Emotions play a pivotal role in guiding our behaviour within society and our environment. In particular, emotions enable interpersonal social interactions through non-verbal communication that may be below conscious awareness. However, when there is some disruption to normal emotional processing, such as in anxiety disorders, quality of life of the individual can be severely disrupted. Anxiety disorders account for nearly a quarter of all mental health diagnoses, however the aetiology and underpinning neural correlates of anxiety are still not fully understood. This thesis sought to investigate the neurobiological mechanisms of emotion processing, specifically in the amygdala, in a healthy sub-clinical cohort. Six different studies are presented using quantitative methodology to explore amygdala activation and connectivity during emotion processing, and structural differences, as modulated by gender and sub-clinical anxiety. Overall results reveal a modulating effect of sub-clinical anxiety on amygdala habituation, fronto-amygdala connectivity (at rest and during emotion processing) and neural structure. In addition, results presented in this thesis suggest that there may be an attentional component to characteristic hyper-responsivity of the amygdala during emotion processing seen in clinical anxiety patients that should be incorporated into future models of maladaptive emotion. Furthermore, various different chapters in this thesis present evidence that the left amygdala appears to be more specialised for responses to more socially salient stimuli and the right amygdala appears to be more responsive to threat related stimuli indicating that key theoretical models of emotion (the dual processing model, and the salience detection model) should be integrated into one cohesive model of emotion processing. In addition to these theoretical implications, results demonstrating the modulating effect of anxiety and gender presented in this thesis suggest that research on emotion should account for individual differences as a matter of standard practice. This thesis also supports the use of resting state -functional magnetic resonance imaging (fMRI) as a low cost, valid alternative, to task based fMRI within the study of anxiety. Finally, results suggest that investigation of structural differences in sub-clinical populations, and the use of analytical methods such machine learning classification techniques, could aid the development of diagnostic tools that can track disease progression and identify individuals at risk of developing anxiety disorders. The possibility of identifying such neural biomarkers will allow research to look for therapeutic treatments and interventions, which could prevent individuals from transitioning from sub-clinical anxiety to chronic anxiety disorders.

Introduction: Little is known about the relationships between those diagnosed with Borderline Personality Disorder (BPD) and their care coordinators in UK community mental health settings, with the role of care coordinator poorly defined with limited guidance. The purpose of this research was to explore these relationships and interactions from the perspectives of those diagnosed with BPD. Method: Semi-structured interviews were conducted with eight participants diagnosed with BPD in current relationships with care coordinators. The transcribed interviews were analysed using Interpretative Phenomenological Analysis (IPA). Results: Four superordinate themes were identified: Trust, Qualities of the care coordinator, The complexity of the relationship and Developing a safe base. The first three themes are viewed as contributing to the final theme. Discussion: Themes were discussed in the context of attachment theory with consideration that the development of secure attachments in care coordinator relationships may be therapeutically beneficial and important in recovery. The research was critiqued and future directions considered. Implications for Practice: Whilst the generic role of care coordinator is not specifically defined as therapeutic there is potential for this relationship to be therapeutically beneficial or conversely counter-therapeutic for those diagnosed with BPD.

