Background: Recent neurobiological insights gained from functional neuroimaging studies suggest that bulimia nervosa (BN) is underpinned by dysregulated frontostriatal circuitry, which supports self-regulatory control and food reward processing capacities. Brain-directed interventions may therefore hold promise as treatments for the disorder. The overarching aim of this research was to investigate the therapeutic utility of transcranial direct current stimulation (tDCS; a form of non-invasive brain stimulation) in patients with BN. Methods: Four studies were conducted: (1) a systematic review of the clinical efficacy of tDCS across all psychiatric disorders; (2) a randomised controlled trial (RCT) of single-session tDCS applied to the dorsolateral prefrontal cortex (DLPFC) in healthy individuals with frequent food cravings; (3) a cross-sectional study of temporal discounting (a marker of poor self-regulatory control) in patients with BN and healthy controls; and (4) an RCT of single-session tDCS applied to the DLPFC in BN. Results: The main findings were as follows: (1) existing data indicate that tDCS interventions comprising multiple sessions can ameliorate symptoms of several major psychiatric disorders, both acutely and in the long-term; (2) a single session of sham-controlled DLPFC tDCS transiently suppressed craving for sweet foods (i.e., altered food reward processing) among individuals with frequent food cravings; (3) patients with BN showed greater temporal discounting (i.e., poorer self-regulatory control) relative to healthy participants; and (4) a single session of sham-controlled DLPFC tDCS temporarily reduced symptoms, improved mood, and lowered temporal discounting (i.e., increased self-regulatory control) in individuals with BN. Conclusions: Taken together, the results provide preliminary support for the therapeutic utility of tDCS over the DLPFC in BN, and offer justification for multi-session trials in this patient population.

This thesis explored current, and anticipated future health and social needs, and support provisions of adults with ASD, from their own and family members’ perspectives. Using a cross-sectional mixed methods research design, 74 adults with ASD completed the Camberwell Assessment of Need for Adults with Developmental and Intellectual Disabilities (CANDID) and 49 family members participated in semi-structured, face-to-face individual interviews. Additionally, a comparative analysis of two age groups of adults with ASD (18-29 and 30+) was undertaken to investigate similarities and differences in reported need and support provision. Knowing what the health and social support needs of adults with ASD are is the first step in understanding how to best meet them. Quantitative findings suggest there may be an association between age and the level of support needs among adults with ASD. Older adults aged (30+ years of age) had greater levels of support need, and unmet support in comparison with younger aged adults (18-29 years). Specifically, high unmet needs of comorbidities of mental illness were reportedly unaddressed in this sample. Qualitative findings provided depth, details and varied perspectives of the lived experiences and support needs of adults with ASD. Results highlight a void in supportive services for adults with ASD with family members attempting to fill the adults’ support needs. The stability and continuity of family relationships and support for adults with ASD was emphasised but results suggested it may be diminished or absent in the future with greater need for formal support. Moreover limitations in communication, and skills of daily living placed adults with ASD at risk of harm and exploitation without adequate and effective support. Future support, wellbeing and safety of adults with ASD were primary family concerns but few had developed emergency or future support plans. These findings have relevance for service providers and public policy.

The focus of this thesis is on attentional biases for emotional faces within trait social anxiety. There are two central aims. Firstly, to provide a theoretical expansion of what is known about attentional biases in social anxiety, especially regarding the theorised bias-components of facilitated attention toward threat, delayed disengagement away from threat, and attentional avoidance of threat. The second aim is to provide an experimental expansion by exploring paradigms that are relatively novel to the field, by using a mixed-method approach across four studies. The first study presents adaptations of the attentional blink task. Between these tasks, processing stages and task-relevance of the emotional faces are manipulated. The second study investigates whether a child-version of the attentional blink task can be used to investigate attention bias in child social anxiety. Study three means to disentangle bias components by measuring eye-movements using a saccadic curvature paradigm and study four explores if anxiety-related sustained attention toward different emotions is reflected in neural activation with a steady-state visual evoked potential paradigm. Ultimately, the findings and the existing literature are brought together under three themes. The first two map onto the thesis aims. Under the theme of components of attention bias, mixed support for facilitated attention, delayed disengagement and attentional avoidance in social anxiety is offered. The second theme evaluates that, with suggested adjustments, the presented novel techniques have the potential to explore attention bias in social anxiety. The third theme stems from the findings and focuses on how task-relevance of emotion might moderate social anxiety-attention links. Taken together, this thesis extends knowledge of differential information processing in social anxiety and reveals the potential benefits of using novel techniques.

