Background. There is growing recognition of the impact of sensory difficulties in autism. However, traditional ‘sensory integration therapies’ lack empirical support and behaviour-based measures may misrepresent some sensory experiences in autism, meaning that sensory atypicalities are poorly understood and supported. There is therefore a need for a new self-regulatory approach to understanding and managing sensory experiences, which is consistent with theory, and draws upon self-reports of individuals with autism. Aims. 1) To expand the evidence base of self-reports of sensory experiences of adolescents with autism. 2) To evaluate the effectiveness of a new 8-week CBT-based group intervention for self-regulation of sensory experiences. Methods. Twelve adolescents aged 11 to 16 years with diagnoses of autism and IQs above 70, from one mainstream secondary school completed the study. A randomised controlled trial (RCT) design was used. To address Aim 1, self-reports were elicited pre-intervention, in a semi-structured interview and analysed thematically. To address Aim 2, quantitative measures of sensory behaviours, anxiety and repetitive behaviours were taken at baseline, post-intervention and follow-up, together with qualitative interview data from experimental groups and parents, post-intervention. Results. Aim 1) Thematic analysis revealed 5 main themes: ‘need for control’, ‘resonance with stimulus affects reactivity’, ‘self in-relation-to others’, ‘barriers to coping relate to consciousness’, and ‘features of adaptive coping strategies’. Aim 2) Quantitative analysis revealed no significant intervention effects, although qualitative reports indicated the intervention raised meta-conscious awareness of sensory experiences, expression and use of language, sense of self in-relation-to others, and adolescents’ use of new coping behaviours. Conclusion. Striking qualitative data suggest the intervention was effective in raising meta-conscious awareness and self-regulation. Results indicate the future need for larger sample sizes, and for the development of more sensitive and valid sensory measures. Implications for EPs include facilitating supportive group dynamics, and developing parent and staff understanding.

About a third of stroke survivors have some degree of depression. Depression has a significant impact on recovery after stroke, and identification is important so it can be treated. A common symptom of stroke is aphasia, where comprehension or expression of language is significantly impaired. Communication problems following stroke have been shown to be a major predictor of depression after stroke, yet these problems often make assessment of mood using conventional, language-based measures difficult or impossible. Though some non-verbal, self report mood measures exist, their utility is limited and evidence base lacking. The aim of this study was to design, create and validate a non-verbal mood assessment instrument suitable both as a general outcome measure and as a screening measure for depression in stroke patients with aphasia. A series of four judgement experiments were conducted based on 22 photographic sittings, and a series of scales were developed. The resulting prototype instrument Dynamic Visual Analogue Mood Scales (D-VAMS) is a tablet/computer-based instrument consisting of seven bipolar scales comprising images of human faces whose expressions are modulated by sliders. The instrument was then validated in a sample of 46 stroke survivors recruited from online, from stroke clubs and via NHS rehabilitation services. Good construct validity was demonstrated by high correlations between word and face versions of the seven D-VAMS scales (r=.73 to r=.79), however discriminant validity was poor, with substantial cross-correlations between scores for all of the face scales (r=.58 to r=.88). Internal consistency of D-VAMS was very high, with a Cronbach’s α of 0.95. A Principal Components Analysis revealed one factor accounting for 80% of the variance, corresponding to pleasantness or unpleasantness of mood. Excellent criterion validity was evidenced by strong correlations between D-VAMS and Hospital Anxiety and Depression Scale (HADS) depression subscale (HADS-D) scores (r=.73). Excellent test-retest reliability (r=.89), and high sensitivity and specificity against HADS-D cut-offs of 4–7 were also found. The findings suggest that the D-VAMS is a valid, brief measure of pleasantness of mood in a range of 0–100 which is suitable for use as a general outcome measure for stroke survivors with aphasia, and which may serve as an indirect, simplified measure of depression. Though D-VAMS may also be useful as a screening measure for depression following stroke, further validation is needed to examine how it performs in people during the acute stage after stroke. Some supervision may be required for people unfamiliar with using a tablet or PC interface.

