Our understanding of psychotic symptoms can be improved by research exploring schizotypal traits in the general population. Investigating the trauma associated with adverse childhood experiences (ACE), and how these may influence coping resources (locus of control and self-esteem) and maladaptive coping is of interest as previous research indicates these variables may contribute to exacerbation of psychotic-like symptoms in clinical and non-clinical populations. This study used questionnaires posted as a survey on Amazon's Mechanical Turk website to gather information on the foregoing variables from 254 participants. Mediation analyses indicated that an external locus of control mediated the association between ACE and maladaptive coping; that maladaptive coping mediated the relationship between an external locus of control and schizotypal traits; and that maladaptive coping fully mediated the relationship between ACE and schizotypal traits. ACE was not associated with low self-esteem, though maladaptive coping mediated the relationship between low self-esteem and schizotypal traits. The results improve our understanding of the nature of the psychosis spectrum. Implications for future research are discussed.

No description available.

No description available.

Mindfulness Based Cognitive Therapy (MBCT) has been shown to be effective in preventing relapse of depression in adults who have experienced multiple episodes of depression and is recommended in the NICE guidelines (2009). More recent evidence has also indicated its efficacy in helping adults who are actively depressed. Increasing numbers of young people are diagnosed with depression. Depression is a disorder characterised by a recurrent course and there is notable continuity of depression into adulthood. Depression in children and young people is associated with significant impairment. This is of concern in terms of individual well-being and the future burden of a recurring mental health problem on the health and economic systems of the country. MBCT has been adapted for use with children and adolescents and has been shown to be feasible and acceptable in community and clinical settings. The research reported here examines the feasibility of establishing MBCT group therapy provision in National and Specialist CAMHS Mood Disorder Clinic for adolescents with depression. It also provides a pilot analysis of the efficacy of an MBCT group for young people who have received a course of psychological therapy but who present with residual symptoms and are at high risk of relapse. Treatment completers (n=3) report satisfaction with the therapy and qualitative analysis of feedback interviews with them provides areas for future development of this service. Pilot analysis revealed reduction in levels of depressive symptoms between pre and post treatment, alongside positive change in measures of mindfulness skills and cognitive processes such as rumination. Group MBCT was seen to be feasible and acceptable within this setting using quantitative and qualitative methodology. Information for the service on potential areas for future development is provided.

