Objective: Somatisation as a process suggests that mood changes are responded to physically rather than psychologically. This concept is linked to “medically unexplained symptoms”, including conditions such as chronic fatigue or fibromyalgia. Alexithymia, difficulty in identifying or expressing emotions, is the proposed causal mechanism. This study tested this proposal by measuring association between alexithymia and somatic symptoms and exploring whether experimentally induced mood changes are responded to by those with higher alexithymia scores with more physical than psychological sensations than those with lower alexithymia. Methods: A median split of Toronto Alexithymia Scale scores was used to create two groups (higher and lower alexithymia) from a sample of 21 participants with a diagnosis of chronic fatigue syndrome and / or fibromyalgia. Participants rated mood and physical and psychological state at baseline and following sad and happy mood induction. Ratio scores of psychological over physical state ratings were calculated for each mood state. Measures of depression, anxiety, somatic complaints, acceptance, beliefs about emotions and health anxiety were also administered. Results: No correlation was found between alexithymia and intensity of somatic or psychological symptoms. There was no significant difference in ratio scores by mood or between those with higher or lower alexithymia. The mood manipulation did lead to changes in psychological sensations and physical sensations. Conclusion: The alexithymia hypothesis of medically unexplained symptoms was not supported in this study using a clinical sample. Further research should include a control group of people experiencing depression or anxiety without significant physical symptoms.

The main aim of this thesis was to investigate a controversial type of problematic behaviour; problematic internet use, and assess whether or not its characteristics resemble traditional types of addictions such as substance dependence and pathological gambling. Problematic internet use is a construct which has created fierce debates amongst researchers. This reflects inconsistencies in the evidence associated with various factors related to it, which have left researchers arguing whether it is a real psychopathological entity and similar to substance-related and addictive disorders or not. This necessitates further research with an emphasis on identifying similarities and differences regarding problematic internet use in relation to markers that have been reliably associated with the development and maintenance of addictive behaviours. Thus, in this thesis I followed a pragmatic approach and comprehensively investigated behavioural and physiological markers of addictive behaviours in the field of problematic internet use. More specifically, emphasis was given to cognitive markers such as decision-making and the physiological function underling them, attentional bias and inhibitory control processes, as these have been implicated as playing a major role in the initiation and maintenance of addictive behaviour. The main research questions were investigated using a sample of internet users whose internet use ranged from non-problematic to problematic and was associated either with generic or specific online applications; Social Networking Sites (SNS). Overall the results of this thesis support the view that problematic internet use resembles substance-related and addictive disorders and offers important implications for its legitimacy.

Background and Objectives: It has been suggested that reassurance seeking may play an important role in the development and maintenance of common mental health problems such as OCD and depression. We first considered the extent of reassurance seeking in depression and OCD relative to a healthy comparison group and secondly tested the hypothesis that reassurance seeking is primarily motivated by threat in those suffering from OCD and by interpersonal concerns in those suffering from depression. Methods: The frequency and intensity of reassurance seeking and the motivation for seeking reassurance was measured using the reassurance seeking questionnaire in 28 people with OCD, 18 people with depression and 29 healthy controls. Results: The OCD group sought reassurance more and at a higher intensity than both the depression group and healthy controls. For the OCD group, reassurance seeking was found to be linked to threat concern motivation. The depression group were not motivated by threat or interpersonal concerns. Conclusions: For people suffering from OCD, reassurance is motivated by threat concern. For the depression group the motivation to seek reassurance is less clear but interpersonal concern may not be a distinct motivational factor. Key words: Reassurance seeking, Obsessive-Compulsive Disorder, depression, reassurance seeking questionnaire, threat motivation, interpersonal motivation.

Young people (YP) with Autism Spectrum Disorders (ASD) experience high levels of anxiety and depression. The NICE guidelines (2013) suggest adapted Cognitive Behaviour Therapy (CBT) for such difficulties. Research has identified prerequisites to engage in CBT, including the ability to understand thoughts, feelings and behaviours. In order to employ these skills, people need to have an awareness of their own emotions, and to be socialised to (or understand) the CBT model. However, there is no evidence to suggest whether prerequisite skills and emotion awareness are important factors in CBT outcome for YP with ASD. This study aimed to explore differences in emotion awareness between: 1) YP with ASD and controls; and 2) YP with ASD with and without prior experience of CBT; and 3) whether emotion awareness and cognitive competencies for CBT were related to treatment outcome. Three groups of YP (aged 11-20 years old) took part in the study; those without ASD who had not had CBT (n=50), those with ASD who had not participated in CBT (n=23), and those with ASD who had taken part in CBT (n=27). All participants completed the Emotion Awareness Questionnaire (EAQ-30). A novel CBT skills task was developed and piloted by 14 YP with a diagnosis of ASD who had taken part in CBT. They also completed an interview about CBT and psychoeducation, and clinicians rated socialisation and therapeutic outcome. On the EAQ-30, those with ASD scored significantly lower than the control group on four subscales. Those with ASD who had attended CBT scored significantly lower on Differentiating Emotions and higher on Attending to Others' Emotions. On the CBT task, participants could identify a greater number of feelings than thoughts or behaviours, and could link them together. Performance on the CBT task was not significantly related to outcome, socialisation, or psychoeducation. However, 85.7% reported a positive experience of CBT. This is the first study to examine the prerequisite skills for CBT and recognition of own emotions in adolescents with ASD. It highlights the importance of tailoring CBT and ensuring YP are taught about understanding their own emotions.

