Background: The Marlatt model of alcohol treatment (Marlatt & Gordon, 1986) is widespread. A key component of that model is alcohol expectancies. Alcohol expectancies refer to the effects of alcohol use anticipated by individuals. Metacognitive beliefs about alcohol are considered to be a specific form of alcohol expectancy (Spada, Moneta, & Wells). The present study argues that development of a triphasic metacognitive formulation for problematic drinking (Spada, Caselli, & Wells, 2012) represents the single most important advance in alcohol treatment since the advent of the Marlatt model. The formulation postulates that a reduction in positive and negative alcohol metacognitive beliefs leads to a reduction in alcohol use. A crucial element of the metacognitive formulation is attention allocation (Steele & Josephs, 1990). Internally generated conflict, such as gender role conflict (O’Neil, 1981), it is hypothesised, can disrupt attention allocation thereby reducing efficacy of metacognitive treatment. Method: A clinical sample of 102 (male, 74; female, 28) completed the Positive Alcohol Metacognitions Scale (PAM), Negative Alcohol Metacognitions Scale (NAM), Gender Role Conflict Scale (GRCS) and the Alcohol Use Disorders Identification Test (AUDIT). Results: Regression analysis indicated that gender role conflict moderated the relationship between positive alcohol metacognitions and alcohol use in men but not in women. Similar results were obtained for the GRCS subscale ‘Restricted Emotionality’. Conclusions: Findings have implications for gender sensitive interventions in both the Marlatt model generally and metacognitive therapy specifically.

Hyperlipidemia is defined by abnormally elevated levels of one or more lipids such as cholesterol or triglycerides in the bloodstream. It also involves elevated levels of lipoproteins especially LDL-cholesterol and this is the most common form of dyslipidemia. Hyperlipidemia is the result of complex interactions between environmental and genetic factors. Hyperlipidemia is the main cause of congestive heart diseases in adulthood. It is also the main cause of atherosclerosis which is the pathophysiological cause of vascular diseases such as angina pectoris, myocardial infarction, and stroke. It occurs due to disorders in lipid metabolism including elevation in cholesterol, low density lipoprotein, or triglyceride, or due to low levels of high density lipoprotein. Lifestyle is the main factor in prevention of hyperlipidemia. If lifestyle is not beneficial in the treatment or prevention of hyperlipidemia, drug therapy is required. Statins, fibrates, nicotinic acid bile acid sequestrants, and ezetimibe are approved drugs for the treatment of hyperlipidemia. Because of the tolerability problems, side effects, and low effectiveness of some of these drugs, discovery of new drugs is explored and investigated. Herbal products are not well explored as an alternative treatment for the treatment of hyperlipidemia. Ilex latifolia is a traditional Chinese medicine which has been used for decades for the treatment of hyperlipidemia and for weight loss. Prunella vulgaris, Rheum palmatum, and Panax notoginseng have been also used in traditional Chinese medicine. Very little work has been published about the effect of Ilex latifolia on hyperlipidemia. In this research project, Ilex latifolia hypolipidemic effect was compared to several herbs effects by assaying the effect of the extracts on pancreatic lipase. Ilex latifolia was the most active, and the other parts of the project focused on its effect on HMG-CoA reductase expression, and on LDL receptor expression in HepG2 and AML-12 hepatocytes. Ilex latifolia effect on mitochondrial metabolism, and glucose uptake was assayed in HepG2 and AML-12 hepatocytes. Chapter I is an introduction to hyperlipidemia, its types, causes, and treatment. A review of the literature relating to Ilex latifolia and other herbs and herbal compounds is given. Chapter II describes the assay of extracts from several herbs, and herbal compounds, for their inhibitory effect on pancreatic lipase, using orlistat as a positive control. It also shows that HPLC is more sensitive and accurate than a spectrophotometric assay of lipase. Ilex latifolia showed the most inhibition activity on pancreatic lipase compared to other herbs. Chapter III describes the fractionation of Ilex latifolia and pancreatic lipase inhibition activity of each fraction. Chapter IV describes the effect of Ilex latifolia extract on HMG-CoA reductase expression in HepG2 cells and the effect of Ilex latifolia extract on LDL receptors expression in HepG2 and AML-12 cells. Chapter V describes the effect of Ilex latifolia extracts on cell growth, mitochondrial toxicity, and glucose uptake in HepG2 and AML-12 cells. It also describes the effect of Ilex latifolia extract on ATP production in HepG2 cells. This study has demonstrated for the first time that Ilex latifolia can play a role in the treatment of hyperlipidemia through pancreatic lipase inhibition. Effects on HMG-CoA reductase inhibition and mitochondrial inhibition were not marked, but under some circumstances glucose uptake can be significantly affected. It remains to be seen, using animal studies and other cell culture models, whether inhibition of pancreatic lipase can wholly account for the hypolipidemic activity of Ilex latifolia, or whether other mechanisms may be involved.

