained by these predictor variables, with cognitive appraisals most predictive of all Transactional Model components. Statistical theory testing of cognition-emotion processes did not confirm the Transactional Model (Lazarus, 1999). These findings question the prescriptive nature of the theory and further testing is suggested, particularly in response to chronic stressors. Guidelines for methodological improvements are provided. The thesis concludes with proposals for further research, including suggestions for theory- informed interventions.

Child and adolescent depression is a complex and multifactorial disorder that is likely due to the co-action and interaction of multiple psychosocial and genetic risk factors. Identifying the specific psychosocial factors which confer risk is a paramount aim of depression research since this is essential to informing the design and implementation of preventive interventions. Prior research has suggested that a range of family factors are associated with the development of child and adolescent depression. However, the extent to which these associations are likely to be causal is unclear due to a range of issues such as establishing the direction of effects and estimating the role of potential confounding factors which include genetic influences and alternative psychosocial risks. In this thesis I use different research designs to examine the ‘environmental’ effects of two specific family factors which have established associations with child and adolescent depression symptoms: parent child hostility (study 1) and parent depression (study 2). I also explore whether there is moderation of the putative environmental effects of these family factors by specific gene variants (gene-environment interaction; study 3). The role of both parent and child tender was examined across studies. Using genetically sensitive and longitudinal designs, environmental effects on child and adolescent depression symptoms were detected for mother-child hostility and parent depression. For both family factors, effects appeared to be stronger for girls suggesting their increased susceptibility to these stressors. No evidence of an environment interaction was detected.

The research presented in this thesis applies a process-orientated perspective to understanding children's emotional and behavioural adjustment in the context of hostile and violent inter-parental conflict. The studies presented examined the relationship between inter-parental conflict and the quality of parent-child relations, and the role that dysfunction in these family relationships may play in determining children's psychological adaptation. In particular, the primary focus of this research was concerned with children's perceptions, or social cognitive processing, of these family relationships as a primary mechanism through which exposure to inter-parental conflict ranging in severity, influences children's psychological wellbeing. Using data from three separate samples of children and parents drawn from community and clinical settings in the United Kingdom, a set of four interlocking studies was conducted. First, using a sample of over 200 children and parents, the quality of parent-child relations was found to play a mediating role in the relationship between parents' reports of marital conflict and children's immediate and longer term externalising behaviour. Recognising the need to examine the interrelationships between the marital and parent-child relationship from the child's perspective, the second study considered the joint role'played by children's appraisals of both inter- parental conflict and parent-child relationship quality in explaining children's adaptation in the context of varying levels of conflict. Children's appraisals of both relationships were found to be important in conveying effects to children's psychological adaptation across the spectrum of inter-parental behaviour, although there was some variation in processes underpinning children's development as a function of conflict severity and the index of adjustment considered (internalising symptoms, externalising problems). Next, the role of younger children's appraisals of family relationships was examined. Children's appraisals were found to play an intervening role in the relationship between hostile inter-parental conflict and adjustment, although children's internalising symptoms were found to be affected directly through children's appraisals of threat relating to parents' marital conflict, whereas children's externalising problems were found to be affected indirectly, through children's respective appraisals of both the inter-parental and parent-child relationships. Finally, children's appraisals of multiple family relationships were examined as a mechanism through which very hostile forms of inter-parental conflict influenced children's concurrent adjustment. Broad agreement was found with the previous studies, where children's appraisals of the inter-parental relationship seemed to be particularly important in accounting for children's internalising symptoms in the context of high inter-parental conflict, whereas children's views on the quality of relations with parents were more important in accounting for children's externalising problems. Collectively, these studies represent a process-orientated account of how inter- parental conflict across the spectrum of severity affects children's adjustment, and in particular locates children's understanding of family relationships as a primary mechanism through which hostile and violent inter-parental conflict impacts on children's psychological functioning. These findings are of relevance to researchers, practitioners and policy makers seeking to understand how interparental conflict and domestic violence affects children.

