This thesis examines selective attention in young adults with Autism Spectrum Disorder (ASD). Existing literature regarding this issue is mixed; some research suggesting an overly-focused attentional style (Rincover & Ducharme, 1987) while others highlight an abnormally broad attentional lens (Burack, 1994). The research presented here has, for the first time, examined selective attention in individuals with ASD using a theoretically-led approach based on Lavie’s Load Theory of attention and cognitive control (Lavie et al., 2004). Load theory states that the perceptual load (amount of potentially task relevant information) of a task affects selective attention. This theory may explain the equivocal findings in the current data on selective attention and ASD. Using behavioural measures, the pattern of selective attention under various levels of load was explored in individuals with ASD and matched controls. The results provide evidence of increased perceptual capacity in ASD. This means that, at any one time, individuals with ASD may be able to process more information from the visual environment. This increase in capacity was evident on tasks of both unconscious and conscious perception. In light of the social deficits observed in the condition, the work in this thesis also explored selective attention in the presence of social distractor stimuli. Results indicated that faces are less salient for individuals with ASD and, unlike for typical adults, are not processed in an automatic and mandatory fashion. These results bring together findings on selective attention with work on social processing in an attempt to find basic abnormalities which might be fundamental in explaining the disorder.

This research project focuses on the cognitive process of rumination and its association to depression. Part one of the project is a literature review, which aimed to provide a comprehensive summary of the current state of research on the relations between rumination and the major cognitive processes in people with depression. A systematic search identified 25 studies in the existing literature which fulfilled the basic requirements of studying rumination and at least one other cognitive process with valid measure(s) or experimental manipulations in people with a diagnosis of major depressive disorder. These studies covered 8 domains of cognitive deficits and biases related to rumination. They included overgeneralised memory, memory biases, thinking biases, attentional biases, inhibitory deficits, impairments in general resource allocation, maladaptive thought control strategies, and problem-solving deficits. The review investigated the conclusions made by these studies in terms of their suggestions on the interrelations between depressive symptoms, rumination, the cognitive process in question. Particular attention was paid to each study's conceptualisation of rumination, and whether it addressed subcomponents of rumination which underlie its negative effects. Part two consisted of the empirical paper. The empirical study focussed on the ability of one particular hypothesis - the mood-as-input model -to explain the mechanisms underlying the perseverative thinking style which characterised depressive rumination. Using a rumination interview paradigm, it compared participants with major depressive disorder (MDD) with healthy controls for the extent of their perseverative thinking during the rumination task. The performance of each participant in both the depressed and control group was also measured and contrasted across two experimental conditions. In each these conditions, participants were asked to adopt either an 'as-much-as-can' or a 'feel-like-continuing' stop-rule as guidelines for decision making on how and when to terminate the task. Results indicated that the interaction of depressive symptoms and 'stop-rule' significantly influenced perseveration in all participants. Participants' changes of mood during the rumination task, as well as their spontaneous selection of stop-rule in their daily life were also explored. Finally, the critical appraisal in part three offered a reflection on the my motivations for undertaking this research and some reasons for the important decisions made in the process. It also provided further discussions on the designs and methodologies of the experimental study, and the research and clinical implications of its findings.

Aims: To evaluate the use of external aids in cognitive rehabilitation for memory impairment in patients with acquired brain injury resulting from TBI and stroke. Methods: Studies evaluating external aids published up to 2008 were extracted from the systematic reviews of cognitive rehabilitation by Cicerone and colleagues (Cicerone et al., 2000, 2005, 2011). In addition Medline, PschINFO and CINAHLPlus were searched from 2008 up to March 2012. The reference lists of relevant articles were scanned to identify any additional studies. Results: 39 studies were reviewed. 12 studies evaluated paper-based aids and 27 studies evaluated electronic aids. All studies reported improvements in memory functioning associated with use of an external aid, although only one study directly compared an external memory aid to alternative memory interventions. Conclusions: External aids are an effective tool in the rehabilitation of memory impairment following TBI and stroke. Further research is required to explore whether particular aids are differentially suited to particular types of patient or memory problem, and to explore the factors that are predictive of sustained use after discharge.

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Neurocognitive models of anxiety highlight the importance of attentional control and prefrontal control mechanisms and posit that anxiety is characterised by impaired effectiveness and efficiency during inhibition, especially under high cognitive load and in the presence of threat-related stimuli (Eysenck, Derakshan, Santos, & Calvo, 2007). The current thesis utilised behavioural, oculomotor, pupillary, and neurophysiological measures to examine the inefficient/ineffective inhibitory control and increased cognitive effort in high (vs. low) anxious individuals in the presence and absence of threat under high and low cognitive load conditions. Across three experiments, the results demonstrated that, high (vs. low) trait anxious individuals exert increased effort (as evidenced by increased pupillary responses) and invest more attentional resources during response preparation (as evidenced by decreased negative frontal neurophysiological responses), yet they have impaired inhibitory control (as evidenced by slower and erroneous oculomotor responses and less negative inhibition-related neurophysiological responses), especially under high cognitive load. These findings indicate inefficient inhibitory processing and ineffective inhibitory performance in high trait anxious individuals, especially when the task demands are high.

