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No description available.

The purpose of this research is to gain insight into the early experiences of those who have (or have had) Anorexia Nervosa, prior to the onset of symptoms. The study uses thematic analysis to analyse and identify themes in the data, taking a critical realist stance throughout. The researcher has personal experience of Anorexia Nervosa and is training as a counselling psychologist. Semi-structured interviews looking at memories from childhood were carried out. Interview questions covered topics concerning family relationships, peer group experiences and how participants perceived themselves as children. 14 adults (13 female, 1 male) took part, who self-reported as having experience of Anorexia Nervosa. Participants ranged from 20 to 48 years of age and were at varying stages of recovery. No participants were receiving in-patient care at the time of interview. Analysis of participants’ retrospective accounts of their childhoods led to three main themes; issues relating to relationships within the family, in particular parental relationships, issues concerning challenge and adversity in childhood, and finally participant’s views of themselves. The study aimed to give voice to those who have experience of Anorexia Nervosa. By identifying themes in participants’ accounts of childhood and drawing on existing literature, it has been possible to gain a deeper insight into the perceived effects of childhood experiences with regard to Anorexia Nervosa. The discussion highlights identity development as being a significant underlying issue for those who go on to develop Anorexia Nervosa. It then goes on to explore implications for practice within Counselling Psychology and the treatment of the disorder generally, including the need to provide clients presenting with Anorexia Nervosa with a facilitating environment for identity exploration.

Epilepsy is a chronic neurological disorder in which patients have spontaneous recurrent seizures. Approximately 50 million people worldwide live with epilepsy and of those ~30% fail to adequately respond to anti-epileptic drugs (AEDs), indicating a need for further research. In this study oscillatory and epileptiform activity was explored in the rodent piriform cortex (PC) in vitro, an underexplored brain region implicated in the development of epilepsy. PC gamma oscillations have been studied in both anaesthetised and awake rodents in vivo; however, to date they have not been reported in vitro. Extracellular field potential recordings were made in rodent PC brain slices prepared from 70-100g male Wistar rats in vitro. Application of kainic acid and carbachol reliably induced persistent gamma oscillations (30 – 40 Hz) in layer II of the PC. These oscillations were found to be pharmacologically similar to gamma oscillations previously found in other rodent brain regions in vitro, as they were dependent on GABAA receptors, AMPA receptors and gap junctions. Persistent oscillations were also induced and characterised for the first time in human neuronal tissue in vitro. Human brain slices were prepared from excised tissue from various brain regions (primarily temporal) from paediatric patients undergoing surgery to alleviate the symptoms of drug resistant epilepsy. As in the rodent PC, oscillations were induced by application of kainic acid and carbachol, however, these oscillations were found to be within the beta frequency range (12 – 30 Hz). Despite this difference in frequency band, these beta oscillations were pharmacologically similar to gamma oscillations found in the rodent PC. Seizure-like events (SLEs) were induced in brain slices prepared from 70-100g male Wistar rats via application of zero Mg2+ artificial cerebral spinal fluid (0[Mg]2+ aCSF). The properties of these SLEs were found to be similar between brain regions when recordings were performed in layer II of the anterior and posterior PC and lateral entorhinal cortex (LEC) and the stratum pyramidale of CA1. In the majority of recordings SLEs occurred in the PC before the LEC or CA1 and SLEs were displayed in the PC in a higher proportion of slices than the LEC. The sensitivity of these PC slices to 0[Mg]2+ aCSF was assessed at several stages (24 hours and 1 week (early latent), 4 weeks (mid latent) and 3 months+ (chronic period)) following the reduced intensity status epilepticus (SE) protocol for epilepsy induction compared to age-matched controls (AMCs). A decrease in excitability of the slices was observed in slices prepared from AMC animals with age, as the inter-event interval and latency to first SLE was observed to be longer in slices prepared from aged compared to young AMC animals. Slices prepared from SE animals maintained their youthful hyperexcitability with no difference in IEI or latency to first SLE observed in the early latent period compared to the chronic period. The pharmacoresistance (or sensitivity) of these SLEs to single and double AED challenge was evaluated. Differences in efficacy of the AEDs were found between SE and AMC in the mid-latent period; increased efficacy of Na+ channel modulating AEDs were found in slices prepared from SE compared to AMC animals. The proportion of slices that displayed pharmacoresistance of these SLEs to AEDs was found to be higher in slices prepared from young animals (early latent period and AMCs), and was similar to that found clinically in human patients. The pharmacoresistance of the SLEs to AEDs was lower in slices prepared from older animals (mid latent, chronic and AMCs) compared to young animals (early latent and AMCs). This age-dependent reduction in resistance likely reflects normal alterations in neuronal networks with ageing. SLEs induced in young control PC slices could be exploited as a new in vitro model of drug resistant epilepsy. Overall, oscillatory and epileptiform activity in the PC and human cortex in vitro could be further explored as tools to evaluate the efficacy and mechanism of action of newly developed AEDs, as well as to explore the networks involved in drug resistant epilepsy.

