This thesis investigates the social construction of an increasingly relevant aspect of social life, namely mental depression, in British and Chinese news media over the last two decades, aiming at delivering a contribution to people’s understanding of the link between discourse and the social reality of depression. A discourse is understood as the totality of all the texts that have been produced within a particular discourse community. The special discourse analysed consists of two diachronic corpora including articles in which the lexical item depression or 抑郁症 (yiyuzheng, ‘depression’) occurs in British and Chinese national newspapers from 1984 to 2009. Corpus analysis is complemented by a targeted paraphrase analysis of the paraphrastic content expressed in the context of relevant keywords. My findings suggest that in the British corpus, there has been a circular movement in the construction of the meanings of depression, swinging between a psychological problem that needs psychotherapy and a biochemical condition that needs pharmaceutical intervention. The Chinese corpus constructs ‘抑郁症’ (yiyuzheng, ‘depression’) as a problem that is normally caused by external social factors, and therefore psychological support and improvement of the social environment have been represented as more helpful than medical treatment.

This study postulates that there are currently four main dyslexia paradigms. These paradigms are: a) the Positivist-Intrinsic-Dyslexia-Paradigm, which reflects positivist studies on dyslexia that hold the etiological view that dyslexia exists intrinsically to the individual (of constitutional origin), b) the Interpretivist-Intrinsic-Dyslexia-Paradigm, which holds the etiological view that dyslexia exists intrinsically to the individual c) the Positivist-Extrinsic-Dyslexia-Paradigm, which reflects studies on dyslexia that hold the etiological view that dyslexia exists extrinsically to the individual (not of constitutional origin), and, d) the Interpretivist-Extrinsic-Dyslexia-Paradigm, which reflects studies on dyslexia that also hold the etiological view that dyslexia exists extrinsically to the individual. This study moves beyond the four main dyslexia paradigms by combining the I-E-D-Paradigm with elements of Burrell and Morgan's (1979) sociological Radical Humanist Paradigm, thus creating a Radical I-E-D-Paradigm from which to conduct the present study. From the position of a Radical I-E-D-Paradigm this study develops an alternative perspective on dyslexia, i.e., a non-constitutional perspective on dyslexia (N-C-PoD), and, emancipatory intervention aimed at assisting 'dyslexic' students to explore their perceptions of dyslexia. This study explores the influence that the N-C-PoD and emancipatory intervention has on the descriptions of dyslexia, in relation to self-concept, of two 'dyslexic' students studying in tertiary education.

The aims of the study were to uncover the major psychological factors underlying tokophobia, their impacts, and whether there is likely to be a role for psychological counselling to help women and their families. Nine women who indicated that they fear and avoid childbirth despite wanting a baby, volunteered and participated in a semi-structured interview. Six of these interviews were transcribed and analysed using the guidelines provided by Smith, Jarman & Osbourn (1999), from which tables of individual themes were created. For the participants, violation of expectations led to enduring distress, which manifests as symptoms of post-traumatic stress. ‘Loss of control’ and ‘loss of self’ are powerful themes that support existing literature. The theme ‘need of acknowledgment’ adds to the existing literature. As difficulties adapting to changes in lifestyle were expressed, a seven-phase transition model was suggested as a way of explaining and understanding difficulties faced by women with regard to changes in identity and lifestyle. It was concluded that the presentation of ‘secondary tokophobia’ does not fit with the term ‘phobia’. A reclassification of tokophobia was suggested for women who experience fear and avoidance of childbirth following a traumatic birth.

Objectives: To carry out a preliminary exploration and measurement of therapy expectancy and motivation in adults with intellectual disabilities through the development and psychometric evaluation of the Therapy Expectation and Motivation Measure (TEAMM). Design: The initial scale development phase combined top-down theory driven and bottom-up data driven processes to identify TEAMM items and format. The subsequent scale evaluation phase piloted the TEAMM and used correlational analyses to evaluate reliability and validity. Method: Six adults with intellectual disabilities took part in semi-structured interviews about therapy expectancy and motivation in order to identify TEAMM items. A further 22 participants piloted the measure for psychometric evaluation. Results: Preliminary psychometric evaluation confirmed that the TEAMM has acceptable test-retest reliability and internal consistency. Assessment of construct validity found a strong and positive relationship with a measure of general self-efficacy. Client expectations of therapy were largely positive and congruent with therapy as a goal-oriented process in which they will be an active participant. However, a number of individuals were unclear about the reason for referral and felt a low level of involvement in the process. Client and carer perceptions of referral understanding were significantly different. Conclusions: The TEAMM may help clinicians to identify potential barriers to engagement in therapy and find ways of enhancing the therapeutic experience of adults with an intellectual disability. Further psychometric evaluation of the TEAMM with larger samples is required to confirm the factorial structure of the scale and enhance its clinical utility.