Amid calls from the World Health Organization (WHO) and Global Mental Health to ‘scale up’ psychiatric treatments, globally, there are other calls (sometimes from those who have received those treatments), to abolish psychiatric diagnostic systems and to acknowledge the harm caused by some medications. This thesis elaborates a space for these arguments to encounter and to be encountered by each other. This is a thesis about encounters; about psychiatry’s encounters with the global South; about research encounters in India with mental health Non-Governmental Organisations (NGOs); and about colonial encounters more generally. Drawing on analysis of interviews and visits to a range of mental health support provision in India, this thesis traces some conceptual and material mechanisms by which psychiatry travels - across borders - into increasing domains of everyday experience, and across geographical borders, into low and middle-income countries. It explores the claims of Global Mental Health, ‘to make mental health for all a reality’, as being particular mechanisms of psychiatrization - ones that may employ similar codifications to those of colonial discourse. Global Mental Health and WHO mental health policy often mobilise psychiatric interventions in response to a ‘crisis’ or an ‘emergency’ in mental health, globally. Yet while this current incitement suggests an abnormal deviation from a normal order, mental illness may also be read as a ‘normal’ reaction to the (dis)order of globalisation. Nevertheless, in making the claim that mental health problems, such as Depression, are a ‘normal’ response to inequitable market relations in the global South, may also be normative, as it glosses over a simultaneous globalisation; that of bio-psychiatric explanations of distress. Thus, while Global Mental Health marks an explicit making political of psychiatry through its conceptualisation of mental health as key to an agenda of international development, it simultaneously disavows psychiatry as political through its universal application of psychiatric technologies. To claim the universality of psychiatric diagnoses is different from making the claim that distress, manifest in myriad forms, is universal. This is because psychiatric frameworks are mediators of that distress, they provide but one way of understanding yet they are often framed as being the ‘truth’, globally. 4 Reading Global Mental Health psychopolitically, then, enables an engagement with the double process through which conditions of inequality and alienation may become internalised –how inequality may come to play on the body, to be made flesh. This move occurs alongside another process that reads the mechanisms by which socio-economic crisis comes to be rearticulated and reconfigured as individual crisis, as mental illness. To read Global Mental Health as a colonial discourse is to trace how particular knowledge is mobilised in the creation of a space for psychiatric ‘subject peoples’, a global space. This research traces some of these ‘on the ground’, often powerful, techniques of recruiting subjects and fixing them. It also interrogates the knowledge base of Global Mental Health to create a space to read this alongside alternative ways of knowing; specifically psychiatric user/survivor and critical psychiatry critiques. This works to explore how psychiatry encounters difference (both within the global North and South), and to (re)think how Global Mental Health might be encountered differently. This thesis thus explores how the colonial relation is mobilised within psychiatric treatment in order to think through how the violence of colonialism may enable a re-thinking of contemporary forms of psychiatric treatment as being violent, the violence of psychiatrization - violence in the name of ‘treatment’. Using the post-colonial theory of Frantz Fanon, Ashis Nandy and Homi Bhabha, as conceptual tools, alongside research encounters (interviews, ethnographic field work, policy documents) in India, enables exploration of how psychiatrization may allow relationships of domination and resistance to continue after formal colonialism has ended. It also enables engagement with how strategies of resistance to colonialism may be read alongside and used to illuminate resistance to psychiatry – resistance that may be secret, sly, covered up. This research concludes by attending to emerging counter-hegemonic ways of knowing distress, epistemologies of the South, in order to creatively re-think the work of Global Mental Health and psychiatry in countries of the global South. To imagine a global mental health that attends to the heterogeneity and complexity of local, indigenous ways of knowing distress, that rethinks issues of consent – specifically around the use of psychiatric terminology and the provision of non-medical (and non-‘western’) spaces 5 of healing, and that recognises psychiatry as one of many approaches, questioning whether it can, or should, be global.

