Mismatch negativity (MMN) has been hailed as a 'break-through biomarker in predicting psychosis onset' (Naatanen 2015). This is because deficits have been found in clinical populations diagnosed with psychotic syndromes such as schizophrenia. MMN is an auditory evoked potential (AEP) difference waveform produced by subtracting standard from deviant stimuli AEPs elicited by an oddball paradigm; purportedly arising from any discriminable change in auditory stimulation. Despite nearly four decades of basic research into MMN the underlying mechanisms are not fully understood. Although popular theories suggest that it reflects a sensory-memory trace disruption and/or differential adaptation of responses to standard and deviant/oddball stimuli, there remains considerable debate over the neural mechanism and its interpretation. Nevertheless, associations made between N-methyl-d-aspartate (NMDA) receptors in schizophrenia and findings showing that NMDA receptor antagonists (e.g. ketamine) induce MMN deficits in healthy volunteers suggests abnormal MMNs share common traits and support its use as a biomarker from an electrophysiological perspective. However, this is still speculative and there is great impetus on developing reliable preclinical models of MMN in order to examine the underpinning neurophysiology and therefore its reliance on NMDA receptors as a test of pathology in schizophrenia. A question this thesis aims to address is whether a mismatch response (MMR) exists in rodents which is analogous to the human MMN, and whether its modification by NMDA receptor antagonists or as a result of schizophrenia-related genetic modification sheds light on its utility as a biomarker in disease models of schizophrenia. This thesis describes three experiments performed using mitogen activated protein kinase kinase 7 heterozygous (Map2k7+/-ˆ’) mice and their wild-type littermates, incorporating NMDA receptor antagonism with ketamine (10 mg/kg i.p.). The MAP2K7 gene is associated with schizophrenia and codes for a post-synaptic intracellular signalling enzyme which is activated following glutamatergic excitation, for instance via NMDA receptors. The MMR to stimuli duration, frequency and intensity changes in oddball paradigms are characterised in urethane-anaesthetised and conscious animals, followed by an examination of laminar auditory cortex activity in response to these physical changes. Data recorded throughout this series of experiments includes cortical electroencephalography (EEG), video footage, and intra-cortical spiking information. These data were then analysed using various time, frequency and time-frequency domain techniques; although mainly focussing on the event-related potential (ERP) approach. Recordings demonstrated substantial differences in the AEP waveform evoked from urethane-anaesthetised and conscious animals, with the latter displaying considerably more dynamic responses, although onset and offset of auditory stimuli induced comparable waveform features in both states. Effects of varying physical properties of stimuli in oddball and control paradigms have been identified as key determinants of the AEP and correspondingly the MMR difference waveform amplitudes. The finding that NMDA receptor disruption in conscious animals by ketamine acutely diminishes a specific AEP feature (≈20-50 ms post stimulus onset) which may impact the resulting MMR tentatively links this study in mice with findings from humans noted above. Ketamine was also found to enhance animal movement and increase EEG spectral power in the 50-70 Hz (gamma-band) frequency range, observed for approximately 10 minutes following drug administration. Both anaesthetised and conscious cohorts of Map2k7+/-’ mice displayed a significantly enhanced onset response (≈0-20 ms) in the AEP. Interestingly, ketamine did not appear to have a differential effect on Map2k7+/-ˆ’ mice compared with the wild-type group, suggesting that NMDA receptor-mediated neurotransmission is unimpaired in this genetic model relevant to schizophrenia. Overall, the findings suggest that the MMR in mice is fundamentally influenced by the physical properties of stimuli employed; ketamine causes an acute, specific alteration to the AEP in conscious mice in addition to other electrophysiological and behavioural changes; and Map2k7 gene disruption causes a specific and replicable change in AEP amplitude. Overall this study indicates that mouse models are useful for exploring the effects of different pharmacological and genetic manipulations on the auditory evoked response; however, MMN data in clinical cohorts still needs to be interpreted with care. In order to address whether the rodent MMR is analogous to human MMN, it would be necessary to probe how influencing factors revealed in the rodent studies impact on the human response. Whilst the rodent MMR and human MMN show some degree of translation, their potential as schizophrenia biomarkers requires further characterisation and validation.