Background: Post-traumatic stress disorder (PTSD) can occur following a traumatic event that has led to moderate to severe traumatic brain injury (TBI) even when there is little or no memory for the event. The incidence of PTSD is higher when diagnosed by self-report questionnaires compared to structured clinical interview. Previous studies suggest PTSD can be misdiagnosed in a significant proportion of cases and the incidence is in fact low. To explore this issue further there is a need to not only understand whether there are differences between cases that do and do not fulfill symptom criteria for PTSD, but also whether some cases have ‘partial PTSD’; that is to say they have PTSD symptoms but do not fulfill the DSM-IV symptom criteria exactly. Aims: The study aims to establish whether an attentional bias to trauma related words exists in people with TBI who report PTSD symptoms and to investigate the relationship between physiological arousal and attentional bias in people with a TBI reporting PTSD symptoms. Method: Forty-one participants with severe-extremely severe TBI were recruited from the community and completed measures of cognitive functioning. Attentional bias was measured using a Stroop task in which trauma, negative, neutral and positive words were administered randomly. Physiological reactivity (heart rate) was recorded and PTSD ‘caseness’ was established using a self-report questionnaire and a clinician-administered structured interview. Results: No significant relationship between PTSD symptom severities and attentional bias to trauma stimuli was apparent. Those with ‘PTSD’ demonstrated significantly slower reaction times to negative words however; this bias was associated with self-report of depression rather than PTSD symptomatology. Heart rate decreased throughout the interview and was not associated with PTSD symptom severities. Conclusions: Greater PTSD symptom reporting was not associated with an attentional bias to trauma words. Heart rate decreased over the course of the interview, independent of PTSD severity and diagnosis. This suggests that ‘partial’ PTSD was not present, and instead those who reported PTSD symptoms were curious about the gap in memory caused by amnesia without the associated fear response.

Introduction: Deliberate self-harm is being increasingly recognised as a behaviour with significant clinical importance. Yet, there remains uncertainty regarding which forms of psychological therapy are most effective for its treatment. Schema Therapy is an integrative psychotherapy blending elements of cognitive behaviour therapy, object relations and gestalt therapy into a unified approach for the treatment of individuals with complex and chronic psychological conditions. The current thesis aimed to provide a better understanding of the Schema Therapy model and its association with deliberate self-harm. Systematic Review: Despite the increasing evidence base for the efficacy of Schema Therapy, less is known about the evidence for its theoretical underpinnings. To address this gap in the literature a systematic review was undertaken to explore the following question: How empirically supported is the theoretical underpinning of Schema Therapy? In a systematic search of the literature conducted until 01 June 2012, studies based on cross-sectional, longitudinal, intervention, meditational and experimental designs were considered. These studies underwent detailed quality analysis culminating in 19 articles being included in the current review. Overall these studies indicate that many of the key theoretical assumptions in Schema Therapy are supported by the literature. Empirical Study: Schema Therapy has recently been expanded to include the ‘schema mode’ concept, with a number of researchers highlighting an association between particular schema modes and a number of chronic psychological conditions. Although the schema mode model allows a method for understanding moment-to-moment emotional states it has not previously been explored in relation to deliberate self-harm. The current project aimed to explore the relationship between these variables and their association with early experiences of parental bonding and current levels of perceived stress. 70 psychiatric outpatients with a history of deliberate self-harm completed a number of measures including the Deliberate Self-Harm Inventory, Schema Mode Inventory, Parental Bonding Instrument and Perceived Stress Scale. Results revealed significant associations between deliberate self-harm, maladaptive schema modes, perceived stress and patterns of parental care. Maladaptive schema modes significantly mediated the relationship between parental care and deliberate self-harm. The Punitive Parent and Angry Child modes were significant mediators in this relationship. Conclusion: Results from the systematic review support the notion that Schema Therapy has a good theoretical underpinning. The empirical study also supports Schema Therapy by highlighting the meditational role of maladaptive schema modes in the relationship between low parental care in childhood and deliberate self-harm in adulthood. These findings provide further support for the Schema Therapy model and suggest that individuals with deliberate self-harm may benefit from this treatment.

