Introduction It is widely reported that people with schizophrenia have social cognition deficits. In addition to their negative impact on functioning and quality of life, these deficits may also contribute to the use of violence. It has recently been established that social cognitive interventions (SCIs) can ameliorate deficits in facial affect recognition (FAR). This project aimed to systematically review whether SCIs can also improve theory of mind (ToM) abilities in people with schizophrenia. The empirical study aimed to explore whether the extent of the deficits in FAR and ToM in people with schizophrenia differed between those with and without a substantial history of violence. Method A systematic review was undertaken to identify studies where SCIs were provided to adults with schizophrenia or schizoaffective disorder. Key findings were highlighted with the quality of the studies’ methodology and reporting assessed. A quantitative research study was also undertaken involving 22 men aged 18-64 with a diagnosis of schizophrenia or schizoaffective disorder, comparing those with and without a substantial history of violence (SHV) on measures of FAR and ToM. Results The majority of the 13 studies included in the systematic review found that the provision of SCIs led to significant improvements in ToM. However, all studies demonstrated a potential for bias and were limited by inadequate sample size. In the empirical study, less than half of participants scored within the normal range for overall FAR ability, with no difference identified between the SHV and no-SHV group. However, the SHV group were poorer at recognising sadness and showed a tendency to perform better at the detection of faux pas, compared to the no-SHV group. Conclusions The systematic review identified that a wide range of SCIs can improve ToM abilities in people with schizophrenia. Its findings highlight that stringent, adequately powered studies should be undertaken, utilising standardised assessments of a range of levels of ToM ability, to enable identification of the most effective intervention. The findings of the empirical study are limited by a small and imbalanced sample size between groups and so must be interpreted with caution. However, patterns observed in the results highlight areas for further exploration. The strengths of this study’s design and recruitment challenges are discussed.

Qualitative research has tended to not recruit participants with learning disabilities due to concerns that they would not be able to engage with the research process. Interpretative phenomenological analysis (IPA) is a new qualitative methodology which aims to make sense of participant's experiences through the researcher's interpretative enquiry of a homogenous sample. A literature is presented which synthesised, developed a quality guide and evaluated whether IPA is an appropriate methodology to use with people with learning disabilities. The main focus was around the quality of research is this area and additional issues to consider when recruiting people with learning disabilities. An empirical paper that investigated the experiences of women of South Asian origin in receipt of social services using IPA is also presented. It revealed that the participants are satisfied with services through 3 super- ordinate and 8 subthemes. Further research is needed in this area.

Objective: This systematic review explored how “adjustment” is generally defined in adults with an acquired visible difference (AVD) and what positive psychological factors have been evidence to be associated with positive coping and processes of adjustment in AVD. Method: A systematic search for peer reviewed journal articles from 1980 to February 2016 was conducted using: PyschINFO, Medline, EMBASE and CINAHL. Studies were appraised according to eligibility criteria and evaluated against a quality criterion to assess risk of bias. Results: Fourteen studies were included and were in the areas of head and neck cancer, burns and amputation. Selected studies demonstrated inconsistent conceptualisations of adjustment ranging from: lack of psychopathology, resilience, post-traumatic growth and quality of life. Psychological factors identified were; social functioning (social support, social self-efficacy), coping strategies (emotion, problem-focused, active coping) and dispositional optimism. Studies were considered to be of moderate methodological quality with weaknesses including; a lack of control/comparison groups, lack of measure sensitive to the unique challenges of living with AVD and minimal account for confounding variables. Results are discussed in the context of future research implications. Objective: This study aimed to explore the relationship between two dimensions of attachment insecurity (avoidance and anxiety), body image dissatisfaction and perfectionism using theoretically driven multiple mediation models that included emotion dysregulation and interpersonal problems as hypothesised mediators. Method: Fifty female outpatients seeking cosmetic surgery on the National Health Service (NHS) and 26 females interested in seeking cosmetic surgery within the public domain participated in this cross-sectional study (N=76). Participants completed measures of attachment avoidance and anxiety, body image dissatisfaction, perfectionism, emotion dysregulation and interpersonal problems. Results: Attachment insecurity was significantly associated with body image dissatisfaction and perfectionism. Interpersonal problems and emotion dysregulation also significantly partially mediated the relationship between attachment insecurity and body image dissatisfaction, specifically satisfaction with discrete aspects of body parts. Emotion dysregulation was also found to significantly partially mediate the relationship between avoidant attachment and perfectionism, but not anxiety. The clinical implications of this research are discussed.

