This study enquired into a puzzling feature of Post-Traumatic Stress Disorder (PTSD); a loss of wayfinding ability (Osofsky et al., 2010; Ehringa et al., 2006; Lubit et al., 2003; Kowitz, 2011; Adler et al., 2009; Handley et al., 2009; Butler et al., 1999). Previous research by Smith et al. (2015) demonstrated that in cases of PTSD allocentric processing was impaired. This thesis pursued this line of enquiry and assessed the impact of PTSD and of any trauma exposure on navigation performance using a static perspective taking task and a more ‘active’ navigation paradigm. The study also introduced navigation questionnaires to these assessments, to see how accurate individuals with different experiences of trauma (including combat) were in their perceptions of their own navigation competence (or indeed impairment). Finally, the thesis approached the issue of genetics and explored the influence of the Brain-Derived Neurotrophic Factor (BDNF) gene on experiences of PTSD and on navigation behaviour. In summary, the study’s findings confirmed those of Smith et al. (2015) that PTSD impaired allocentric processing. What is more, this thesis revealed that PTSD also impaired egocentric navigation and that allocentric navigation performance was also impaired in healthy trauma exposed individuals who reported no ill-effects from their trauma. The thesis demonstrated for the first time that PTSD brought with it an associative bias which was transferable to navigation behaviour. This was interpreted as being the consequence of a competition for hippocampal resources between trauma processing and navigation in otherwise healthy individuals (Vasterling & Brewin, 2005). When it came to perceptions of navigation competence, healthy trauma exposed participants were accurate in their self-reported competence, but those with PTSD-related navigation impairment (including those who had been military trained) were not. Notably, the correlation between self-reported and actual navigation competence was limited to allocentric (not egocentric) navigation competence. This was explained using models of neural processing which present hippocampal dependent memory systems as being more declarative than associative memory systems (e.g. Morris in Andersen et al., 2007). In the final chapter, the explorative analysis of the BDNF gene produced some noteworthy findings. Zhang et al. (2014) speculated that the relationship between BDNF and PTSD is likely confounded by environmental conditions (i.e. the diversity and extent of trauma exposure and opportunities individuals have to process it). BDNF did not influence the PTSD prevalence or severity in this study which did not control for such conditions. In terms of navigation, there were no distinct performance disadvantages from carrying the met allele and this is in line with many similar studies (e.g. Sanchez et al., 2011, etc.). Nonetheless, BDNF met carriers showed different patterns of egocentric performance to valval homozygotes. What is more, met carriers showed an inability to accurately describe their competence at allocentric navigation and observations were made of data that indicated a delay in their uptake of allocentric strategy during navigation (similar to significant findings of Banner et al., 2011). The observations were consistent with Lövdén et al.’s (2011) suggestion that met carriers may require more ‘obvious’ cues to apply allocentric processing to a given task than valval homozygotes do. The implications of these genetic differences in approach to allocentric processing are considered in terms of both trauma processing and navigation training interventions.

Food cravings are a commonplace experience in the general population and ordinarily, are not associated with emotional distress or a lack of behavioural control (e.g. bingeing). However in some groups with disordered eating, food cravings can be associated with significant distress and are implicated as a contributory factor in binge eating. Recent advances in cognitive theory have highlighted the role of appraisal and thought control strategies in emotional distress and various strategies for controlling unwanted thoughts have been described. In particular the thought control strategies of worry and punishment have been associated with higher levels of distress. It is therefore proposed that the way in which craving thoughts are appraised and dealt with is theoretically and clinically a more meaningful focus of analysis than the craving thoughts themselves. The current study is a cross sectional correlation design exploring the association between thought control strategies, ratings of dimensions of cravings, eating behaviour and emotional distress in dieters. 127 dieters currently attending Weight Watchers to achieve weight loss were recruited to complete a battery of questionnaires. In addition beliefs about craving and coping strategies were explored in more detail in a subsample of ten dieters. The current study found that both the appraisal of the negative experience of food craving and the thought control strategies of worry and punishment were associated with dysfunctional eating behaviour and emotional distress. The theoretical and clinical implications of the role of appraisal and thought control in the behavioural and emotional response to food cravings, are discussed. Areas for further research are highlighted.