Despite reviews exploring the emotions experienced by emergency and nursing staff when working with individuals with Borderline Personality Disorder (BPD), to date there is no review summarising the experiences of therapists. Therefore, the aim of this review is to systematically review the available literature about the emotions therapists experience when working therapeutically with clients with BPD. Psycinfo, Scopus, Medline, Web of Knowledge and CINAHL were searched to identify relevant articles. The inclusion criteria for the search were; therapists or counsellors working with adult clients with BPD, utilising any therapy. The comparators were any other clients accessing therapy and the outcomes considered were emotions, reactions, attitudes and health outcomes. 16 papers were identified; 12 quantitative papers and four case studies. Therapists experience a wealth of strong emotions when working with clients with BPD. There were two client characteristics which influenced the emotions experienced by therapists, client burnout at the beginning of therapy and level of patient functioning. Therapist characteristics which may influence emotions were specialist training, primary discipline, experience, age, therapist expectations and the boundaries therapists set. In conclusion the author recommended that therapists are provided with sufficient support, such as supervision, to prevent strong emotions impacting upon the therapeutic relationship. Therapists may also benefit from accessing specialised training in BPD such as mindfulness, Dialectical Behaviour Therapy or Mentalisation Based Therapy. To date this area has not been researched using robust qualitative methodologies and the use of these would allow a greater understanding of the emotional experiences of therapists. Abstract for empirical paper: Individuals with Borderline Personality Disorder (BPD) may present with high risk behaviours such as deliberate self-harm, suicidal thoughts or attempts. Therapists report a variety of emotional experiences when engaging with this client group. Dialectical Behaviour Therapy (DBT) is a multi-modal psychological intervention designed for use with BPD. It has been hypothesised that the structure of DBT and its key components may provide support to the therapist and prevent negative emotional experiences. The aim of this study was to explore the emotional experiences of therapists whilst implementing a DBT approach. Nine semi-structured interviews were conducted and the transcripts analysed using Interpretative Phenomenological Analysis. The analysis established five themes within the data; 1) Developing an allegiance to DBT; 2) Learning to share responsibility; 3) Adjusting to the boundaries in DBT; 4) DBT contains therapists’ emotions; and 5) Needing support from others; i) Consult providing a secure base; ii) Needing support from the wider organisation. In conclusion, therapists' emotions appeared to be contained by DBT and therefore it may be an attractive approach to utilise for clinical work with individuals with BPD.

Research on memory in Autism Spectrum Disorder (ASD) points to difficulties in memory for personal experiences (episodic memory - EM). In particular, difficulties were found for the processing of relations between units of material leaving memory for single items mostly intact. The aim of this thesis was to examine EM in ASD further by investigating the influence of meaning, type of material, and relations, and by assessing the influence of complexity, executive functions, and attention on memory, learning, and spatial navigation in ASD. In addition to memory behaviour, eye movements were measured. It was found that the EM impairment in ASD adults with average intellectual abilities persisted across a range of materials and types of relations, and that item memory was also affected when using tests of similar complexity to relational memory tests. Eye movements indicated attentional differences in ASD that may have had an impact on the observed difficulties, and they indicated that memory difficulties went beyond explicit deliberate retrieval of information also affecting implicit memory and, therefore, suggesting that also encoding and postencoding processes may work differently in ASD. Spatial navigation was particularly affected by executive function and item memory difficulties in ASD, and structural learning may be the fundamental mechanism that underlies the cognitive difficulties observed in ASD. Future research should concern the development and application of measures for less verbal and/or intellectually able ASD individuals and the investigation of how the studied processes are affected by ageing in the ASD population. In addition, training and support strategies should be developed to investigate whether memory difficulties in ASD are caused by a processing bias or a deficit and to attempt to alleviate them. Finally, the investigation of memory encoding and consolidation is needed to test whether these processes operate differently in ASD and, if so, how they could be improved.

Down’s syndrome is a complex genetic condition arising from trisomy of chromosome 21; it is characterised by alterations in behaviour and synaptic plasticity, leading to deficits in learning and memory. The Tc1 mouse is a transchromosomic mouse model of trisomy-21 which carries a freely segregating and almost complete human chromosome 21. The main aim of this thesis was to explore recognition memory processes in the Tc1 mouse model of trisomy-21. The initial goal was to provide insight into the learning and memory changes associated with triplication of genes on human chromosome 21 in mice. The Tc1 mouse had previously been shown to display a deficit in object recognition memory following a delay of 10-min, but not following a 24-h delay. This thesis aimed to confirm and extend these findings, by testing Tc1 mice on an array of novelty based recognition tasks. This thesis also aimed to explore some of the biological systems underpinning the pattern of learning and memory changes demonstrated by the Tc1 mouse. The expression of c- fos was used as a marker of neuronal activity, allowing for the assessment of regional activity, and in addition, the expression profile of the GluR1 subunit of the AMPA receptor and the GluK1 and GluK5 subunits of the Kainate receptor were examined. Finally, this thesis investigated the impact of the administration of a novel AMPAkine, drug 9A, on the cognitive phenotype of the Tc1 mouse. The behavioural and biochemical analyses provided evidence that the Tc1 mouse model showed a selective deficit in short-term recognition memory while sparing longterm memory for the same type of information, and that a near complete copy of human chromosome 21 in Tc1 mice did not impair place recognition. In addition, c-fos expression studies provided evidence for aberrant perirhinal cortex activity in response to familiarity. Further to this, there was a significant reduction in expression of the GluR1 AMPA receptor subunit in the hippocampus, and a significant reduction of the GluK5 kainate receptor subunit expression in the perirhinal cortex. Finally, this thesis provides some preliminary evidence that a novel positive allosteric modulator, drug 9a, had a positive cognitive enhancing effect in the Tc1 mouse.