Thesis (M.Dev.) --University of Limpopo, 2015 / In preparation for the launch of the Flemish Interuniversity Council-Institutional Cooperation (VLIR-IUC) in 2010, the Development Facilitation and Training Institute (DevFTI), University of Limpopo, conducted a scoping exercise with community members in villages within Dikgale in the Limpopo Province. The purpose of the exercise was to identify both the assets within the community — as well as the challenges being experienced in the area. During discussions with leaders of the Community Based Organisations (CBOs) it became apparent that mental health related issues were an emerging issue of concern — with special emphasis placed on the levels of stigma that existed towards mental illness in the area. It is against this backdrop that the researcher was motivated to conduct a study with the aim of finding out the opinions and knowledge of the lay people about mental illness in Dikgopheng community, situated within the broader Dikgale area, in Polokwane Local Municipality in the Limpopo Province. The study used a quantitative descriptive survey research design in which participants answered questions administered through questionnaires. A random sampling strategy was used to secure a representative sample size of 249 respondents out of the total population of 700. IBM’s Statistical Package for Social Sciences for Windows (SPSS version 20) was used to analyse the descriptive statistics. Inconclusive results were found about formal knowledge of the psychosocial risk factors associated with the onset of mental illness. In contradistinction, patterns of cultural associations linked to the onset of mental illness were significant. Furthermore, an overwhelming majority of the community (75.1%) of the community members were found to have ‘stigmatisation’ opinions about people with mental illness. Due to the lack of the psychosocial knowledge about risk factors and the onset of mental illness, it is recommended (i) that there is a need for education and training to raise awareness about risk factors associated with the onset of mental illness and (ii) that further qualitative research be undertaken to explore issues relating to mental illness and stigma in more depth in the area that specifically focuses on ameliorative measures that address stigma that could be implemented within the community.

Introduction: Socio-emotional behaviour difficulties following acquired brain injury (ABI) have been shown to have a persisting negative effect on quality of life. A systematic review was carried out to look at the efficacy and clinical effectiveness of available psychological treatments for socio-emotional behaviour difficulties following ABI. Research was carried out to further understand socio-emotional behaviour by exploring the possible underlying cognitive aspects (specifically social cognition) in a traumatic brain injury (TBI) population. The study investigated the relationship between social cognition and socio-emotional behaviour post-TBI. Method: A systematic search of articles published between January 2008 and November 2013 was carried out following the Cochrane (2008) guidelines. Papers were quality assessed to identify strengths and weaknesses. In the research study, forty TBI participants were asked to complete tasks of emotion recognition, theory of mind, cognitive flexibility, processing speed, attention and working memory. Selfrated and proxy-rated behaviour questionnaires were also administered. Results: The systematic review revealed seven studies for inclusion; three papers looked at a Comprehensive Holistic Approach, two papers on Cognitive Behavioural Therapy, and two on Cognitive Rehabilitation Therapy. The findings suggested that CHA showed the best efficacy and generalization. However, there were also positive results within the CBT studies. The research paper found that the TBI group performed significantly poorer than the control group on measures of emotion recognition and three out of the four ToM tasks. The TBI group also performed significantly poorer on measures of processing speed and working memory (executive function). There was no association found between performance on any of the cognitive tests and socio-emotional behaviour. Conclusions: This is an area of limited research, likely due to the challenges of carrying out research in an ABI population. The systematic review highlighted the limited research available which has implications in clinical practice due to a lack of evidence base for potentially effective interventions. The research study results suggest that there is still a lack of understanding of socio-emotional behaviour and its underlying cognitive functioning. Further research would improve understanding and could also focus appropriate post-ABI interventions for socio-emotional behaviour problems.

The study aimed to examine the relationship between wellbeing, burden, distress and third-wave factors, including self-compassion and psychological flexibility, in caregivers of people with psychosis. The study secondly aimed to trial a new brief group intervention, combining Acceptance and Commitment Therapy (ACT) and Compassion-focused Therapy (CFT) for this population. Twenty-nine participants were assessed at baseline on primary measures of wellbeing, distress, psychological flexibility and self-compassion. Secondary factors including burden and mindfulness were also collected. Correlation analyses were used. Fourteen participants completed the group in intervention and follow-up measures, and pre-post investigations were employed. Lower levels of psychological flexibility and self-compassion were related to lower levels of wellbeing and higher levels of burden and distress. There was a potential mediating effect of psychological flexibility on the relationship between self-compassion and wellbeing. The group intervention was acceptable to caregivers, and there were significant positive changes in self-compassion, distress, burden and mindfulness. The study adds to the existing data regarding wellbeing and burden in caregivers of people with psychosis. This study provides new insights into the factors of self-compassion and psychological flexibility within this population. The ACT with Compassion intervention is a promising, brief intervention which would benefit from further application and evaluation.

