Aggressive behaviour in people with intellectual disability is a far reaching problem, estimated to be expressed by 7% of the population of people with intellectual disability. People with intellectual disability who are aggressive often experience an inequality in service provision. Carers who work in aggressive environments can find the management of aggression an overwhelming challenge and may suffer burnout. At a service level, providing suitable care for people who may be aggressive, whilst also providing a comprehensive care package, is very difficult. Aggression in people with intellectual disability is more prevalent than in equivalent cared for groups, but there is little research to date on the sequential nature of that aggression. Like all behaviour, aggression occurs as part of a sequence, and a crucial part of understanding violent behaviour in people with intellectual disability is to understand the nature of their aggression, and especially the (temporal) structure of these episodes, as well as the potential factors involved. Current research in aggression in people with intellectual disability focuses on the nature of static risk factors, mental health issues and the function that aggressive behaviour provides for the individual expressing it. The main aim of this thesis is to document the patterns of aggressive behaviour in people with intellectual disability in order to examine what factors may be involved in increasing the risk of aggression in this population. Guidance as to what those factors may be was taken from research into aggression in the general and intellectual disability population. The first phase of this study involved creating a database of violent incidents from the health care records of 18 participants, drawn from three National Health Service units for Intellectual Disability. These were collated into an aggressive incident database that brought together information from different sources about individual incidents. The patterns in the incidents were used to construct a typology of aggression. The second phase of the study formed the main focus of the research, and involved analysing the aggressive incident database using Sequence Analysis methods. The pattern of these results indicated that reports focused mainly on aggression that involved staff, and found visits, outings and denial of requests by participants were significant factors in the sequence of an aggressive incident. The third phase focused on data drawn from a risk management system called Sentinel, and examined all aggressive incidents occurring across three units for people with intellectual disability over four and a half years to investigate temporal patterns of aggression using time interval analysis. This was used to identify distinct temporal patterns of aggression for each of the three units involved in the study. The results indicated that visits and outings, meal times and requests were part of the sequence of aggression behaviour in people with intellectual disability. The possible implications of this were discussed, and these findings related to the wider literature.

Joint Protection (JP) education is considered an essential component of therapeutic programmes for Rheumatoid Arthritis (RA) patients. The main emphasis is teaching alternate patterns of movement at affected joints to reduce joint stress, particularly in the hands and wrists (Hand JP). Little has been published investigating patients' knowledge of, attitudes towards and adherence to Hand JP following education. Assessments were developed to evaluate these constructs. Reliability and validity were established. A pretest-posttest trial was conducted with RA patients attending a 4 x 2 hour arthritis education programme, including 2.5 hours of JP over 2 sessions (n = 21). Teaching techniques typical of those current in the UK were used. Adherence was evaluated using the Joint Protection Behaviour Assessment. Subjects were videorecorded performing a standardised kitchen activity (making a hot drink and snack) in their own homes. Hand movements during 20 tasks within this (e.g. turning a tap) were analysed and scored as Correct (5%), Partial (2.5%) or Incorrect (0%) Hand JP behaviours. Maximum score =100%. A significant score increase was determined as 20%. Subjects were kept blind to trial aims. There was no significant behaviour change in the pre-education control phase (median score at assessment 1 = 18.40%, IQR 10.25-35.55%). No significant increase occurred at 6 and 12 week follow ups. Mean score change was +4.01% (SO 10.59%; p = 0.14). No significant knowledge increase occurred. Post-education interviews identified a number of barriers to behavioural change. A cognitive-behavioural JP education programme was developed, using motor learning, recall and adherence enhancement strategies, of 4 x 2 hours, with an optional home visit. A crossover trial was conducted (n = 35). There was no significant difference between treatment phase first (Tl, median 15.00%, IQR 5.15 - 25.60%) and control phase first(C1, median 8.75%, IQR 4.38 - 26.25%; p = 0.47) groups' scores pre-education. Both groups' scores rose significantly at 6 weeks post-education, which was sustained at 18 weeks (Tl: median 52.50%, IQR 31.75 - 65.00%; p = 0.00) (Cl: median 41.25%, IQR 30.00 - 60.23%j p =0.00). A significant increase in knowledge occurred. Factors most associated with behaviour change were: hours of education (8 or more); regular home practice; weaker grip, poorer hand range of movement and less hand pain. These results suggest: current JP education methods are ineffective; and this cognitive-behavioural programme significantly increases Hand JP at 4.5 month follow-up. Having demonstrated adherence can be achieved, it is essential to demonstrate whether any therapeutic benefit results before advocating the widespread use of this approach in practice.

