Background and Aims: Anxiety is one of the most frequently occurring psychological disorders in children and adolescents. Interventions for child and adolescent anxiety to date have focused on 'traditional' cognitive-behavioural approaches. Whilst these have been shown to be effective in approximately 56% of cases (e.g. Cartwright-Hatton, Roberts, Chitsabesan, Fothergill and Harrington, 2004) a significant proportion do not benefit. An information processing theory of emotional disorder, the Self-Regulatory Executive Function Model (Wells and Matthews, 1994), suggests that dysfunctional attentional processing, such as heightened self-focus and rumination, maintain emotional disorders. Attention Training Technique (AIT; Wells, 1990; 2000), was developed with the aim of reducing dysfunctional self-focused thinking and allowing the individual to develop conscious attentional control over processing. Preliminary case series have shown the effectiveness of AIT in reducing anxiety in adults. The main aim of the current study was to test the effectiveness of AIT on an analogue-clinical sample of adolescents with high trait anxiety using a case series design. A secondary aim was to investigate correlations between anxiety, self-consciousness and attentional control. This study represents the first attempt to investigate AIT in an adolescent population. Method: A total of 110 participants were involved in the screening stage which involved completing the State-Trait Anxiety Inventory (STAI, Spielberger, 1983); the Attention Control Scale (ACS, Derryberry & Reed, 2002) and the Public and Private Self Consciousness Scale - Revised (SCS-R, Sheier & Carver, 1985). Six participants were involved in the case series investigating the effects of AIT. The case series employed a multiple baseline A-B design with follow up (Barlow & Hersen, 1984). The participants were allocated to baselines ranging from 3-6 weeks, during which they completed weekly questionnaires, prior to the four week AIT phase. AIT was delivered on a once-weekly basis, and daily home practice was set using CD versions of ATT. Standardised measures (STAI, ACS and SCS-R) were administered on a weekly basis. Results: The screening stage found a significant correlation between attentional control and trait anxiety, consistent with previous research with children. In addition, a significant correlation was found between trait anxiety and self-consciousness, consistent with previous research with adult samples. The case series provided little overall support for the positive impact of AIT on the standardised measures. Following AIT, two out of six participants showed reductions in trait anxiety scores; one out of six showed a reduction in state anxiety scores; one out of six participants showed a small increase in attentional control; and finally there was no convincing evidence for a decrease in private self consciousness for any participants. Conclusions: This study did not demonstrate the effectiveness of AIT in the population under investigation. It is not possible to draw any firm conclusions ab.out the effectiveness or otherwise of AIT in this population due to the small sample size. Potential reasons for the findings are discussed with reference to the apphcablhty of this technique to younger populations. The strengths and limitations of the study are outlined, along with the clinical implications and directions for future research.

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Schizotypy is traditionally conceptualised as a personality trait reflecting vulnerability to the opment of psychosis. This thesis introduces the concept of schizotypal symptoms as state phenomena, related to both the development of psychotic symptoms, and to long-term recovery from the disorder, ft is argued that schizotypal symptoms may be at the core of psychosis, occurring both prior to onset and following the remission of an acute psychotic episode. Schizotypal symptoms may therefore provide a bridge for the symptom-disability gap which has long been established in psychosis.

The investigation of associations between places, people and mental health is complicated and there are serious limitations in the current methodology. Using data from the Caerphilly Health and Social Needs Study (CHSNS), as well as the British Household Panel Survey, this thesis investigated some of these methodological issues. Firstly, motivated by the skewed distribution of the Mental Health Inventory (MHI-5), methods for analysing the mental health score were examined. Five methods for deriving a cutpoint on the MHI-5 based on linking with the General Health Questionnaire, were investigated and cutpoints derived for each. These outpoints and methods were compared and contrasted. When investigating associations between place and health, hierarchical modelling is an extremely useful tool. Sparse levels of information are a potential problem when using this method. In the CHSNS, households represent a sparse level of context. A simulation study was conducted to explore the effect of sparse levels on the results of hierarchical analyses. It was found that, in general, the underestimation of fixed effect standard errors is smaller when a sparse level is included than when it is excluded. Another methodological consideration for hierarchical modelling concerns the choice of geographical hierarchy to use. Administrative hierarchies have been criticised for being heterogeneous and arbitrary. An algorithm was developed to partition regions into areas that are homogenous with respect to a given set of variables, and was applied to Caerphilly county borough. The resulting sets of boundaries were compared with the 2001 census administrative boundaries. These new boundaries performed favourably in comparison with the administrative boundaries, indicating that administrative boundaries may not represent the most suitable hierarchy to employ in hierarchical analyses. The thesis has led to a greater understanding of the effects of context on multilevel analysis and contributed to the area-effects on health literature.