High health anxiety has negative repercussions at the individual, interpersonal, and societal levels. According to cognitive behavioural theory, health anxiety is maintained, in part, by behavioural factors, termed safety behaviours. Health-related Internet use (HRIU) may be an important safety behaviour for some health anxious individuals. The Internet offers an abundance of health information, and opportunities to engage in health-related behaviours. Paper 1 aims to establish what is known about the relationship between health anxiety and HRIU. A systematic search was undertaken to identify studies that fell into five broad categories. The identified studies (N = 30) were then narratively reviewed, with an emphasis on methodological quality, and consideration also given to clinical implications and directions for future research. The review indicated that research to date has focused almost entirely on the relationship between health anxiety and using the Internet to obtain health information, termed online health research (OHR). Health anxiety appears associated with amount of, and emotional response to, OHR. The majority of existing studies are cross-sectional. Many use unvalidated measures of HRIU, and/or convenience samples recruited from universities or via commercial services. The Cyberchondria Severity Scale has potential clinical utility as a measure of a specific health anxiety maintenance cycle. However, there is a need for a more general instrument that can be used to assess various dimensions of HRIU in a validated manner. Paper 2 is a cross-sectional, correlational study of relationships between HRIU, health anxiety, and health service utilisation in a clinical, help-seeking sample. Participants were recruited from primary care practices, and completed questionnaire measures. Extent and nature of HRIU, and emotional and behavioural responses to HRIU, were measured using the Online Health Beliefs and Behaviour Inventory (OHBBI). The OHBBI is a recently developed measure that has undergone preliminary psychometric validation. OHBBI subscales explained 30% of variance in health anxiety, but did not improve prediction of self-reported service utilisation. A moderated regression indicated that the relationship between the Illness-Focused Searching subscale and health service utilisation varied as a function of health anxiety, with a negative relationship at low levels of health anxiety, and a positive relationship at high levels. This study provides further evidence of a role for HRIU in the maintenance of health anxiety, and advances the literature by using a validated measure of HRIU, a clinical sample, and well-controlled models. Paper 3 is a critical, reflective appraisal of the thesis as a whole. Methodological decisions, and their ramifications, are discussed in detail. The importance of the thesis is summarised, and implications for clinical practice and future research are revisited. The OHBBI requires further psychometric refinement. Longitudinal studies, and studies that use objective measures of service utilisation, are needed. Safety behaviours, including various forms of HRIU, may interact with each other to perpetuate health anxiety; such complex maintenance cycles merit empirical investigation.

In their day-to-day tasks, police officers are repeatedly subjected to stressful and traumatic events and as such are at significant risk of developing post - traumatic stress disorder (PTSD). There is a wealth of literature exploring risk and protective factors, however there is still a need to develop our understanding of specific factors which may be unique to the police. In light of this need, two potential factors have been identified for this current research, burnout and social connectedness. Burnout relates to a culmination of stress which is unmanaged and untreated. Social connectedness relates to the internal experience of feeling connected to others and the world around. This thesis is primarily concerned with exploring the relationship between these factors and PTSD and general distress within the context of the police force. This research took place within one UK police force. In total, 93 participants from specialist departments at high risk of exposure to trauma took part in an online survey. The survey included self-report measures of burnout, social connectedness, Post-Traumatic Stress Disorder (PTSD) and general distress. Non-standardised measures also sought to capture demographic information and an additional outcome variable of sickness absence. A series of multiple forced-entry regressions were carried out. Increased symptoms of exhaustion (one aspect of burnout), significantly predicted increased PTSD symptom severity. Further exploratory analyses found that exhaustion significantly predicted two of the four PTSD symptom clusters: intrusion and alterations in arousal and reactivity. The same multiple regression analysis indicated that social connectedness made a significant contribution to the model predicting PTSD symptom severity, greater than that of exhaustion. It was also found that increased symptoms of exhaustion significantly predicted increased general distress, whereas disengagement (a further aspect of burnout) and social connectedness did not. Lastly, it was found that none of the predictor variables made a significant contribution to the model predicting sickness absence. These findings are discussed in terms of their theoretical and clinical implications.