Systemic Psychotherapists, versed in working from a social constructionist and feminist perspective, can encounter positioning dilemmas when working within the high risk field of anorexia. A common discourse of anorexia is that it has a relationship to issues of control, feelings of subjugation and lack of agency. For professionals, when working within the dominant psycho-medical domain immediate physical risk can be reduced, but so can the client’s sense of agency. On the other hand, if the therapist works within a social constructionist domain agency can be increased, but so might physical risk. Using semi-structured interviews, qualitative data were collected, recorded and analysed from eight systemic family psychotherapists who were currently working with anorexia in a variety of clinical settings. Focus was given within the dialogically constructed interviews to the positions that the participants took within the discourse of anorexia, both theoretically and in action. Positioning dilemmas and issues of power dynamics were given particular focus. The data were analysed using constructivist grounded theory, with three main theoretical codes emerging inductively from the axial codes. The findings that emerged are arranged as a hermeneutic circle of influences upon the positions taken, and encompass history, context, view, position, action and response. The positions of expert, unsettled and not-knowing were identified. Finally the actions of comfort, support and challenge emerged from the data. The participants varied from each other and within their own positioning, with context of client age and chronicity seemingly having a strong influence on how social constructionist positions could be taken in the face of physical risk. The influence of their own and other professional and personal discourses also had bearing. In this study, the findings suggest that an informed orienteering approach (a term that I coined based on dialogic principles, Shotter’s concept of withness and orienteering and Mason’s thinking on working within safe uncertainty) can help systemic therapists position themselves within discourses about anorexia. My informed orienteering approach allows incorporation and attention to both the psycho-medical and social constructionist positions, whilst accounting for issues of power, particularly through feminist critique and the thinking of Foucault and Bourdieu. Implications for the field of family therapy are considered, as are recommendations for future research.

The present thesis has investigated the role of emotions in obsessive-compulsive experiences. First, a literature review explored whether specific compulsive presentations were underpinned by consistent affective profiles. A systematic search procedure identified 23 studies which were eligible for inclusion. Analysis of the results reported across the studies led to five key conclusions. First, washing profiles were consistently characterised by elevated levels of disgust. Second, checking profiles were consistently characterised by elevated levels of guilt. Third, hoarding profiles appeared to be characterised by fewer undesirable phenomena. Fourth, aside from hoarding, anxiety and depression were found to be consistently present across the profiles of all compulsions. Fifth, individuals experiencing multiple compulsion types were considered to experience profiles characterised by increased affective phenomena of a potentially distressing nature, for example, anxiety and stress. These findings highlighted the importance of considering affective variables when assessing, formulating, and supporting obsessive-compulsive difficulties. Second, a research project was designed to investigate the influence of self-disgust on obsessive-compulsive experiences, as this emotion had been rarely considered alongside such presentations. An online questionnaire was completed by 149 eligible participants with clinically significant obsessive-compulsive difficulties. The results of a multiple regression analysis revealed that self-disgust was a significant independent predictor of hoarding behaviours; no other compulsive behaviours were predicted by self-disgust. Results were explained in terms of existing theory and empirical evidence. Again, findings were considered with regards to their clinical implications and the importance of using holistic formulations to inform clinical interventions. Third, a critical appraisal was completed to reflect upon the thesis. This comprised an extended discussion of the research paper. Additionally, consideration was given to the research process, including the challenge of balancing the necessary use of the medical model with person-centred values.

This thesis explores the narratives of people with long-term experience of eating disorders and the wider socio-political, psycho-medical discourses that surround these presentations. It comprises a narrative literature review, a research article and a critical appraisal. The literature review provides a social constructivist critique of the limiting nature of language in the case of anorexia nervosa. By reviewing diagnostic criteria, historical accounts and dominant explanations of anorexia, this article explores their epistemological underpinnings, and the consequent impact of these on research, policy and service-user experience in a neo-liberal political context. The research paper applies a narrative analytic approach to the accounts of eight participants with long-term experience of eating disorders and specialist service provision. The findings are presented in six cinematic style scenes across three acts, which illustrate participants’ first contact with specialist services, a brief overview of what had happened to get them to this point, the context and quality of their current relationship with services, and their needs and hopes for the future. The contributions of these narratives are discussed in relation to the role specialist services play in the construction of participants’ sense of self, and the implications of this for clinical practice and service development going forward. Finally, the critical appraisal adopts a narrative approach to the exploration of my experience undertaking this research. Using a similar process to the analysis of participants’ narratives in the research article, I reflect on my introduction to eating disorder services and the reason I became interested in this research, what had happened in my life story to influence this decision and approach, before providing an overview of the challenges, strengths and limitations of the process, and reflecting on what I have learned from researching this topic in this way.