Studies to date have failed to agree on a consensus as to whether people with Autism Spectrum Disorders (ASD) are more likely to be compliant in their behaviour. Victimisation and ostracism have been shown to increase compliance in the typically developing population. The study objective was to ascertain whether people with ASD are more compliant than typically developing individuals, using both self-report and a novel experimental test of compliance. The role of victimisation, anxiety, fear of negative evaluation and self-esteem, which have been shown to be related to increased compliance, was also assessed. A cross sectional design was utilised, and compared 19 people with ASD and 19 age and gender matched typically developing controls. The ASD group were significantly more compliant on self-reported compliance compared with the control group. However, no differences were found in observed compliance. Of the psychological constructs, only anxiety was found to be significantly higher in the ASD group. In the ASD group, there appeared to be a relationship between higher levels of past victimisation and self-reported compliance, with this relationship trending towards significance. Hierarchal multiple regression demonstrated that a significant amount of the variance in self-reported compliance was accounted for by fear of negative evaluation and a history of victimisation. These results would suggest that individuals with ASD who have experienced victimisation and ostracism are also likely to have a tendency towards over compliance; this finding has important implications across a range of settings.

Recent government initiatives have addressed employment opportunities for adults with autism spectrum disorder (ASD). Employment for adults with ASD is now of legislative, clinical and financial concern. Supported employment has been shown to improve the economy and increase social networks and well-being for adults with ASD. This is pertinent considering adults with ASD report poor mental health and demonstrate an uneven profile of executive functioning skills. In the present thesis, three studies address the effects of employment on mental health and executive functions in adults with ASD. Study One shows adults with ASD report higher levels of anxiety, lower levels of well-being and lower levels of satisfaction with life compared to adults without ASD. Also, unlike adults without ASD, levels of anxiety remain high for adults with ASD whether employed or unemployed. Study Two shows no significant differences in group performance on executive function tasks post-employment compared to pre-employment and no adult with ASD demonstrates consistent meaningful improvement on executive function tasks post-employment compared to pre-employment. Also, adults with ASD report similar depression, anxiety, satisfaction with life and well-being scores pre- and post-employment. This demonstrates the heterogeneity within autism and suggests a certain profile of an adult with ASD may exist in autism and employment services e.g. fewer self-reported mental health problems than other adults with ASD. Study Three shows social support predicts an increase in job satisfaction and a decrease in anxiety for employed adults with ASD. The findings are discussed in relation to: co-occurring intellectual disability and clinical disorders; the use of measures and types of reports; task complexity and the range of executive function tasks; the focus on group rather than individual differences; the role of anxiety; neurodiversity; and the legislative, clinical and financial impact of employment as a means of social inclusion for adults with ASD.

There is a paucity of research and theory to account for homelessness as experienced by people with a diagnosis of autism. Historically, the terrain of knowledge regarding both autism and homelessness has neglected to account for the views of those with personal experience. In response, this research shall develop a model of homelessness as experienced by people with a diagnosis of autism that prioritises the views of people with personal experience. This research is intended to inform the work of clinical psychologists when working with this group. A critical realist grounded theory was adopted due to its congruence with the research aims. The grounded theory model "losing and gaining connection" was constructed from interview data provided by people with a diagnosis of autism who have personal experience of homelessness and professionals who offered them support. "Losing connection" was the dominant process that led up to homelessness. This process demonstrated how multiple contexts limited the lives of those with a diagnosis of autism. People with a diagnosis of autism responded to such limiting contexts through disconnecting with them, resulting in homelessness. "Gaining connection" was the dominant process during and following homelessness. This process demonstrates the ways in which people with a diagnosis of autism and their networks acted in flexible ways to respond and transform such contexts during and following homelessness. This study demonstrates the importance of developing and maintaining the connection that people with a diagnosis of autism have with others and makes recommendations for how this can be achieved.