Objective: Childhood abuse (CA) is commonly associated with increased frequency of high-risk behaviours (HRB) in adolescence. Similarly, research has highlighted links between CA and blunted responses to reward. To date, little attention has been devoted to examine if altered reward processes may also be linked to increased engagement in HRB. To explore this hypothesis, this systematic review collated research that investigated the relationship among CA, reward processes and HRB. Specifically, the review addressed the question: Are HRB associated with altered reward processes in children and adults with a history of CA? Method: Behavioural and neurobiological studies on CA, reward processing and HRB in children and adults were selected from multidisciplinary and subject-specific databases published prior to the 1st of March 2016. The systematic literature search yielded 271 records with 198 non-duplicated results. Screening of 14 full-text publications led to five eligible studies synthesized in this review. Results: Results confirmed impaired reward learning and increased HRB in those with a history of CA. Associations of blunted anticipatory or consummatory reward processing and HRB in individuals with CA remained inconclusive. Conclusions: Reward learning appears to be associated with CA. Further research is required to explore the relationship between reward processes and HRB. Understanding CA from a neurodevelopment perspective is a critical step to developing effective intervention strategies to reduce HRB. Empirical Paper: Abstract Objective: Following childhood abuse (CA), adolescence often sees the onset of depression and high-risk behaviour (HRB). Despite the prevalence, little is known about underlying neurobiological factors linking CA and HRB. To address this gap, I examined if anticipatory and consummatory reward processing in adolescents with CA predict frequency of HRB, irrespective of depressive symptoms. Methods: Thirty-seven adolescents (M=17.08 years; SD = 1.86) participated in the study: 13 females with CA and current major depressive disorder (MDD), eight females with MDD and no CA, and 16 individuals with no CA and no MDD for comparison (control group). Adolescents completed the Card-Guessing paradigm to assess reward processing, while undergoing a magnetic resonance imaging scan. Neural region-of-interest responses in the striatum and pallidum were assessed during anticipatory and consummatory reward phases. Hierarchical regression models investigated if neural responses to reward were altered based on exposure to CA and if altered neural responses predicted higher use of HRB. Results: Data showed that (1) depressed adolescents engaged more frequently in HRB irrespective of history of CA, (2) anticipatory and consummatory reward processes were not altered based on a history of CA, and (3) blunted activation in right pallidum in anticipation of rewards predicted HRB irrespective of depressive symptoms. Conclusion: Although the current study did not confirm changes in reward processing following CA, blunted reward ‘wanting’ was linked to more frequent HRB. Findings are relevant to theories highlighting the critical role of the pallidum in perceiving cues as rewarding and in initiating goal-directed actions to obtain rewards.

Background: There is increasing theoretical interest in the idea that a greater tendency for the mind to wander may reduce positive emotion experience, with specific interest in clinical conditions such as depression that are characterised by reduced pleasure experience (anhedonia). However, it is unclear to what degree these claims are empirically supported. Objective: A systematic review was conducted to examine the evidence regarding the association between mind wandering and positive emotion experience. Method: The Cochrane library, MEDLINE, PsycINFO, and Web of Knowledge databases were searched. A narrative discussion considered both the pattern of findings and the methodological approaches utilised in this literature. Results: 879 studies were identified and 21 relevant papers were fully reviewed, consisting of cross-sectional, prospective and manipulation studies. Conclusions: Fourteen out of 15 cross-sectional studies supported the claim that increased mind wandering was related to decreased pleasure experience. One prospective study indicated that mind wandering generally preceded but was not subsequent to reductions in positive mood. There were six studies that manipulated mind wandering experimentally, four of which found that inducing greater mind wandering led to reduced positive affect and two of which found null results. Overall, this literature supports the claim that greater mind wandering is related to reduced positive affect. However, very few studies examined this relationship in the context of depression and therefore it remains to be established if these findings generalise to clinical populations. Empiricial Paper: Previous research has established that greater levels of mind wandering are associated with reduced positive affect (PA) in the general population. The present study aims to examine whether this mechanism may mediate the relationship between depression and reduced PA (anhedonia). A community sample (N = 69) with differing levels of depression severity took part. Using experience sampling methodology, we measured mind wandering and PA during everyday life and when completing a few scheduled positive activities. To examine if mind wandering specifically influenced PA or emotion experience more generally, we additionally measured levels of negative affect (NA). Across both contexts, both greater mind wandering and greater depression severity were independently associated with reduced PA and increased NA. Greater depression severity was associated with increasing levels of mind wandering in everyday life, but not during scheduled positive activities. Mind wandering did not mediate the link between depression and reduced PA/increased NA. Exploratory analyses did however reveal that a greater tendency for the mind wander to negative rather than positive themes did mediate the link between depression and reduced PA in everyday life. We replicated previous findings that increased mind wandering is related to reduced PA and increased NA but there was no evidence that this mediated the relationship between depression and altered affective experience. However, the greater tendency for the mind to wander to negative themes may mediate the link between depression and affect. If depression treatment approaches are to target mind wandering this suggests they should therefore focus on mind wandering valence in addition to extent.

