Self-compassion – a self-relating style characterised by kindness, acceptance, and the motivation to soothe emotional distress – has been empirically validated as a correlate of optimal psychological functioning, wellbeing, and physical health among adults. However, literature examining the relationship between self-compassion and positive outcomes during adolescence is in its infancy. The current research portfolio was thus designed to examine self-compassion as a potential intrapersonal resilience resource that may help young people navigate transitions and challenges during the adolescent period, including living with a chronic illness. The association between self-compassion and subjective wellbeing in adolescents was estimated through meta-analytic modelling, while self-compassion was empirically examined as a correlate of effective disease management in adolescents with type 1 diabetes. The meta-analysis revealed a large, positive correlation between self-compassion and subjective wellbeing (r = .46) in studies with adolescents aged 10 to 19. Among a sample of 52 adolescents (aged 11 to 18) with established type 1 diabetes, self-compassion was found to predict improved glycaemic control and regimen adherence, outcomes linked to a reduced risk of short- and long-term health complications. Impaired self-soothing was also discovered to mediate the relationship between emotional distress and poorer diabetes regimen adherence. A compassionate self-approach thus appears to be linked with the subjective experience of wellbeing among adolescents, as well as having specific implications for behavioural and physiological resilience among those living with a chronic health condition. As a trainable resource, self-compassion may provide a valuable tool for promoting positive mental and physical health among young people.

Background: The experience of trauma in childhood, for a minority of individuals, can lead to chronic and distressing symptoms of post-traumatic stress disorder (PTSD) and other mental health difficulties. Cognitive models of PTSD demonstrate key factors involved in the development of symptoms, however, research evidence regarding the role of different pre- peri- and post-trauma predictors of PTSD in children and adolescents is limited and variable. Furthermore, there is scope to understand predictors of mental health outcomes other than PTSD. With the expected publication of ICD-11 in 2018, further research is also necessary to develop our understanding of the new diagnostic category of ‘Complex PTSD’ in children and adolescents. Methods: Firstly, a systematic literature review and meta-analysis was conducted, summarising the current evidence regarding the role of peritraumatic psychological risk factors in the development of PTSD. Secondly, empirical analysis of pre-existing data from a longitudinal study of children and adolescents experiencing a single-event trauma was conducted. Multiple linear regression models were used to assess four theory-derived predictive models of mental health outcomes (PTSD, CPTSD, depression and anxiety) of trauma in this sample. Results: Population estimates of effect size were moderate for peritraumatic subjective threat and fear as risk factors for PTSD. Effect size estimates for peritraumatic dissociation were small, and evidence for data-driven processing was limited. The empirical study indicated that a cognitive model of predictors was most powerful in predicting the development of all four disorders following trauma, and psychosocial and objective event severity models were weak predictors of mental health outcomes. Conclusions: Cognitive processes occurring during and after trauma may be valuable markers of which individuals may be at risk of developing PTSD, CPTSD, depression or anxiety after trauma. Further research of multiple predictors and outcomes of trauma is required in children and adolescents, particularly related to CPTSD.

Context: Acquired brain injury (ABI) can have a profound impact on virtually any aspect of an individual’s functioning and recent figures suggest ABI affects approximately 700,000 people in the UK each year. However, treatment and rehabilitation guidelines state there is currently insufficient evidence to recommend any specific form of therapy to support the process of emotional adjustment following ABI. Aim: This research portfolio aimed to increase the understanding of the experience of well-being following ABI and the resources, which may contribute to this. Design: The project is presented in a thesis portfolio format combing two main research papers: a systematic review and a qualitative, Interpretative Phenomenological Analysis (IPA), research study. The systematic review explored the existing evidence for the effectiveness of creative activity groups on psychological well-being including mood and quality of life. The IPA study examined eleven participant’s accounts of their experience of well-being post-ABI and explored the resources that helped them to achieve this. Results: The systematic review identified some tentative, preliminary evidence for the usefulness of creative activity groups as a potential resource towards improving psychological outcomes well-being post-stroke. The IPA research identified six main themes, which illuminated the experience of wellbeing in relation to internal and external resources. The resources identified broadly related to either; personality traits or states of mind, engaging in activities or support from others. Well-being tended to be described as feelings of “inner-peace”, warmth or happiness. Conclusion: Findings are presented tentatively, and further research is required. However, there is some evidence to suggest that supporting individuals to engage meaningfully in their environments may be beneficial to post-ABI adjustment and well-being.

