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A qualitative exploration was conducted of the conceptualisations of the process of change held by 10 independently employed health psychologist and counselling practitioners who work with clients with chronic health conditions in a context parallel to primary care. The health psychologists were in their early careers while the counsellors were older and had practiced longer. A thematic analysis of responses to semi-structured interviews found commonalities in intervention beliefs among the participants from the two professions, sharing two overarching themes of “Change can be prompted by expert techniques” and “Providing love and safety lets change happen”. These themes were believed to facilitate an end-state of healthy change in the patient/client. The health psychologists appeared to believe that techniques based on theories and evidence provided an appropriate basis for intervention while the counsellors appeared to believe that an eclectic mix of relational theory and selected techniques were sufficient to support their approach. The health psychologists and counsellors approached their clients/patients with different objectives, with the health psychologists focused on improved outcomes while the counsellors focused on the quality of the therapeutic relationship. A sub-theme of “Frustrated by lack of therapeutic skills” was derived from some of the health psychologists who believed that a lack of training in relational skills inhibited the quality and possibly the efficaciousness of face-to-face interventions whereas the counsellors appeared more confident in their practice and exhibited no similar frustration with their approach. It is suggested that the expert procedures in the Trans-Theoretical Model of behaviour change could provide the basis for additional relational training for health psychologists as this model derives from psychotherapeutic change theory and practice. Further research should be carried out to explore and test the utility of combining health psychological theory and evidence with relational approaches in health interventions in clients/patients with common chronic conditions.

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Overview of the Thesis Research interest in body image has accelerated in recent decades. As such, there exists a substantial body of literature examining affective and behavioural correlates of body dissatisfaction. Although this literature has consistently demonstrated positive relationships between body dissatisfaction and depression, social physique anxiety, disordered eating and physical inactivity, the underlying mechanisms of the relationships between one's body image and affect remain poorly understood. Furthermore, although body image researchers have commonly examined discrepancies between one's current (or actual) self and one's ideal self, they have not commonly done so within an established theoretical framework. Higgins' (1987) self-discrepancy theory proposes that individuals possess three selves: an actual self, an ideal self, and an ought self; and that discrepancies between these selves result in distinct emotional consequences. Furthermore, it has been proposed that individuals possess a feared self, which may act as a moderator of the relationships between ideal and ought selves, and affect. Although this proposal has begun to receive research attention within the global self-discrepancy literature, it has yet to be examined within the context of body image. As such, utilising a self-discrepancy theory framework, this thesis presents a detailed examination of ideal, ought and feared body image self-discrepancies and their interactions as predictors of social physique anxiety, body dissatisfaction and disordered eating attitudes. The first study extends the work of Carver et al. (1999) and W oodman and Hemmings (2008) by examining the moderating role of the feared self in the relationship between women's ought body fat discrepancies and social physique anxiety. Specifically, we examined the hypothesis that the positive relationship between ought body fat discrepancies and social physique anxiety will be stronger when women are farther from their feared self. Results were in line with that hypothesised and provide initial support for such an interaction framework in examining body self-discrepancies; highlighting the importance of considering the role ofthe feared self in the relationship between body self- discrepancies and social physique anxiety. Study 2 was an examination of the interaction between ought and feared body fat discrepancies in predicting social physique anxiety and disordered eating attitudes. Study 2 extended the fmdings of Study 1 by examining a model of mediated moderation such that ought and feared discrepancies interact to significantly predict disordered eating attitudes, 11 III and that this relationship is mediated by social physique anxiety. Results demonstrated that the ought x feared interaction on disordered eating attitudes was fully mediated by social physique anxiety. However, the form ofthe ought x feared interaction was in contrast to that hypothesised (cf. Study 1). Specifically, the positive relationship between ought body fat discrepancies and disordered eating attitudes was significant only when women were close to their feared self. Study 3 addressed the growing body of correlational and experimental literature examining the effects of acute exposure to media ideals on body image and associated affect (e.g., Halliwell & Dittmar, 2004, 2005). We extended this by examining the moderating role of exposure to media ideals on the relationship between body discrepancy magnitude and affect. Specifically, we examined whether the positive relationships between ideal discrepancies and body dissatisfaction; and ought body discrepancies and social physique anxiety, are attenuated by exposure to media ideals. Results provided support for these hypotheses such that the positive relationship between ideal body discrepancies & body satisfaction, and ought body discrepancies & social physique anxiety, were weaker following exposure to media ideals compared to a control condition. Utilising a hierarchical linear modelling approach, Study 4 examined within-person variability in the specific shape of interactions between self-guides in predicting social physique anxiety. Specifically, we examined whether the moderating role of the feared self differs as a function of mean levels of social physique anxiety. Results demonstrated a three-way cross-level interaction such that when mean social physique anxiety was high, the positive relationship between ideal discrepancies and social physique anxiety was significant only when participants were relatively far from their feared self. In contrast, when mean social physique anxiety was low, the positive relationship between ideal discrepancies and social physique anxiety was significant only when participants were relatively close to their feared self. The fmal chapter presents a discussion of the central fmdings of the thesis and the advances made in understanding the interplay between body self-discrepancies in predicting affect. Furthermore, we discuss the implications and propose future directions for body image, social physique anxiety and self-discrepancy research.