According to the Office of National Statistics (2011), approximately six million people provide unpaid care to a family member. The growth of interest in the carer role has helped establish the idea that the provision of informal care warrants attention because of the relationship between caring and burden. It has been suggested that living with someone with depression is comparable to that of other serious mental health problems, such as schizophrenia or dementia. Furthermore, there is evidence that partners are most at risk of burden within the informal caregiving context. The meta-ethnography of existing research indicates that qualitative studies which specifically explore the experiences of living with a family member with depression are somewhat heterogeneous regarding types of relationship with the depressed individual. Combining different relationships (e.g. partners, siblings and parents) within the same study makes it difficult to disentangle data and therefore gaining an in-depth understanding of specific experiences is almost impossible. This study therefore aimed to explore the experiences of living with a partner with depression. In-depth interviews were conducted with nine female and four male participants who live with a partner with depression. A critical realist perspective was held and data was analysed using Braun and Clarke’s six phases of thematic analysis (2006), with the assistance of MAXQDA. Results identified five key themes: ‘making sense of the depression’; ‘the depression cannot be compartmentalised’; ‘a light at the end of the tunnel’; ‘learning to navigate the ‘depression’ maze’; and ‘gaining a new perspective’. The findings illustrate that living with a partner with depression is not a static process and that the needs of the depressed partner are constantly changing. Furthermore, although the findings outline a sequential process that appears cyclical in nature, recognition is given that the phases are dynamic and may overlap. Clinical implications and recommendations are discussed within the context of the Care Act (2014).

Understanding the brain in both health and disease is of critical practical importance as well as fundamental scientific interest. The acute neural tissue slice is a widely used experimental preparation, it facilitates treatments and measurements not practical in vivo while preserving a largely connected network representative of the true in vivo structure. This thesis presents the development of two techniques for the study of the acute neural tissue slice, both particularly well suited to the study of epilepsy, followed by an application of one of these techniques. A slice chamber is presented that allows extended regions of a tissue slice to be exposed, in isolation, to changes in ionic environment or pharmacological manipulation, readily providing an entirely in vitro model of focal epilepsy. Secondly, a transformation is derived that converts the slow dynamics of the intrinsic optical signal (IOS) associated with neuronal activity both in vivo and in vitro to the form of the associated local field potential, allowing the advantages of the IOS to be exploited while mitigating the primary disadvantage - the lack of direct correspondence between the IOS and the associated network dynamics. Finally a study is presented that employs the transformation of the IOS to facilitate a quantitative characterisation of the spatio-temporal dynamics of adenosine release in response to electrographic seizure activity.