This thesis investigated the long held claim that reliance on routines and rituals (restricted and repetitive behaviours [RRB]) is related to a difficulty with flexibly generating novel ideas (imagination) in those with autism spectrum disorder (ASD). The sparse body of previous research into this relationship has yielded equivocal findings. Therefore the main aim of this thesis was to address the question: what is the nature of the relationship, if any, between imagination and RRBs in individuals with ASD? In order to test this relationship, I developed the first self-report measure of RRBs suitable for use with autistic adults, the Adult Repetitive Behaviours Questionnaire-2 (RBQ-2A), which has since been published in the Journal of Autism and Developmental Disorders. In Study One I tested the RBQ-2A with neurotypical (NT) adults and showed that it is a reliable and valid measure of RRB, comprising two components: repetitive motor behaviours (RMB) and insistence on sameness (IS). Study Two showed that autistic adults scored significantly higher on the RBQ-2A compared to NT adults, and in a larger sample of autistic adults (Study Three), three components were identified: RMB, repetitive sensory behaviours (RSB) and IS. In Study Four, significant associations between RBQ-2A score and the imagination subscale of the Autism-Spectrum Quotient were found; although this relationship was unstable. More convincingly, participants who reported not playing pretend as a child showed significantly higher levels of IS, and a more limited pattern of self-chosen activities, compared to participants who did play pretend. Finally, a range of imagination measures were administered to a small sample of autistic adults (Study Five). There was a great deal of variation in performance on imagination tasks, but none of these measures correlated with each other. There were also no significant relationships between these tasks and the RBQ-2A. However, 89% of participants reported both impoverished past pretend play and a limited pattern of self-chosen activities. In summary, in this thesis I showed that the conceptualisation of imagination in ASD is incomplete and suggested a conceptualisation of imagination for future research, comprising the key components of generativity, novelty and flexibility. I also showed that the RBQ-2A is a reliable and valid self-report measure of RRBs in autistic adults. Finally, in terms of the nature of the relationship between imagination and RRBs, I provided evidence that this relationship is restricted to IS and past pretend play; that is, individuals with ASD who showed poor pretend play as children go on to behave in a more restricted manner in later life. However, this is a weak relationship, and individuals with ASD may still show high levels of creativity in other domains.

This thesis explores the benefits of physical activity on cerebrovascular health in healthy subjects and in Huntington’s Disease (HD), where cerebrovascular health is thought to be jeopardised. A cross-species approach was employed, to inform the relevance of MRI findings in humans, using histology and pre-clinical imaging. In Chapter 2, measurement of cerebrovascular markers using arterial spin labelling (ASL) MRI showed that arterial compliance and resting cerebral blood flow was lower in subjects with higher cardiorespiratory fitness, whilst differences in cerebrovascular reactivity (CVR) to a breath-hold task were not statistically significant. Measurements of vessel density in Chapter 3 showed that running mice had greater vessel density than non-running mice following a 6-week voluntary wheel running intervention, which may be attributed to a process of angiogenesis. Methods developed in healthy subjects were subsequently applied to investigate the cerebrovascular benefits of exercise in HD. In Chapter 4, pre-/early- symptomatic patients with HD were assessed for subtle differences in cerebrovascular health and whether this varied with cardiorespiratory fitness. Disease-related differences were observed in cognition, and ASL measures including resting CBF and CVR, but no clear relationship with fitness was observed. Preclinical imaging was used in Chapter 5 to measure longitudinal changes in resting CBF and CVR in a transgenic Q175 mouse model of HD, prior to behavioural deficits (preHD). Neither CBF or vessel density differed between preHD animals and controls, and did not appear altered by voluntary running.