Objectives: Although theoretical conceptualisations of animal hoarding have been published, few empirical studies have been conducted. The current study investigated animal hoarding from the perspectives of professionals who come into contact with people who hoard animals through their employment in various capacities, primarily in animal welfare. Design: A qualitative research design was employed using inductive thematic analysis. Methods: Twelve professionals who had experience working in animal hoarding were interviewed. Participants’ professions included: mental health nurse, vet, animal behaviour consultant, animal inspector, animal warden and animal welfare officer. Participants reported working in a diverse range of locations across the UK. Semi-structured interviews were conducted either in person or over the telephone. Interviews were audio recorded and transcribed verbatim before analysis. Results: Animal hoarding was conceptualised primarily by the presence of multiple animal neglect or suffering. The term ‘animal hoarding’ was used by participants to reflect those who are neglecting animals unintentionally, living in squalor, self-neglecting, experiencing distress or mental health problems, and using animals as a replacement for people. Animal hoarding appears to be maintained or repeated despite interventions from animal professionals, possibly because the human aspects of this issue are currently overlooked. Conclusions: Better understanding and education, particularly on the human aspects of animal hoarding, are needed for both professionals and the public. Joint working and greater communication is needed in both directions between animal professionals and those working in mental health and social services. Practitioner Points • The findings suggest that animal hoarding should be given much greater attention, both clinically and in research, within the field of psychology. • There are social and mental health aspects of animal hoarding which are inadequately addressed by professionals in the UK currently. Animal professionals should be aware of psychological and social issues such as the mental capacity of individuals to make decisions about their animals. Social and psychological interventions should be offered to engage people who are hoarding animals, safeguard people living in animal hoarding situations, address social isolation or support network issues, relieve psychological distress from comorbid mental health problems, increase insight, and instigate behaviour change. • The current study is limited by the representation of only professional perspectives on animal hoarding. The perspectives of animal hoarders and their families are not represented. • There was a majority of animal professionals compared with mental health professionals interviewed in the current study which may have caused a paucity of information on the social and mental health aspects of animal hoarding and professional responses to this.

Background: The presence of a dermatological condition may deter contact with the affected person because it falsely signals the threat of disease to others. The current study investigated whether avoidance of anticipated contact was expressed towards individuals with visible dermatological conditions, and was associated with disgust, health anxiety and contamination fear. Method: 236 participants completed an online survey. They were randomly allocated to one of three conditions where they viewed a face with the appearance of acne, psoriasis, or no visible dermatological condition. Participants rated the attractiveness of the face, and indicated their willingness for social and indirect contact with the person. Measures of disgust, health anxiety and contamination fear were completed. Results: Consistent with the prediction, participants reported significantly less willingness for indirect contact with a person with acne or psoriasis. Contrary to prediction, participants expressed more willingness for social contact with a person with acne or psoriasis compared to a person with no dermatological condition. Contrary to prediction, there was not a consistent relationship between willingness for contact and disgust, health anxiety or contamination fear. Instead, the perceived attractiveness of the person depicted in the acne and psoriasis conditions was positively correlated with willingness for social and indirect contact. Conclusion: The findings suggest that people respond differently to individuals with dermatological conditions. Reported willingness for social contact may be motivated by socially desirable responding, yet as the potential for immediate physical contagion increases, indirect contact is possibly avoided. The positive association between perceived attractiveness and increased willingness for contact with individuals with dermatological conditions substantiates appearance-related concerns reported by this population. Further research investigating observed behaviour in interactions with individuals with dermatological conditions is required to examine what underpins willingness for contact in light of the limited association between disgust, health anxiety, contamination fear, and contact.

Objectives. The aim of this study was to gain service users’ perspectives on whether therapeutic alliance, if at all, featured as part of their experience of the Systems Training for Emotional Predictability and Problem Solving (STEPPS) group programme. Design. A qualitative, semi-structured interview-based study to explore service users experiences of therapeutic alliance within their treatment. Methods. Seven individuals diagnosed with Borderline Personality Disorder (BPD), who were attending STEPPS groups, were interviewed as part of the study. Results. Three themes were identified from the data using thematic analysis: ‘A process of identification and feeling understood, ‘Building camaraderie’ and ‘Recognising positive change’, processes that map directly onto the concept of therapeutic alliance. Group members sought out opportunities to relate to one another, a process which was facilitated by the content and structure of the treatment. Therapeutic bonds were built within the group, and these positive relationships appeared to increase mutual engagement and commitment to see the treatment through. As part of this experience, participants noticed positive changes within themselves, which they attributed to attending the STEPPS programme. Conclusion. Service users experiences outlined within this study suggest that therapeutic alliance featured in the STEPPS treatment. Whilst STEPPS focuses on being a skills based programme, the relationships formed between all group members emerged as an important mechanism from which change was made possible. Further research is required to build on these findings and investigate the extent to which therapeutic alliance affects treatment outcome and drop out within this treatment package for individuals with BPD.