The research contained in this thesis was designed to assess the origin, structure and development of children's concepts of the earth. The research programme began as an evaluation of Vosniadou's mental model theory (Vosniadou & Brewer, 1992. However, Vosniadou's findings were not replicated and the research programme became focused on developing an alternative account of conceptual development using a range of novel research methods to assess children's concepts of the earth. The thesis begins with a review of the relevant theories and research into children's conceptual development in general and children's concepts of the earth in particular. The first empirical study is an exploration of children's concepts of the earth and the results indicate that Vosniadou's mental model theory is not supported. The second study is a methodological comparison between the drawing method used by Vosniadou and the 3D model selection method used in the first study. This establishes that there are flaws with the drawing method and that the 3D model method is a more sensitive method of assessing children's concepts of the earth. The third study involves the use of wh- questions to compel children to make explicit the reasoning behind their thinking about the earth. This reveals that children's thinking about the earth lacks coherence. The forth study consisted of a pictorial Q-sort of iconic representations of the earth. This revealed children' depth of preference for some properties of the earth over others. The fifth study involved an investigation of children's concept of gravity and revealed that children's thinking in this domain also lacks the coherence. The thesis ends with a summary of the research findings and a proposed model for the origin, structure and development of children's concepts of the earth.

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Research suggests that postnatal depression affects social, cognitive and emotional development in the child. Impaired mother-infant interactions have been observed in postnatally depressed mothers and have been posited as a mediator of the developmental effects. A previous study found that mothers with postnatal depression had improved mother-infant interactions after attending baby massage classes. The current research aims to confirm and extend these finding~ and contribute to theoretical knowledge about the processes involved. Three groups participated: tvvo depressed groups, assigned randomly to baby massage classes (n=31) or support group sessions (n=31), and a group of non-depressed mothers (n=34). Mothers completed the Edinburgh Postnatal Depression Scale, the Spielberger State Anxiety Scale, the Infant Characteristics Questionnaire and a bonding scale and were filmed interacting with their infants before and after interventions, or at matched timepoints for non-depressed mothers. At one year, the Strange Situation Procedure and a distractibility task were also completed. Both depressed groups showed similar patterns of improvement on questionnaire measures over time, generally remaining worse than nondepressed mothers. At outcome, more 'massage' mothers showed a clinical reduction in depression scores than support group mothers despite no difference in mean scores. At one year, the median depression score for (massage mothers was in the non-depressed range while that of the support group remained above this range. Mother-infant interactions were not disturbed amongst depressed mothers at baseline. However, maternal interactions at one year for massage mothers were more similar to non-depressed mothers than to support group mothers. The findings show that both depressed groups improved over the study period. There is some evidence that depression scores improved more after massage classes than support group sessions. Lack of disturbance in mother-infant interactions at baseline confounded the goal of improving them and raises questions about the importance of postnatal depression as a risk factor for infant development.

The main purpose of the studies conducted in this thesis was to explore relations between attachment representations and individuals' understanding self and others. The first two studies focused on young adults, whereas Study Three involved a sample of children aged between 4 and 6 years. Study One investigated how (a) cultural differences in caregiving practices related to young adults' perceptions of their parents as being caring versus overprotective, (b) perceived parenting and culture impacted on attachment style in relationships with peers, and (c) representations of relationships with parents and peers related to individuals' self- esteem. Cypriot college students (n = 236) were compared with British university undergraduates (n = 168). Compared with their British counterparts, the Cypriot participants perceived their parents to have been more overprotective and were less likely to report secure attachment style in their relationships with peers. Regardless of culture, higher perceived parental care and secure or dismissing attachment style with peers were independently associated with higher self-esteem. The results of Study Two on a sample of 73 Cypriot college students showed that similar relations were observed between attachment representations and self- esteem when attachment was assessed in terms of unconscious internal working models (IWMs) of parental attachment relationships using the Adult Attachment Interview (AAI). Individuals classified as secure or dismissing on the AAI reported higher self-esteem than those in the preoccupied group. Study Two also addressed how attachment representations related to adults' theory of mind abilities, and investigated whether such abilities mediated the relation between attachment and self- esteem. Preoccupied attachment as assessed either by the AAI or self-reported attachment style with peers was associated with slower processing on an adult theory of mind task. However, there was no evidence for theory of mind abilities mediating the relation between attachment and self-esteem. Study Three investigated inter-relations between attachment representations, theory of mind, emotion understanding, and self-view in a sample of 80 Cypriot children with a mean age of 61.5 months. Secure attachment representations were associated with superior theory of mind and emotion understanding, but much weaker relations between attachment representations and self-view were found compared with the results on the adult samples in Studies Two and Three. Moreover, the one significant relation observed between attachment and self-view appeared to be indirect, and was mediated by children's emotion understanding. The results are discussed in terms of (a) the influence of perceived parental attachment on relationships with peers, (b) the discriminant validity of the IWM construct, and (e) the tendency of adults and children to use their mentalising abilities in interpreting and explaining other people's behaviour.