It has been suggested that polyphenols are linked to behaviour and wellbeing. A randomised chronic 10-week, parallel group, double blind, placebo controlled study investigated the effects of daily consumption of a flavanone-rich orange juice drink compared with a placebo on behaviour and wellbeing in 8 to 10 year old healthy schoolchildren (n=32). As the intervention study aimed to use data collected, from multiple informants using measures of behaviour and wellbeing, this thesis also aimed to establish the value of self-report measures in the accurate reflection of a child’s behavioural and emotional difficulties, using the Strengths and Difficulties Questionnaire (SDQ). The tool development work explored the psychometric properties of SDQ data collected from different informants; parents, teachers and the children themselves, in a sample of healthy young schoolchildren aged 8 to 10 years old (n=126). The study found that the internal reliability, inter-rater agreement and concurrent validity of the SDQ, when completed by the adult informants (parents and teachers) were satisfactory and consistent with previous research. The structural validity of the teacher informant data supported the original five-factor structure of the SDQ as proposed by Goodman (1994). While, the parent informant data generated a four-factor solution and the children’s self-reported data produced a three-factor solution, which appeared to reflect young children’s categorisation of behaviours and traits. Overall, the factor structure generated provides valid information about behaviour and wellbeing in children as young as 8 years old. The randomised chronic 10-week, parallel group, double blind, placebo controlled study, then used the tool development to investigate the effects of daily consumption of a flavanone-rich orange juice drink compared with a placebo on behaviour and wellbeing (using the SDQ, RCADS and SNAP-IV) in 8 to 10 year old healthy schoolchildren (n=32). This exploratory study did not find any effect of the flavanone-rich dietary intervention on any measures of behaviour and wellbeing, as reported by any of the informants. Taken together, the research presented in this thesis highlights the importance of assessing the validity and reliability of measures used to assess the behaviour and wellbeing of young children in clinical practice and research. It also provides an indication of how these measures might be further developed for future work in the field.

Systemic interventions, including family therapy (FT), have been found to have positive outcomes for individuals who engage in self-harm behaviour (SHB) (Brent et al., 2013; Carr, 2016; Cottrell et al., 2018b). A number of factors related to family functioning have been associated with SHB (Fortune, Cottrell, & Fife, 2016). Research has shown that narratives of responsibility are an important part of the FT process, however, none investigate how responsibility for self-harm is negotiated in a FT setting. This study uses the discursive action model (DAM, Edwards & Potter, 1993) to explore how responsibility is negotiated within FT for adolescents who have self-harmed. Video data of FT sessions were made available under the access provisions of the Self-Harm Intervention- Family Therapy (SHIFT) Trial (Wright-Hughes et al., 2015; Cottrell et al., 2018b). The findings show that negotiations of responsibility are central to the talk in the initial FT sessions and that family members and therapists managed their interests (stakes) through a variety of actions within the talk. The analysis revealed that family members, in particular the parents, tend to enter therapy with interests which compete with the therapist’s goal of achieving a narrative of shared responsibility. For example, parents entered therapy with actions that managed the risk that they are seen as ‘bad parents’ and responsible for their child’s SHB. It is, therefore, important for therapists to consider how they might negotiate powerful discourses of responsibility, whilst considering the interests of family members and maintaining a therapeutic relationship. I have evidenced the applicability of the DAM in deconstructing the discourse in a FT setting. I suggest its use as a clinical tool in FT practice. Principles from the DAM could be used in identifying the actions and stakes of family members in order to be mindful of these within the FT process.