Refugee young people (RYP) represent a growing and clinically significant population in the UK. Research and practice knowledge suggests that they face multiple challenges and have particular and complex needs. Despite this, reports indicate that refugee young people currently under-utilise mental health services. A growing body of literature argues that it is problematic that research and practice in the field of psychology are primarily bound to Western constructs and models of understanding. This position contends that such constructs often inadequately or inappropriately address the needs of this population. While this debate has particularly centred around concepts of psychopathology and trauma, relatively little attention has been paid to the validity and relevance of the concept of wellbeing when applied to RYP. The present study sought to investigate how wellbeing is understood and constructed by one group of RYP, in order to consider the relevance and applicability of dominant conceptualisations. A social constructionist-critical realist epistemological position was taken to explore this group of RYP's understandings and beliefs about wellbeing. Semi-structured interviews were conducted with ten young people from refugee backgrounds who had recently arrived in the UK. The transcripts were submitted to a thematic analysis through which three main themes were identified: ‘Managing Current Contexts’, ‘Moving Forward’ and ‘Practicing Faith’. These themes captured the influence of participants’ current context of seeking asylum and underscored the imperative role of underlying beliefs and faith in frameworks of understanding wellbeing. They also highlighted the central role that ideas of hope and moving forward held for participants. As such, analysis of the data drew attention to socio-cultural variations that exist in constructions of wellbeing, indicating that wellbeing is a concept strongly informed by individual context and grounded in one’s cultural and religious beliefs and assumptions. Conceptions of psychological and social wellbeing have significant implications for devising psychological treatment and policies aimed at ameliorating RYP’s difficulties. The findings from this study call for improved knowledge and consideration in research and practice on the impact of contextual, cultural and religious factors to constructs of wellbeing. Psychologists and policy makers need to question the taken-for-granted assumptions that underlie our theories and pre-shape our understandings, concepts and frameworks used.

As the prevalence rate of Autism Spectrum Disorder (ASD) continues to increase, more and more interest is being given to training the parents of children diagnosed with the disability so that they can become effective parent therapists. This thesis investigated different parent training options, focusing on a variety of skills. The aim was to understand which contingencies are relevant for effective parent training and generalisation of acquired skills. In Study 1 a questionnaire was cascaded to parents of individuals in Northern Ireland with an ASD diagnosis to understand the services and support provided following the diagnosis and to determine which services, if any, were lacking. Results showed that parents in Northern Ireland desired effective behavioural help which was not forthcoming from statutory services. From these findings Study 2 investigated the impact of a four-week intensive parent training course in the principles of behaviour analysis and strategies derived from these principles for teaching new skills and changing behaviour. Results showed that all participants, when compared to baseline data, had an increase in their understanding of behavioural principles. Lessons from Study 2 informed the design of Study 3. This time the training intensity was reduced to 10 1-hour session or 5 2-hour sessions to determine whether attendance was more consistent than was observed in Study 2. Both training events augmented the findings of those in Study 2, with all participants increasing their understanding of key behavioural principles while attendance at both events was consistent. Studies 4 and 5 examined the effectiveness of a one-day training event that focused on one behavioural technology to teach new skills. Results from Study 4 showed that all participants were able to break a skill down into the specific components and from understanding of the task analysis procedure could teach new skills. Data from Study 5 showed that traditional methods of educating adults may not be the most effective. Three conditions were used to teach parents to identify mistakes in the Discrete Trial Teaching method. The superior condition included an Animation, devised specifically for explaining Discrete Trial Teaching. The other two conditions, a PowerPoint presentation and Text were not as effective. Collectively, the findings in this thesis pave the way for effective training for families living with autism and they offer suggestions for innovative ways in how we teach behaviour analysis.

Section 1 describes a systematic literature review examining quantitative correlates of stigma in adults with epilepsy living in Western countries. To identify relevant literature, four academic databases (PsycINFO, CINAHL, PubMed, and Scopus) were systematically searched using key terms related to stigma and epilepsy. The findings of the review suggested that stigma can be predicted by demographic, illness-related, and psychosocial factors; although associations were found to be highly culturally-specific. Detrimental effects of stigma included both physical health, including effective management of the condition, and psychological wellbeing, including difficulties such as depression and anxiety. These findings suggested that culturally-informed educational initiatives and therapeutic interventions which aim to address stigma in people with epilepsy (PWE) are needed. Section 2 describes a research study examining the extent to which self-compassion can predict depression, anxiety, and resilience in PWE, when controlling for other important demographic and illness-related variables. Adults with epilepsy were invited to take part in a survey either online or in epilepsy or neurology clinics. Data were then analysed using hierarchical multiple regression models. In this sample of PWE, self-compassion was found to significantly predict lower depression and anxiety and higher resilience when other significant sociodemographic and illness-related variables had been taken into account. These findings indicated that self-compassion is an important factor in determining psychological outcomes for PWE, providing preliminary support for the use of compassionfocused approaches in this population. Section 3 provides a critical appraisal of the thesis. This includes a summary of the main findings; a discussion of some of the key decisions, challenges, and professional issues identified during the research process; a consideration of potential future research arising from the findings; and personal reflections on the process of undertaking the work.