Background: Reflective practice is regarded as a key competency in managing the complexity and uniqueness of clinical work (Schön, 1983). However, the dearth of research combined with the methodological limitations of how this concept has been explored has limited our understanding of how reflective practice is being used in clinical practice, particularly outside of a training context. Design: This project is presented as a thesis portfolio, which includes a systematic review of qualitative literature on the uses of reflective practice among qualified therapists’, an empirical study exploring clinical psychologists’ experiences of how they use reflective practice in their clinical work, an extended methodology chapter, and a discussion and critical evaluation chapter. Results: The systematic review produced eight studies, and within these seven interrelated themes emerged, which were encapsulated by two overarching themes: the value of reflective practice and conceptualising reflective practice. Despite difficulties with understanding and integrating reflective practice, therapists reported many benefits to reflection including: increasing self-awareness, enhancing connection with clients, enhancing clinical practice and facilitating self-care. The empirical study used an interpretative phenomenological analysis (IPA), which produced three superordinate themes to capture participants’ experiences of reflective practice: 1) discovery through exploratory questioning, 2) containment in practice through making sense of their thoughts and feelings and 3) human survival. Conclusion: The findings from the systematic review suggest the criticisms of the literature have yet to be addressed, with the majority of studies reporting therapists’ retrospective opinions of reflective practice. The findings from the empirical study suggest reflective practice may enhance perspective-taking abilities, interpersonal skills, and personal resilience. The study has begun to address criticisms of the literature by combining reflective diaries and interviews to capture lived experience, therefore linking the benefits of reflective practice to real world examples.

Background: Postnatal depression (PND) has been found to have detrimental effects on the mother-infant (M-I) relationship, parenting and maternal bond (MB). Objective: To explore some of the factors that may have an association with the strength of the M-I relationship, parenting or MB. These include factors within the individual such as posttraumatic growth (PTG), PND, current depression and perceived social support as well as external factors such as the impact of treating PND on the M-I relationship and parenting. Method: Electronic databases were used to conduct a systematic review on the current available evidence to assess the impact of treating PND on the M-I relationship and parenting. In addition, a quantitative research study was conducted using a cross-sectional design to explore whether the presence of PTG following PND contributes to the MB whilst controlling for social support and current depression. Participants (N=98) for this study were recruited online and completed measures of MB, PTG, perceived social support and current depression. Results: Systematic Review: eight papers met the inclusion criteria, of which, five papers were rated as methodologically ‘strong’ and three were rated as ‘moderate’ in relation to the review aims. There were some consistent findings suggesting the positive impact of treating PND on both the M-I relationship and parenting. Quantitative research study: Results showed that PTG can be achieved following PND. In addition, of the variables included, current depression was the strongest indicator of the strength of MB. Conclusion: The need for further investigation into variables that contribute to the strength of all aspects of the mother-child relationship has been highlighted within this thesis portfolio. A greater understanding into these variables could inform the expansion of interventions to better suit the needs of postnatally depressed women and their children.

Introduction: Adults with autism spectrum disorders (ASD) are at heightened risk for several comorbid mental health conditions. However, the prevalence of common co-occurring difficulties such as anxiety and depression and associated risk factors are poorly understood. Aim: The aim of this thesis was to both quantify the prevalence of anxiety and depression in adults with ASD and to investigate how internalising (anxiety and depression) and externalising (conduct problems) symptoms in adulthood are related longitudinally to symptoms in childhood, quantifying any additional impact of exposure to adverse life events and poor parental mental health. Method: The prevalence of anxiety and depression was estimated by conducting a systematic review and meta-analysis consisting of 36 studies, including 30 studies measuring anxiety (n=26,070) and 29 measuring depression (n=26,117). The empirical study included 115 young adults with ASD who were assessed at three time-points (at 12,15 and 23 years of age) on measures of internalizing and externalizing symptoms. Structural Equation Modelling was used to investigate the impact of adverse life events and parental mental health on internalizing and externalizing symptoms. Results: The estimated current and lifetime prevalence for anxiety and depression in adults with ASD was 27% and 42%, and 23% and 37%, respectively. Results of the empirical study indicated that internalizing and externalizing symptoms in young adults with ASD are significantly related to exposure to adverse life events and mental health symptoms in childhood and adolescence. Additionally, poor parental mental health and wellbeing was found to predict a higher frequency of externalising problems but did not moderate the impact of adverse life events. Discussion: The results of this thesis suggest that anxiety and depression are highly prevalent in adults with ASD and that symptom severity in childhood and adolescence, exposure to life events and poorer parent mental health are all independent predictors of symptom severity.

For over one hundred years, Western Psychology has been preoccupied with developing an understanding of the dyad par excellence: mother and child. This thesis explores the cultural validity of attachment theory and the concept of the dyad in families of African Caribbean heritage in London, UK. This is developed through the juxtaposition of an ethnography of emic perspectives and experiences of Caribbean families in London, and a series of semi-structured interviews and group discussions with practitioners from fields of relevance. The thematic analysis of the data collected puts forward conflicting interpretations, between practitioners and families, on three common themes: the meaning of being Caribbean, family bonds, and attitudes towards society. The discussion of these three themes, and divergent perspectives of participants, indicates that the key tenets of attachment theory (maternal sensitivity, quality of care and stability of attachment) are not representative of the experiences and perspectives presented by the families. Considering these results, I formulate a possible alternative theoretical framework to represent and theorise dynamics in Caribbean families: fluctuant attachment. Whilst this new framework, based on three themes identified by families as central to their experiences, wishes to limit stereotypical interpretations of family bonds; it fails to recognise children’s role in these relations. In my conclusion, following a Foucaldian deconstruction of attachment theory, I argue for the necessity for Childhood Studies to be a field of critical theory, based on children’s rights, and to develop new theoretical frameworks that recognise children as active agents.

