This portfolio and the competency folders contain two years of reflective practice logs and demonstrate evidence of how I have met the required competencies for the Professional Doctorate in Health Psychology. In the form of four case studies, one systematic review and a research thesis conducted over a period of two years, it shows my range of knowledge and skills gained within Health Psychology. Both the portfolio and the competency folders consist of a range of practical experiences of how I have put health psychology theories and constructs into practice within NHS, charity and corporate settings. The skills and experiences I have gained in this portfolio have been mainly placed within public health but also working alongside the NHS, which Health Psychology heavily contributes to. This portfolio demonstrates my development as a reflective practitioner through a variety of experiences and roles needed to meet each competency. My main role throughout this course has been as a Specialist Stop Smoking Advisor and Smoking in Pregnancy Lead. A large part of this portfolio and my development as a Health Psychologists is Section C3, (page 109), the research competency. When starting this course, it took me a long time to decide on an original topic of research for the thesis, (Section C3, page 109) and I feel that at the beginning, when writing my ethics proposal, my thought process was much more basic. My research thesis examined the use of electronic cigarettes within smoking cessation and the effects this can have on individuals changes in weight. It explored this by comparing different smoking cessation aids, (NRT, Champix and E-cigarettes), gender, ethnicity (Asian or Non-Asian), eating behaviours and activity levels to compare different variables in their strength in predicting weight changes during smoking cessation. Initially, my thought process felt that e-cigarettes could be a stronger variable at preventing weight changes compared to other smoking cessation aids, despite other contributing factors. However, throughout the duration of the course, I feel that my thought process developed as a Health Psychologist and I wanted to consider the results further. Initially, the results from an ANOVA showed that people using e-cigarettes did gain the least amount of weight over a 6-month period. However, after further analysis using the other variables available, I found that the strongest variables at predicting weight changes was gender and eating behaviours. I feel that this was a big change in my way of thinking and allowed me to find more significant results. My overall conclusion was that women are more likely to gain weight during smoking cessation due to them being more sensitive to changes in eating based on emotion and stress. This means that I feel more confident in this being a unique and original contribution of research in Health Psychology and I am proud of what I have achieved and developed within this competency. Following this, the systematic review, section C3.1, (page 212), was one of the most challenging competencies I faced during the two years. This is something that was very new for me and I was initially concerned about my ability to complete this and it was challenging for me to choose a relevant topic. However, after hours of researching and some supervision support, I developed the review to choosing a unique topic and varied area of research for my portfolio. I decided to research and compare the varied perceptions of individuals on people with epilepsy driving. This included the perceptions of people with epilepsy themselves, health professionals and the public. I felt that each step of the review process was new to me and I was always checking that what I was doing/had completed was correct, which I feel has helped me to develop new skills. Only nine studies met the inclusion criteria and of those, only one compared the perceptions of all three individuals; people with epilepsy, health professionals and the public. The review highlights the need for more education about epilepsy and how it can affect an individual to all physicians and members of the public who interact or work with patients with epilepsy. Another challenging part of this review was the Quality Assessment tool for Quantitative studies that I completed for each of the nine studies. This was a new assessment tool to me that I had not used previously and I felt initially confused on how to use this most effectively. However, with more research, practice and supervision, I feel as though this is another skill I could develop for further research in the future. I am also hoping to get this review published to increase my list of publications. The competency I feel I developed in the most is the consultancy, section C4 (page 276), which will illustrate one consultancy project where I designed and developed a Smoking in Pregnancy scheme and educational project. The idea of this consultancy came directly from Public Health, who asked me to target the pregnant women who smoke and decline a referral to the stop smoking service. This gave me the opportunity to work with a range of different health professionals working at different levels, including service leads, locality managers, maternity department, consultants and commissioners within maternal health. This was a new opportunity for me and I was given the responsibility to design and develop the individual sessions delivered to these pregnant smokers. The idea was to work directly with maternity services, specifically the Public Health Specialist Midwife, to deliver this educational session to the pregnant women with the hope for them to decide to try and stop smoking and work directly with the community midwives to ensure appropriate referrals. This was the biggest challenge for me over the duration of the course, as it involved working at such