Introduction: Meaning making has been shown to be beneficial to family wellbeing and has been explored in terms of problem construction at the beginning of therapy. However, there have been no studies which have looked at how meaning of change is negotiated at the end of family therapy. The final session is a pivotal point for these meanings to be discussed and these will be the understandings that the family take with them after therapy. This thesis aims to address this gap in the literature base by exploring how the participants in a final family therapy session negotiate their understanding of the therapy process and its outcome. Method: Video recordings of six final family therapy sessions were analysed using a discursive psychology method. The data were selected from a pre-existing database from the Self Harm in Family Therapy (SHIFT) trial, which studied family therapy for adolescents who self-harm. Each transcript was analysed using a protocol based on the guiding principles of discursive psychology and then extracts were selected as significant examples of how the therapy process and outcomes were discussed in the session. Results: The analysis found that the outcomes of therapy that were constructed were; increased family resilience and functioning, changes in problem meaning and a reduction in stress. Two interpretative repertoires were drawn upon for constructing agency in the therapy process; change comes from the family system and change comes from the therapists and the therapy forum. This analysis found that of the six families, four worked collaboratively together to develop a shared understanding of the therapy and two families resisted the therapeutic process and a shared understanding did not appear to have been reached. Discussion: Different actions were taken by the various stakeholders in the session, which seemed to either support or hinder the shared meaning making process at the end of therapy. The therapists supported the collaborative process by attempting to maintain alliances through neutrality, empowering individuals as well as the family as a whole and by fostering ‘realistic’ hope for the future. The parents, as well as the therapists, acknowledged the developmental stage of the young person and this appeared to have different outcomes based on the young person’s perspective on this. Finally, the young people seemed to take one of two courses of action in the final session; either to participate in the session and collaborate with the others in the room or they took the action of protesting and not engaging with the session.

Stigma against obesity has been demonstrated in children as young as 3 years old. Previous research has emphasised the negative attitudes displayed by young children towards peers with obesity however, far less consideration has been given to positive social interactions, such as pro-social behaviour. The aim of this study was to further explore young children’s attitudes towards peers with obesity across a range of pro-social behaviours. Young children (aged 4-6 years old, n=72) were asked to select characters with either healthy weight or obesity in a story involving different pro-social scenarios (helping, sharing & comforting) and asked to give a reason for their character selection. The frequency of character selections were analysed as well as using thematic analysis to identify the themes in children’s reasoning. Comments were also coded for valence and linked to children’s character selection. In line with expectations, children were less likely to choose a character with obesity as a playmate. Girls were less likely to help and comfort a character with obesity and boys less likely to share. Overall there was little evidence of negativity towards the characters with obesity within children’s reasoning, although two children were consistently negative. These findings indicate that young children may have unconscious bias against obesity or that they are not attuned to obesity any more than other physical differences. This study suggests that for the majority of young children, stigma against obesity is not as pervasive as has been portrayed in earlier research. Young children may not require interventions to reduce obesity stigma, however, promoting pro-social behaviour generally may help with peer acceptance and prevent stigma against obesity from developing.

This thesis describes the development of the BATS: a brief, evidence-based tool monitoring and evaluating therapists' delivery of psychological therapies used in routine practice for alcohol and drug use problems. The BATS is transtheoretical, applicable to the range of widely used therapies in addiction. Four studies were undertaken to develop the BATS. Study 1 identified twenty-six fidelity measures from the literature that evaluate therapists' delivery of psychological therapies for alcohol and drug use problems. Study 2 generated items and response formats for potential inclusion in the BATS using the identified measures as a basis. Generation of the items was primarily based on the results of a thematic analysis; eighteen exemplar items were developed. Study 3 generated a consensus among experts in the fields of addiction and psychotherapy on the content of the BATS. A consensus was obtained using a three-round Delphi survey. At the conclusion of the third round, group agreement on the 12 scale items and response format was reached. This content formed the first version of the BATS. Study 4 tested the psychometric properties of the newly developed scale. The results provided support for inter-rater reliability and convergent validity. The BATS provides a reliable and valid method for evaluating treatment delivery in routine practice, helping to improve our understanding of the process of therapy in addiction. The real world application of the BATS provides a useful tool for training and supervision, which has the potential to impact on therapist competence and treatment delivery.

