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An in depth exploration of perspectives held by boys who have social emotional behavioural difficulties (SEBDs) on their lifestyle, health and access to health-related services using a music-based approach. RAP ‘n CAB is a collaborative exploratory study between 2 secondary schools asking what perspectives boys with SEBDs hold on their lifestyle, health and access to health-related help. The methodology is qualitative using a participative approach involving peer researchers to collect data. Using purposive sampling, eight boys aged 14 years consented to participate on invitation by their teachers. Analysis of the data reflected a subjectivist epistemological approach. Use of Labov’s Evaluative Framework (1972b) was attempted as its narrative analysis methodology fitted the dual purpose of the research: to facilitate the telling of perspectives on health and lifestyle that are unique to the individual and to understand that telling. Due to methodological problems arising it was found that relevant data was excluded. A thematic analysis was therefore developed using Labov’s concept of clause social function to code data. This was enabled by the development of an inclusive narrative clause definition so that all the data collected could be included in the analysis. The use of face-to-face semi-structured interviews, focus groups and original composition of raps were effective in obtaining subjective data depicting personal perspectives that fulfilled the research objectives. The findings suggested that family, school and peer contexts were important to the research participant’s lives but that their lifestyle actions were predominantly influenced by good friends, peer competition and peer pressure. Interesting insights revealed the importance of invisible routines to lifestyle choices and the extent that eating was no longer included within the fundamental routine of their daily lives.

Cognitive interpretation biases have been associated with the development of depressive psychopathology. As adolescence is linked to an increased risk of developing mood disorders, research has focused on whether cognitive training can be an effective intervention. The theoretical paper therefore reviews literature on Cognitive-Bias Modification of Interpretation (CBM-I) which looks at experimentally manipulating cognitive biases and then measuring the subsequent impact on mood. In addition, studies assess if the training can have a protective influence when individuals are faced with a stressor. Research has been carried out with clinical and healthy adults and recent work has shown that bias induction can be successful with children and adolescents. If limitations outlined by the review can be overcome, then the training may pose an alternative low-cost preventative intervention, or an adjunct to traditional face-to-face psychological therapies, for children and adolescents. The empirical study used functional magnetic resonance imaging (fMRI) to compare 15 medication- free adolescents who met criteria for major depressive disorder against 15 healthy control adolescents on their ability to reappraise negative emotions, evoked through receiving peer rejection, and the underlying neural substrates involved. A pilot study was first conducted in a community sample to investigate the effectiveness of the reappraisal training script - with promising results. Thus, reappraisal training was applied to adolescents with and without depression pre-scanning. Behavioural data attested to its effectiveness in altering thoughts and mood. Significant brain activation during a Reappraisal> Baseline contrast was found in the dorsomedial and ventrolateral prefrontal cortex thought to be associated with the cognitive control of emotions and in particular reappraisal. No significant between-group differences were found in the fMRI or the behavioural data suggesting that depressed adolescents can reappraise peer rejection as effectively as their control counterparts when they have been instructed to do so. This may point to support for techniques used in psychological therapies.

This thesis contains three related pieces of work that considered young people's experiences of mental health difficulties. The first is an original piece of qualitative research. Semi-structured interviews were used to investigate the lived experience of eight females with mental health difficulties, aged between 15 and 17 years. Through interpretative phenomenological analysis, five themes emerged; these were 'keep it hidden', 'the stickiness of a diagnosis', 'life is different now', 'relationships are different now' and 'other young people with difficulties'. How these young women related to their diagnosis became a topic of interest and therefore the focus of the second piece of work, a literature review. This review identified 15 studies. Ten studies employed quantitative methods to assess mental health literacy and attitudes in young people in the general population. Five studies used qualitative methods to investigate the attitudes of young people who had received a mental health diagnosis. The results suggested that many young people in the general population displayed poor, at best moderate, mental health literacy and that many young people held negative preconceptions about mental health diagnoses. Individuals who had received a diagnosis described themes that suggested high levels of shame and an altered sense of identity. Both the research Young people's experiences of mental health difficulties 7 and review papers considered the concept of pre and post diagnostic counselling as a potential clinical implication and this was discussed in the third piece of work. The discussion paper summarised that there are few specific recommendations for sharing a mental health diagnosis with adults or young people. It was suggested that further research is required to assess whether pre and post diagnostic counselling could be an effective way of improving the diagnosis experience for young people. Finally my personal reflections of completing the thesis are shared.

