Background and Aims: There is a paucity of research investigating Callous Unemotional (CU) traits and emotional processing in females with conduct problems. The research that does exist has largely been conducted within a young, community dwelling age group. A number of these studies have suggested that adolescent girls with conduct problems present differently to both boys with conduct problems and girls without conduct problems on measures of CU traits and emotional processing. The current study therefore aimed to investigate the level of CU traits in a sample of adolescent females with conduct problems. In addition, the study aimed to measure a number of emotional processes (i.e. affective empathy, processing of emotional stimuli and emotional dysregulation) and investigate the relationship between these processes and CU traits. Finally, the study sought to clarify whether patterns observed in adolescent males with conduct problems are similar in adolescent females. Method: Seventy-four participants (mean age= 16.4) were recruited from youth offending teams and local schools into three experimental groups: females with conduct problems (n = 25), males with conduct problems (n = 24) and control females (n = 21). Participants were asked to complete self-report questionnaires about affective empathy, CU traits and emotional dysregulation. They were also asked to complete a computerised lexical decision task. Results: As predicted, females with conduct problems presented with a different pattern of emotional processing when compared to boys with conduct problems as shown by higher levels of affective empathy and emotional dysregulation but lower levels of CU traits. Whilst CU traits were associated with a deficit in cognitive and affective empathy in boys, CU traits were not associated with a deficit in affective empathy in girls. This relationship also did not differ depending on the level of emotional dysregulation reported by the young person. Finally, boys with conduct problems showed a deficit in attentional facilitation to emotional words whilst girls with conduct problems did not. When comparing females with conduct problems to control girls, they scored higher on a measure of CU traits and emotional dysregulation but lower on a measure of affective empathy. Affective empathy was not associated with CU traits in either female sample, and there was no difference in the level of attentional facilitation to emotional words between the control girls and conduct problem girls. Conclusions: Overall, our findings suggest that adolescent females with conduct problems and CU traits present differently to both their male counterparts and to control girls. These results have implications for future research and are potentially clinically relevant.

Background: Obsessive compulsive personality (OCR) characteristics and altered social-emotional processing are central to aetiological and maintenance models of eating disorders (EDs). These characteristics may be associated with genetic risk for EDs. Thesis aim: To examine the gender specificity and familial nature of OCR features and social-emotional processing in EDs. Self-report and behavioural data were collected to test hypotheses. Results: Males with an ED (N = 29) have significant levels of OCR characteristics. They exhibited a rigid and fragmented cognitive style relative to healthy males (N = 42) on behavioural tasks. Men with EDs were not significantly different from healthy males on a measure of visuo-spatial local processing or on social-emotional tasks. As expected, ED offspring of family trios (mean age 21 years) had a detailed, fragmented cognitive style with was some evidence for cognitive inflexibility (N = 73). Mothers of ED offspring (N = 77) had elevated levels of OCR features on self-report measures compared to mothers of healthy offspring (N = 51). On behavioural measures, mothers of ED offspring had relative strengths in local processing and relative difficulties in global processing and spontaneous flexibility. Fathers of ED offspring (N = 60) had higher levels of self-reported obsessive-compulsivity than fathers of HC offspring (N = 56). ED offspring had significant levels of trait and social anxiety. Altered social-emotional processing was associated with a more protracted illness. Mothers and fathers of ED offspring had higher trait and social anxiety than HC parents. There was little evidence for altered attention for social stimuli or difficulties in emotion recognition in parents of ED offspring. OCR and anxious traits were more pronounced in parents who screened positive for a lifetime ED.