Multiple neurotransmitter systems have been implicated in the pathophysiology of schizophrenia. In particular, changes in the GABAergic and glutamatergic system could be upstream to changes in the dopamine system, and also responsible for the cognitive and negative symptoms of the disease. This thesis has utilised genetic models of glutamatergic dysfunction, both globally in mice lacking the GluA1 AMPAR subunit (Gria1 KO), and in a circuit specific manner in mice lacking the NR1 NMDAR subunit specifically in parvalbumin (PV) positive interneurons (Grin1?PV). In addition, the chemogenetic DREADD silencer hM4Di was used to transiently and specifically silence PV positive interneurons in vivo. These genetic and chemogenetic manipulations have been used in combination with behavioural assays that could assess schizophrenia-relevant behaviours in rodents. Grin1?PV animals were found to be largely normal when tested for schizophrenia-relevant behavioural abnormalities. However, when Grin1?PV animals were challenged with the NMDAR antagonist MK-801 (commonly used to pharmacologically model glutamatergic dysfunction) there was clear behavioural divergence between Grin1?PV and control animals. In contrast to previous reports, Grin1?PV mice appeared to be sensitised to the effects of MK-801. This has important implications for the understanding of how NMDAR antagonists can induce schizophrenia-relevant behavioural deficits in rodents. Hypofunction of PV interneurons, particularly in the hippocampus, is predicted to underlie schizophrenia-relevant behavioural deficits. To directly test this, hM4Di was expressed in PV interneurons in the dorsal or ventral hippocampus, preferentially in area CA1. Despite the fact that hM4Di was capable of reducing the excitability of PV interneurons in vitro, there was no evidence that silencing of PV interneurons in CA1 in vivo could induce the predicted behavioural deficits. Gria1 KO mice have a well established behavioural phenotype that could be relevant to schizophrenia. A viral-rescue approach was utilised to reintroduce GluA1 preferentially into area CA3 of the hippocampus of Gria1 KO animals. This was sufficient to rescue novelty induced hyperactivity and spatial novelty preference but not spatial working memory in Gria1 KO animals. Recordings of local field potentials (LFP) in the dorsal hippocampus revealed enhanced theta power oscillations in Gria1 KO mice. This elevated theta power was also rescued by GluA1 re-introduction into area CA3 of Gria1 KO mice. Together these experiments question the hypothesis that NMDAR antagonists preferentially exert their effects through NMDARs on PV interneurons. In addition, with respect to schizophrenia-related behavioural deficits, hypofunction of PV interneurons in area CA1 of the hippocampus might not be be as critical as hypofunction of PV interneurons in other circuits. Finally, area CA3 of the hippocampus is implicated as a brain region in which GluA1 expression appears particularly important for some behaviours relevant to schizophrenia.

<strong>Background</strong> Alcohol consumption is widespread and increasing in some sectors of society. Whilst adverse effects on the brain of chronic heavy use are well characterised, the effects of more moderate use are poorly understood. Previous work has lacked prospectively gathered data on alcohol use. Robust evidence of harm would have important public health implications. <strong>Methods</strong> Associations between self-reported alcohol consumption data gathered over a thirty-year period (1985-2015), neuroimaging markers of brain structure and function, and cognition were examined in community dwelling older adults in the Whitehall II cohort (n=550). Structural, diffusion tensor, and resting state functional magnetic resonance imaging was performed in 2012 to 2015. Cognitive performance was determined cross-sectionally across multiple domains at the time of scanning and longitudinally throughout the study. <strong>Results</strong> No participants scored as alcohol dependent on the CAGE screening questionnaire. Higher alcohol consumption throughout the study was associated with hippocampal atrophy (even in those drinking 14-21 units (112-<168g) weekly), lower white matter integrity of the corpus callosum, increased functional connectivity within the Default Mode Network, and faster decline of lexical fluency. No protective effects of light drinking were found. Age, sex, premorbid IQ and white matter integrity predicted better verbal memory performance in the presence of small hippocampi. <strong>Discussion</strong> This thesis describes three novel neuroimaging associations with moderate alcohol consumption. Alcohol, even in small quantities, may represent a modifiable risk factor for adverse brain outcomes and faster cognitive decline. Learning effects or confounding by higher premorbid intelligence or social class may explain previous findings of a protective effect of moderate alcohol consumption.