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The aim of this thesis was to explore the constructs of rumination and worry and investigate how they impact mental health. Rumination and worry have similar process characteristics and are collectively referred to as repetitive negative thinking (RNT). RNT is defined as recurring thoughts, about negative topics, that are experienced as difficult to control. This definition does not account for the observed variations between these processes such as differences in content. Rumination has been found to focus on past negative experiences whereas worry focuses on future concerns. These processes are considered to have a detrimental effect on mental well-being with rumination frequently associated with depression and worry with anxiety. Despite these negative associations, there is growing argument that rumination and worry are adaptive self-regulatory responses to perceived failure to achieve desired states or goals. They are problem-solving attempts to resolve discrepancies between current and desired status, and only become problematic in certain circumstances such as when goals are unattainable. Goal-linking is the degree to which people link the attainment of everyday goals with more salient personal strivings (e.g. to be happy) and may be one circumstance in which engaging in RNT has unconstructive consequences. People high on the tendency to goal-link are known as 'linkers'. Linkers are thought to spend more time ruminating because their goals are linked to higher-order personal strivings that hold more meaning, are more abstract, and tend to be more enduring. This increases the degree of discrepancy they experience because they are aiming for a reference value that is vague (e.g. happiness can occur in many forms) and makes it difficult to disengage from the goal due to its perceived importance. Being able to disengage from RNT would likely improve linkers mental health and well-being. Mindfulness is an alternative cognitive process associated with better well-being, and people who are more mindful ruminate less. It is proposed that mindful people are able to notice when they are ruminating and disengage from these thoughts if they are unhelpful. Training linkers to be more mindful could potentially reduce the degree to which they engage in RNT and subsequently improve their mental health and well-being. Chapter 1 presents a systematic literature review of the studies that have directly compared rumination and worry. The aim of this review was to consider the evidence for rumination and worry being similar enough processes to be conceptualised within one overarching meta-process, namely RNT. A systematic search of the literature identified 15 studies that met specific inclusion criteria for comparing rumination and worry with one another. The methodological quality of the papers is assessed using a recently developed quality tool and the data are qualitatively analysed and presented. The review evaluates how rumination and worry are conceptualised and measured distinctly, and the degree of overlap found between them. Results are discussed in relation to the wider literature base and clinical implications for the measurement of rumination and worry are conveyed. Chapter 2 is an empirical paper investigating the relationships between the key constructs relevant to this thesis in a non-clinical sample. The aim was to address some of the gaps in the literature and establish the impact of goal-linking and cognitive processes on mental well-being. Linkers have been found to ruminate more than non-linkers but, to the best of the author's knowledge, this relationship has not been investigated in relation to worry or RNT. A student sample completed an online survey of the constructs of interest. The differences between linkers and non-linkers with regards RNT, rumination, worry, and mindfulness, are examined using theoretically derived hypotheses. The mediating effect of RNT on goal-linking and depressive and anxious symptoms was assessed, in addition to, the mediating effect of mindfulness on goal-linking and well-being. The findings are discussed in the context of previous research, relevant literature and recommendations for future research. The chapter concludes with clinical implications of the study.