Research indicates that certain family environments can impact negatively on psychosis. Expressed Emotion (EE) in relatives is a reliable measure of the individual’s interpersonal family environment that has been shown to predict relapse. However, the factors contributing to the development of EE in this condition and the mechanisms by which EE leads to relapse are still poorly understood. Relatives’ control attributions and behaviours have been linked to EE, and controlling behaviours have been found to be predictive of relapse. This thesis investigated the role of behavioural control, controllability and self-blame attributions in high- and low-EE relatives of individuals with psychosis, and explored the impact of these cognitions and behavioural responses on patient’s symptom outcomes and on relative’s distress. The first empirical study (Study 1) utilised a cross-sectional design to compare types of behavioural control attempts (direct influencing vs. buffering) in high-EE-critical/hostile and high-EE-overinvolved relatives of patients with recent-onset psychosis; and examined whether behavioural control attempts and controllability attributions differed for the high- and low-EE relatives. The links between relatives’ behavioural control and patient relapse were also explored. Results confirmed that types of behaviours (direct influencing and buffering) were associated with different sets of beliefs (about controllability) and with different types of EE (criticism and EOI). However, EE, controllability attributions, nor behavioural control predicted patient relapse. Study 2 used a cross-sectional design to explore the links between self-blame attributions and distress, and self-blame attributions and behavioural control in recent-onset relatives. Results showed that self-blame attributions predicted relatives’ controlling behaviours towards the patient. Relatives who blame themselves did so for not overseeing their family member’s mental health problems properly or for perceiving themselves generally as poor carers. However, self-blame was not predictive of distress. The final empirical study (Study 3) examined temporal associations between contact with high/low EE relatives, behavioural control, affect and symptom experiences in the daily life of patient-relative dyads experiencing psychosis, using experience sampling methodology. Findings revealed that contact with high/low-EE relatives per se did not impact on patient’s symptom experiences or affect, but behaviourally controlling interactions did, suggesting that the measure of behavioural interactions rather than the EE status of the relative may be more sensitive to momentary fluctuations in patients’ symptoms. Momentary self-reports of relatives’ behavioural responses were also linked with their negative affect. This thesis evidenced that relatives’ controllability and self-blame attributions and behavioural control are associated in significant and meaningful ways with psychosis experiences and can impact both patient and relative outcomes, shedding some light into the EE mechanisms that relate to relapse and to the development of EE responses in relatives. However, more work is needed to further understand how these mechanisms operate, particularly in high-EE-overinvolved or low-EE relatives, in order to increase our knowledge about relapse prevention. The findings highlighted that the concept of behavioural control should be considered in future clinical work with families experiencing psychosis.

Both the NHS and Public Health are keen to identify how best to manage long term health condition’s as a result from obesity and vice-versa. There is evidence to support the efficacy of psychological support in weight management programmes. This study explored the perceived importance of psychological support within weight management services; perspectives of both client and healthcare practitioners, in view of considering the implications for the role of a counselling psychologist. There were nine interviews conducted with five healthcare practitioners and four clients. The professionals’ disciplines included: physiologist, dietician, health psychologist, programme manager, and a medical consultant. Of the four patients, two had accessed psychology services as part of their weight management programme and two had not. Data was analysed using thematic analysis. Five overarching themes were identified. Tension (pivotal central theme) this connected to: Lifestyle; Quality of Life (QoL); Service Delivery Model; and Professional and Personal beliefs and values. The findings highlighted that perceived importance of psychological support was influenced by an individuals’ background and experiences by both groups. The implications for the role of a counselling psychologist was to provide training to health professionals as well as raising clients’ awareness of the role of counselling and psychological support within such programmes. Further research is needed to understand better the potential of psychological support within weight management services to help contain UK obesity.