Introduction: Interpersonal relationships are beneficial for people with a learning disability (PWLD), acting as a protective barrier against transition difficulties, social stigma and negative outcomes such as physical and mental health problems. The social networks of PWLD are, however, often more restricted than those of the general population. There has been very little research which has explored the views and experiences of PWLD about their social and sexual relationships. A systematic review of the qualitative research surrounding the sexual relationships of PWLD was conducted. Eleven studies were reviewed, which revealed five themes: ‘A lack of knowledge regarding sexual relationships’, ‘Sexual relationships as restricted and regulated’, ‘Sexual relationships perceived as wrong’, ‘Sexual relationships being desired’, and ‘Sex as a negative experience’. Positive developments in the attitudes of others and supports were described, but the impact and influence of stigma, assumption, ignorance and a lack of autonomy regarding sexual relationships were dominantly reported. However, the findings of the reviewed studies must be considered with caution due to methodological limitations. The current study aimed to build on the existing qualitative research by exploring the experiences and perceptions of both sexual and close relationships for PWLD. Method: Data were gathered from ten PWLD using one to one semi-structured interviews. Interviews were recorded, transcribed and analysed using Interpretive Phenomenological Analysis. Results: Five super-ordinate themes were identified; ‘Relationships feeling safe and being useful’, ‘Who’s in charge?’, ‘Struggling for an ordinary life’, ‘Touching people in relationships’ and ‘Hidden feelings’. The findings were shared with participants who confirmed their relevance in the lives of PWLD. ‘Touching people in relationships’ is presented separately within a journal article format. Discussion: The findings suggest that fundamental components of close relationships were feeling safe and receiving some form of positive gain. The lack of agency participants experienced limited the development of these aspects, whilst also preventing the ability to live an ‘ordinary existence’, which included physically intimate relationships for many individuals. Finally, participant’s feelings were generally unclear, which could be related to being interviewed by a relative stranger or emotional expression difficulties. Based upon these findings it is considered that those who support PWLD should focus their assistance on addressing negative attitudes and redressing the power imbalance to facilitate an ‘ordinary existence’ for these individuals, which may indirectly enable them to naturally develop safe and useful relationships. It is also possible that reducing the barriers and stigma surrounding close relationships would open up communication regarding this area, which could indirectly promote PWLD ability to express their emotions regarding relationships. Conclusions: The research provides a greater insight into the lived experience of close relationships for PWLD. Participants valued close relationships that were safe and useful, but their ability to develop and maintain these was described as being restricted by other people and service rules. It is proposed that those supporting PWLD need to balance protective action against the freedom and choice required to develop and maintain close relationships, as restricting the already limited social networks of this population will negatively impact upon their quality of life.

Developmental dyslexia is widely believed to be caused either mainly or in part by an impairment of phonological representations. Although this hypothesis predicts that individuals with dyslexia should show deficits in tasks which require the use of implicit phonological knowledge, this has not yet been directly tested, as the evidence cited in support of this hypothesis usually comes from metalinguistic tasks which demand explicit awareness of phonological units. Additionally, since the ability to perform metalinguistic tasks which involve phonological segments can be enhanced by an individual’s competence in alphabetic literacy, the possibility remains that phonological skills may have been inadequately isolated from the influences of literacy acquisition in many cases. The study reported in this thesis investigated both the representations and the metalinguistic skills of a group of adults with a history of developmental dyslexia, examining areas of phonology which do and do not have orthographic counterparts. To isolate phonological skills from orthographic skills, the representations of conventional segmental contrasts (e.g. /k/ vs /g/) were compared with the representation of suprasegmental contrasts (as seen in minimal pairs such as ′toy factory and toy ′factory), which have no orthographic counterpart. Basic metalinguistic skills were tested by means of a phonological awareness task targeting both segmental and suprasegmental units, and phonological manipulation skills were tested using a Pig Latin task and a Spoonerism task, where participants were required to manipulate both segmental and suprasegmental units (e.g. extracting the segment /b/ from consonant clusters and the main stress from SWW or WSW stress patterns). The results showed that although the performance of the dyslexic group was weaker than that of the control group when tasks required the manipulation of either the segmental or suprasegmental components of words, no evidence was found for a deficit in the tasks which drew on implicit representations or basic metalinguistic skills. These findings suggest that the phonological deficit in dyslexia may be restricted to the ability to manipulate phonological units rather than in the representation of them per se.