Communication impairments are common following acquired brain injury (ABI) and have a significant impact on a person’s quality of life (QOL) post-injury. While some treatments have improved communication skills, few have measured QOL, and even fewer have shown improved QOL for people with ABI following communication-based treatments. Project-based treatment is an alternative treatment approach that could have an impact on communication skills and QOL for people with ABI who are long-term post-injury. The treatment is embedded in a context of meaningful activities chosen by people with brain injury, whereby, as a group, they work collaboratively to plan and achieve a concrete goal or outcome that contributes others and/or the wider community. Project-based treatment has not been empirically evaluated for people with ABI. More specifically, no research has evaluated whether projects can improve both communication skills and QOL in people with ABI. Therefore, this research aims to evaluate the effectiveness of project-based treatment on the communication skills and QOL for people with ABI. An exploratory study was designed as a prospective quasi-randomised controlled trial with pre, post and follow-up assessments, using mixed methods, and feasibility testing to investigate the effect of project-based treatment. Twenty-one people with ABI were recruited from community settings, allocated to either a TREATMENT (n=11) or WAITLIST group (n=10). Treatment was completed over 6 weeks and comprised an individual session (to set specific communication goals with the person with ABI and their communication partner), followed by nine sessions conducted in groups of 2-3 people. These sessions involved a range of meaningful activities chosen by people with ABI that contributed to a tangible end product designed to help others (e.g. video, pamphlet, radio podcast, piece of art). Mixed methods were used to determine the effect of the treatment on people with ABI. The primary communication outcomes were: (1) Blind ratings of the person with ABI’s conversations on the Interaction and Transaction scales of the Adapted Measure of Participation in Conversation (MPC). The secondary communication outcomes were: (1) Blind ratings of the communication partner’s involvement in conversations on the Acknowledging and Revealing Competence scales of the Adapted Measure of Support in Conversation (MSC); (2) Blind ratings for the Impression scales that described how appropriate, rewarding, effortful, and interesting a conversation was; (3) La Trobe Communication Questionnaire (LCQ) as rated by the person with ABI, and their communication partner; and (4) Goal Attainment Scaling (GAS). The primary QOL outcome was the Satisfaction With Life Scale (SWLS), and the secondary QOL outcome was the Quality of Life in Brain Injury (QOLIBRI) measure. The qualitative data was drawn from semi-structured interviews conducted post-treatment. The first set of analyses for the primary and secondary outcome measures, compared the TREATMENT group with the WAITLIST group over two time points, between which only the TREATMENT group had received the treatment. This showed that people with ABI in the TREATMENT group had improved Interaction scores on the MPC, their communication partners had improved Revealing Competence scores on the MSC, and the conversation was perceived as less effortful, compared to the WAITLIST group. No changes were found for the remaining communication outcomes, or the QOL outcomes. The second analyses compared pre-treatment, post-treatment, and follow-up scores across all people with ABI (i.e. scores for both the TREATMENT and WAITLIST group were combined). This showed significant changes for communication partners on the MSC and LCQ, and significant achievement of communication goals on GAS, as rated by both the person with ABI, and their communication partners. Significant improvement on the QOLIBRI was found, with a trend towards significance on the SWLS. No other significant changes were found. Qualitative data was analysed using content analysis where the content and context of the interview transcripts were analysed and themes identified. People with ABI described overwhelmingly positive experiences of the treatment, the group, the project, and working on goals. They also described a range of positive benefits including improved awareness and skill, and positive feelings. Project-based treatment made modest improvements to both communication skills, and QOL. Moreover, people with ABI perceived positive experiences, and benefited from inclusion in the treatment. While this study was an exploratory trial, with feasibility testing, the results highlight that this treatment could be a potential alternative to other treatments available to people with ABI.

Public speaking anxiety (PSA) is a common problem, and in some cases can lead to significant social and occupational difficulties. While exposure therapy combined with cognitive restructuring is currently the most effective treatment available, approximately 25% of individuals fail to respond. Acceptance and Commitment Therapy (ACT), a third-wave behavioural approach predicated on supposed different mechanisms of change, may have additional benefits to more traditional interventions, and may be more acceptable to those individuals with PSA who find exposure based therapy too difficult. A multiple single-case design was used to examine the effects of a self-help ACT intervention for PSA on self-reported, implicit, imaginal, and in-vivo outcomes, across six replications. All participants reported a reduction in speech anxiety, with evidence of reliable change in three cases. The four participants who reported an increase in willingness to approach a feared public speaking scenario, also completed an in-vivo voluntary speech task. Triangulation of quantitative (daily and weekly measures) and qualitative data (change-interview) indicate that mindfulness (self-as-context and present-moment awareness) may be a key mechanism of change in ACT for individuals with PSA. The findings offer support for ACT delivered in a self-help format to treat speech anxiety, however, further research is needed to generalise these findings and examine the long term effects.

Objective: To explore the relationship between compulsive exercise and shame in a clinical sample of eating disorder patients. Method: In a cross-sectional study, individuals with an eating disorder (n=21) completed self-report measures of compulsive exercise, internal shame, external shame, bodily shame, anxiety and depression. Results: Internal shame was moderately associated with compulsive exercise (r=.496, p < .05). No further variables were significantly related to compulsive exercise. Individuals with Anorexia-Nervosa and Bulimia-Nervosa did not significantly differ on any of the study variables. Discussion: Hypotheses regarding the possible nature of the relationship between compulsive exercise and shame are suggested. For instance, that compulsive exercise may serve a role in the regulation of internal shame. That compulsive exercise may act as a compensatory behaviour and be a consequence of high levels of shame. Or that internal shame may result as a response to negative perceptions of one’s exercise habits. The results are discussed in line with current literature.