Little is known about the relationship of individual factors to wellbeing in mental health staff. The systematic review conducted for this thesis found evidence of associations between individual factors and wellbeing outcomes in this population, and suggests that a mindfulness-based construct, psychological flexibility, is of particular interest. Three studies were conducted to examine psychological flexibility in staff of Crisis Resolution Teams (CRTs). Staff in 25 CRTs (n=723) completed questionnaires including measures of psychological flexibility and wellbeing at two time points 12 months apart. Service user satisfaction and service use data was collected for each team. The resulting data has been used to investigate: 1) the extent to which psychological flexibility predicts wellbeing in individual CRT staff; 2) associations between managers’ levels of psychological flexibility and staff wellbeing and psychological flexibility; and 3) associations between team-level psychological flexibility and service user satisfaction and service use. The results provide evidence that, in line with previous research in other populations, psychological flexibility predicts better wellbeing at the individual level in CRT staff (Coeff. -0.36, 95% CI -9.38 to -0.94, p < 0.01). In a novel contribution to the field, manager psychological flexibility was also found to be positively associated with better staff wellbeing (Coeff. -0.31, 95% CI -0.60 to -0.03, p=0.03). An unexpected result was that average team-level psychological flexibility was associated with lower service user satisfaction (this may be due to methodological factors) (Coeff. -0.55, 95% CI -1.08 to -0.02, p=0.04), and was not associated with service use. The results contribute evidence about psychological flexibility in a group not previously studied. They demonstrate the benefits of multi-level research, and suggest further research is warranted to investigate the use of interventions to increase psychological flexibility at the individual and management levels in mental health contexts, and thus improve wellbeing in this important group of staff.

Individuals with Down syndrome (DS) show a high degree of inter-subject variability in cognitive ability. Elucidating factors associated with variability in cognitive function can inform us about intellectual disability severity and potentially provide biomarkers of ability for clinical trials targeting cognition in individuals with DS (including trials aimed at preventing cognitive decline). Resting-state electroencephalography (EEG) can be used to obtain information about neural factors that may be underlying variability in cognitive function. This thesis uses eyes-open (EO; n=48) and eyes-closed (EC; n=36) resting-state EEG paradigms in adults with DS free from detectable signs of cognitive decline or dementia to identify EEG measures associated with general cognitive ability, and to investigate age-related changes in EEG activity in this population. Oscillations of interest were then modelled using dynamic causal modelling (DCM) to identify potential neurophysiological mechanisms underlying individual differences in general cognitive ability. Initial analysis suggested that individuals with DS have an overall slower EC EEG spectrum (and particularly strong differences in alpha activity) compared to typically-developing age-matched control subjects (open source control dataset used). Within individuals with DS, increasing age was associated with EEG changes in both paradigms. When controlling for age, higher general cognitive ability was associated with higher delta power (EO only), higher theta power (EC only), and higher alpha peak amplitude (EC only). Modelling the theta-alpha network identified “intrinsic self-inhibition” as the most important neurophysiological parameter underlying the relationship between theta-alpha activity and general cognitive ability in this sample. Further analysis revealed a strong inverse relationship between occipital intrinsic self-inhibition and general cognitive ability. Findings of this thesis enhance our understanding of neural factors associated with individual differences in general cognitive ability in adults with DS, provide a potential biomarker of ability for clinical trials, and indicate potential targets for cognitive enhancement in this population. The finding that increased inhibition may be associated with cognitive impairment in this population is in keeping with animal model literature and warrants further investigation.

Increasing demand for mental health treatment and the transfer of a large portion of our lives online has led to the development of a growing range of computerized psychological therapy programmes. We are also creating and storing data at ever increasing rates, a trend that has led to the development of sophisticated textual analysis approaches. This thesis sits at the cross-section of these evolving areas. It is an exploratory analysis of how text mining analysis can be applied to online cognitive behaviour therapy. The project emerged as a collaboration between two commercial partners: Ieso Digital Health and Linguamatics, and UCL. Ieso Digital Health provide online cognitive behaviour therapy via an online instant messaging platform and Linguamatics are the developers of text mining software I2E. The involvement of the two industrial partners in this project shaped two major components of this research; the data studied and the platform for textual analysis. Linguistic analysis of textual data in mental health is a wide and variable field that brings together a variety of methods and data formats. These are broadly introduced in Chapter 1 and Chapter 2 provides a systematic review of research on the analysis of language used within therapeutic exchanges during mental health treatment. The research carried out in this thesis involved the development of a number of linguistic features within I2E and statistical analyses to explore their association with mental health outcomes and the development of predictive models of outcome. The results (Chapters 4-10) suggested that there were statistically significant associations between selected language features and therapy outcome scores but that these language features did not fare well as predictors of outcome when developed models were externally validated. These results and recommendations for the application of text mining in therapy transcripts are discussed in Chapter 11.