Only rarely is it necessary to detain a troubled adolescent under the Mental Health Act (1983). Frequently the more disturbed adolescents will be placed in specialist adolescent secure inpatient facilities. Many of these young people present a primary risk to themselves in the form of serious self harm and potential suicide. The present research project seeks to investigate the therapeutic value of teaching problem focussed coping skills to deliberately self-harming adolescents. The six individual participants included in the project show a mixed response to the intervention. Three participants demonstrate a good response to the intervention as measured by frequency of self harm. However, follow-up data on one of these participants suggests a relapse of self harm after the end of the intervention. Psychometric measures of symptomatology show very limited convergence with reduction in self harm. However, assessment of coping responses at pre and post intervention suggests that the observed reduction in frequency of self harm is associated with the development of more adaptive coping responses. Of the remaining three participants, two fail to demonstrate a response to the intervention, and the third failed to engage in the intervention. The limitations of attempting to evaluate a specific and relatively discrete intervention in the case of complex and challenging patients are discussed. However, the results suggest that coping skills interventions are a necessary and vital component of an effective therapeutic programme for self harming adolescents and further refinement and integration with other therapeutic modalities may substantially improve the prognosis for some of our societies most damaged young people.

This study examined the relationships between retrospective recall of childhood experiences of parenting and abuse, and self report measures of adult attachment styles and personality disorder, in a sample of men diagnosed with personality disorder and detained in a high security psychiatric hospital for committing serious criminal offences. The results found predominantly insecure attachment styles within this sample and an association between attachment anxiety and severity of personality disorder. Recalled repeated separations from attachment figures were related to severity of personality disorder. Specific characteristics of parenting and abuse were related to severity of attachment anxiety and avoidance in adult intimate relationships. Furthermore, greater attachment anxiety was found for participants with a history of sex offences against children, compared with participants who had committed violent non-sex offences. These results suggest that adult attachment style may play a mediating role between childhood experiences and severity of personality disorder. These results provide further support for the applicability of attachment theory to the understanding of offending. The results highlight clinical implications for individuals therapy, ward interventions, patient selection and service organisation. In particular the interaction between staff attachment styles and effectiveness of interventions is discussed. This study suggests areas for future research including more detailed research of childhood experiences, attachment theory and personality disorder.

The current research investigated the strong interests in media characters or narratives for a group of adults with learning disabilities seen by clinicians for behavioural and mental health problems. These interests were termed "Special Media Interests". Six people with learning disabilities and a special media interest were interviewed (four interviewed once, two interviewed twice). Independently, seven clinicians were interviewed: clinicians (n=5) whose clients had been interviewed and clinicians (n=2) whose clients (n=3) were not interviewed. There were seventeen interviews in total. A grounded theory method was utilised to analyse the interviews and the findings of this analysis were as follows. People with learning disabilities and special media interests made comparisons of themselves to their interest: parallels were drawn, transformational desires expressed and the transition from child to adult focused upon. Comparisons necessitated people with learning disabilities and special media interests reality testing media representations. Indicators of both interest control and indicators of the strength of interest were found. Special media interests were considered to have both positive and negative consequences. There were indications of individual features characteristic of those with special media interests as well as the features of media interests that make them attractive. The findings of the current research are set within a context of special media interests as being of therapeutic utility in clinical work and as informative about the lives of people with learning disabilities: in these interpretations the conceptualisation of self-pluralism was important. A framework of enquiry for clinicians to explore and assess their clients' special media interests is presented.

Introduction: The impact of abuse and neglect on a child, their family and the associated societal costs are well documented. Despite this, there are a limited number of evidence based interventions (EBIs) that are available for families when abuse and neglect is identified and little available guidance for how EBIs should be introduced into existing services. This often results in a gap between the research evidence and clinical practice. Literature focusing on introducing EBIs into existing services identifies collaboration between professionals as a key part of this process. The current research aimed to understand the factors that help and hinder the process of collaboration when an EBI was introduced into an existing service, so that these findings might be applied to other intervention and contexts. Method: This process of collaboration was explored with front-line and specialist practitioners, when an EBI for child abuse and neglect: Multi-Systemic Therapy for Child Abuse and Neglect (MST-CAN), was introduced into Leeds Children’s Social Work Services. Eleven semi-structured interviews were carried out with participants from the social work (n = 6) and MST-CAN team (n = 5). The qualitative data was analysed using thematic analysis. Results: Three key themes emerged from the analysis that described the process of collaboration: ‘adapting the intervention to the local context’, ‘committing to the intervention’ and ‘working together to deliver the intervention’. MST-CAN had to be adapted to fit the local context and practitioners had to commit to the intervention before they could begin working together to deliver it. There were ten sub subthemes from the analysis that related to factors that helped and hindered collaboration between professionals. Discussion: The findings of the current research mirrored some of those from previous research and presented new findings in relation to factors that help and hinder collaboration in the context of children’s social care. The results are considered in relation to models of collaboration, implications for clinical work and future research.