Background: In view of the estimation that around one fifth of individuals abused in childhood will develop psychological difficulties which require professional input there is a high chance that counselling psychology trainees will encounter adult survivors in their practice. Counselling psychology trainees are continuously faced with philosophical and practical challenges when they seek to integrate psychological models into their practice. The critical literature review discusses the contentions regarding the most appropriate therapeutic approach when working with this client group, alongside maintaining the focus of therapeutic relationship. The review also explores the risk to clients of re-traumatisation through poorly conducted therapeutic interventions. In addition, potential risks to trainees have also been discussed such as difficult affective reactions or vicarious traumatisation. Aims: A lack of research was identified with regards to exploration of trainees’ internal experiences of working with this client group leading to the research question: How do counselling psychology trainees experience working with adult survivors of childhood sexual abuse? Methodology: Semi-structured interviews were conducted with six trainee counselling psychologists enrolled on BPS Accredited Counselling Psychology Doctoral courses, who had experience of working with adult survivors of CSA. The transcripts of the interviews were analysed using Interpretative Phenomenological Analysis (IPA). Results: From the analysis the following three key super-ordinate themes were developed: balancing the power dynamic in therapeutic relationship; management of vicarious emotional state of self; questioning competent versus incompetent self as therapist. Findings: The study identified clinical implications to develop further understanding and requirements for trainee counselling psychologists in relation the superordinate themes. Furthermore, an important limitation from the study was identified with regards to the inclusion of only one male participant. This highlighted the issue of gender differences between client and therapist; however, it underlined an important area requiring further study.

This qualitative research study explored the therapeutic relationship in online therapy from a counselling psychology perspective. An overview of the different types of online therapy and a brief history of the field were given and the existing literature surrounding online therapy and the therapeutic relationship was critically reviewed. Through this, a need was identified for an understanding of how therapeutic relationships are established in online therapy, with a particular focus on therapy via instant messaging. Semi-structured interviews were conducted asking online therapy practitioners about their experiences of therapeutic relationships. The resulting data were analysed using the grounded theory method and a tentative model of the processes that influence the formation of a therapeutic relationship online was created. An important factor in the model was therapists’ development of skills in online communication, which serve to overcome the lack of a physical presence and non-verbal communication that hinder text-based interactions. Another key influence was the management of the therapeutic frame, which is challenged by the nature of the online setting. Also significant was a client’s rationale for choosing online therapy, which influences their ability to engage in a therapy relationship online. The implications of the findings for counselling psychology professional practice, training and research were discussed.