Computerised Cognitive Behavioural Therapy (CCBT) has been recommended for patients in the National Health Service (NHS) Primary Care across the United Kingdom for management of mild to moderate anxiety and depression. This approach also promises financial savings, and may fill the gap between demand and supply of face-to-face therapy. Studies have shown that CCBT is feasible and effective. However, dropout rates can be as high as 86%, but the reasons remain unclear and the information available is limited. This thesis explores factors that may impact on the usability and user experience of this computer-mediated therapy. Espousing the “real world” research philosophy and widely used methods in the Human-Computer Interaction (HCI) field for usability evaluations, four studies using a mixed-methods design were conducted. Study I was an online usability survey, which investigated if usability evaluations had been conducted for CCBT applications. Two versions of questionnaires were sent to four CCBT software developers and ten authors of randomised controlled trials. The categories and responses of the questionnaires gathered from five respondents were reviewed and summarised. The findings suggested that usability evaluations for CCBT were still in their infancy when compared to other healthcare interventions to which HCI approaches have been widely applied. Study II was a usability Heuristic Evaluation (HE) conducted with four expert evaluators to assess two different CCBT applications’ interfaces (MoodGYM and Living Life to the Full) against the self-designed usability heuristics for their compliance. The findings revealed numerous usability issues. Major problems related to navigation and inconsistency of the interfaces were identified. These could be rectified to enhance the user experience. Study III focused on other factors besides usability that might have an influence on the effective use of CCBT. Perceptions of service providers who were involved in both decision-making about CCBT availability and supporting its use were gathered. Nine service providers at different NHS organisations were interviewed. The interviews were analysed using techniques from Grounded Theory (GT). The findings suggested that the practitioners’ attitudes towards CCBT might have affected its service delivery. Four categories from the data analysis were identified: (1) shaping behaviour, (2) implementing and delivering, (3) making an appropriate referral, and (4) technology/CCBT packages - advancing with time. A conceptual model was also generated, “building support around CCBT”: a road-map that could address some of these issues. Study IV examined patients’ perceptions and acceptance of a CCBT application (Beating the Blues), its usability and the user experience, and also whether the user characteristics (e.g. computer experience (CE) and computer self-efficacy (CSE)) had any influence on patients’ use of this technology. A mixed-methods approach was utilised with a sample of 33 participants. Face-to-face and email interviews were conducted. Feedback was also gathered from a usability questionnaire and think-aloud protocol with seven participants selected from the sample. The data were analysed using Thematic and Saliency Analysis to uncover themes. Descriptive statistics were used to describe data from questionnaires. Two overarching themes from the interviews were identified: (1) access to CCBT services, and (2) perceptions and attitudes towards CCBT. Both themes revealed issues which might have significantly impacted on patients’ engagement with CCBT. Numerous flaws were also discovered in the application’s design and functionality (e.g. navigation, aesthetics, relevance of content, and inflexibility). However, the results from CE and CSE questionnaires suggested that participants were confident in using this technology. The four studies provided an in-depth understanding of factors that affect the usability and user experience of CCBT and possible reasons for the high attrition rates. The implications of this research point to the need for health policymakers to focus on the current implementation issues and on how best to deploy this treatment therapy to patients. Further development of CCBT is pivotal to its success, in particular, expanding contexts of use and increasing usability evaluations. Keeping users interested and engaged will improve treatment efficiency, completion rates and will achieve better clinical outcomes.

Rationale: This study was conducted to help improve mental health care for Black and Minority Ethnic (BME) clients as previous research carried out in non-western countries has suggested that western-developed psychotherapies often need to be culturally adapted to become more effective in treating this client group. The aim of this study was to explore how CBT therapists deliver manualised CBT with BME clients and if they make any adaptations, how and to what extent are they implemented. Method: Interpretative Phenomenological Analysis (IPA) guided the conduct and analysis of one-to-one, semi-structured interviews with six CBT therapists working in an Improving Access to Psychological Therapies (IAPT) service. The inclusion criteria for participants was accreditation with the BABCP, completion of an IAPT programme CBT diploma and to be currently working in an IAPT service, at least two years experience as a CBT therapist and at least four cases of completed therapy with BME clients. Findings: Four master themes emerged (1) CBT is based on western principles, (2) The complex nature of CBT, (3) Changing practice of manualised CBT and (4) The influence of therapist factors. Conclusion: The participants experienced many issues in their practice of manualised CBT with BME clients which led them to make changes including adaptations to manualised CBT. They described their current practice as being integrative as they incorporated therapeutic approaches other than pure manualised CBT, making them more flexible and adaptable. The adaptations involved altering the cognitive and behavioural interventions to better suit the individual needs of the client. The adaptations took into account the client’s culture, religion, language, psychological mindedness, acculturation to their host country, education and age. The participants’ confidence in CBT and their self-identity as therapists also influenced their overall practice of therapy. Recommendations for practice are discussed in relation to therapeutic practice, training of therapists, supervision and policy makers.