The aim of the research was to study how recently licensed clinical psychologists in southern Israel perceive their relationships with their supervisors as trainees in the psychodynamic paradigm and to further the understanding of psychodynamic supervision. The study examined the experiences of supervisees in psychodynamic supervision employing a constructivist grounded theory approach, and included 10 participants who had completed their licensing exam within the last three years, and had trained in Israel. The research was retrospective, as time had passed since the licensing exam, and was also reflective, as the participants had gained experience and maturity in the field. A system of open coding was used to analyze the interviews. Following this stage, the codes were grouped into focused codes, and a summary of the memos were organized for each participant. A constant comparison was made between the focused codes of the interviews until the categories were saturated, that is no new categories emerged, and a core category became apparent. Theoretical sampling was used by interviewing three of the 10 participants a second time in order to fill in gaps in one of the categories. The goal of the study was interpretive understanding. The findings suggest that classical psychodynamic supervision provides the trainee with an experience of containment and reliance on the expertise of the supervisor during the initial stages of training and supervision. However, relational psychodynamic supervision empowers the supervisee in the latter stages of training by providing mutuality and open dialogue in an asymmetrical relationship. Classical supervision often did not address the self-perception of the supervisee, or the relationship between the supervisor and the supervisee. The failure to process these issues seemed to affect the agency of the supervisee in her relationship with her supervisor and, to some degree, fostered a sense of dependence. The supervisees who expressed their experience in supervision as transformational were those who experienced their own agency, and a sense of empowerment. In my study, the tension created between the expectation of finding the ideal supervisor and coping with the supervisor in their relationship was the central challenge of supervision. The ‘teach or treat’ dilemma appeared to be a conflict only in the classical style of supervision, as the boundaries between professional knowledge and personal issues are protected. In the intersubjective relational mode, the boundaries are more permeable, allowing more self-disclosure and temporary focus on personal issues The ‘real’ relationship in psychodynamic supervision was apparent in my study and was contingent on the two people involved in the interaction.

Purpose - The purpose of this research is to shed some light on the experience of individuals being medicated with anti-psychotics. The original contribution to knowledge is a study conducted online using Skype to interview young adults with schizophrenia about how their medication affects them socially; psychologically and physically. This will form the basis for further research in the field of counselling psychology, particularly regarding treating schizophrenia. The findings of this study may indicate additional services which healthcare providers can deliver, with the goal of improving the quality of treatment for managing schizophrenia in the long-term. Thus, these findings may lead to a greater focus and investment in high-quality, psychological interventions. Method – A convenience sample of nine participants (three female, six male), between the ages of 18 – 40 who were taking some form of anti-psychotic medication, took part in semi-structured interviews conducted via Skype. Thematic analysis was performed on the data, with relevant extracts from the interview transcriptions collated to form themes, and was predominantly inductive and driven by the data. The researcher was based in London, UK, while participants were based in the UK and other European countries. Main Findings – Participants reported their experiences of taking anti-psychotic medication. In total, eight themes were identified: (1) Being Different; (2) Self-Care is Important in Addition to Medication; (3) Successful Treatment Requires a Close Doctor-Patient Relationship; (4) Taking Anti-Psychotics Has Many Disadvantages; (5) Contemplating the Origins of the Disorder; (6) The Self Reframed by Diagnosis; (7) Environmental Support is Needed in Addition to Medication; (8) Anti-Psychotics Improve Quality of Life. Conclusion - The experience of being medicated with anti-psychotics is complex, and comprised of many factors. It was reported that, overall, this medication improved quality of life by reducing symptoms of psychosis. However, recovery is often hampered by disadvantages such as adverse side-effects and a loss of autonomy. Taking anti-psychotics can also negatively affect an individual’s self-image. From the viewpoint of the patient, medication is integral to the recovery process along with other relevant factors such as self-care, good communication with one’s doctor(s) and access to alternative treatment options. If healthcare professionals familiarise themselves with patients’ medication-related concerns and social needs, they will be better placed to offer the holistic support that is important for recovery. Subsequently, this could lead to greater treatment adherence, and higher rates of rehabilitation.