a high level on important and relevant work. Throughout the project, it became a big interest for other services within the East of England, in which I was asked to deliver a presentation of the project and the results gained throughout at various meetings and conferences. Despite being terrified initially, my confidence grew quickly and I was pleased with the overall outcomes of this work. This gave me the opportunity to develop in a way that was not available within my normal role and I feel that it has contributed enormously to the health professional I have become today. Following this, the competency I was most worried about completing was the teaching and training, (section C5, page 319) as I did not feel I had the confidence to deliver a teaching or training session. At the beginning of the course, I had never delivered any teaching or training sessions and did not feel it was something I would enjoy. I felt that it was important for me to embrace this opportunity, knowing it was important for these feelings to change by the end of the course. Therefore, this was the first competency I chose to complete. I started by delivering two lectures at the university for both undergraduate and postgraduate level students. Initially, I was concerned about the content of the lectures and my ability to teach others information. However, after some guidance and support from my peers and during supervision, I feel that I delivered two effective and interesting lectures to students leaving me able to complete the competency report. Following this, I was keen to increase my confidence further within this competency and I could start delivering training sessions within my role for the Level 2 Stop Smoking Advisor Training. Upon completion of this training, trainees are qualified and competent to support and guide individuals to stop smoking and so it was important for me to deliver an effective training. This was a full two-day course that involved both delivering information and interactive sessions with an online assessment to complete their training. / I think that this has helped me tremendously in building my confidence delivering training and I was able to continue this further and deliver the Make Every Contact Count (MECC) to other health professionals where needed. Finally, by the end of the course, I was training other staff members to deliver these two training sessions so there were more staff available when needed. This has allowed me to develop as an autonomous practitioner in both skills and confidence and I feel that it has prepared me for the delivery of future training. The competency I feel I sit most naturally in and throughout the course of the doctorate I delivered many behaviour change interventions, (Section C2, page 30). Throughout my training, I was regularly delivering interventions to clients who wanted to stop smoking and helping to support them through their behaviour change. Therefore, I decided to increase my knowledge and skills to a different area for the intervention report. I had the opportunity to work with a Child Weight Management Team at delivering a physical activity session at the end of each nutritional session within their programmes. This allowed me to develop the skills and experience needed to work with young children and their families in a health setting within weight management, not just adults. I enjoyed delivering these physical activity sessions and although initially, I was not sure how to deliver an effective session to children, the team were a great support. I am pleased that the outcome of the intervention increased attendance rates and later became an important part of their child weight management programmes.

Background: People suffering from severe mental illness (SMI) engage in fewer health behaviours and, in return, suffer a reduced lifespan by up to 25 years. Past literature on health behaviours and SMI is complex, fragmented and inconclusive, and has chiefly focused on single health behaviours in relation to specific mental illnesses. For example, nicotine and caffeine consumption have been found to interfere with anti-psychotics by reducing their effectiveness. Exercise, however, has been found to lessen the negative symptoms of schizophrenia and lower scores in depression. This research project seeks to explore the potential link between multiple health behaviours (being active daily, eating healthy, not smoking, drinking alcohol in moderation, and being in a healthy weight range) and different mental health diagnoses. Method: A clinical sample of 84 (56 males; 28 females) was drawn from a Luxembourg sheltered work environment. Participants completed a questionnaire developed from the eating habits measure, the health behaviours measure, the Eppendorf schizophrenia inventory, the psychological symptoms index and the mental health inventory. In order to triangulate the participants’ symptoms, with their consent, a third-party also assessed their symptoms. Results: Regression analyses indicated that only exercise predicted self-reported symptoms. In addition, there was also an interaction between exercising and healthy eating: exercising was associated with a decrease in symptoms, whereas exercising while eating healthy was associated with an increase in symptoms. Health behaviours did not affect diverse diagnoses differently. Moderation analyses showed that symptom awareness did not moderate the relationship between exercising and symptoms. However, healthy eating moderated the relationship between exercise and symptoms; at a high level of healthy eating, participants reported worse symptoms. Conclusions: Results point towards a possible impact of self-criticism upon the relationship between health behaviours and SMI. Implications for theory and practice are discussed, and recommendations for future research will be proposed.