Five studies tested a key tenet of the Elaborated Intrusion theory (EI theory; Kavanagh, Andrade & May, 2005), that intrusive thoughts play an active role in craving, as well as the predicted adverse effects of thought suppression and beneficial effects of mindfulness for coping with intrusive thoughts

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'Muscle dysmorphia' is a relatively new concept, primarily researched in the USA. It is used to describe those who experience distress because they perceive their physique to be inadequate and are consequently preoccupied by this, engaging in 'muscular enhancement strategies' such as excessive exercise, diet control, supplement use, and steroid abuse. The literature is divided as to whether muscle dysmorphia is best conceptualised within an eating disorder, obsessive-compulsive disorder, or body dysmorphic disorder framework. Several measures and a biopsychosocial model of muscle dysmorphia development have been proposed. This study aimed to investigate the suitability of one of the measures (the 'Muscle Dysmorphic Disorder Inventory': MDDI) for use with a male UK internet sample, and the predictive power of variables within Grieve's model on muscle dysmorphia symptomology (MDS).

La dépression et les troubles anxieux chroniques constituent une problématique majeure de santé publique et les stratégies pharmacologiques conventionnelles que sont les antidépresseurs apparaissent à la fois souvent d'une inefficacité limitée et potentiellement source d?iatrogénie. Pour mettre au point de nouveaux traitements la modélisation animale demeure une solution de choix pour évaluer les modifications comportementales induites par ces nouvelles molécules. La création de nouvelles modélisations plus performantes apparaît comme un champ d'investigation important afin d'optimiser le rôle de filtre de la recherche préclinique. L'objectif du travail que nous présentons et de proposer des traitements exploitant des nouvelles voies pharmacologiques comme celles interagissant avec les voies opioïdergiques ou présentant des propriétés anti-oxydantes. Les résultats présentés mettent ainsi en lumière à travers le test de la nage forcée chez le rat, les effets antidépresseurs d'un nouvel inhibiteur des enképhalinases, l'opiorphine, et d'un extrait polyphénolique de cacao. Nous présentons secondairement le développement de nouvelles modélisations animales chez le rat afin de mieux appréhender deux types de situations cliniques. Nous proposons d?une part une nouvelle modélisation éthologique de l'anxiété extrême dans laquelle plusieurs traitements de référence (fluoxétine en chronique et en aiguë, imipramine, diazépam et clonazépam) révèlent une efficacité comparable à celle observée en clinique dans le cadre du trouble panique. D'autre part, une modélisation associant une procédure de stress chronique modérée à une carence chronique en donneurs de méthyle (folates notamment) conduit à manifestations comportementales et des modifications neurobiochimiques originales dont le rapprochement avec certaines psychopathologies peut être discuté (dépression mélancolique et trouble panique). Les données que nous présentons sur l'évaluation de nouveaux traitements comme sur la mise au point de nouvelles modélisations posent des bases prometteuses pour la recherche sur les troubles anxio-dépressifs / Depression and chronic anxiety disorders are a major public health problem and conventional pharmacological strategies (antidepressants) appear often ineffective with a iatrogenic potential. In order to develop new treatments, animal models remain a solution of choice for evaluating the behavioral changes induced by these molecules. Creating new models more efficient seems to be a major field of investigation in order to optimize the role of filter of preclinical research. The objective of the work we present here is to propose some treatments exploiting new pharmacological tools like those with interaction with opioidergic pathways or with anti-oxidant properties. The results in the forced swimming test in rats show the antidepressant effects of a novel enkephalinase inhibitor, opiorphin, and of a cocoa polyphenolic extract. Secondarily, we present the development of new animal models in rats to better understand two types of clinical situations. We propose a new ethological model of extreme anxiety in which several reference treatments (chronic and acute fluoxetine, imipramine, diazepam and clonazepam) showed an efficacy comparable to that observed in panic disorder. On the other hand, a modeling procedure combining chronic mild stress to a chronic deficiency of methyl donors (folates in particular) leads to behavioral manifestations and neurobiochemical changes whose similarity with certain psychopathologies can be discussed (melancholic depression and panic disorder). The evaluation of new treatments and the development of new models set the foundations for promising research on anxiety-depressive disorders