Background: Schwartz Center Rounds® (SCRs) are multidisciplinary reflective forums where healthcare staff can discuss the psychological and emotional impact of work. Two NHS trusts piloted SCRs in 2009. They now run in 150 UK sites to support staff and enable compassionate care. The investment into SCRs has not been evidence-based. Early studies indicating positive outcomes for healthcare teams at individual, relational, and organizational levels were criticized for lacking rigour. Reflective practice groups (RPGs) share similarities with SCRs but pose a lighter burden on resources. No systematic reviews have investigated the outcomes of these interventions. Therefore, it was important to consider the evidence for both. Objective: To investigate the impact of SCRs and/or multidisciplinary RPGs on healthcare teams on individual, relational, and organizational levels. Method: Qualitative, quantitative, and mixed-methodology empirical studies and autoethnographic evidence on SCRs and/or multidisciplinary RPGs were sought via PsycINFO, Scopus, and Web of Science, The Point of Care Foundation evidence library, the Journal of Compassionate Health Care, and from two recent SCRs studies’ investigators. Results: The search yielded 863 records; 83 were fully accessed and 21 included. The studies’ quality was variable. All matched PICOS criteria and were maintained. Discussion: Four themes were identified: 1. Reflection, learning, and development; 2. Emotional and psychological impact; 3. Storytelling: Connecting humans through narrative communication; 4. Leadership and culture: Openness and honesty. Enablers and barriers, specifically, resources and safety, were connected to, and discussed within, theme four. Conclusions: SCRs and RPGs showed positive effects on healthcare teams at all levels. RPGs may be more conducive to establishing safety; SCRs held greater potential for staff to develop more holistic perspectives with opportunities for dialogue to effect organizational changes. The findings should be treated with caution given the potential bias of many participants and authors and the dearth of SCRs/RPGs’ non-participants’ perspectives. Whether SCRs have the power to effect sustained organizational change has yet to be established. Keywords: Schwartz Center Rounds, Reflective Practice Groups, healthcare teams, compassion Empirical Paper: Do Schwartz Center Rounds® Hold Transformational Power? An Investigation into the Subjective Experiences of Panellists in Devon. Abstract. Objective: To investigate the subjective experiences of NHS Schwartz Center® Rounds (SCRs) panellists in Devon. To explore whether SCRs hold transformational power on three levels: individual, (group/self-other) relational, and organizational, within an overarching systemic approach. Data sources/study setting: Twelve panellists who had presented at the Royal Devon and Exeter NHS Foundation Trust-Devon Partnership NHS Trust (RD&E-DPT) SCRs in South West England, the first joint SCRs initiative between an acute NHS trust (RD&E) and a mental health NHS trust (DPT). Six RD&E and six DPT panellists took part between May and November 2016, who were also regular attendees (N=4), non-regular attendees (N=5), and non-attendees (N=3) of SCRs. Study design: Twelve individual semi-structured qualitative interviews. Data analysis: Thematic analysis from a social constructionist position was employed to identify patterns across the data set. Key findings: The analysis identified three overarching themes: 1. Psychological safety, culture/s, and leadership; 2. Reflection, learning, and development; 3. Storytelling, connection, and compassion. Reciprocal relationships appeared mutually reinforcing amongst these interacting themes. SCRs in this context appeared to effect transformation at individual and relational levels, with limited impact at the organizational level. For most participants, relational changes were around increased human connection, compassion, and empathy towards colleagues rather than patients. Conclusions: SCRs’ transformational power may be constrained if organizations are solely focused on achieving external goals and if barriers, particularly related to psychological safety, cultural assumptions, norms, and values, are not addressed. Possible SCRs’ mechanisms cited by previous research were supported and a new theoretical model proposed. Key words: Schwartz Center Rounds, compassion, empathy, staff support, human.