Existential psychotherapy is one of the longest-established forms of psychological intervention, but little is known about its contemporary worldwide practice and the nature of its intervention remains unclear. Different existential therapies have different perspectives about practice, but there is little consensus on what separates and unifies them. Three complementary studies were conducted to help to develop a shared and systematized research definition for existential therapy’s contemporary theory of practice. A systematic online search of existential institutions around the globe was developed and a total of 128 existential therapy institutions were found in 42 countries from all inhabited continents. Drawing from this, an international survey was conducted asking existential practitioners to identify the practices they considered most characteristic of existential therapy and the authors and texts that most influenced their practice. Data from 1,264 worldwide existential practitioners’ showed that the scope of influence of an author is pretty much limited to the branch he is related to and only a few authors, in particular Frankl and Yalom, influence practitioners from different branches. The phenomenological method most unifies and characterizes the existential theory of practice. The other shared constitutional practices were methods associated with specific existential branches, practices informed by existential assumptions, relational practices and practices from other therapeutic paradigms. An observational grid was developed from those categories of practice and applied over recorded existential therapy sessions. The observed practices were mainly relational, followed by hermeneutic interventions and reformulations. Data indicates that existential therapies are spread worldwide and help to develop a greater understanding of the contemporary influence, scope and nature of its intervention. Differences among branches are confirmed and commonalities may help to develop a global and coherent framework of existential theory and practice. This opens new avenues for research concerning the applicability and effectiveness of these conceptual and practical frameworks.

Background: There is an established association between parental Expressed Emotion (EE) and mental health disorders in children and adults. Most research has focussed on parental EE regarding under 12s or adult offspring, with very little attention devoted in the literature to the impact of parental EE regarding adolescent offspring. Furthermore, most studies have used methods of coding EE that were designed for use in relation to adult offspring, raising questions about the validity of their findings. The aim of this study was to compare level of parental EE regarding adolescent offspring (12-18 years) referred for treatment for depression and/or anxiety with parental EE regarding adolescent offspring recruited from the community. Design: A cross-sectional, between-subjects’ design was used. A clinical group of adolescents and one of their parents were recruited from a Child and Adolescent Mental Health (CAMH) service. A community group of adolescents and a parent were recruited as a comparison group. EE was assessed using the Five Minute Speech Sample (FMSS) with a coding scheme adapted for use with adolescent offspring. Parents completed the FMSS and a measure of psychopathology. Adolescents completed a questionnaire measure of their own anxiety and depression. Results: Level of parental EE, Criticism and Emotional Over-Involvement was non-significant between the two groups. Level of Warmth and number of positive comments was significantly lower in the clinical group. Parental EE was significantly associated with higher adolescent self-reported symptoms of depression. Parental psychopathology was not associated with parental EE. Conclusions: EE may be more normative in relation to adolescents compared to other studies. Lack of positive elements of EE may be more of a risk factor for adolescents. However, the cross-sectional design of this study means that causality cannot be inferred. Key words: Expressed Emotion, Parents, Adolescents, Internalising disorders.

Paranoia is thought to exist on a continuum with 10-15% of the general population experiencing high levels (e.g. Freeman, 2007). Many different cognitive and affective factors have been linked to the experience of paranoia. These include theory of mind, jumping to conclusions bias, attributional bias, self-esteem, low mood, anxiety and social anxiety. However, there is mixed evidence that each of these factors is related to paranoia. One potential reason for this is that few studies have looked at the inter-relationships between these factors. Some studies have investigated the role of several factors together but most of this research has been done in the clinical population which makes it difficult to isolate paranoia from other clinical symptoms which may have a confounding effect on the findings. The aim of this study was to contribute to the current understanding of paranoia by determining which factors are uniquely related to the experience of paranoia and the direct and indirect relationships between these factors and paranoia. 151 participants aged between 18 and 70 completed an online survey consisting of measures of paranoia, cognitive and affective theory of mind, attributional bias, jumping to conclusions bias, self-esteem, low mood, generalised anxiety and social anxiety. Cognitive theory of mind, social anxiety and generalised anxiety were found to predict paranoia. Furthermore, mediation analysis indicated indirect relationships between self-esteem and paranoia, and externalising bias and paranoia, through social anxiety. The findings build upon previous studies in the clinical population and suggest that social anxiety plays a key role in the experience of paranoia.