This research aimed to identify the help seeking process of people with Post traumatic stress disorder from Domestic violence through exploring their experiences of attempting to gain access to an appropriate service and get treatment for PTSD. Interviews with 8 participants, 7 female and 1 male, were conducted and analysed using Interpretative Phenomenological Analysis (IPA). The analysis identified three superordinate themes and further subthemes within them. A map of the themes was developed to show the process of help seeking. The beginning of their journey towards accessing the service is captured in the first superordinate theme; Past influencing present with subthemes including attitudes of others. The second superordinate theme explains communication and power in approaching help. A final crucial stage in reaching help is captured in the final superordinate theme recognition of PTSD. This theme describes a lack of awareness of the symptoms of PTSD within professionals and through wider society which prevents access to appropriate treatment for PTSD. The clinical implication is that this may extend the help seeking process for people with PTSD from domestic violence often by many years.

Four groups of women were involved in this study: (1) Patients with eating disorders (ED) who met DSM-IV criteria for anorexia nervosa or bulimia nervosa (n=35). (2) Symptomatic dieters (SD) with past or present partial features of an eating disorder (n=16), (3) Normal dieters (ND) without an eating disorder (n=30), and (4) a Control group (C) of non-dieting, non-eating disordered women (n=34). All women completed: (a). The Young Schema Questionnaire-short-form (YSQ-S1). (b) The Eating Disorders Beliefs Questionnaire (EDBQ). (c) The Eating Disorder Inventory-2 (EDI-2). (d) The Beck Depression Inventory-Second Edition (BDI-II). (e) The Rosenberg Self-Esteem Inventory (RSE). (f) A quantitative measure of behavioural features of eating disorders. In terms of maladaptive core beliefs it was shown that; 1) ED women showed higher levels on most YSQ sub-scales, and the EDBQ negative self-beliefs (EDBQ-NSB) scale than the women in the ND and C groups. They showed higher levels than SD did on the EDBQ-NSB sub-scale and four YSQ sub-scales. 2) ND women showed similar YSQ and EDBQ-NSB levels to C women and 3) SD showed higher YSQ levels then controls on four sub-scales and higher levels than normal dieters did on seven sub-scales. Using the EDBQ-NSB sub-scale SD showed higher levels of core beliefs than dieters and control women did. Measures of eating disordered beliefs, factors associated with eating disorders and disordered eating symptomatology were strongly associated with core beliefs, however, this effect was heavily mediated by levels of self-esteem and depression. The clinical, academic and research implications for the assessment and treatment of core beliefs as measured by the YSQ and the EDBQ are critically discussed.

This study investigates: The relationship between shame, social rank, self-directed hostility, and self-esteem in a female eating disordered population; The relationship between anorexic and bulimic beliefs and behaviours and eating disordered diagnosis; The relationship between shame, social rank, self-directed hostility, self-esteem, and eating disordered diagnosis; and The relationship between shame, social rank, self-directed hostility, self-esteem and anorexic and bulimic beliefs and behaviours. Data was collected from 187 eating disordered females. They completed the Stirling Eating Disorders Scale (measuring anorexic and bulimic dietary cognitions and behaviour, low assertiveness, perceived external control, low-self esteem and self-directed hostility), the Internalised Shame Scale, and the Other As Shamer Scale. All met diagnostic criteria for Anorexia Nervosa, Bulimia Nervosa, Eating Disorder Not Otherwise Specified, Or Multi-Impulsive Bulimia Nervosa. The mean scores for all diagnostic groups on internal shame, low assertiveness, perceived external control, and low self-esteem were clinically significant. All diagnostic groups reported means for external shame higher than those found in previous studies with non-clinical samples. Internal and external shame was strongly related to aspects of social rank (low assertiveness and perceived external control), low self-esteem, and self-directed hostility. Anorexic and bulimic cognitions and behaviours were common across eating disordered diagnoses. Results support a 'transdiagnostic' approach to eating disorder assessment and treatment. A large minority of eating disordered patients experience clinically significant restricting and bulimic behaviours. Clinically significant differences were found between participants with differing patterns of anorexic and bulimic beliefs and behaviours in levels of internal and external shame, low-assertiveness, perceived external control, low self-esteem and self-directed hostility.