L’objectif de ce travail était d’étudier l’évolution des symptômes dépressifs (SD) chez 2590 sujets âgés français, issus de la population générale et suivis pendant 20 ans entre 1988 et 2008. Une méthode d’analyse du changement fondée sur l’identification de trajectoires individuelles de développement a été utilisée afin de tenir compte de l’hétérogénéité pressentie dans cette population. Les facteurs et évènements évolutifs associés aux trajectoires de SD ont été étudiés. Nous avons identifié cinq trajectoires d’évolution de SD entre 1988 et 2008 et trois trajectoires entre 65 et 104 ans. La majorité des individus ne présentait pas ou peu de SD au cours des 20 ans de suivi. Cependant, environ une personne sur dix suivait une trajectoire compatible avec un diagnostic de dépression chronique. Les antécédents psychiatriques, la polymédication, les comorbidités somatiques et la perte d’autonomie étaient des facteurs fortement prédictifs de dépression « émergente » ou « persistante ». Le veuvage apparaissait être un facteur protecteur d’appartenance à la trajectoire de dépression « persistante » pour les femmes uniquement. L’entrée en institution et le décès étaient plus fréquents dans les trajectoires les plus défavorables. Les trajectoires de SD étaient significativement associées aux trajectoires de consommation d’antidépresseur. Notre travail confirme l’hétérogénéité de l’évolution des symptômes dépressifs en population âgée. Il alerte sur la prévalence préoccupante de la chronicité et aide à déterminer des sujets à plus haut risque d’évolution défavorable qui pourraient faire l’objet d’actions de prévention. / The aim of this study was to investigate patterns of the course of depressive symptoms (DS) in 2590 community-dwelling older adults followed over a period of 20 years, between 1988 and 2008. Using a group-based trajectory method, we modelled the course of DS and examined associations between trajectory patterns and baseline socio-demographic and health variables, as well as outcomes. We identified five time-related trajectories between 1988 and 2008, and three age-related trajectories between 65 and 104 years old. A majority of participants experienced no or only mild DS. However, about one to ten belonged to high-level trajectories consistent with clinically relevant chronic depression. Psychiatric history, polypharmacy, somatic comorbidities and functional limitation were strongly associated with membership to increasing and persistently high trajectories. Being widowed seemed to be a protective factor for membership of this persistently high trajectory group only in women. Institutionalization and death were more prevalent in worse trajectories. Trajectories of DS and trajectories of antidepressant use were significantly associated. Our study confirmed heterogeneity of the evolution of DS in late-life and highlighted the problematic risk of chronicity. We identified several high-risk groups for later-life depression that can be easily detected and that are amenable to preventive intervention.

L'exposition à une situation de stress entraine des réactions cognitives, affectives, physiologiques et comportementales. Ce travail de thèse s'est attaché à examiner des réponses affectives et physiologiques induites par une situation de stress modéré, plus particulièrement l'état d'anxiété et la tension musculaire, et a également considéré les caractéristiques de la situation et le trait d'anxiété des individus. Une première étude a montré chez des individus de traits d'anxiété différents une réactivité physiologique similaire au cours de la situation stressante, bien que les individus de trait d'anxiété "haut" aient rapporté un état d'anxiété plus élevé que les individus de trait d'anxiété "bas". En revanche, après la situation stressante, les individus de trait d'anxiété "haut" ont montré un délai dans la récupération de certains paramètres végétatifs et musculaires. Ces résultats ont suggéré que des différences dans les réponses physiologiques entre des individus de traits d'anxiété différents pourraient émerger au cours de la période de récupération. Ainsi, les réponses, qu'elles soient affectives ou physiologiques, pourraient dépendre du niveau de trait d'anxiété des individus. Les deux autres études ont montré chez des individus de trait d'anxiété homogène soumis à la situation stressante des patrons d'activation musculaire différents selon les muscles. Ces résultats ont suggéré un lien entre les différentes réponses musculaires et le rôle fonctionnel des muscles. Par ailleurs, les résultats ont montré une diminution de l'état d'anxiété et de ces réponses musculaires au cours d'une deuxième exposition à la situation stressante, excepté pour le muscle trapèze qui semble avoir une réactivité particulière liée à sa fonction. Toutefois, l'adaptation des réponses des différents muscles et de l'état d'anxiété suggère que les réponses affectives et musculaires pourraient être influencées par les caractéristiques de la situation (nouveauté et répétition). Finalement, l'ensemble de ces résultats suggère qu'il est important de considérer les caractéristiques de l'environnement et la personnalité des individus dans l'étude des réponses affectives et physiologiques en situation de stress / Exposure to stressful situations is typically associated with cognitive, affective, physiological and behavioral responses. The aim of this work was to examine the affective and physiological responses to moderate stress, particularly state anxiety and muscle tension and also to consider the characteristics of the situation and the trait anxiety of the subjects.Our results showed that high anxious subjects have a higher level of state-anxiety than low anxious subjects during the stressful task, but no difference in physiological reactivity has been found between both groups. However, after exposure to the stressful situation, high anxious subjects have delayed physiological recovery. This suggests that physiological differences might emerge during the recovery period according to trait anxiety level. Thus, affective and physiological responses could depend on trait anxiety level. Furthermore, our results showed in individuals with homogeneous trait anxiety level that muscle tension induced by the stressful situation could differ depending on the muscles. This result suggests a relationship between the different muscular responses and the functional role of the muscles. Moreover, the results showed that state anxiety and these muscular responses decrease during a second exposure to the same stressful situation, except for the trapezius muscle which seems to have a particular reactivity to the stressor. However, adaptation of these muscular modifications and of state anxiety suggests that affective and muscular responses could be influenced by the characteristics of the situation (novelty and repetition).In conclusion, these findings highlight the importance of considering the environmental characteristics and the personality trait of individuals in research on stress responses