The voices of people labelled with intellectual disabilities (ID) who are non-heterosexual are often unheard in both clinical practice and the research literature. Much of their lives are therefore hidden (Abbott & Howarth, 2005). Previous research has been over narrated by family, carers and professionals, with little input from people labelled with ID. Findings of previous studies have been inconsistent and suggested: that some people who engage in same-sex sexual behaviour identify as heterosexual (Thompson, D., 1994), that sexual identity has a context dependent fluidity where people may continuously change the labels they use (Thompson, S.A., 2002), or that people routinely use labels such as lesbian, gay, and bisexual (Abbott & Howarth, 2005). Studies involving people labelled with ID talking about their experiences tend to be ten or more years old, with some being much older. The socio-cultural and political climate has evolved over this time period, with more legally protected equality for minority groups than ever before. Little is known about how people currently experience their identities, however, and whether they have felt any benefits of cultural and legislative changes. Understanding what people think and feel about their sexual identities has clinical implications for therapists and for informing psychologically supportive systems of care. The best available evidence on which policies and guidance are based might not accurately reflect people’s current experiences and their clinical need. The general aim of this project is therefore to foreground the voices of people labelled with ID who are non-heterosexual, in order to add to new understandings to the existing research evidence base. Interest in the broad research topic of sexual identity developed as a result of the researcher’s personal reflections on his own experiences of coming out as gay. The narrower focus of the project is on lesbian, gay, bisexual, and/or trans (LGBT) identities in people labelled with intellectual disabilities (ID). This focus evolved through a combination of factors: wider reading of the psychological literature for identified yet currently underexplored issues in sexuality research; growing awareness of challenges faced by people labelled with ID, through conversations with potential research supervisors and clinical teaching units; and a personal interest in issues of equality and rights to freedom of expression, which are also clinically relevant issues for people labelled with ID. The overall aim of the project is an exploration of the lived experiences of lesbian, gay, bisexual and/or trans (LGBT) people labelled with intellectual disabilities (ID). The project is reported in two chapters. Chapter one is a report of a systematic review of qualitative research literature exploring first-person accounts of sexual identities in lesbian, gay, bisexual and/or trans (LGBT) people labelled with intellectual disabilities (ID). Compared with service user voices, staff and family views were often over represented in the literature, however, a sufficient number of retrieved studies were eligible for inclusion in the review. Included studies dated from the previous twenty years with few recently published studies. Results were reported in a narrative summary. More interpretative syntheses would have been inappropriate given the limitations of the data. Key findings suggested that people labelled with ID who had same-sex attractions had mixed experiences of sexual identities. Further qualitative research was suggested to explore how people might experience their sexual identities in the current socio-political climate. Chapter two reports on an original empirical study conducted with a sample of LGBT-identified people labelled with ID. The main research question followed the theme of chapter one: how do people labelled with ID who are LGBT experience their sexual identities? IPA methodology was felt to be the most appropriate approach for this study as IPA privileges an individual’s unique experiences through in-depth analysis. The position and effect of the researcher is considered an important aspect of IPA research, which felt significant given the researcher’s own sexual identity experiences. Participants were recruited via a support group for people labelled with ID who are LGBT. Participants therefore had access to LGBT-specific support, which offered a unique opportunity for the researcher to explore their experiences of sexual identities and coming out process in the context of an LGBT-affirmative environment. Key findings from data analysis suggested that participants had well established ideas about their identities and disclosed LGBT labels (or ‘come out’) to some people. In abusive environments some people made active decisions about what information felt safe to share, resulting in not coming out to everyone. A key clinical implication of the study is participants’ need for holistic services to support them with their ID and LGBT needs simultaneously. Qualitative research is suggested which included further exploring the clinical implications of the coming out processes described by participants.