This thesis examines weight anxiety and eating disorders amongst women from an attributional perspective. The studies comprise two distinct but interrelated components: investigations of the role of attribution in the development and maintenance of weight anxiety and eating disorders; and analyses of two screening instruments for eating disorders. The study presented in Chapter 2 examines whether, amongst women without an eating disorder, attributions can be extracted in a factor-analytic manner to form relevant stereotypes associated with 'fat' or 'thin' women. The results confirm that clear weight-related factors can be extracted, and these resemble common stereotypes of fatness and thinness. In Chapters 3 and 4 the attributions of both eating disordered and non-eating disordered women were examined. Four groups have been examined: the Anorexic group; the Bulimic group; the Over-Eater group; and the Non-Eating Disordered group. It is proposed that the attributions of eating disordered women and non-eating disordered women will differ; that the various eating disordered groups will also differ in their attributions; and that attributions will differentially contribute to the development and maintenance of different weight anxieties and eating disorders. The results confirm these propositions: this thesis shows that there are attributionaI differences between the women with and without eating disorders; that there are differences in the attributions of the Bulimic, Anorexic and Over-Eater groups; and that there is evidence to suggest that attributions contribute differentially to the development and maintenance of weight anxiety and eating disorders. The internal validity of the subscale structure of the Eating Disorder Inventory (EDI) (Garner, Olmsted and Polivy, 1983) is examined in Chapters 5 and 6, and Chapter 6 analyses the structure of another assessment instrument, the SCANS (Slade and Dewey, 1986). The results confirm the doubts raised about the validity of the subscale structure of the EDI: no clear support for the subscale structure put forward by Garner et al. has been found, and the factor analyses indicate that no single factor structure can be replicated. The factor analysis of the SCANS, presented in Chapter 6, suggests that the subscale structure of this measure is also not well replicated. It is argued that the subscales of both instruments should be used only with caution. Chapter 5 also examines weight anxiety in older women. This study has shown that older women also are anxious about their weight and that their weight anxiety takes a similar form to those of younger women; for this group of women lifestyle might be an influential factor in their weight anxiety. Chapter 7 discusses all the issues raised in the earlier chapters in relationship to the literature. Finally, the findings of this thesis are discussed, models of the role of attributions are outlined and directions for future research are discussed.

1.6 million young people are currently in higher education (HEFCE, 2010). Even though participation ‘stands at 57% for the 20% most advantaged ... compared to 19% for the most disadvantaged 20%’( Inside Government, 2011), this is an increasingly diverse population. Among the attendant pressures for both students and staff, mental health concerns predominate: since the Royal College of Psychiatrists published their first report into the mental health of students, (RCP, 2003), the issues ‘highlighted have shown no signs of abating and in many respects have become more pressing’ (RCP. 2011:17). Universities for their part increasingly seek to address students’ mental health needs, thereby supporting successful completion of their studies. This doctoral research examines the experiences of ‘home’ undergraduate students in one Russell Group university (henceforth anonymised as Midlands University) and the staff who support them. A qualitative approach serves to highlight the voices of participants and offer an in-depth account of their lived experience of access to, and participation in, the social and academic life of the University. Social Capital theory, Emotional Geographies and the Capability Approach provide a theoretical framework for the analysis of interview data. Key findings confirm the ongoing impact of stigma and discrimination, and indicate the importance of the affective domain of education and the role of student culture on support experiences. The overall aim of this study was to improve student and staff experiences of support. The findings have been and continue to be used to inform policy and practice within the study University.

The ability to restrain oneself from acting on aggressive impulses is arguably a crucial aspect of human functioning and interaction. Yet growing evidence in the literature suggests that people’s self-control resources may be limited and, at times, self-controlled regulation could even increase the association between aggressive triggers and aggressive behaviour. As an alternative, mindfulness practices encourage individuals to be aware and accept their aggression-related thoughts and emotions simply as an ephemeral state rather than to control them. Across four studies, we investigated the possibility that brief, as opposed to extensive, mindfulness exercise may reduce aggression, and whether this potential effect can be separated from a general mechanism of self-control. The relationships between mindfulness, self-control, and aggression were explored in their dispositional forms (Study 1; N = 241). Then, the effect of brief laboratory inductions of mindfulness was tested following manipulations designed to either bolster (Study 2; N = 99) or weaken (cross-cultural samples: Study 3; N = 119 vs. Study 4; N = 110) the resources of self-control. In addition, the potential roles of individual differences in sensitivity to provocations (SP) and frustrations (SF), and self-harm on aggression were also assessed. Results indicated that (i) despite one’s dispositional ability to exert self-control, the presence of a mindful quality uniquely reduced the experiences of anger and hostility, (ii) under the condition of full self-control resource (i.e., after self-control training), mindfulness induction contributed only in reducing more subtle/implicit forms of aggression, and (iii) under lack of self-control resource (i.e., following ego-depleting task), mindfulness induction significantly reduced direct physical aggression after the experience of provocation across cultures. The benefit of mindfulness on aggression appears to be more salient when individual’s self-control resource has been taxed, which operates similarly in Western and non-Western settings. Therapeutic tools focusing on the mechanism for controlling the expression of aggression would benefit from an inclusion of mindfulness-based strategies, as well as an early identification of individual’s sensitivity to different types of aggressive triggers and risks for self-harm.