Background: The previous and current NICE guidelines consider cognitive-behaviour therapy (CBT) to be the best psychological intervention for the treatment of bulimia nervosa (BN). This is despite various issues with the studies contributing to this evidence-base. Overall, research has suggested that CBT is associated with the highest levels of symptom reduction, but little is known about what makes the therapy effective. Clients’ views regarding the topic have been especially neglected thus far. Aims: The study aimed to gain a detailed understanding of women’s experiences of CBT and its impact on their post-therapy lives. It also sought to provide clinicians and other professionals with helpful insights into how best support individuals with bulimic difficulties. Methodology: Semi-structured interviews were completed with four women who met the inclusion criteria for the study. The verbatim transcripts were analysed by using Interpretative Phenomenological Analysis (IPA). Findings: Three master themes and nine subthemes were revealed through the analytical process. The master themes were: Loss of control; Staying on the surface; and Holding onto power. Conclusions: The findings indicated that the concept of ‘control’ and concerns regarding its loss and maintenance were central to all four women taking part in the study; these concerns were present in each master theme. Although all participants reported CBT to have helped them to address their disordered eating behaviours, parts of the women’s identities associated with these difficulties were left untouched. The implications of the findings to clinical practice, and suggestions for future research will be discussed.

Background: Gestational diabetes mellitus (GDM) has adverse effects on the level of docosahexaenoic acid (DHA) in phospholipids of maternal and cord red blood cells and cord plasma. This finding was of major concern because DHA is vital for maternal wellbeing and health, and for optimal development of foetal brain and retina. GDM is also associated with increased oxidative stress. There is controversy about omega-3 LCPUFA supplementation and oxidative damage. This ambiguity needs to be explored to reveal its role as modulator of oxidative stress in GDM. Specific Aims: To investigate if (1) GDM adversely affects the plasma omega-3 and omega-6 long-chain polyunsaturated fatty acid (LCPUFA) levels in pregnant women. (2) High BMI is associated with adverse plasma fatty acid profile in GDM women. (3) Supplementation with DHA-enriched formula, enhances the level of the nutrient in the GDM women and their neonates. (4) Antioxidant vitamins status is enhanced by DHA-enriched supplementation in GDM women and their newborns. Methods: Women with (n = 142; 72 active-group, 70 placebo) and without gestational diabetes (n = 28; 10 active-group, 18 placebo) were supplemented from the recruitment (at Newham University Hospital, London) until delivery. Both active- and placebo-groups received 2 capsules of either DHA-enriched formula or high oleic acid sunflower seed oil respectively. Each active supplement capsule contained 300 mg of DHA, 42 mg of eicosapentaenoic acid (EPA) and 8.4 mg of AA, and placebo 721 mg of oleic acid. Blood samples taken from the mothers at recruitment and delivery (maternal and cord) were analysed for plasma fatty acid composition and antioxidant vitamins levels. Results: At recruitment, no significant difference was found in the DHA level in plasma phospholipids (CPG, 4.9% vs. 4.4%, P > 0.05) and neutral lipids (CE, 0.9% vs. 0.9%, P > 0.05), (TG, 0.9% vs. 0.9%, P > 0.05) between healthy pregnant and GDM women respectively. When categorized on the basis of their BMI, obese and over-weight GDM women had lower omega-3 (ALA, P < 0.05) and higher omega-6 PUFA (AA, P < 0.05) levels as compared to normal-weight GDM women. A total of 140 women completed the trial. GDM active-group compared with GDM placebo-group had significantly higher percentage of DHA in plasma CPG (4.4% vs. 3.7%, P < 0.05), CE (1.1% vs. 0.9%, P < 0.05), and TG (1.2% vs. 0.8%, P < 0.05) at delivery. There was no significant difference in the cord plasma [CPG (5.4% vs. 5.8%, P > 0.05), CE (1.1% vs. 1.0%, P > 0.05), TG (2.9% vs. 3.3%, P > 0.05)] DHA between GDM placebo and active-treatment groups. Though not significantly, the levels of vitamin A and β-carotene were reduced, however, the level of vitamin E was comparable between GDM and healthy pregnant women, at recruitment (P > 0.05). At delivery, no significant difference was found in maternal plasma vitamin A (21.1 μg/dl vs. 18.0 μg/dl, P > 0.05), vitamin E (1.4 