Background: Adolescent-to-Parent Violence and Abuse (APVA) continues to be one of the most hidden forms of family-abuse, remaining unrecognised at a policy level and under-researched at a theoretical level, especially in the United Kingdom. Although research has started to emerge, much of this has focussed on mapping the nature and extent of the phenomena with limited attention given to parents' lived experiences of parenting in the context of the adolescent child-to-parent abuse dynamic, which this study attempts to address. Given the complexities of accessing parent-victims of APVA, qualitative researchers have employed somewhat innovative methods, though Interpretative Phenomenological Analysis (IPA) as used within the present study has been relatively overlooked having not been previously used in the UK, highlighting the need for additional research from wider perspectives into the area. Aim: With this in mind, the current study aimed to explore the lived experience of parents who describe being violently and/or abused by their adolescent child to gather a richer understanding of how adolescent-to-parent violence and abuse impacts upon the parenting experience. Method: This research employed a qualitative design using semi-structured interviews with 6 parents (5 mothers and 1 father); the majority of whom were in their early to late 40's. Interpretative Phenomenological Analysis (IPA) was used to develop a rich and multi-layered account of participants' experiences. Results: The analysis produced four superordinate themes. These were: 'Not knowing and the search for answers': Needing to understand, "I love him but I don't like him": Facing and avoiding complex emotions, "Like playing chess with the grand master": Parenting amidst abuse and "I won't be defined by fear": Temporality and seeking change. The superordinate themes and corresponding subordinate themes are discussed in relation to the relevant literature. Clinical implications, methodological considerations and directions for future research are also presented. Implications: This research provided insight into the lived experience of being a parent within an APVA dynamic. The research highlighted the challenges faced by parents as they maintain parental responsibility for a child who is perceptibly abusing them and the ways that the current systems and absence of policy serve to maintain this dynamic. It also emphasised the importance of how parents seek to identify causation as a way of negating parental blame and the associated experience of shame which emerged as underpinning wider complex emotions, particularly fear. It also highlighted the need for timely and specific guidance, support and interventions to parents who experience this unique yet increasingly reported form of family-abuse from a Clinical Psychology and wider professional perspective.

Background: Despite the so-called "generalised" nature of many epileptic seizures, patient specific spatio-temporal properties have been shown using imaging data at the macroscopic level of the cortex. Previous computational models have failed to account for spatial heterogeneities at the scale of the entire cortex. Furthermore, one of they key benefits of developing a model is the ability to easily test stimulation protocols. Previous studies of generalised spike-wave (the hallmark of absence epilepsy) have abstracted away from this.METHODSIn this work we develop a set of models of epileptic activity, one of which is at the scale of the entire cortex and incorporates anatomically relevant connectivity from human subjects. A similar model incorporating physiologically relevant thalamocortical circuitry is developed in order to test hypotheses regarding stimulation protocols.RESULTSWe show that the model can account for large-scale spatio-temporal dynamics similar to those seen in epileptic patients. We demonstrate, using the model of thalamocortical interaction, that such a modelling approach can be used for the evaluation of stimulation protocols which are shown to successfully abort the seizure prematurely.CONCLUSIONThis work highlights the importance of computational modelling to support existing data and to make specific predictions regarding testable hypotheses. For example, a stimulus given at the correct time with the correct amplitude will stop the seizure.