Chronic Spontaneous Urticaria (CU) is a pruritic skin disorder that affects 0.8% of the population. As its aetiology is not fully understood the aim is to control symptoms through medicines to improve quality of life (QoL). Demographic and clinical factors have been inconsistent and poorly predict QoL but one modifiable factor that has gained credence is ones illness representations. The Common-Sense Model (Leventhal, Meyer and Nerenz, 1980) postulates that these guide coping procedures that impact outcomes. The aim of the thesis was to examine whether CU representations (mediated by coping) predicted QoL and whether both representations and QoL in CU were amenable to change via intervention. Preliminary studies undertaken validated CSM measures in CU and confirmed key reference values for CU-related QoL and its measurement. CU was seen as uncontrollable, emotionally arousing, chronic, cyclical, caused by stress and immunity with serious consequences and has a moderate impact on QoL (n=78). The necessity to take CU medicines equalled concerns about side effects. Cognitive representations were the strongest predictors of QoL explaining 35.0-60.6% of the variance independent of coping. Qualitative analyses presented CU as unsightly, uncontrollable and difficult to comprehend and self-regulate. Fifteen participants undertook psych-education and action plans to change CU representations. Multivariate analyses found a strong within-group main effect on QoL outcomes (p < .001) and for aspects of outcome over time (all p < .001). Correlation based change analysis further inferred that targeting CU cognitions resulted in changing QoL outcomes over time. In summary the thesis supported that: poor QoL is prevalent in individuals experiencing CU. Not only do CU representations predict QoL outcomes, they are amenable to change via intervention as are QoL outcomes. Such findings have implications for CU-related QoL research and how health psychology-dermatology collaborations maybe instrumental to improving outcome through psycho-education interventions in routine care to facilitate better CU self-management.

The lack of age-appropriate (paediatric) authorised medicines is a long-standing problem amongst regulatory authorities, patients, parents and prescribers. This is driven by the paucity of information on clinical efficacy, deficiency in safety data (i.e. biopharmaceutics) and the lack of quality information such as palatability and acceptability data in children. To counteract this deficiency bespoke, unlicensed formulations are formulated by contract manufacturers, hospitals and dispensing pharmacists using a variety of ‘recipes’ and differing manufacturing protocols. In this work, Morphological Analysis as a problem structuring method is deployed using key stakeholders of the problem complex. This method, developed from operational research and design thinking sectors, has the ability to structure and parameterise a complex problem to isolate a smaller subset of an internally consistent solution space for the design of experiments. Hence, Morphological Analysis is used experimentally to decide which pharmaceutical dosage forms of furosemide would be selected as a solution space for paediatric patients with low cardiac output syndrome. Morphological Analysis application resulted in the selection of two different dosage forms for further work (Microemulsion oral liquid dosage form and an Orodispersible Mini-tablet). The furosemide microemulsion formulation was developed using ternary phase diagrams to isolate the efficient self-emulsification regions. A range of experimental techniques and instruments were used to characterise the system such as HPLC, phase stability studies, droplet size determination, surface tension measurement, drug-excipient compatibility studies using FTIR and NMR, viscosity determination, thermodynamic stability assessment and determination of shelf-life via accelerated and long-term stability studies. The optimum composition of the furosemide microemulsion consisted of: MCT Oil 14%, Labrasol 60%-Transcutol-HP 20% (3:1) and Water 6%. A furosemide oro-dispersible mini-tablet formulation (ODMT) was also developed and analysed for quality assessment. The development approach for ODMT used factorial design at two levels with four factors. Pre-formulation studies included drug-excipient compatibility assessment using differential scanning calorimetry and powder flowability evaluation using angle of repose and Hausner’s ratio techniques. For that, sixteen batches of ODMTs were manufactured using a Manesty F3 tablet press; Post-compression testing and characterisation processes were performed and this involved testing for weight variation, hardness assessment, friability, in vitro disintegration, wetting time, drug content analysis, dissolution time and stability of ODMTs under ICH conditions. The optimum composition of furosemide ODMT was found to be (ludiflash excipient + 0.6% magnesium stearate lubricant + 1mg/tablet furosemide API) with 10 minutes mixing time at value 19 compression force.