Introduction: There have been several studies in the intellectual disability/autism literature that have found a relationship between high parental Expressed Emotion and child maladaptive behaviour. Most of these studies have been carried out using mothers. The present study aimed to examine some of the reported associations. Using a logistic regression analysis, factors examined in the present study with Critical Comments were: Paternal psychological morbidity, paternal causal attributions, and child externalising and internalising behaviour. In addition, the differences between critical and non critical fathers in respect of child maladaptive behaviour were examined. Methodology: A cross sectional survey design was carried out, interviewing sixty-eight fathers of children with autistic spectrum disorder, who also completed questionnaires. Interviews were transcribed and coded for Critical Comments and attributions. Questionnaires addressed child maladaptive behaviour and paternal psychological morbidity. Results: Critical fathers differed from non critical fathers in having children with more externalising behaviour, although no difference was found for internalising problems. Externalising behaviour was the only statistically significant predictor of Critical Comments, using logistic regression. An additional finding related to a significant correlation between paternal psychological morbidity and child externalising behaviour. Correlations were also found between Critical Comments, and three independent variables: Child internalising and externalising behaviour, and the control attribution. Discussion: The present study supported previous study findings regarding the relationship between Critical Comments and child externalising behaviour, and partial support for an attribution theory of EE. Clinical and theoretical implications of study findings were discussed, as well as suggestions for future research. Findings suggest that paternal mental health needs to be considered, as an adjunct to parenting programmes, as well as the importance of including fathers, when designing interventions to reduce high EE in families.

Background: Autism spectrum disorder (ASD) affects 20-30% of adults with intellectual disability. This group are vulnerable to mental health problems and poor quality of life. They usually share a common mental health care pathway with adults who have intellectual disability without ASD. However, there is little evidence on whether this is an appropriate approach. Aim: The thesis aimed to explore differences between those with and without ASD among specialist mental health service users with intellectual disability. Method: The needs, mental health, behaviour, social functioning and service use of 50 participants with ASD from a specialist mental health service for adults with intellectual disability in South East London were compared with 48 participants without ASD. ASD diagnoses were assessed using the Autism Diagnostic Observation Schedule (ADOS). In addition, anonymised case records provided routinely collected, clinical data on 788 participants. Results: Participants with ASD consumed fewer services than those without ASD despite having more needs. ASD was a significant predictor of poorer mental health and behaviour. Participants with ASD had poorer social functioning than those without ASD. However, when severe intellectual disability, absence of a psychiatric disorder and needs were taken into account, ASD was not a significant predictor of poorer social functioning. The rate of clinically diagnosed ASD among specialist mental health services users with intellectual disability was 33.5%. However, there was evidence that undiagnosed ASD and unrecognised ASD behaviours were common. Conclusion: The mental health, behaviour and social functioning of specialist mental health service users with intellectual disability was poorer for those with ASD and significantly associated with factors that characterise many of these individuals. There appeared to be high levels of undiagnosed ASD and a lack of ASD-specific assessment protocols or care pathways. However, these findings may be limited to the specific service user group sampled. More research is needed to determine whether increased recognition of ASD and improved access to services would lead to better outcomes for adults with intellectual disability who have mental health needs.

Aims: Following a traumatic experience, nightmares can maintain psychological distress. Interventions that include the treatment of trauma-related nightmares contribute to increasing psychological and physical well-being. This study examined the efficacy of treating trauma-related nightmares independently, using a cognitive-behavioural rescripting intervention. The influence of metacognitive beliefs about the power and meaning of nightmares was also addressed. Method: The study employed a mixed quantitative and qualitative design reporting on ten participants suffering with chronic trauma-related nightmares. Participants completed a six-hour group treatment of Exposure, Relaxation and Rescripting Therapy (ERRT: Davis & Wright, 2005). Treatment effects were examined using sleep diaries, measures of anxiety and depression and the Nightmare Belief Questionnaire. Qualitative interviews were held with participants at follow-up and thematic analysis was used to analyse the transcripts. Results: Medium to large treatment effect sizes were noted for nightmare frequency, distress, sleep efficiencies, cognitive beliefs, depression and anxiety. Qualitative interviews identified six themes relating to the participant experience. Overall, participants found the intervention successful to help them eliminate or reduce their trauma-related nightmares citing important factors of new learning, gaining a sense of mastery and control and the engagement with others in a group treatment. Conclusion: ERRT appears to be an effective intervention for treating the frequency and distress of trauma-related nightmares whilst improving sleep efficiency and mood. It is proposed that establishing a sense of mastery is among the predominant mechanisms of change and improvements in metacognitive beliefs around the power and meaning of nightmares are a contributory factor to sustainability.