mg/dl vs. 1.4 mg/dl, P > 0.05) and β-carotene (16.1 μg/dl vs. 11.1 μg/dl, P > 0.05) levels between GDM placebo- and active-treatment groups. Neonatal plasma antioxidant vitamins levels were also comparable between GDM active-treatment and placebo groups (P > 0.05). Conclusion: The present study shows that the plasma DHA and AA levels are not compromised by gestational diabetes in pregnant women. It may be that the comparable plasma DHA and AA levels observed in the GDM women is linked to a failure to incorporate these fatty acids into the phospholipids of the red cell membrane and/or impaired placental transport. Moreover, the majority of samples were collected during the third trimester (between 28-32 weeks), so it is plausible that the duration of the diabetes was very short to produce an obvious adverse effect on the plasma DHA and AA levels. Additionally, this study shows that higher pre-pregnancy BMI is associated with higher n-6 PUFA and lower n-3 PUFA levels in GDM women. However, it is difficult to establish whether BMI causes adverse fatty acids profile, or whether the direction of this association is reversed. This unique study also demonstrated that supplementation with a daily dose of DHA (600mg) from diagnosis until delivery was effective in enhancing the level of the nutrient in plasma of GDM women but not foetal. The inefficacy of the supplement to improve foetal status suggests that the transfer of DHA across the placenta may be impaired in the GDM women. This finding has implications for the management of neonates born to GDM women because they are born with a lower level of DHA and the condition is considered to be linked with a risk of neuro-developmental deficit. We suggest that the provision of a DHA supplement should be integrated with the antenatal care of pregnant women with gestational diabetes to optimize foetal development and avert maternal DHA depletion in pregnancy. Also, the babies of the GDM women, particularly those not sucking mother’s milk, similar to those who born prematurely require formula milk containing a higher level of DHA. This study demonstrates that DHA-enriched supplement did not improve yet not deteriorate the antioxidant vitamins status in GDM women. This may be because of small dose and short duration of supplementation. We can allude that the moderate amounts of omega-3 LCPUFA in dietary intake for longer duration may reduce the incidence and complications associated with oxidative stress in diabetic pregnancy.

The aim of this study is to explore how individuals with bulimia nervosa (BN) understand processes of change in individual cognitive behavioural therapy (CBT). The treatment of individuals with BN remains a major challenge and research suggests that treatment only helps a modest number of individuals. The rationale for this investigation is to learn more about the factors that influence change, which might contribute to or shed further light on the body of research that already exists in this area. A qualitative research method is chosen and used from a critical realist framework. The in-depth interviews of eight participants’ experiences of change in CBT for BN are analysed using a grounded theory methodology. The data analysis includes initial open coding, categorisation and linking the categories to construct a theory that is grounded in the data. The findings indicate that healing from BN is a complex and painful continual process of personal transition, which involves ‘a journey towards de-fusion of the sense of self and the BN’. Participants described how BN gradually became part of self and how bodily sensations and attributes affected cognitions and emotions. The overall finding demonstrates an immediate connection between the participants’ physical and psychological realities. This symbolic communication via the body, however, was not experienced as metaphors but rather as actual reality, which affected the change processes in several ways. The processes of de-fusion of the sense of self and therapeutic change in the BN seemed to have an interactional relationship that was central to the experiences of change at all stages of CBT for BN. The main findings are linked to the wider context and the possible implications are discussed. A critical evaluation of the study is offered followed by recommendations for future research and practice in the field of counselling psychology and beyond. In particular, mentalization-based therapy is explored as a possible framework for conceptualising BN, which might help grasp some basic limitations and difficulties in psychotherapy and treatment in general.

