Part one of this thesis is a literature review on the use of Imagery Restructuring (IR) within anxiety disorders. Narrative methods were used to synthesise the findings of 18 studies. The review details the range of different IR methodology and revealed IR to be an effective short-term, long-term and preventative technique across different anxiety disorders, reducing anxiety, imagery and memory related symptomology. However, IR could not be established as an effective intervention in isolation with long-term therapeutic effects. Given the heterogeneity of the studies’ methodology, of IR and anxiety pathology, a range of potential mechanisms underpinning IR are theorised. However, underlying mechanisms were not explicitly explored in the studies. Finally, the clinical implications of IR and the limitations of the review are reflected upon before research recommendations are made. Part two is an empirical study which investigates the effect of egocentric and allocentric memory processing on intrusive memory (IM) frequency following exposure to analogue trauma films. Forty five healthy participants were allocated in turn, stratifying for gender to the egocentric or allocentric recognition memory task group or to the control group. Participants who undertook an egocentric memory task experienced significantly fewer intrusive images than the control group (who listened to music). This supports Dual Representation Theory (DRT) – that intrusive memories are underpinned by relatively stronger sensory-perceptual egocentric memory representations and relatively weaker contextualised, allocentric based memory representations. Allocentric memory tasks did not significantly increase or reduce the number of intrusive memories experienced. Theoretical, neurobiological and methodological explanations are offered for these findings. Part three is a critical appraisal which addresses four issues. Firstly, the conceptualisation of intrusive imagery as being transdiagnostic and on a continuum. Secondly, how the project prompted the consideration of PTSD as a construct more broadly. Thirdly, the issue of measuring intrusive memory and considerations for measurement in future research. Finally, two key learning experiences around ethics of trauma designs and the dynamics of working with a research assistant.

Volume 1 of this thesis evaluates the development of a low intensity Cognitive Behavioural Therapy (CBT) intervention for Generalised Anxiety Disorder (GAD), its feasibility and acceptability. This volume consists of three parts. Part 1, the literature review, examines using meta-analysis and network meta-analysis the effectiveness of psychological treatments for pathological worry in Generalised Anxiety Disorder (GAD) using the Penn State Worry Questionnaire (PSWQ) as a primary outcome measure. The review also considers the relative effectiveness of currently available psychological treatments. The quality of the current evidence base and methodological issues are discussed and further research suggested. Part 2, the empirical paper, is a pilot study, which examines the feasibility and acceptability of the delivery of a brief guided self-help intervention for excessive worry and GAD, which drew on Behavioural Change Theory (Michie, Van Stralen & West, 2011) following a review of current interventions for GAD. The results showed that there was a clinical need for a specific worry and GAD intervention, that Understanding Worry (UW) was as acceptable to patients as Treatment as Usual (TAU) as there was no significant difference in drop out, attendance, cancellations or DNAs. There was no significant difference in post-treatment scores between UW and TAU in observed clinical contact and at session four as predicted by the Mixed Methods Linear Model (MMLM). Implications for treatment and further research are discussed. Part 3, the critical review, explores critically the empirical study, the background to the research, conceptual issues in the intervention design and the challenges of conducting research in NHS clinical settings. The review particularly focuses on recruitment and the involvement of clinicians the research process and future directions for research.

Objectives: The current study aimed to develop a measure of positive and negative beliefs in non-suicidal self-injury (NSSI), the Self-Harm Beliefs Scale (SHBS). A secondary aim was to explore the impact of these beliefs on NSSI behaviour. Design: The study adopted a cross-sectional design. Methods: Adults (n=98) with a history of NSSI were recruited from general and clinical populations across the North-West of England. The relationship between beliefs and NSSI behaviour (i.e. current NSSI, NSSI severity and future likelihood of NSSI) were assessed. The impact of NSSI beliefs on shame and mental well-being were also explored. Results: The SHBS demonstrated good reliability and convergent validity. Individuals with current and historic experience of self-harm endorsed positive and negative beliefs about NSSI. Increased endorsement of positive beliefs appeared to predict current NSSI behaviour as well as future likelihood of NSSI. Both positive and negative beliefs were significant predictors of shame however, only negative beliefs significantly predicted mentalwell-being. NSSI beliefs did not appear to significantly predict NSSI severity. Conclusions: The SHBS is a reliable and valid measure of beliefs about NSSI and presents as a useful clinical and research tool. Exploring NSSI beliefs appears important for better understanding the maintenance of NSSI and improving treatment approaches for this population.