This thesis considers the role of psychological factors in disclosure of rape, and the attrition of rape cases. Part 1 begins by considering literature on how psychological reactions to rape affect disclosure. It considers who people disclose rape to, incentives and barriers to disclosure, the reaction of the confidante, and the effect of disclosure on the victim. Part 2 investigates the role of three psychological consequences to rape: PTSD, shame and self-blame, in the high attrition rate of rape cases. Specifically, it uses three mixed-methodology studies to investigate victim and police perspectives on the police interview and on the high attrition rate (data collection for study 1 of the thesis was in collaboration with Hardy (2008), see Appendix 1). Finally, Part 3 considers challenges that arose in Part 2, in particular in relation to psychodynamic ideas about the functioning of the organisations involved in recruitment for the studies.

The study of intrusive mental imagery in anxiety is a growing area of interest. Whilst there is an appreciation of the variation in thematic content (Hirsch & Holmes, 2007), less is understood about the wider phenomenology and function of intrusive imagery across the anxiety disorders. The aim of the review is to adopt a transdiagnostic perspective, and compare and contrast the literature on intrusive imagery in anxiety in terms of the content, prevalence, frequency and characteristics. In addition, a further aim is to present preliminary findings concerning the function of imagery across the spectrum of disorders. The final section of the review summarises the conclusions and suggests areas for future examination.

Interest in the exploration of attitudes towards individuals with intellectual disabilities (ID) has increased significantly over the last few decades. This research has largely focused on assessing explicitly reported attitudes via self-report measures. Despite numerous studies highlighting the significant influence that implicit attitudes can have on the behaviours of an individual (e.g. Bohner & Dickel, 2011), exploration of such attitudes towards this population is greatly lacking. Part one of this thesis details a systematic review of literature which examined implicit attitudes towards individuals with disabilities (physical and / or intellectual) via the Implicit Association Test (IAT; Greenwald, Schwartz & McGhee, 1998). It considers methodological issues pertinent to the use of the IAT and future directions for research into implicit attitudes towards individuals with disabilities. Part two summarises the results of a study which explores implicit attitudes towards individuals with ID using a Single Target-IAT. These are contrasted with participants’ explicitly reported attitudes and stigma towards this population. The relationship between these variables and emotional reactions towards and contact with individuals with ID is also assessed. The study concludes that implicitly reported attitudes are negative and in marked contrast with the considerably positive explicit attitudes and low levels of stigma reported. Possible explanations for these differences and the implications implicit attitudes may have for individuals with ID are discussed. Finally, part three presents a critical appraisal which explores the process and challenges of assessing implicit attitudes towards individuals with ID and possible future developments of this approach. The use of web based research designs, and considerations for further research in the area are also discussed.

There is a high attrition of rape cases, despite Government attempts to improve rates of conviction (Kelly, Lovett & Regan, 2005). This review will first examine the methodological issues in investigating and current understanding of attrition. It will be suggested that trauma memory may play a role in attrition, given the criminal justice system's emphasis on victims' ability to provide coherent accounts of rape (Office for Criminal Justice Reform, 2006). This proposal will be considered through examination of the processes underlying memory formation, retrieval and PTSD. Related research will be reviewed, indicating that trauma memory is characterised by enhanced spontaneous retrieval and impaired intentional retrieval, thereby impairing victims' ability to recollect rape and potentially contributing to attrition.

Depression is one of the most common psychological disorders and is associated with a wide range of impairments. Whilst prevalence rates in childhood are relatively low they increase in adolescence and a number of programmes have now been developed which aim to prevent depression in this age group. This paper reviews those programmes that target children and adolescents considered at risk by virtue of their already elevated depression symptoms. A range of such programmes exist the majority are cognitive behavioural but a number also focus on interpersonal influences on depression. Whilst results provide evidence that such programmes can potentially reduce depression symptoms only a few studies have considered diagnoses and more research is needed in this area. Differences in who programmes target, their setting, length of interventions and in design make studies difficult to compare and further coherence will be needed in the field if a picture of 'what works for whom' is to emerge.