The pilot study served to develop and initially evaluate a cognitive behavioural bibliotherapy programme for use in treating Generalised Anxiety Disorder. Administered during 16 one hour appointments with a Psychologist, the programme was associated with significant improvements in anxiety, depression and problem severity. The finalized programme comprised two components - information about anxiety and cognitive behavioural anxiety management guidance. In the main study 46 patients with a primary diagnosis of Generalised Anxiety Disorder were randomly allocated to one of two treatment conditions - receipt of the full programme or only the information component - or a waiting list control condition. Psychologist administration of the programme took 10 minutes. Patients in receipt of the full programme experienced significantly greater gains than those in the waiting list condition in self assessed anxiety, depression, quality of life, and stress. There were no other between condition differences, but a trend in pre to post changes favouring the full programme. The presence of other co-morbid anxiety or depression conditions did not affect outcome. Clinical improvements in both treatment conditions were associated with improvements in anxiety related health attitudes including self-efficacy. Additionally, clinical improvements in patients in the full programme condition were associated with improvements in coping skills and compliance with the programme. The potential inter-relationship between clinical, attitudinal and coping skills change, and programme compliance were discussed.

Background: Huntington’s disease (HD) is a devastating neurodegenerative condition, caused by an expanded polyglutamine tract in the Huntingtin (Htt) protein. HD is manifested by personality changes, movement disorders and/or dementia. Prior evidence exists for sterol dysregulation in HD models, observed both in neurons and astrocytes. In the brain the cholesterol is produced in situ, as the blood brain barrier prevents the cholesterol metabolized in the periphery to be used by the brain cells. The consensus stablished supports the idea that neurons synthesize the cholesterol needed in the soma, but rely on the cholesterol delivered by astrocytes in the form of apolipoproteins at synapses. A key player studied to be responsible to communicate the cholesterol status of neurons to astrocytes is the 24S-hydroxycholesterol (24S-OHC) also knows as the cerebrosterol (the brain oxysterol). Aim: Prior results from the lab showed cholesterol accumulation in primary striatal neurons infected with lentiviral expression vectors encoding a mutant Htt fragment (Htt171­82Q) compared to cells expressing a wild-type Htt fragment (Htt171­18Q). Following on these results and the previous published work from different laboratories, the aim of this thesis was to investigate the sterol status of HD striatal neurons in order to better understand this process and the consequences for the neurons and astrocytes’ health in the context of HD. Methods: Filipin staining, cholesterol oxidase assay, isotope-dilution gas chromatography­mass spectrometry, NeuN positive staining cell count – neuronal cell death assay, Mitosox assay, Fluo-4 AM imaging, extracellular multi-electrode array recordings, immunocytochemistry and real-time quantitative PCR. Results: I observed sterol accumulation in primary striatal neurons expressing mutant Htt, which one release into the medium significantly increased levels of 24S-OHC. The cerebrosterol is toxic to striatal neurons and the mechanism elucidated was by inducing increased superoxide levels in the mitochondria. Besides the toxicity effect, 24S-OHC was observed to sensitize N-Methyl-D-aspartate (NMDA) receptor function, measured by increased calcium influx in the presence of NMDA and increased amplitude and frequency of firing in the presence of glutamate, modulating NMDA receptor activity. In addition, the studies collected support that 24S-OHC induces sterol dysregulation in astrocytes by downregulating SREBP2 target genes and the purposed mechanism is by blocking the transcription factor’s migration into the nucleus, in this way promotes inhibition of cholesterol and its precursors synthesis. In parallel 24S-OHC up-regulates LXR target genes aiming to increase cholesterol efflux. Conclusion: The results part of this thesis conveyed with others’ published work and brought novelty into the field. Like others I observed sterol accumulation at the plasma membrane and in lysosomes and stablished a link with the sterol dyshomeostasis observed in my model with HD hallmarks – mitochondrial stress and excitotoxicity, caused by the increased of 24S­OHC efflux. In addition, I was also able to link the sterol dysregulation in neurons with astrocyte’s cholesterol dyshomeostasis, as evidenced by a different group. This thesis provides new insights into the potential aetiopathogenic mechanisms of HD and reconcile some apparently disparate previous findings regarding sterol disposition in this disorder.