Background: Co-rumination is the process of problem discussion within a dyadic relationship that is repetitive and unproductive with a focus on negative affect. Co-rumination has been found to have adaptive and maladaptive facets, which result in it being positively correlated with both negative affect and friendship quality. To date research has focused upon relationships between co-rumination and depression within children and adolescents using cross-sectional designs. Aim: To assess the relationship between co-rumination, depression and anxiety in adults using a prospective design. Methodology: This study used a two-wave prospective design where adult participants were asked to complete an online survey (comprising measures of rumination, co-rumination, depression, generalized anxiety and social anxiety) at two time points three months apart. Participants rated co-rumination in relation to the confidant they most often discuss problems with (e.g. same-sex best friend) Findings: Positive correlations were found between the affects depression and generalised anxiety, and co-rumination at Time 1 which became non-significant when controlling for rumination. At Time 2, generalised anxiety exhibited this trend; however relationships between depression and co-rumination remained significant when controlling for rumination. No relationship was found between social anxiety and co-rumination at either time point. When results were split by confidant type, positive correlations were found between same-sex friend co-rumination and depression and generalised anxiety. However, significant positive correlations between these variables were only found at Time 2 for Romantic partner dyads. Hierarchical linear regression found that co-rumination at Time 1 predicted generalised and social anxiety at Time 2 but it was not found to be predictive for depression. Conclusions: Cross-sectional correlational analysis supports prior findings in the field. However prospective analysis indicated that co-rumination predicts generalised and social anxiety but not depression. Differences in the relationship between co-rumination and affect are observed between different confidant types. Implications of these findings are discussed.

Background: Given their highly unacceptable nature, negative intrusions are likely to promote the experience of negative affect such as fear, shame and guilt. Moreover, moral thought-action fusion (believing that negative thinking is the equivalent of acting immorally) is likely to inflate the occurrence of negative affect when intrusions are experienced. In turn, negative affect is likely related to disclosure. The current study investigated whether thought-action fusion beliefs predict anticipated disclosure of hypothetical negative intrusions, and whether this was mediated by anticipated negative affect. Method: An online survey was completed by a sample from the general population (n=175). The survey assessed anticipated negative affect and anticipated disclosure of hypothetical negative intrusions, guilt and shame proneness, frequency of negative intrusions, thought-action-fusion beliefs, and general self-concealment. Results: A strong positive relationship was found between TAF-Moral beliefs and anticipated negative affect from experiencing negative intrusions. The analysis indicated evidence of co-operative suppression: when both TAF-moral beliefs and negative affect were entered into a model predicting anticipated disclosure, the effect of both predictors increased. Whereas TAF-Moral beliefs predicted lower likelihood of disclosure, negative affect predicted increased likelihood of disclosure. Conclusion: The current findings add to the literature in that they suggest that individuals may be less inclined to disclose unacceptable intrusions. Further work is needed to understand the conditions under which negative intrusions are more or less likely to be disclosed. Limitations and recommendations are discussed.

Objective: To explore the impact social class biases may have on the treatment of clients by psychological and psychotherapeutic professionals in Britain. Design: A cross-sectional on-line study among 156 psychological and psychotherapeutic professionals working in the NHS incorporating a comparison between two groups - video vignettes representing ‘lower’ and ‘upper’ class clients. Methods: The video vignette depicted a psychological assessment session of a client who had been referred by his general practitioner after incidences involving deliberate self-harm. The accent and dress of the client were varied. Study participants completed measures of clinical reasoning relating to diagnosis, risk and treatment, measures of their awareness of the influence of social class on their work and a social class brief implicit association test. Results: Within the context of this study participants tended not to discriminate against clients in relation to their class. However, they believed that a ‘lower-class’ client was more likely to receive an ‘alcohol or substance misuse’ diagnosis (p= .002; d=0.40). They also scored the ‘lower-class’ client as more motivated to make changes (p=.032; d=.29). Seeing a ‘lower-class’ client resulted in significantly higher scores indicating participants reflection on personal conflicts relating to their own social class and the impact such biases may have on their work. Conclusions: There was no general pattern of discrimination against clients in relation to their social class. This may be due to client class cues priming the psychologist to reflect on their position. Practitioner Points: •Training and professional development for Psychological and Psychotherapeutic Professionals in ways to raise awareness of their personal beliefs about social class may help reduce class bias. •Working with clients such professionals perceive to be a ‘lower’ class allows them to reflect on these personal beliefs.