Shame is considered to be a negative emotion which encompasses feelings of inferiority, self-condemnation and the desire to hide from others. It has been associated with psychopathology, including depression, which is a significant and growing concern particularly in young people. Understanding how shame contributes to adolescent depression is therefore important. 0 Previous research with adults indicated that rumination and social rank are important in the relationship between shame and depression. However the small number of studies related to adolescent depression suffered from methodological weaknesses and did not test for mediation. Objectives The present study aimed to elucidate the contexts inwhich adolescents experience shame. Moreover it aimed to investigate whether rumination and social rank (social comparison and submissive behaviour) mediated the relationship between shame and depression in adolescents. Method A cross-sectional, questionnaire-based design was used and data were collected from a community sample of 16 to 18 year-olds (mean age 17.09). Measures of chronic, external and event-specific shame, general and event-specific rumination, social comparison, submissive behaviour and depression were completed by 188 participants (175 females and 13 males). Results The findings suggested that adolescents experienced shame in a variety of contexts including bullying, poor academic achievement and relationship difficulties. Mediation analyses suggested that rumination did not significantly mediate the relationship between shame and depression in adolescents, independently of social 104 nk. social comparison and shame appeared to act in a reciprocal relationship to influence adolescent depression. Shame and submissive behaviour behaved similarly but in adolescents submissive behaviour may be protective. conclusion The findings differed from previous research examining shame, social rank, rumination and depression in adult samples. In the presence of shame, social rank may be more important than rumination during adolescence in relation to depression as an outcome.

No description available.

Child and Adolescent Mental Health Services (CAMHS) are provided according to a four tiered model (Health Advisory Service, 1995), based on the assumption that increasing levels of problem severity, complexity and persistence should be managed across the tiers. There is little research to underpin these assumptions and while some studies have indicated factors associated with CAMHS access and usage, there is a paucity of evidence to suggest which children can be managed at each tier of service. If severity, complexity and persistence do differ across the tiers, measures could be used at assessment that would indicate which children should access tier 2 or tier 3. This would aid the effective use of resources. A retrospective longitudinal study followed-up 378 children after assessment in CAMHS tier 2 to determine whether parental and clinician ratings of severity, complexity, duration and type of difficulties reported at assessment, differed between children who accessed tier 2 only or subsequently accessed tier 3 within 1 or 1-5 years. Parents completed the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997), while the researcher completed the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA; Gowers et al., 1999) and the Paddington Complexity Scale (Yates et al., 1999) retrospectively from case-notes. Findings indicated that children with more severe, complex, persistent and externalising difficulties were more likely to access tier 3 in both the short and the long-term. Multinomial regression indicated that the strongest predictors of tier 3 access within l-year was HoNOSCA total scores, while SDQ total and SDQ conduct scores predicted access within 1-5 years. A model is proposed to use information from the SDQ and HoNOSCA, at assessment, to allocate children to tier 2 or 3 CAMHS. The limitations of the study, national implications and suggestions for future research are discussed.

Background Young people who consult with their GP are known to have a higher psychological morbidity and accompanying emotional distress, than those who do not seek help. A small body of research has identified that GPs have difficulty in identifying emotional distress in this patient population unless it is severe. The implications of a low detention rate of distress by GPs include recurrent and enduring distress which continues into adult life and impacts negatively on social, educational, psychological and emotional development. Consultations with young people in this clinical arena can be problematic yet little is known about how the situation is perceived by GPs. In contrast, GPs are increasingly involved in responding to adults with emotional distress and psychological difficulties and their involvement has been well researched. The research presented here explores GPs’ views and experiences of managing emotional distress in young people who present in general practice. Methodology Grounded theory methodology was used, augmented by the application of situational analysis. Nineteen semi-structured interviews were conducted with practising GPs in the North East of England between January 2009 and July 2010. Findings and conceptual theory GPs vary in their degree of engagement with young people who present with emotional distress. This clinical terrain is perceived by the majority as being unfamiliar territory and creates professional anxiety and uncertainty. Three domains emerged as being pivotal in shaping a GP’s response to this problematic situation. They are defined as a GP’s performance in the clinical encounter; a GP’s perspective of young people and their health needs and a GP’s epistemological frame of reference. These domains form the pillars of the conceptual theory. The three areas intersect with each other to shape a iv GP’s engagement with emotionally distressed young people; which is translated in the clinical encounter as ‘the enactment of role’. Conclusion A GP’s role in responding to emotional distress in young people is ill-defined and unsupported. This results in anxiety and uncertainty about how to proceed. By developing a conceptual theory to explain what influences GPs’ responses in this challenging clinical encounter it is possible to support greater involvement of GPs with young people who present with emotional distress. This has implications for education, practice, research and policy.