Background: Schizophrenia is a pervasive and often debilitating disorder, although vulnerability is not easily assessed. Cannabis has a positive relationship with schizophrenia. To date, it is unknown whether or not this is a causal relationship. Nonetheless, those with vulnerability to psychosis have displayed a differential sensitivity to cannabis. Aims: There were two main aims to this programme of research: 1) Contribute to discussions relating to ‘causal inference’ in the relationship between cannabis and psychosis. 2) Assess the reliability and validity of the Cannabis Experiences Questionnaire (CEQ) as a measure of psychotic vulnerability based on a differential sensitivity to cannabis. Methods: Two studies were conducted. The first was a Cross-sectional investigation in which two groups of cannabis users were recruited, participants with self-reported depression (n = 85) and participants with self-reported psychotic disorder (n = 48). This investigation also considered data from a community sample recruited as part of other research studies. These consisted of cannabis users (n = 861) and non-users (n = 306). These groups were compared on measures of schizotypy and cannabis induced experience. The second study was an experience sampling investigation, in which regular cannabis users (n = 36), submitted 7 responses per day via a mobilephone, for a period of 14 days. Participants completed measures of: psychotic-like states, stressed states, calm states, drug consumption, stressful and pleasurable events, and aversive cannabis induced experience. Results: Cross-sectional investigation: There was no significant difference between cannabis users with reported depression and reported psychotic disorder in the disorganised or interpersonal domains of schizotypy. The cannabis-using groups of participants displayed a differential sensitivity to cannabis, with those who reported psychotic illness having significantly more aversive cannabis experiences than the community sample (U = 15106.5, z = 3.142, p = .002, r = 0.10) and participants with reported depression (U = 1241.0, z = 3.746, p < .001, r = 0.32) . The most effective means of identifying psychotic vulnerability consisted of a two-step process, firstly utilising assessments of schizotypy and secondly assessments of aversive cannabis induced experience. Experience sampling investigation: In a dose dependent fashion cannabis predicted increases in interpersonal (b = 0.24 95% CI 0.07 to 0.42, p = .006) and disorganised psychotic like experience (PLE) (b = 0.16 95% CI 0.04 to 0.27, p = .006). However, disorganised PLE significantly increased the odds of cannabis consumption (OR = 1.245 95% CI 1.045 to 1.247, p = .003). Cannabis positively and significantly predicted ‘calm’ states in a dose dependent fashion (b = 0.23 95% CI 0.07 to 0.39, p = .006). Cannabis and stressed states interacted to significantly predict PLEs (b = 0.33, 95% CI 0.17 to 0.49, p < .001). Aversive cannabis induced experience significantly predicted PLEs both within (b = 0.22, 95% CI 0.10 to 0.33, p < .001) and between participants (b = 0.66, 95% CI 0.06 to 1.27, p = .033). Previously documented aversive cannabis experiences significantly predicted propensity to experience stressed states (b = 0.15, 95% CI 0.05 to 0.24, p= .002). Conclusion: Aim 1): Within a continuum model of psychosis the results of these studies support three mechanisms of a cannabis-schizophrenia interaction; cannabis use causes schizophrenia; schizophrenia causes cannabis use; schizophrenia and cannabis use maintain one another. There is evidence to suggest psycho-social stressors interact with cannabis to induce PLEs. This may indicate that cannabis causes schizophrenia via a cross-sensitisation mechanism. At-risk groups should be warned against using cannabis as a stress coping mechanism. Aim 2): These results confirm a differential sensitivity to cannabis in those vulnerable to psychotic disorder. This investigation has demonstrated that psychosis vulnerability can be assessed by aversive cannabis induced experience. This investigation has demonstrated concurrent, convergent, and predictive validity of the CEQ as an assessment of psychotic vulnerability. This scale could be useful for drug education programmes and risk assessment in recreational cannabis users; screening for medicinal cannabis prescription; screening for research trials with cannabinoids or other known psychotomimetics; and in the allocation of psychological intervention for cannabis dependence, and (possibly) stress-reduction in those with disorder or at ultra-high risk.

No description available.

This thesis includes a literature review, empirical paper, and reflective paper, which explore different aspects of formulation within Clinical Psychology. Chapter one reviews literature to answer the question 'Why Formulate? Why not Formulate?' This review considers the idea that formulation is a defining skill within clinical psychology, before discussing the function, reliability and validity of formulating across differentsituations. Literature suggests that individual differences and client characteristics determine the focus of the formulation, as well as the amount ofinformation shared and how the information is delivered. The basis for not formulating was considered, although it seems to be a tenuous premise to suggest that some clinical psychologists do not formulate just because these' hypotheses are not shared with clients. There is a shortage of evidence to support the notion that formulation is unique to clinical psychology but it is without contention that the skills involved in formulating are integral to the profession. The review raises a number of important research questions, including reaching a better understanding of who does and does not use formulation in everyday practice, comparing the value of formulating and not formulating, and illuminating client's experiences ofreceiving formulations. There are a number ofvalidity considerations to be examined and there is also a shortage of empirical evidence regarding the use offormulation within integrative frameworks. These research questions suggest qualitative analyses in the first instance and it seems likely that in most cases the clients themselves will Chapter two reports the findings of an empirical paper, exploring clients' experience of formulation with the use ofa grounded theory approach to methodology. Views from clients and therapists were sought respectively and the emergent theories highlighted two subtly different models. A linear model was proposed to describe clients' views, detailing a journey of growth. This consisted ofthree core constructs: initial doubt, assimilation and empowerment. Each construct was understood on a continuum to represent the fluctuating nature of the process. A circular model was proposed to describe therapists' views of clients' experience of formulation. Connection with the process, self, and other was thought to result from interaction in the 'dance'. This enabled clients to view formulation as tangible, providing them with the opportunity to integrate the formulation. Integration was thought to continue throughout clients' lives, whereby understanding and connectivity contributed to a reflexive loop of development. Similarities and differences between the models are considered, as are limitations and ideas for future research. Clinical implications are made, and include the use ofthe models to offer guidance to training programmes on the areas on which to focus when teaching formulation. The role of the models in developing measures to assess clients' experiences, to ensure that therapists are focussing on the elements thought to be central to formulations, in addition to reassuring individuals new to the process of formulation is also considered. This study also draws attention to the presentation of a formulation, how it might be used, the audience who might have access to it, and the importance of not forcing a model on a client. Chapter three reports a reflective paper, which consists of therapeutic letters to therapists', clients' and myself. This chapter (and the letters contained within it) is XIII 1111111111'11111 ttl XIV Consideration is made ~fhowmy own training mirrors the models derived from the .........-=.:---.:~--------~.'.-,,-, .U1I I the impact that this research has had on my personal and professional development. empirical paper, alongside reflections on why the topic of formulation was chosen and experiences, interests, beliefs and social identity has shape~ this research. J therefore reflexive, enabling me to reflect upon ways in which my own values experiences, interests, beliefs and social identity has shape~ this research. Consideration is made ~fhowmy own training mirrors the models derived from the .........-=.:---.:~--------~.'.-,,-, .U1I I the impact that this research has had on my personal and professional development. empirical paper, alongside reflections on why the topic of formulation was chosen and the impact that this research has had on my personal and professional development.