This thesis addresses the complexity of the experiences of severely distressed contemporary combat veterans in the Western world. It examines the specific features of their affliction that is not accounted adequately for either by the existing psychiatric approach to mental health disorders or by the complementary psycho-philosophical “moral injury” paradigm. Following a systematic review of the relevant literature, a new approach is proposed to address these distressing phenomena of combat-related disorientation based on thymos, an ancient Greek anthropological concept. The “moral injury” paradigm has previously examined the relevance of thymos in contemporary veteran care, but has limited its consideration to Homeric material, and has also cross-interpreted the concept through modern psychological and physiological lenses in order to develop clinical applications. The original contribution of this thesis is the provision of a diachronic lens for investigating thymos in its organic philosophical context from Homer through the Golden Age of Greek philosophy, the teachings of early Christianity, and its current use in Eastern Orthodox Christian monastic tradition. This diachronic perspective provides an existential understanding of certain features of such combat-related disorientation that were previously unidentified. More specifically, it discerns a systemic dysregulation of three essential capacities for human flourishing that can occur, often sequentially, after exposure to intensely adverse events in combat: primary emotion, instinctive motivation to action, and moral intuition. Moreover, it develops a comprehensive account of two distinct features that are previously not addressed sufficiently: (1) the enduring sense of self-horror after a perceived “absorption of evil” in battle, and (2) radical loss of the ability to attribute meaning to events or to maintain narrative coherence of life’s experiences.

A theoretical model of eating disorders called the shame and pride model has suggested that pride is a key psychological mechanism underpinning restrictive eating disorders and that it is also important in the maintenance of such conditions. Despite being included in this model, pride has been little investigated in the eating disorders field, especially when compared to shame, which has received extensive theoretical and empirical attention. Therefore, the overall aim of this PhD thesis was to investigate the role of pride related to eating disorders and its relation to motivation to change in clinical and non-clinical samples. Firstly, a systematic mixed studies review was conducted to examine the empirical evidence concerning pride and eating disorders. This review showed that this is an under-researched area (only 10 studies were identified). However, it provided initial evidence highlighting that low levels of pride in physical appearance precipitated the onset of eating disorder behaviours, such as food restriction, binge eating, and purging. It also suggested that over time, high levels of pride experienced through the ability to control food/calorie intake and weight loss, appeared to maintain eating disorders. Secondly, three empirical studies were conducted; a qualitative study, followed by two quantitative studies. The grounded theory qualitative study aimed to understand the meaning of pride in eating disorders from the perspective of women with anorexia nervosa. The second study aimed to develop and validate a measure to assess the component structure of pride in eating pathology. The third study investigated, over a period of 12 months: i. whether pride in eating pathology acted as a mediator between anorexia nervosa symptoms and the precontemplation stage of change (i.e. no motivation to change), and ii. whether pride in healthy weight and healthy eating interacted with anorexia nervosa symptoms to predict the action stage of change (i.e. actively engaging to change eating disorder behaviours). Both qualitative and exploratory component analysis indicated that pride in eating pathology is a multidimensional self-conscious emotion that is comprised of unhealthy and healthy aspects. In addition, findings from the qualitative study and the longitudinal mediational study demonstrated that pride in eating pathology evolves over time and predicted people’s unwillingness to change eating disorder behaviours after a year. Finally, results from the longitudinal moderational analysis revealed that pride in healthy weight and healthy eating did not act as a moderator between anorexia symptoms and being in the action stage to change eating disorder behaviours at 12 months. However, the qualitative study revealed that pride related to healthy eating behaviours promotes recovery in a clinical sample. Results from this PhD thesis provide empirical evidence to further develop the shame and pride model postulated by Goss and Gilbert (2002) and highlight the role of pride as a precipitating and maintaining factor of eating disorder behaviours. In addition, it was found that pride in eating disorders influences motivation to change. Clinical implications of the findings from these empirical studies are discussed throughout the PhD thesis, along with directions for future research.