‘FRIENDS for Life’ is a manualised, 10 week, Cognitive Behavioural Therapy (CBT) based programme designed to be run in school and community settings (Barrett, 2010b). The programme has been introduced to schools within the local authority where the researcher is based via the local Targeted Mental Health in Schools (TAMHS) project. The programme is well reviewed and is recommended by the World Health Organisation for the treatment of anxiety disorders in children (World Health Organisation, 2004). Previous research has evaluated the programme when delivered in closely monitored situations with optimal implementation. The aim of this study is to evaluate the impact of FRIENDS for Life as implemented in a mainstream secondary school by school staff trained as part of the TAMHS initiative. This study makes an original contribution to the existing research base by evaluating the programme in a naturalistic, real world setting using an alternative methodology to the majority of published evaluations. Data regarding implementation of the programme was collected and analysed using activity theory. A single case experimental design was used to monitor the impact of the intervention on the emotional distress, anxiety levels and coping strategies of 5 secondary school participants (aged 11-13) who had been identified by school staff as appearing anxious. The findings suggest that participation in FRIENDS did not result in the hypothesised reductions in emotional distress, anxiety and negative coping skills or the hypothesised improvement in active coping skills. These results are discussed with regard to the finding that some aspects of the programme were not delivered. Analysis of the context using activity theory suggested that factors such as lack of time, space for delivery and experience and training impacted upon implementation. Methodological issues contributing to these findings are considered and implications for the local TAMHS project and for Educational Psychologists are discussed.

The thesis begins with a review of the trauma literature as it relates to fire and rescue work and the attention given to the negative psychological consequences of involvement in such work. Clinical authorities warn of the psychological harm caused by exposure to traumatic incidents despite the recognition that psychological growth often follows adversity. To address this, firefighters were used in a series of studies to investigate the role of social support in facilitating growth. A philosophical overview of current understandings of trauma and growth was made along with the methodology chosen to pursue this investigation. The first empirical chapter is a test of the relation of growth to two different philosophical types of well-being. It found growth to be related to eudaimonic change, rather than hedonic change. A comprehensive review of the literature on social support and growth then found mixed findings for the association of social support and growth but no strong evidence of a causal relation. Four empirical chapters follow that examine the relations between different types of social support and growth in firefighters. The final empirical chapter is a longitudinal study of social support and growth in firefighters based on the findings of earlier cross-sectional studies. Overall, findings were mixed and the role that social support plays in the facilitation of growth remains unclear. A critical realist perspective was taken at the end of the thesis that raises philosophical concerns about clinical understandings of trauma, its treatment and reliance upon a medical framework for explaining psychological change. The findings offer directions in which future research may progress to establish the role of social support in the facilitation of growth following adversity.