γ-Aminobutyric acid has been shown to be a major inhibitory neurotransmitter in the central nervous system (CNS). This study is concemed with the examination of a number of GABA antagonists in two in vitro assay systems. A series of cage-structured compounds including bicyolic phosphate esters (2,6,7,-Trioxa-l-phosphabicyclo (2,2,2,) octan-l-oxides with suitable 4-substituents) have been shown to be potent a GABA antagonists. These compounds do not act directly on the postsysnaptio GABA receptor site but probably at the same site as another potent GABA antagonist piorotoxinin. It has been shown that the substituent group on the bridge-head on the 4-carbon atom in the molecule plays a very important role in the toxic potency and GABA antagonistic properties of these compounds. A very bulky and branched substituent caused a great increase in potency. This property was utilised in the synthesis of a series of these compounds. The binding of radiolabelled ligands (both agonists and antagonists) to synaptic membrane fractions can be utilised as a convenient assay for the study of GABA receptors. Such assays using frozen--thawed rat brain synaptosomal membranes has been demonstrated to be stereospecific and saturable using (3H)-GABA, the potent GABA agonist (3H)-muscimol also with GABA antagonists using (3H)-bicuculline methobromide and (3H)-dihydropicrotoxinin. Utilising these methods a number of agonists and antagonists have been examined to evaluate their ability to displace the stereospecific binding. The synthesised GABA antagonists have also been used to evaluate their properties on the depolarising effect of on the rat superior cervical ganglion in comparison to results obtained by known GABA, antagonists. The bicyclic phosphate esters were shown to be very toxic when administered to mammals causing seizures and death, this effect being attributed to the antagonism of GABA in the CNS. They were shown to be potent inhibitors of GABA in the superior cervical ganglion. In binding studios with (3H)-muscimol they did not displace any of the bound agonist and also were shown not to displace bound (3H)-dihydropicrotoxinin. The results obtained in this study have been discussed and compared with structure-activity relationships to other compounds of similar structure.

The Herrnstein matching law was used to dissociate motoric from motivational drug-induced performance changes. The effects of neuroleptic drugs were compatible with, at low doses, a reduction in reinforcer efficacy, and at higher doses, an additional motor impairment However, the Herrnstein matching law was found to be prone to artifactual error; in particular, under reinforcement-lean conditions reductions in reinforcer efficacy were time-dependent These problems compromised the use of the Herrnstein law to assess drug-induced performance changes. Raclopride-induced time-dependent reductions in response rate occurred in the absence of both primary and secondary reinforcement. Within-session decrements in both operant and consummatory behaviour were observed following administration of sulpiride to the anterodorsal striatum, but not following administration of sulpiride to the nucleus accumbens. The implications of this finding are discussed in relation to the internal organisation of behaviour, and Parkinson's disease. Consumption of sucrose and operant responding maintained by sucrose pellets follows an inverted-U-shaped concentration-intake function. Systemic administration of raclopride shifted the curve to the right. It is argued that this curve shift reflects an impairment in the primary reward process. Effects of intracranial administration of sulpiride on sucrose consumption were restricted to the nucleus accumbens at a low concentration of sucrose, but were also observed within the anterodorsal striatum and basolateral amygdala at higher concentrations. These findings are discussed in relation to the neuroanatomical substrates for the guidance of behaviour by external cues, and for reward processes.

Metal ions play a major role in a wide range of biological processes in the human body. Metal ions in low-molecular weight complexes are of particular interest because of their greater 'mobility' and 'reactivity' compared to the high-molecular weight protein-bound metal ions. In this project, low-molecular weight metal ions encountered in vivo due to bone and joint disease are studied, namely gold, titanium and iron metal ions. Gold compounds such as disodium aurothiomalate (Myocrisin) have been used for over 50 years in the treatment of rheumatoid arthritis (RA). As gold (I) acts like a soft Lewis acid, it possesses a high affinity for thiol ligands and therefore primarily distributes itself amongst protein and to some extent non-protein thiol groups in vivo. Most of the gold is bound to the protein serum albumin, principally at the sulphydryl site Cys(34)-SH, and a smaller amount is bound to immunoglobulins. A small amount of the total circulating gold is present as low-molecular weight or "free" gold, which is likely to play an important role in gold transportation processes and the attainment of chemical equilibrium of gold between the protein binding sites. In this study the concentration of low-molecular weight gold in the biological fluids of RA patients undergoing gold drug therapy (chrysotherapy) was analysed. The biological samples were centrifuged in order to obtain ultrafiltrate which would be free of highmolecular weight gold. The ultrafiltrate, containing the low-molecular gold was treated with potassium cyanide to facilitate the production of an auro(I)cyanide complex which could detected and quantified by the use of high pressure liquid chromatography (HPLC) in conjunction with ultra-violet (UV) detection at a wavelength of 211 nm. HPLC provided a method that was sensitive to the low concentrations found. The results obtained were backed up by measuring the "free" gold concentration by means of flameless atomic absorption spectrometry (AAS). In addition the chemical nature of titanium ions found in localised darkly stained tissue adjacent to titanium-aluminium-vanadium hip implants was investigated. The production of the dark blue/black complex seen in the affected tissue was simulated in vitro by synthetic pathways. The speciation of the titanium (III)/titanium (IV) complexes in the biological matrices was investigated with Fourier transform infra red (FTIR) spectroscopy and high field proton nuclear magnetic resonance (NMR) with a Hahn spin echo pulse sequence. The chemical nature of non-protein bound iron present in knee joint synovial fluid obtained from RA patients was also investigated by use of NMR.