Counselling psychology, with its humanistic value base and adherence to certain aspects of the medical model, is in a positional dilemma on issues such as diagnosis. There seems to be a current need to define counselling psychology’s epistemological position due to doubts about its independence as a profession. How counselling psychologists respond to diagnosis has been tentatively explored in the literature, but responses in terms of thoughts, feelings, perceptions, and their interpretation of these responses is absent. To address this gap, semi-structured interviews were carried out with six counselling psychologists and the interviews were analysed using Interpretative Phenomenological Analysis (IPA). Two themes were identified: ‘diagnosis is something to hang your hat on,’ and ‘the bigger picture.’ Like previous research, these themes highlight the different epistemological positions taken up by counselling psychologists on diagnosis. However, the current findings also describe the lived experience of holding these different positions; for example feelings of tension are expressed and the level of uncertainty that needs to be tolerated is explored. A suggestion is made in terms of defining this changeable position, as one of safe uncertainty (Mason, 1993), in order to facilitate clear communication regarding a position. Specific recommendations are made for research, training and practice, including: the need for tolerance of uncertainty to be made more explicit on counselling psychology training programmes; suggestions for further IPA and Grounded Theory Research; and the development of a special interest group has been suggested, where counselling psychologists and other professionals can share ways of managing the impact of diagnosis on their practice.

South Asians (SA) are a high-risk group for cardiometabolic disease, which is partly attributed, to their ‘thin-fat’ body composition (BC) phenotype. Generally, SAs have a higher % fat mass (FM) and less skeletal muscle mass (SMM), together with a more abdominal distribution of body fat, compared with white Europeans (WE) at equivalent body mass index (BMI) values. SAs also tend to have a shorter adult stature. Effective paediatric monitoring and clinical management requires improved tools for assessing body fatness and other components of BC. This is partly due to BMI being regarded as an inadequate indicator of adiposity and SMM, particularly for SAs, thus other field-based measures of BC have been investigated. In addition to BMI, several UK BC references for WE children and adolescents are available, including WC, %FM, and SMM; however, there are no similar references available for their SA counterparts. This thesis is comprised of four key studies in which ethnic variations in BC (%FM and appendicular SMM (SMMa)), WC, and leg length (LL) in particular relative LL (RLL) between SA and WE children and adolescents (aged 5-18y) were investigated. The core aim was to develop age- and sex-specific percentile references for %FM, SMMa, and WC for the SA ethnicity. In study one, the BC418 bioelectrical impedance analyser (BIA) was validated against DXA for field-based BC assessment, in a sample of SA children (n= 53; 5-21y) to develop an ethnic-specific prediction equation for FM, FFM and SMMa determination, as prior studies have found BIA underestimates %FM in SAs. This equation was found to be only valid for children ≥9y, which was attributed to the opportunistic nature of recruitment. It was concluded that no single equation was valid across the whole child and adolescent population. This equation needs to be tested in an independent group to confirm its accuracy and functionality, prior to wider application. Due to discrepancies in DXA weight and scale weight, it was not possible to develop a prediction equation for SMMa, although the existing BIA output was considered acceptable due to the very small between-method relative differences. In study two the new BIA prediction equation was applied to a large SA dataset of children (n =1,624) from low-income communities. Compared to UK90 (SDS) reference data, both SA girls and boys (9-14y) were significantly shorter, lighter, with a lower mean BMI and WC compared with their WE counterparts, with no significant differences in %FM. %FM and SMMa reference curves were constructed and comparisons were made between published WE (from affluent areas, WE1) reference curves, together with a low-income cohort (WE2). Comparisons in %FM at the 50th centile, between the SA and WE cohorts revealed that SAs had greater %FM overall, and this difference increased after application of the new equation. Similarly, across all age ranges SAs had significantly less relative SMMa than their WE counterparts. The third study generated SA sex- and ethnic-specific WC centile curves. SDS comparisons with the WE2 cohort revealed SAs had a significantly lower mean WC than their WE2 counterparts. It was concluded that, as WC acts as a proxy for visceral fat, ethnic-specific cut-offs similar to those adopted for adults in India should be considered for children. The final study on LL revealed that SAs had a longer RLL than WE children, although as RLL data for WEs was derived, this would require further verification. The outcomes from these studies provide the evidence base and assessment tools to support the use of ethnic-specific references for children and youths in the UK from a SA background. The findings in this thesis demonstrate that overweight and obesity vary across different ethnic groups and this variation needs to be considered in the context of the clinical referral for individual children as well as for population surveillance. These are the first set of reference percentile charts for BC, proportions and dimensions in the UK SA paediatric population. Our findings support the use of these ethnic-specific references that go beyond BMI as an indicator of obesity-related metabolic health risk.