Text in Afrikaans / Die doel van hierdie studie was om die aard van betekenisgewing in die identiteitsvestiging van adolessente met probleme, veral ten opsigte van die realiteit en by die aanleer van sekere lewensvaardighede, te ondersoek. Die ondersoek bestaan uit 'n literatuurstudie sowel as 'n eie empiriese ondersoek. Die betekenisgewingsfenomeen is vanuit 'n empiries-pedagogiese perspektief ondersoek, veral met die implikasies daarvan vir identiteitsvestiging. Die adolessent met probleme is geneig om op 'n onrealistiese wyse betekenisse aan sy verskillende relasies toe te ken. In kort bestaan die probleem daarin dat die adolessent met probleme nie oor die vermoe beskik om die eie 'self' objektief waar te neem nie. Die adolessent se gebrekkige insig en begrip van die realiteit lei dikwels tot irrasionele of onlogiese betekenisgewing. Irrasionele denkwyses veroorsaak by sommige adolessente gevoelens soos angs, vrees, emosionele opwelling, selfverwyt, minderwaardigheid en rigiditeit. Hierdie emosionele probleme manifesteer in 'n identiteitskrisis en word sigbaar in die adolessent se gedrag. Adolessente wat irrasionele betekenisse toeken en nie tot realistiese identiteitsvestiging kom nie, leef dikwels hulle probleme uit deur te steel, seksueel losbandige lewens te lei, dwelmmiddels te gebruik en selfs van die huis weg te loop. In die literatuurstudie is verder ook aandag gegee aan die volgende: • Terapievorme wat van toepassing is in die hulpverlening aan adolessente wat irrasionele betekenisse toeken, • Hulpverlening in groepsverband en • Kommunikasie in groephulpverleningsgebeure. Die empiriese ondersoek is 'n idiografiese ondersoek wat aan die hand van 'n model, volgens Dryden, wat gestruktureer en aangepas is, uitgevoer is. Die model is gebaseer op rasionele-emotiewe-terapie (RET) soos voorgestaan deur Ellis. Vyf adolessente is in die ondersoek betrek. Aan een adolessent is op individuele basis hulp verleen terwyl die ander vier adolessente groepshulpverlening ontvang het. Dit blyk uit die idiografiese ondersoek dat die model en werkswyse wat toegepas is, wel 'n bydrae kan lewer tot die wysiging van onrealistiese betekenisgewing by adolessente met probleme. Deur die hulpverlening verwerf die adolessent 'n lewensvaardigheid waardeur oorgegaan word tot realistiese betekenisgewing en -identiteitsvestiging. Uit die bevindinge van die ondersoek word enkele aanbevelings met betrekking tot verdere navorsing en praktykvoering gemaak. / The aim of the study was to investigate the nature of meaning attribution by which adolescents with problems establish their identity. The following aspects were focussed on: the reality and acquiring certain life-skills. The investigation comprises a literature study as well as an empirical investigation. An empirical-pedagogic perspective was used to examine the phenomenon of significance attribution and the implications thereof in establishing identity. The adolescent with problems tends to attribute unrealistic meaning to his various relationships. Briefly the problems exist because of the lack of ability to perceive the 'self' objectively. This inadequate perception of the adolescent with problems, causes him to attribute irrational or illogical meaning. The tendency of some adolescents, to attribute irrational meaning, causes feelings of anxiety, fear, emotional ebullition, self-blame, inferiority and rigidity. These emotional problems are manifested in an identity crisis and show in the actions of the adolescent. The adolescents, who attribute unrealistic meaning and who do not arrive at realistic self-definition, often act out their problems by stealing, living promiscuous lives, abusing drugs and absconding from home. In the study of literature the following aspects were also focussed on: • Types of therapy applicable in rendering assistance to the adolescent who attributes unrealistic meaning. • Group therapy. • Communication in group therapy events. The empirical research comprises an idiographic investigation, structured on an adapted form of Dryden's model. The model is based on rational-emotive therapy, (RET) as advocated by Ellis. five adolescents were used in this investigation. Individual therapy was given to one adolescent while the other four adolescents received group therapy. From the idiographic investigation it has become evident that the model and the procedure followed, can make a contribution to the adolescent with problems, in changing his tendency to attribute unrealistic meaning to his relationships. He can make successful use of the model as an acquired life-skill to attribute significant meaning in his efforts to arrive at a realistic self-definition. He is thus able to actualise his defined self. Based on the findings of this investigation certain recommendations, concerning further research, as well as counselling in practice, were proposed. / Psychology of Education / D. Ed. (Empiriese Opvoedkunde)