The motivation for the main body of work presented in this thesis arose from three sources. Initially, the need to develop and test a reliable, portable and unobtrusive method of observing human feeding behaviour in a clinical setting. Secondly, curiosity concerning the serotonergic modulation of feeding. In practice, to examine the effects of the 5-HT reuptake inhibitor and anti-depressant fluoxetine on food intake and choice, body weight and subjective states in both non-depressed normal-weight and obese subjects. The third and final impetus arose from the observation that, in rats, the expression of meal-induced satiety offered a background against which to examine the possible mechanisms underlying the effects of acute and chronic administration of serotonergic agents on consummatory and behavioural functioning.

Quadriceps weakness can occur by atrophy and by reflex inhibition due to stimuli from a damaged knee joint. The mechanisms by which quadriceps weakness occurs are not understood enough to allow weakness to be prevented. The nature of reflex inhibition has been studied in patients undergoing arthrotomy and meniscectomy in order to find ways of preventing inhibition. The maximal voluntary activation (MVA) of quadriceps was recorded, using surface integrated electromyography, during straight leg isometric contractions before end after surgery. Post-operative inhibition was expressed as the percentage reduction from the pre-operative MVA. Knee pain experienced during each contraction was recorded on a linear analogue scale. Post-meniscectomy reflex inhibition of quadriceps is severe (70-80% during the first 3 days), prolonged (35-40% at 2 weeks) and is not related to pain after 24 hours. Inhibition can be temporarily prevented by per-operative infiltration of the knee with a local anaesthetic (Chapter 3). Prolonged voluntary tourniquet ischaemia in normal subjects did not alter subsequent quadriceps function, indicating that the reduced NVA observed in the meniscectomy patients was not due to ischaemia (Chapter 4). Isometric quadriceps contractions are inhibited less with the knee flexed than extended (Chapter 5). Transcutaneous nerve stimulation (TNS) had only a small effect on inhibition, and pain relief was similar in both the treatment and the control groups (Chapter 6). In patients who developed knee joint effusions post-operatively, aspiration always reduced inhibition but did not abolish it (Chapter 7). The effect of knee joint afferent activity on quadriceps activation was studied in normal subjects with knee joint infusions. Intra-articular pressure/volume relationships at rest were similar to results reported by other authors, and during contraction the pressures were higher at each volume (Chapter 8). Inhibition of reflex activation of quadriceps was examined by measuring quadriceps H-reflex (Chapters 9,10 and 11). The central neural pathway of the joint afferent stimuli was investigated by testing for spatial facilitation between joint stimulation (by infusion) and known pathways of quadriceps H-reflex inhibition (by stimulating various nerves). The results suggest that the joint afferents have connections with Ib and cutaneous flexor reflex afferent (FRA) inhibitory pathways, but results for reciprocal inhibition were equivocal. The present investigations have quantified the severity and duration of post-meniscectomy quadriceps inhibition, and have confirmed that the inhibition occurs by a reflex mechanism originating from the knee joint and that it is possible to block the inhibitory stimuli. Investigation of the pathway of the afferent stimuli suggested convergence of joint afferents with Ib pathways and with cutaneous FRA pathways.