The literature review explored group based psychosocial interventions for adolescents and adults with ASD. The interventions detailed in the review addressed many of the reported difficulties of ASD (i.e. social interaction, communication skills, and managing emotional distress). Fifteen studies met the inclusion criteria and almost all studies (n = 14) reported improvements in most or all of their targeted outcomes. Our ability to assess the overall benefit of group based psychosocial interventions was limited, due to small sample sizes, variation in study qualities, and the heterogeneous nature of the interventions. Research in this field would benefit from moving in a coherent direction, with researchers developing an intervention and evaluating its effectiveness in large scale controlled studies, rather than numerous researchers publishing pilot or small scale studies. The empirical paper described a thematic analysis of participants with ASD (n=4) and facilitators’ (n=2) experiences of a social skills intervention. Richly detailed accounts from participants and facilitators described a broad range of individual and group based processes, and allowed a comparison of multiple perspectives. An overarching concept of separate togetherness was identified in the data, which refers to the shared but individual learning experience within and between the participants and the facilitators. Both papers highlight the challenge of generalisation of skills when working with individuals with ASD, and the difficulty of addressing the individual needs of participants in a group intervention. The results suggest that group based psychosocial interventions show promise, however further, longer-term, exploration is needed in order to consolidate the evidence base. The final paper examines the contributions made to theory and clinical practice, whilst outlining areas requiring further research.

Human faces are naturally captivating and display a variety of facial cues that can be accurately identified as mood state or inherent traits. This process of giving meaning to behaviours or signals that we observe is called attribution. When this is directed to self, we make self-attributions and when directed at others, we make social-attributions. Previous research demonstrates that attributions are affected by mood and wellbeing states, and personality traits, and in the initial chapter I discuss how wellbeing state and neuroticism trait predict depressive mood-state. I further aimed to develop an attribution task using self and others’ face. Studies so far have used self-face to understand perceptions of attractiveness, self-esteem and depression, but not specifically to investigate self-attributions relating to changes in mood state, wellbeing and neuroticism. Measuring attributions of facial appearance using self and others’ face is a new approach. It was important that the self and social attributions were meaningfully measured and easily comparable. I piloted the stimuli and the novel task; the latter is discussed in this thesis. I compared three 19-point face scales created using face composites of neuroticism, depression and agreeableness. The Neurotic Face Scale was chosen for the self and social attribution tasks on the basis of the results from the pilot study. I also demonstrate the different positive and negative attributions that are systematically made to neurotic facial cues. In the main experimental chapters, I investigate the association of self and social attributions of facial appearances with individual’s mood, wellbeing and neuroticism. Participants’ own photograph is used for the self-attribution task, while selected portraits of ‘other’ individuals were used for the social-attribution task. I also compare the participant’s self and social attributions with independent observers’ attributions (of the participants). I demonstrate that participant’s increasing severity of depressive symptoms, decreasing hedonic wellbeing and increasing neuroticism relate to misattributions of self and others, but does not affect independent observers’ attributions. I discuss participants displaying classic social projection based on the similarities between their self and social attributions. Finally, I triangulate self, social and observer attributions to demonstrate that misattributions displayed by participants experiencing depression were specifically for positive attributions, whilst maintaining consistent negative attributions as the independent observers. Self-attributions, however, are more sensitive to mood, wellbeing and inherent traits than social attributions. I further calculate discrepancies between basic self-attributions to demonstrate increasing self-negativity with increasing severity of depressive symptoms, neuroticism and decreasing hedonic wellbeing, as well as increasing selfdiscrepancy with decreasing hedonic wellbeing. I further investigate the longitudinal changes (11 weeks) of self-attributions in participants who are clinically depressed. I demonstrate decreasing severity of depressive symptoms overlapping with decreasing self-negativity and selfdiscrepancy, and increasing self-positivity. I further demonstrate that an increase in self-positivity and decrease in self-negativity in the first week predicts depressive symptoms at week 11. Finally in a pilot study, I demonstrate increase in self-positivity after eight weeks of mindfulness practice; a practice that focuses on non-judgemental self-referential processing to increase self-positivity. This pilot study is included in the final chapter for general discussion, to demonstrate the future research potential for the self-attribution task.

The specificity of practice hypothesis and the psychological construct of anxiety are well established bodies of literature within their respective fields of research. The purpose of the current thesis was to design a series of experiments that investigate whether anxiety conforms to the principles of specificity. All experiments within the thesis provide data indicating that a change in anxiety mood state between acquisition and transfer results in a decrement in performance; both if anxiety is added or removed between acquisition and transfer. That is, the optimal performance of movements are linked (directly or indirectly) to the mood state under which they were learnt. Furthermore, the latter half of the experiments aimed to investigate the motor control processes that are affected by the anxiety/mood specificity i.e. whether movement planning (offline processes) and/or adjustment to movements during execution (online processes) are affected. Results support a specificity framework within the construct of anxiety, indicating the motor control mechanisms responsible for this pressure-performance specificity interaction are associated with effortful and non-automatic parameterisation of movement. However, upon further detailed analysis we conclude that any changes in offline processes are a strategy to overcome the reduction in one’s ability to utilise online control processes when performing and learning under anxiety. That is, practicing with anxiety conforms to specificity effects and the strategy that is deemed most useful for success under anxiety conditions is to enhance movement planning. This strategy appears to be due to anxiety disrupting the automatic processes associated with the use of online control. Specificity of practice also offers an alternative explanation for choking and raises important theoretical and practical issues within both the motor control domain and sport psychology domain. That is, experimental paradigms used and the conclusions drawn from them need to be considered with knowledge of the Specificity of Practice Hypothesis (Proteau, 1992).