Aim: Self-concept and identity are impacted by the experience of an acquired brain injury (ABI), often negatively. These changes have been shown to impact on other domains including mood and vocational outcomes. The study aimed to provide practice-based evidence for the effectiveness and acceptability of ‘RE-ID’, a novel vocational rehabilitation group intervention exploring identity after an ABI using an acceptance and commitment therapy (ACT) approach. Method: The study employed an idiographic case series approach, using a mixed methods single case design. Reliable change index and clinically significant change analyses were used to assess changes in self-report measures of self-concept, mood, quality of life, self-esteem, general self-efficacy, and occupational self-efficacy pre to post intervention and at one-month follow-up. Semi-structured follow-up interview data were analysed using deductive thematic analysis. Results: Quantitative outcome measures showed limited change across the intervention. Qualitative data provided preliminary evidence for the potential effectiveness of ‘RE-ID’, with participants reporting change and attributing this change to a combination of ACT therapeutic factors and group process factors. Discussion: The current study provides initial data suggesting that ‘RE-ID’ may be an effective vocational rehabilitation intervention following ABI, and that both the ACT model and the delivery of the intervention in a group format likely contribute to its effectiveness.

Background A positive supervisory relationship is considered essential in ensuring a psychotherapist’s safe and effective practice. Attachment Theory (AT) has been used to investigate factors that may impact upon the quality of the supervisory relationship, for trainee psychotherapists. A literature review revealed inconsistent findings as to whether attachment styles of supervisors and supervisees were associated with the quality of the alliance, suggesting an incomplete understanding the attachment-supervision construct. Objectives To improve our understanding of the attachment-supervision construct, this study aimed to explore, in-depth, how supervisees experienced and understood the supervisory relationship and to explore what within this may be relevant to AT. Method Interpretative Phenomenological Analysis (IPA) was used to interview and analyse data from seven trainee clinical psychologists (supervisees). Results Several participant experiences resonated with AT, including the supervisor demonstrating secure attachment figure qualities, which help the supervisee feel worthwhile. Rather than the supervisory relationship merely being influenced by past infant-caregiver attachment, it appears that there is the potential for a new attachment to form, similar to the freshness of an infant-caregiver attachment. However, unlike an infant, the supervisee has more influence over the attachment, in a collaborative effort with the supervisor, where the relationship seems to benefit from a goodness-of-fit between both relational styles. Non-attachment factors such as reciprocal disclosure were also important in the supervisory relationship. Conclusion Overall, AT appears a useful way to think about the supervisory relationship, particularly for inexperienced trainees. However, as trainee clinical psychologists are trained to think in attachment terms, it remains unclear whether the supervisory relationship is truly a “full-blown” attachment relationship (rather than one consisting of attachment dynamics), or whether this is just the way that trainees approach it. Regardless, the findings suggest that the supervisory alliance may be improved via supervisor attunement to supervisee needs.

Alexithymia and experiential avoidance have both been shown to share substantial relationships with poor mental health outcomes. Both constructs may have heightened importance for men, as male gender is associated with higher rates of alexithymia as well as the increased use of harmful experientially-avoidant coping strategies. Recent research has turned its attention towards the hypothesis that the relationship between alexithymia and negative psychological wellbeing may be as a result of the inflexible application of broader belief systems endorsing the benefits of experientially avoidant coping. This may be particularly relevant for men, who are arguably socialised into suppressing emotional states viewed as unacceptable within dominant masculinity scripts. This thesis aimed to explore the impact of experiential avoidance on the relationship between alexithymia and psychological wellbeing. Specifically, Part One of this portfolio contains a systematic literature review exploring the current evidence base pertaining to the question: how are alexithymia and experiential avoidance related? The findings of the review suggest that studies consistently report positive, significant relationships between alexithymia and experiential avoidance. Additionally, although there have been some mixed findings from mediation analyses, the weight of evidence currently appears in support of experiential avoidance being a critical mediator in the relationship between alexithymia and poorer psychological wellbeing. Part Two presents an empirical paper that investigated the mediating role of experiential avoidance in the relationship between alexithymia and experiential avoidance in men. Findings supported experiential avoidance having a mediating role in this relationship, consistent across depression, anxiety and stress. Findings support the conceptualisation of alexithymia as a learned coping response, which develops alongside preferences for avoidant coping more generally i.e. psychological inflexibility. Parts Three and Four of this portfolio contain details of the clinical experience and academic assignments also completed as part of this clinical doctorate programme.