Relatively little is known about the factors associated with young people’s engagement in self-harm. Given the existing vulnerabilities associated with being lookedafter, the first section of this thesis aimed to examine and synthesise the empirical literature investigating the psychosocial risk factors associated with self-harm and suicide among looked-after children (LAC). Systematic appraisal of fourteen studies highlighted several demographic, socio-environmental and psychological factors thought to place LAC at an increased risk of self-harm and suicidal behaviour. The findings have significant implications for intake assessment, treatment planning, service delivery, and staff training to address the complex emotional and behavioural needs of LAC. Given the potential risk that exposure to the self-harm of others might have on engagement in self-harm, the second section of this thesis aimed to explore, using Interpretative Phenomenological Analysis (IPA), how adolescents made sense of the selfharm of others, and how, if at all, the self-harm of others influenced their own behaviour and well-being. Eight young people, resident at one of two adolescent inpatient units, were interviewed and five themes emerged from the interview data: ‘Exposure to self-harm’, ‘An unpleasant environment’, ‘Helper vs helped’, ‘Separation from the attention seekers’, and ‘Competing for authenticity’. Self-harm prevention efforts aimed towards reducing the social transmission and stigma surrounding self-harm were discussed. The final section of the thesis adopts a critical and reflective stance to consider the decision-making processes regarding the thesis topic including the rationale for the study and the chosen methodology, and the practical and procedural challenges encountered during the course of the research, such as ethics approval processes and recruitment difficulties. The appraisal then goes onto review the researchers’ clinical reflections on the applications of the thesis findings, and the impact of the research on her journey through doctoral training.

This thesis is comprised of a scoping literature review, a research paper and critical appraisal which focus on psychological distress and psychological therapy in the context of Huntington’s disease (HD). The literature review is a scoping review of 29 papers looking at different aspects of irritability in the context of HD. The review examines the validity of irritability as a meaningful construct in HD. Clinical and theoretical implications as well as suggestions for further research are also discussed. The research paper investigates understandings of psychological distress in HD from the perspective of people with HD as well as seeking to understand people’s perspectives of psychological therapy. Semi-structured interviews were conducted with nine participants, prior to commencing a trial of mindfulness-based cognitive therapy (MBCT) and the data subsequently analysed using interpretative phenomenological analysis (IPA). Three themes emerged from the data: (1) Attributing psychological distress to HD: “you’re blaming everything on that now”; (2) Attribution across time: “in the past you’d just get on with it”; (3) Therapy instils hope and fight: “a light at the end of the tunnel”. The results are then discussed in terms of implications for the potential for psychological services to be available to people with HD alongside the need for further research into the acceptability of psychological approaches in the context of HD. The research paper highlights a predominant biological understanding of psychological distress with a more implicit psychological understanding presented, and a hope for psychological therapy to enable people to regain control over their experience. Finally, the critical appraisal reflects on some of the process issues encountered during the research including the impact of attending the MBCT group on the data analysis and barriers to recruitment.

Neurodegenerative diseases are not typically associated with a palliative care approach, despite poor quality of end-of-life care for people with these conditions. The first aim of this thesis was to understand the views of adults with neurodegenerative diseases on end-of-life care. Consequently, a metasynthesis was conducted. This review revealed that the care needs of people with neurodegenerative diseases are routinely not being met. It suggests that autonomy and a sense of control are important as well as contextualisation in decision-making. Furthermore, palliative care would be beneficial in meeting the needs of adults with neurodegenerative diseases. Theoretical, clinical and research implications are discussed. The second aim of this thesis was to explore how people with Huntington’s disease (HD, a major neurodegenerative disease) view assisted dying, a frequently debated issue. A thematic analysis was conducted using semi-structured interviews. Participants views were captured in four themes: 1) Autonomy and kindness in assisted dying; 2) HD threatens identity but is part of life; 3) Dilemmas in decision-making on assisted dying: “There are no winners”; and 4) Absence of explicit discussion on dying and HD: “Elephants in the room”. The study found that HD influenced views on assisted dying and that participants valued maintaining control of both their life and their death. They faced dilemmas in decision making and limited discussion on EOL issues. The final section of the thesis offers a reflective account of the research process.

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