The experience of feeling responsible for the outcomes of one's actions is known as the sense of agency. The phenomenon of reduced perceived temporal proximity between actions and their effects is thought to implicitly index the sense of agency, and is known as temporal or intentional binding. The optimal cue integration account indicates that the sense of agency is dependent of the integration of several cues. This thesis uses temporal binding to investigate instances which afford cues that may hinder the generation of agency. Chapters 3 and 4 examine the modulatory roles of physical and mental effort finding that the implicit sense of agency reduced under physical and mental strain. In Chapter 5, electroencephalography was used to investigate the influence of mental effort on neural response to action outcomes. Concordant with previous findings, neural responses to self-generated outcomes were reduced (i.e. attenuated readiness potentials and N1 components), however, the effect of effort was less reliable, providing limited evidence for the role of individual task difficulty on the attenuation of the readiness potential. Chapter 6 found that high levels of (subclinical) schizotypy weakened the sense of agency, whereby temporal binding was less distinguished across conditions of agency and no agency. In Chapter 7, it was shown that the affective content of social stimuli did not modulate temporal binding, nor did individual differences in social anxiety. Overall, these findings support the notion that the sense of agency is dependent on the availability of cognitive resources, and in contexts in which agency cues concurrently deplete these resources, either by physical or mental effort, or in individuals with tendencies to attribute agency inappropriately, agency is weakened. Nevertheless, the lack of modulation by emotional stimuli and by anxiety provide informative boundary conditions for these effects. Beyond contributing to our understanding of this key aspect of human experience, work in this area could influence how society considers responsibility in everyday life and in law, and how aberrant experiences of agency can be understood in disease.

Huntington’s disease (HD) is a familial neurodegenerative disorder largely caused by atrophy in the striatal and cortical regions of the brain. At the molecular level HD is triggered by a trinucleotide CAG repeat expansion in the Huntingtin gene (HTT), which encodes a poly glutamine (polyQ) stretch, and ultimately leads to the production of the toxic, aggregationprone protein mutant HTT (mHTT). Upon expression of mHTT, several cellular pathways are either disrupted or impaired, including the vesicle trafficking directed by the Rab GTPase family. Here, I focused on Rab8, a protein involved in the secretory traffic from the trans-Golgi network to the plasma membrane, whose down-regulation has been shown to worsen HDrelated phenotypes in mammalian cells. My results show that pan-neuronal expression of Drosophila Rab8 (dRAB8) provides neuroprotection against HD-relevant phenotypes in Drosophila by reducing degeneration of the eye photoreceptors, ameliorating the rate of fly emergence from the pupal case and increasing average lifespan of adult flies. Notably, this rescue depends on the nucleotide-binding state of the GTPase. The protective role of dRAB8 was also validated in a subset of circadian clock cells, the Pigment Dispersing Factor (PDF) neurons. mHTT triggered arrhythmic locomotor behaviour in constant darkness and progressive death of a cluster of PDF neurons, the small lateral neurons ventral (s-LNvs), phenotypes which were partially or completely rescued by dRAB8 overexpression. The levels of aggregated mHTT are increased upon dRAB8 co-expression in flies and experiments performed in HEK293T cells suggest that the interaction dynamics between mHTT and dRAB8 increase in a polyQ dependent manner. Aggregation has been shown to be neuroprotective against toxic soluble mHTT species in several HD model organisms and might underlie the mechanism of dRAB8 rescue. In summary, this study validates Rab8 as a modifier of HD in Drosophila, provides insight into its mechanism of action, and may ultimately inform novel therapeutic approaches for HD.