This dissertation explores the emotional experience of the psychotherapeutic relationship for existential therapists. The intent of this research is to explore therapists’ reflections and descriptions of their emotional experience as they engage in therapeutic relationships with their clients, and how they themselves make sense of and understand the emotions in the therapeutic relationship. Eight participants were interviewed using semi-structured interviews. The material was analysed using Van Manen’s hermeneutic phenomenology. Five themes were identified: i) the idea that the relationship is the therapy; ii) the primacy of emotions in this relationship; iii) the emotional work required by the therapist, iv) the fact that emotions are embodied and v) the idea of the dance of therapy and moments of meeting. Existing literature on the therapeutic relationship and more broadly from existential philosophy was employed in order to illuminate themes arising from the results. The results provide a compelling description of existential therapists’ experiences of emotions in the therapeutic relationship and help to fill an absence of published phenomenological studies in this subject area. The clinical significance of the study includes a recommendation for increased awareness and focus on the emotional work of psychotherapy in training and practice. The study highlights the important role that the profession of counselling psychology plays in advocating for the importance of the therapeutic relationship. Further qualitative work on studies that delve into more specific aspects of emotions in the therapeutic relationship were called for.

The P300 waveform of the auditory event-related potential (ERP) was evaluated in studies which examined measurement methodology and which analysed the separate sub-components of the waveform in a group of patients with schizophrenia and manic depressive illness. Two simulation studies were carried out. One was designed to evaluate a new objective method for measuring P300 latency, the other applied the technique of latency corrected averaging to P300 measurement. A model for the P300 is described which allows the time domain behaviour of the waveform to be predicted when it is subjected to the different high-pass filters used in clinical studies. The first clinical study was a detailed investigation on the measurement methodology in clinical studies of the auditory P300. The second clinical study used novel auditory stimuli as a means of separating the sub-components of the P300 complex. Three clinical tests were used based on the standard auditory "oddball", a standard auditory oddball with additional "distracting" novel stimuli, and a passive paradigm using novel stimuli. The use of Slow Wave as an index of task difficulty was examined. Twenty-eight controls, 29 schizophrenics and 28 subjects with bipolar depression were studied. The results from these experiments showed that abnormalities of P300 sub-components in the schizophrenic group are enhanced when using distracting stimuli and that these differences are present even in passive orienting. The bipolar group also showed abnormal P300 sub-components in responses to the distraction task. These results could imply a more widespread disruption in underlying brain structures in schizophrenia than bipolar depression. Used in conjunction with brain perfusion images derived from single photon emission tomography (SPET), the paradigms described have shown great potential for locating the underlying brain structures involved in the genesis of P300, and how they are affected in abnormal pathological states.