This study qualitatively explores the experiences of six counselling psychologists working with children and adolescents with regards to philosophy, policy, training, practice and professional identity. Interpretative Phenomenological Analysis was employed to analyse participant data. Participants were HCPC accredited counselling psychologists in individual clinical practice with clients aged 0-19. Participants worked in primary care, private practice or 3rd sector practice. Recruitment was through the Counselling Psychologists UK Facebook page, The Division of Counselling Psychology (DCoP) annual conference and a special interest group of the DCoP. Four superordinate themes emerged from the data: 1) ‘Personal and professional growth and development in working with children’ - exploring the value attained from trainee placements and the significance of wider professional support; 2) ‘Working with children is “a different ball game”’ - describing how clinical work with children and adolescents differs from work with adults; 3) ‘Developing a professional framework for working with children’ - exploring the importance of taking a developmental approach and working with the clients’ lived experience; 4) ‘Opening the doors to counselling psychologists working with children’ - exploring the construction of identity through professional development. Participants seemed to take pride in working in a niche area of the profession and felt that counselling psychology could make a unique contribution. However, challenges and difficulties during training and post-qualification appeared to raise the question as to whether working with children was seen as being outside the boundaries of the role of a counselling psychologist.

Background: Identity and health status have been linked in the extant literature, but the lived experience of depression in Black and Minority Ethnic (BME) women in the UK is an under researched phenomenon. This study therefore aimed to gain an in-depth understanding of the experience of depression in a small group of UK based BME women using Interpretative Phenomenological Analysis (IPA), affording the ability to describe, explore and provide an idiographic analysis of this lived experience. Method: Semi-structured interviews were conducted with a purposive sample of five BME women with experience of depression. Participants provided detailed accounts of how they made sense of their experience. Interviews were audio-recorded and verbatim transcripts of the interviews were analysed using IPA. In keeping with the underpinnings of IPA the researcher’s personal and epistemological reflexivity is embedded throughout to demonstrate greater transparency and demonstrate how IPA was applied in practice. Results: The analysis produced two master themes; ‘Cultural Expectations and Depression: “I just need to be me”’ and ‘The Nature of Depression: Agency, Façades and Coping’. The first theme captures how identity conflicts led to isolation for the participants, heightened stress and exacerbated or brought on depression. The experience of being a minority was considered and how this can cause stress, impacting on the ability to cope with adversity and influence perceptions of mental health. The second theme explored perceptions of the nature of depression and the stress of managing physical complaints. Participants adopted a range of coping strategies such as presenting with façades and resilience which impacted on help-seeking behaviours, diagnosis and management of their depression. Discussions around experiences of taking antidepressants served to highlight the importance of the understanding of medication for lay individuals and their implications for treatment adherence. Conclusion: The central finding of this research is that the experience of depression for BME women in the UK is heavily influenced by identity, cultural factors, minority status and pressures of societal norms. This research expands on the extant literature on the relationships between stress, coping and health, illuminating the essence of the lived experience of depression. The recommendations of this research include the need for health practitioners to better understand variabilities in the experience of depression among BME women in the UK (considering ethnic identity and culture) and the need for them to seek to work with individuals in a co-productive way. There is a need for the development of high quality, personalised services which engage with harder to reach communities along with health promotion campaigns and health services to support enhancing the health literacy of BME women with depression.