Rewind is a trauma-focussed imaginal exposure technique for posttraumatic stress disorder and sub-threshold trauma that is incorporated into Human Givens (HG) therapy. It has been claimed that multiple traumas can be treated in a single Rewind session and that trauma details do not need to be discussed during treatment. This dissertation intended to evaluate Rewind within the context of HG therapy. A systematic review and meta-analysis evaluated all known studies on the efficacy of Rewind and HG therapy, including grey literature. There were 24 studies that met inclusion criteria for the systematic review. The quality of studies was mixed. While there was a lack of usable controls, all 13 studies in the meta-analysis had high data capture rates and low attrition rates. The effect size was equivalent to CBT benchmarks. The review considered issues in presenting data using effect size, ‘recovery’ rates, and ‘reliable improvement’. Results suggested that Rewind was a promising treatment and that practice-based studies could produce reliable, high quality data. The empirical study, completed prior to the meta-analysis, investigated the efficacy and acceptability of a single Rewind treatment session and assessed the efficacy of HG therapy against benchmarks. The Rewind treatment session was more effective than control treatment sessions in reducing symptoms and improving satisfaction with life. Severe, chronic and multiple traumas were effectively treated in a single session but many participants required further treatment. The Rewind session was rated as acceptable as other treatment sessions. Outcomes of HG therapy were comparable to CBT benchmarks, however, as there was no randomisation no conclusions should be drawn in comparing treatments. A pilot single session Rewind Clinic was assessed in the service evaluation. Service user pathways and qualitative data were collected. Most service users found the treatment helpful and acceptable, with 37% not requiring further treatment. Preliminary evidence suggested Rewind might have made treatment more accessible for shame-based traumas. More research is necessary.

No description available.

Literature highlights negative attitudes among different health and social care professionals towards individuals diagnosed with borderline personality disorder (BPD). Negative attitudes and inconsistent interactions are implicated in poor outcomes, including: increased stigma, self-stigmatisation, disengagement from treatment, and malignant alienation, often contributing to increased incidence of symptomatology, self-harm, and suicidal ideations and behaviours. To date, efforts to understand the extent to which these attitudes are internalised by service users, from the perspective of service users, are marked by their paucity. Coupling this with research highlighting poor outcomes among the children of individuals diagnosed BPD, along with a noted child protection risk among this group, the present research aims to increase understanding from the perspective of BPD-diagnosed parents themselves. The empirical chapters of this thesis see a phenomenological approach; through an IPA interview study and a phenomenologically driven series of focus groups, to examine diagnosis, experiences of care and treatment, and parenting. Findings highlight experiences of negative attitudes and interactions with service providers exacerbating stigma and self-stigma, lack of understanding of the diagnosis and how it relates to the individual specifically representing a barrier to engagement and therefore treatment. Little specific information is provided about the parenting challenges and capacities representing a significant aspect of the experience of participants. These findings are discussed in relation to previous research, demonstrating inconsistency and iatrogenic interactions during the period of diagnosis and treatment, identifying further impact on parents and parenting. The process and utility of diagnosis is also examined with a proposed diagnostic trajectory model applied to this participant group.