Growing interest in the research community has been shown in clinical neuroscience to assess neurotransmitter profiling both in healthy and diseased subjects. A large body of research in this field focuses on schizophrenia to characterise its glutamatergic level according to the most recent hypothesis of NMDA (N-Methyl-D-aspartic acid) receptors hypofunction. Magnetic Resonance Spectroscopy (MRS) is able to detect some of the most common neurotransmitters but a number of issues, such as low signal to noise ratio (SNR), spectra overlapping and line broadening prevents MRS from being clinically relevant for neuropsychiatry. Four important aims were considered relevant for this work. Firstly, we aimed to compare the reliability of conventional and timing-optimized sequences for the detection and measurement of most of the visible metabolites and, in particular, for glutamate (Glu), glutamine (GIn) and gamma-aminobutyric acid (GABA) to assess the best available sequence for a study in schizophrenia. Secondly, we also intended to investigate whether glutamatergic activity might predict the oscillatory activity and how this link might survive or not in schizophrenia. Thirdly, we wanted to study whether the well known animal model of schizophrenia, the rearing in isolation model, exacerbates the effect of ketamine and determines more profound changes on neurotransmitter profile in rats. Fourthly, a further goal focuses on the improved data acquisition and on the data processing to reliably resolve GABA and to be able to quantify a wider range of metabolites. To address those points five studies were performed. The first work (Chapter 3) describes a study of reproducibility on sequences which have been reported in the literature to be capable to detect Glu and GIn. The study was performed on 14 healthy subjects by scanning them twice and repositioning between the two scans. The absolute percentage difference was then computed to assess the accuracy per sequence and metabolite. A good compromise was found in PRESS sequence (TE=80 ms) which was exploited subsequently for the following study on schizophrenic patients (Chapter 4). Twenty-seven early stage schizophrenic patients and twenty-three aged-matched controls were recruited to undergo a protocol including, in two separate sessions, MRS and electroencephalography (EEG). Anterior Cingulate Cortex Glu was found to predict the induced theta activity in healthy controls but not in patients. Furthermore, the NAA values have also been found to be reduced in schizophrenia and linked to N100, an Event Related Potential (ERP) which is well known to be decreased in schizophrenia. Following on from the findings of the study on the early stage of schizophrenia, further investigations were undertaken to study the psychotic state occurring in the disease via a functional MRS, where 25mg/kg of ketamine (NMDA antagonist) injection was administered to two groups of rats. The two groups were group-housed and reared in isolation. This work was able to show increase of prefrontal GIn levels in both groups but showed a selective GABA decrease only in isolated rats. It would have been very interesting to be able to detect GABA changes in the study at 3T but the used protocol did not allow its accurate quantification. Simulations and reliability tests (Chapter 6)were then utilized to optimize a standard sequence to obtain an accurate and reliable GABA concentration. The optimized sequence reproduces the quantification with 12% of accuracy. The preliminary results of the last study (Chapter 7) give an evidence of the potential of combined use of Monte Carlo, Levenberg-Marquardt and NNLS methods embedded in a novel fitting approach for two-dimensional spectra. The three appendices at the end of this work illustrate the details of some of the algorithms and softwares used throughout the studies.

Multimodal neuroimaging using a combination of Magnetoencephalography (MEG) and ultra-high-field fMRI are used in order to gain further insight into the neural oscillations and haemodynamic responses in the somatosensory cortex. Single pulse electrical median nerve stimulation (MNS) with regular and jittered intervals is used in MEG. A preliminary study is used to determine acceptable trial number and length, and highlights points to be considered in paradigm optimization. Time-frequency analysis shows that the largest activities are beta event-related desynchronization (ERD) and event-related synchronization (ERS) between 13Hz and 30Hz. No significant difference in both the induced oscillations and evoked responses are found. Paired pulse MNS with varying ISIs are studied using MEG and 7T fMRI. The beta ERD is suggested to have a gating role with a magnitude irrespective of the starting point of stimulus. Non-linearity effects both in beta ERD/ERS and P35m are shown for ISIs of up to 2s, implying that the non-linear neural responses to the stimulus may still contribute to the BOLD non-linearity even when the evoked response has returned to baseline. Multiple pulse MNS with varying pulse train length and frequency are also investigated using MEG and MEG-fMRI. The gating role of beta ERD is further confirmed and the N160m is suggested to be modulated under this role. No accumulative effect is seen in the ERS with increasing pulse number but the amplitude of the ERS is modulated by the frequency. This can be explained by a Cortical Activation Model (CAM). Efforts to spatially separate the beta ERD and ERS are shown for all three studies. Group averaged SAM images suggest a separation of activation areas along the central gyrus. Significant difference are found in the z MNI coordinate between beta ERD and ERS peak locations, suggesting that these two effects could arise from different generators. In the multiple pulse frequency study, by including the temporal signature of beta ERD and ERS as a regressor in BOLD fMRI analysis, delayed BOLD responses are located posterior to the standard BOLD response. However, the exact nature of the relationship between this delayed BOLD response and the ERS effects requires further work.

We can extrapolate a large amount of information about what a person thinks or believes, purely by observing their behaviour. There are separate systems in the brain that decode what action is being performed and why that action is performed. Independently, these systems are reasonably well understood but the way in which they interact is still an open question. In this thesis I investigate how we come to understand others actions, particularly if they are unusual or irrational. Irrational actions provide a special test case for examining this question because full comprehension requires an understanding of what an agent is trying to achieve as well as an understanding of why they are performing the action in an unusual way. I examine this question in a series of experiments with typically developing and autistic participants. First, I demonstrate that dissociable brain networks are engaged during irrational action observation using fMRI. I then use eye tracking to examine the cognitive processes that these neural networks reflect in both typical and autistic adults. I report typical cognitive processing of irrational actions in individuals with autism, despite previous reports of atypical neural activity during the same task. Finally, I aimed to examine the social response to irrational actions in typical and autistic children using an overimitation paradigm. I demonstrate that overimitation in typically developing children is socially driven and dependent upon rationality comprehension. However, my data also indicate that children with autism are immune to this drive. I conclude this thesis with a new model of rationality comprehension which links brain, cognition and behaviour. I also propose that individuals with ASC have the cognitive ability to understand irrational actions but may have difficulty with social modulation of their behaviour.