Text in Afrikaans / Die doel van hierdie studie was om die aard van betekenisgewing in die identiteitsvestiging van adolessente met probleme, veral ten opsigte van die realiteit en by die aanleer van sekere lewensvaardighede, te ondersoek. Die ondersoek bestaan uit 'n literatuurstudie sowel as 'n eie empiriese ondersoek. Die betekenisgewingsfenomeen is vanuit 'n empiries-pedagogiese perspektief ondersoek, veral met die implikasies daarvan vir identiteitsvestiging. Die adolessent met probleme is geneig om op 'n onrealistiese wyse betekenisse aan sy verskillende relasies toe te ken. In kort bestaan die probleem daarin dat die adolessent met probleme nie oor die vermoe beskik om die eie 'self' objektief waar te neem nie. Die adolessent se gebrekkige insig en begrip van die realiteit lei dikwels tot irrasionele of onlogiese betekenisgewing. Irrasionele denkwyses veroorsaak by sommige adolessente gevoelens soos angs, vrees, emosionele opwelling, selfverwyt, minderwaardigheid en rigiditeit. Hierdie emosionele probleme manifesteer in 'n identiteitskrisis en word sigbaar in die adolessent se gedrag. Adolessente wat irrasionele betekenisse toeken en nie tot realistiese identiteitsvestiging kom nie, leef dikwels hulle probleme uit deur te steel, seksueel losbandige lewens te lei, dwelmmiddels te gebruik en selfs van die huis weg te loop. In die literatuurstudie is verder ook aandag gegee aan die volgende: • Terapievorme wat van toepassing is in die hulpverlening aan adolessente wat irrasionele betekenisse toeken, • Hulpverlening in groepsverband en • Kommunikasie in groephulpverleningsgebeure. Die empiriese ondersoek is 'n idiografiese ondersoek wat aan die hand van 'n model, volgens Dryden, wat gestruktureer en aangepas is, uitgevoer is. Die model is gebaseer op rasionele-emotiewe-terapie (RET) soos voorgestaan deur Ellis. Vyf adolessente is in die ondersoek betrek. Aan een adolessent is op individuele basis hulp verleen terwyl die ander vier adolessente groepshulpverlening ontvang het. Dit blyk uit die idiografiese ondersoek dat die model en werkswyse wat toegepas is, wel 'n bydrae kan lewer tot die wysiging van onrealistiese betekenisgewing by adolessente met probleme. Deur die hulpverlening verwerf die adolessent 'n lewensvaardigheid waardeur oorgegaan word tot realistiese betekenisgewing en -identiteitsvestiging. Uit die bevindinge van die ondersoek word enkele aanbevelings met betrekking tot verdere navorsing en praktykvoering gemaak. / The aim of the study was to investigate the nature of meaning attribution by which adolescents with problems establish their identity. The following aspects were focussed on: the reality and acquiring certain life-skills. The investigation comprises a literature study as well as an empirical investigation. An empirical-pedagogic perspective was used to examine the phenomenon of significance attribution and the implications thereof in establishing identity. The adolescent with problems tends to attribute unrealistic meaning to his various relationships. Briefly the problems exist because of the lack of ability to perceive the 'self' objectively. This inadequate perception of the adolescent with problems, causes him to attribute irrational or illogical meaning. The tendency of some adolescents, to attribute irrational meaning, causes feelings of anxiety, fear, emotional ebullition, self-blame, inferiority and rigidity. These emotional problems are manifested in an identity crisis and show in the actions of the adolescent. The adolescents, who attribute unrealistic meaning and who do not arrive at realistic self-definition, often act out their problems by stealing, living promiscuous lives, abusing drugs and absconding from home. In the study of literature the following aspects were also focussed on: • Types of therapy applicable in rendering assistance to the adolescent who attributes unrealistic meaning. • Group therapy. • Communication in group therapy events. The empirical research comprises an idiographic investigation, structured on an adapted form of Dryden's model. The model is based on rational-emotive therapy, (RET) as advocated by Ellis. five adolescents were used in this investigation. Individual therapy was given to one adolescent while the other four adolescents received group therapy. From the idiographic investigation it has become evident that the model and the procedure followed, can make a contribution to the adolescent with problems, in changing his tendency to attribute unrealistic meaning to his relationships. He can make successful use of the model as an acquired life-skill to attribute significant meaning in his efforts to arrive at a realistic self-definition. He is thus able to actualise his defined self. Based on the findings of this investigation certain recommendations, concerning further research, as well as counselling in practice, were proposed. / Psychology of Education / D. Ed. (Empiriese Opvoedkunde)