Several theorists have proposed that attachment theory provides a good grounding for the understanding of the development of Personality Disorders (PD). As a result many studies have now used adult attachment measures with this clinical group. The relevance of attachment theory to the development of psychopathology and more specifically of personality pathology has been outlined and the main findings from the research to-date reviewed. The most consistent finding in the literature is the association between Personality Disorder diagnosis and insecure attachment types. Most research has focused on Borderline PD (BPD). Early studies show an association between preoccupied and fearfully preoccupied attachment types and BPD. High rates of lack of resolution with respect to trauma are also seen in Adult Attachment Interviews (AAI). However, the results of more recent research are less conclusive and suggest that sub-types within the BPD diagnosis may be associated with different attachment styles. There is less research on other Personality Disorders, and much of this looks across categories rather than at specific Personality Disorders. However, there is some evidence to suggest that Personality Disorders might be divisible along dimensions of attachment avoidance and attachment anxiety. The range of different attachment measures used in studies makes comparison across studies difficult and the classification of AAI interviews as 'cannot classify' is over- represented in this population. Difficulties in administration of interview based methods and inconsistencies in findings across studies have led to the concern that assessment methods designed for use with normative samples may have reduced reliability and validity with Personality Disorder samples. It is proposed that future research focuses on the development of measures of attachment that draw on specific constructs relevant to attachment in Personality Disordered populations. 1.0 Introduction Literature on attachment theory and Personality Disorder was found by conducting literature searches using the Psychinfo and Medline data bases. The search terms used were: attachment and personality, Personality Disorder or specific Personality Disorders such as Borderline. Additional papers were found in the reference sections of key studies reviewed. All papers that had used either interview or self-report adult attachment measures with either Personality Disordered clinical participants or with Personality Disorder features in non-clinical samples were included. Papers that were excluded included papers that considered clinical symptoms associated with personality functioning such as sex offending or spousal abuse, but not Personality Disorder specifically. 2.0 Attachment theory The origins of attachment theory come from the joint work of John Bowlby and Mary Ainsworth (Bretherton, 2000). Bowlby proposed that all organisms display a range of instinctive behaviours that in more complex organisms may be goal-directed and organised into complex plan hierarchies. The functions of these 'behavioural systems' are to promote survival and procreation (Bretherton, 2000). Bowlby viewed atachment as an innate behavioural system that is responsive to environmental demands. He defined attachment behaviour as that which has the intended outcome of promoting the infant's proximity to the attachment figure and therefore has the evolutionary function of protecting the child from danger (Bretherton, 2000). Throughout the course of infancy these behaviours become focused on the primary caregivers who are the most responsive to the child's needs. By the time the child is able to move around and explore its environment the infant is able to use the attachment figure as a 'secure-base' from which to explore and to return to for protection or comfort (Ainsworth, 1967). From these early attachment relationships in infancy it is hypothesised that the young child comes to construct internalised or mental working models (IWMs) of the interaction patterns that they have experienced with principal attachment figures (Bretherton & Munholland, 1999). These internal working models are 'operable' models of the self and attachment partner formed on the basis of experience and serve to regulate, interpret and predict the attachment figure's and the self's attachment related behaviour, thoughts and feelings (Bretherton & Mulholland, 1999). From this theoretical perspective Ainsworth (1978) devised a classification system to measure attachment patterns in young toddlers (12-20 months of age). This is a laboratory based procedure designed to capture the balance of exploratory and attachment behaviours under conditions of gradually increasing stress (Solomon, George, 1999). The procedure involves two periods of brief separation. During these separations and subsequent reunions with the attachment figure the infant is coded into one of four categories, securely attached (B), Anxious: Avoidant (A), Anxious: Ambivalent/resistant (C), and Disorganised/Disorientated (D).

Autism is currently conceptualised as a unitary syndrome, in which social- communication impairments are found alongside repetitive interests, behaviours and activities (RIBAs). This relies upon the validity of the assumption that social- communication impairments and RIBAs co-occur at an above chance level as a result of sharing underlying causes. In the current review it is argued that the evidence for this assumption is scarce: the very great majority of RIBA research has not been intended for or suited to its examination. In fact only three studies are fit to address directly the question of the relationship between social-communication impairment and RIBA, and these contradict each other. In consequence, further relevant evidence was sought in the behavioural and molecular genetic literature. This approach suggested that the correlation between social-communication impairments and RIBAs has been exaggerated in the current consensus about the autism syndrome, and that these aspects of autism may well share largely independent underlying causes. Some clinical and research implications are discussed.