Introduction: Schizotypy is a personality trait that shares some of the characteristics of clinical disorders such as schizophrenia. Similarities are found in expression of psychotic-like experiences and presence of attenuated negative signs. Furthermore, schizotypal samples are associated with impairments in cognitive tasks, albeit in a less comprised form. For these reasons and others, schizotypy is considered a part of the extended-phenotype of schizophrenia and as such can be utilised as an analogue sample without some of theconfounds associated with illness. Objective: The aim of the PhD is to examine the relationship of schizotypal features and brain function and structure in a sample of adolescents and young adults (age 16-25 years). This will attempt to provide further evidence for the placement of schizotypy on the continuum, along with insights into pathophysiological mechanisms involved in schizophrenia and related disorders. Methods: The study involved three main phases: recruitment via an online survey, further neuropsychological testing and brain imaging on selected high schizotypes and controls. The thesis comprises 5 papers/experiments. Paper 1 utilises confirmatory factor analysis (CFA) to examine the factorial structure of the schizotypal personality questionnaire (SPQ) in a community sample aged 16-25 years. It also examined the effects of demographics on schizotypal levels. Paper 2 examined the association between schizotypy and measures of sustained attention and spatial working memory both in a total sample, and in samples split by age and by sex. Paper 3 further examined the association between schizotypy and cognition laboratory tests of attention, executive function and verbal learning/memory. Paper 4 tested the same participants on measures of functional brain asymmetry. Paper 5 used diffusion tensor imaging (DTI) to examine white matter structures in a sample of high schizotypes and controls. Results: Paper 1 confirmed that the SPQ is most appropriately modelled by a four-factor structure in an adolescent and young adult sample. Demographic effects on SPQ subscales scores mirrored those seen in clinical samples. Paper 2 found that where small associations between schizotypy and sustained attention/spatial working memory function occurred, these were in relation to either age of sex. Paper 3 demonstrated an association between increased schizotypal features and a slight reduction in performance on verbal learning/memory, but no association with tasks of executive function or attention. In Paper 4, schizotypy was associated with a left-hemifield bias on a computerised line bisection task. Paper 5 found that a group of high schizotypes had an increase in tract coherence in the uncinate fasciculus compared to controls. Furthermore, increasing subclinical hallucinatory experiences were associated with increased tract coherence in the right hemisphere arcuate fasciculus. Conclusions: Schizotypy was associated with changes in brain function and structure similar to that demonstrated in more serious mental illness, although to a lesser degree. The current studies suggested that schizotypy is associated with relatively intact prefrontal function, but slight performance bias on measures of medial temporal lobe function. There was also evidence for structural brain changes in schizotypes, with these being indicative of either a protective factor, or a marker of a pathological process. Correlations between hallucinatory experiences and white matter tracts between language regions support theories implicating hyperconnectivity and presentation of symptoms in clinical groups. The functional and structural data collected from this study suggests that the ‘schizotypal’ brain may represent an ‘early’ stage of pathology, but which is likely to be compensated enough such that transition to serious mental illness is unlikely. Further studies could examine similarities and differences between the schizotypal profile and clinical conditions, which would provide further insights into aetiological mechanisms in schizophrenia/psychosis.

Background: Eating disorders are commonly occurring illnesses that frequently cause substantial physical, emotional and psychosocial impairments (Fairburn, et al., 2008). The prevalence of this debilitating condition has led to substantial efforts by researchers and clinicians to search for different ways of understanding the illness for the sole purpose of increasing the presently poor treatment outcomes. Existing theoretical and research literature looking at the role of shame and guilt in eating disorders have put forward a convincing assertion that shame and guilt are poignant features in the psychopathology and symptomatology of the condition. However, these reports have not provided in-depth explanation into how people suffering from eating disorders experience shame and guilt and very little qualitative research has been conducted in this area. Likewise, the interwoven relationship and the differences between shame and guilt and their role in eating disorders psychopathology and symptomatology remain unclear. Aims and Method: The present study is an Interpretative Phenomenological Analysis (IPA) that recognises the uniqueness of an individual’s experience of complex phenomenon such as eating disorder. Thus it aims to explore the understanding and sense-making of shame and guilt experiences by listening to the voices of six people who have been diagnosed and treated for eating disorders using semi-structured interviewing method. The study also explores the role of shame and guilt in treatment particularly their implication in the disclosure of information in the course of treatment. Findings and Discussion: The analysis identified five main themes; the intensity of shame and guilt experience AND the pervasiveness of shame and guilt experience, Guilt and shame as integrated into all facets of the ED, Existential questioning of identity, shame and guilt lived out and developed in different context/ Locus of responsibility. Contribution to knowledge: The study provides deeper understanding of participants’ subjective experience of shame and guilt. The study highlights that shame and guilt are experiences that are intertwined with all facets of eating disorders as well as the individual’s identity. Finally, shame and guilt were described as experiences that negatively impacted on treatment process. The implications of this for counseling psychology practice are discussed, and suggestions for future research are made.