This thesis comprises a literature review, “A systematic review of the relationship between borderline personality disorder or traits and alcohol use: active components, mediators and common risk factors”; an empirical paper, “Borderline personality disorder traits and the effect of a rejection experience on attentional bias towards alcohol” and relevant appendices. Borderline personality disorder is a controversial diagnosis which has been linked with alcohol use and misuse (Trull et al., 2000). A gap in the research was highlighted as no systematic review has explored the active components of borderline personality disorder (BPD) or borderline traits in predicting alcohol misuse, and the mechanisms by which these may influence alcohol misuse. The aim of the literature review was therefore to identify components and mechanisms through mediation, moderation or common-cause analysis. Ten studies were reviewed. Active components were affective instability and impulsivity, mechanisms were mediation through negative emotionality, anti-social personality disorder and social support, common risk factors were genetic factors, which had a stronger influence in later adolescence, shared and non-shared environmental influences, attachment and emotional clarity. This study concludes that traits of impulsivity and affective instability may create a vulnerability to using alcohol as a way of regulating emotions. It was proposed that causal influences can be better understood through longitudinal studies rather than cross-sectional studies. The literature review shows linkages between these variables, but does not explain how affective instability may cause drinking. The empirical paper argued that sensitivity to rejection may increase vulnerability to using alcohol as a way of regulating difficult emotions, and hence is a possible trigger for harmful alcohol (Gratz & Roemer, 2004). The empirical paper reported a study which aimed to explore whether borderline traits would interact with a social exclusion manipulation to predict an attentional bias towards alcohol in 111 students. This was studied using an experimental social exclusion experience and a dot probe task. Results did not show an interaction between borderline traits and exclusion in predicting attentional bias or any main effects. The failure to support the hypothesis may be attributable to the failure of the exclusion experience to elicit affective change and the insensitivity of the dot-probe task. Methodological refinements are suggested.

The overall aim of the thesis is to explore some theorised processes underlying social anxiety. Social anxiety is the experience of anxiety in response to social or performance situations, and is a common (Henderson, Gilbert & Zimbardo, 2014) and impairing (Wittchen & Jacobi, 2005) experience, with high comorbidity with other anxiety and mood problems (Kessler, Avenivoli, et al., 2012; Kessler, Petukhova, et al., 2012) and some indication that it can lead to decreasing functioning and increasing distress over time (Beesdo et al., 2007). More than half the population report some degree of shyness or social worry (Henderson, Gilbert & Zimbardo, 2014), and understanding what underlying functions may perseverate to impair functioning may aid understanding, prevention and earlier intervention to reduce distress and increase functioning. The first chapter of this thesis is a systematic review. Several forms of attachment were included and combined with measures of social anxiety in both clinical and non-clinical populations to explore the nature of this relationship, both directly and through mediation/moderation by other variables. Thirty studies were identified and findings were synthesised narratively, meta-analysis being inappropriate due to variance between studies. Attachment was explored due to theoretical assertions that processes underlying social anxiety develop in attachment relationships (Vertue, 2003). Evolutionary psychological models of social anxiety also indicate a role for shame and social comparison as an overactive social rank system in social anxiety (Gilbert, 2000; 2001), and this was explored as a potential mediator of the relationship between attachment and social anxiety. The second chapter is an empirical study. Continuing the thesis from chapter one, the aims of the empirical study were to a) replicate findings that attachment would be associated with social anxiety, but when controlling for particular cognitive and evolutionary behavioural variables this association would lose significance and b) extend these findings through comparison of anxiety, shame and social comparison in the moment using experience-sampling methodology (ESM). As social anxiety is conceptualised as a continuum of severity and distress (Ruscio, 2010) this comparison was made within-subjects. It was hoped that observing variables in the moment would illuminate processes underlying social anxiety in different contextual settings and elucidate differences between social and non-social environments. Ultimately it was hoped that better understanding of variance in shame and social comparison in the moment could guide identification and prevention of pre-clinical experiences, as well as guide more targeted intervention based on understanding of underlying processes. Overall consideration of attachment as one potential root for these underlying processes could also be considered based on extant research. Appendices were limited by the accepted word count for this thesis, but include author guidance for the formatting of both chapters one and two, which are written to comply with the requirements of the Journal of Affective Disorders. The quality assessment tool used in chapter one is also included, as are methodological points used for chapter two. These include the person-level and ESM questionnaires, as well as the participant information sheet and advert. Following completion of this thesis, it is intended that findings from both studies will be disseminated to academic audiences through publication in peer-reviewed journals, as well as lay descriptive leaflets being emailed to participants who cited their interest in hearing results of the study.