The first part of this thesis was a meta-analysis examining the efficacy of virtual reality exposure The first part of this thesis was a meta-analysis examining the efficacy of virtual reality exposure therapy (VRET) for social anxiety. Effect sizes suggested that VRET was more effective than waiting list controls, and at least as effective as traditional therapeutic interventions. Some concerns were identified with regards to potential for bias. It was also noted that VRET involved the individual viewing a virtual reality (VR) scenario from a first-person perspective. As a recent study has investigated the use of third-person VR doppelgängers for public-speaking anxiety (PSA), this was identified as a key area of further research for the thesis to address. Some research has suggested that individuals who struggle to form vivid mental imagery (MI) are more likely to experience high levels of social anxiety, and may not benefit from visualisation techniques used in therapy. The next part of the thesis found that MI ability was a significant predictor of PSA. Five students with high PSA and low MI were then invited to engage in an enhanced version of the VR doppelgänger intervention, in order to examine the feasibility of incorporating this into the undergraduate psychology programme. The study suggested that the intervention could feasibly be rolled out as part of the course. Participants reported that they struggled with a standard visualisation script due to difficulties associated with MI, but the VR intervention compensated for this. They also discussed noticing significant improvements outside of the VR sessions, and that they felt safe and present in the simulation. A decline in PSA was recorded over time for all participants. The thesis concludes with a review of the theoretical implications of these findings and provides some suggestions for future research, before outlining the implications for clinical practice.

A narrative systematic review of the literature focused on how shame and shame-based processes may play a significant role in the development and maintenance of psychological distress in adults with ID. The review identified 17 relevant studies that had investigated shame in some form. Findings indicated that adults with mild to moderate ID appear to experience both external and internal shame, and that this was associated with elevated levels of psychological distress. However, the scope of the review was limited by the fact that many studies were cross-sectional in nature, and that very little research involved clinical populations. The review concluded by attempting to synthesise the current available research into an explanatory biopsychosocial model of how shame develops in adults with ID, and recommending the development of compassion-focused interventions that might alleviate shame in this population. The empirical study utilised a mixed methods design to investigate the feasibility and acceptability of adapting group CFT for adults with mild ID. Six participants completed session-by-session feasibility and acceptability measures, attended focus groups, and completed pre and post-intervention measures of self-compassion, psychological distress, and social comparison. Focus groups were analysed using thematic analysis, identifying four main themes: (1) motivations for attending; (2) direct group experiences; (3) difficulties in being self-compassionate; and (4) positive emotional changes. Significant increases in overall self-compassion, and significant reductions in self-criticism and unfavourable social comparison, were found. Results indicate that CFT can be feasibly adapted for adults with ID, and is experienced as a helpful intervention. Some issues remain surrounding level of understanding of some conceptual aspects of CFT, and whether this is relevant to outcomes. Implications for future research and clinical practice are further explored.

No description available.

This thesis comprises of the following three papers: (1) a systematic literature review; (2) a qualitative empirical study; (3) contributions to theory and clinical practice. The systematic literature review qualitatively summarises 17 papers dated 2013–2015, exploring possible gender differences in young individuals with autism aged 0–18 years old. The results, although mixed due to variability and limitations in study design and methodology, suggested that young individuals with autism may be more similar than dissimilar in the severity of their core autism symptomatology. However, there may be autism-specific gender differences in the following areas: neurobiological abnormalities; sensory sensitivity; parental distress; the quality and nature of restrictive and repetitive behaviours, interests and activities; and the co-morbidity of other conditions. The clinical and research implications are discussed in detail. The empirical paper presents an original qualitative exploration of 11 high-functioning autistic women’s lived experiences, aged 19–60 years old, around their use or non-use of coping strategies in social situations. A thematic analysis of interview transcripts suggested that the women used various methods to get by socially. The types of strategies reported were either to mask social skills difficulties and autistic behaviours, or, to compensate for certain social skills limitations. Alternatively some of the women had dropped previously used ‘acts’ and others had never wished to compensate or mask, preferring to be open and honest. Regardless of the coping approach used, the women experienced more negative outcomes than positive ones from their social experiences. The clinical and research implications of these findings are explored. The third paper discusses the theoretical, clinical, and research implications of the above papers in further detail.