Mental health has long been a neglected problem in global healthcare. The social and economic impacts of conditions affecting the mind are still underestimated. However, in recent years it is becoming more apparent that mental disorders are a growing global concern that is not to be trivialised. Considering the rising burden of psychiatric illnesses, there is a necessity of developing novel services and researching effective means of providing interventions to sufferers. Such novel services could include technology-based solutions already used in other healthcare applications but are yet to make their way into standard psychiatric practice. This thesis presents a study on how pervasive technology can be utilised to devise an “early warning” system for patients with bipolar disorder. The system, containing wearable and environmental sensors, would collect behavioural data and use it to inform the user about subtle changes that might indicate an upcoming episode. To test the feasibility of the concept a prototype system was devised, which was followed by trials including four healthy volunteers as well as a bipolar patient. The system included a number of sensory inputs including: accelerometer, light sensors, microphones, GPS tracking and motion detectors. The experiences from the trials led to a conclusion that a large number of sensors may result in incompliance from the users. Therefore, a separate investigation was launched into developing a methodology for detecting behavioural patterns in inputs possible to collect from a mobile phone alone. The premise being that a phone is an everyday use appliance and is likely to be carried and accepted by the patient. The trial revealed that monitoring GPS tracks and Bluetooth encounters has the potential of gaining an insight into a person’s social and behavioural patterns, which usually are strongly influenced by the course of bipolar disorder. Lessons learned during these proceedings amounted to a clearer concept of how a future personalised ambient monitoring system could improve the outcome of treatment of bipolar disorder as well as other psychiatric conditions.

Aims and objectives: Bipolar disorder is a severe and enduring mental illness with a high incidence of long-standing interpersonal and psychosocial difficulties that extend beyond the features of manic and depressive episodes. Research into the cognitive style of individuals with a dipolar disorder suggests depressogenic/optimistic attributional style, perfectionism, sociotropy, autonomy and maladaptive schemas play an important role in the disorder, and how individuals cope with it. The presence of early maladaptive schema (EMS) in the bipolar population has so far not been researched. The aim of the present study is to investigate what types of schema are pertinent for this group, and the relationship between schema and individuals' coping style (self-control behaviours).;Method: A within participant design involved 41 individuals with a diagnosis of bipolar disorder completing the Young Schema Questionnaire-short form, the Self-Control Behaviour Schedule, and the Internal State Scale. Data were analysed quantitatively using correlation and analysis of variance. EMS data were compared to normative EMS data.;Results: Self-Sacrifice and Unrelenting Standards were significantly prevalent for this sample. Emotional Deprivation was found to be present, but not significantly different from other EMS. There was a significant relationship between EMS and self-control behaviour.;Conclusions: The clinical and research implications for the psychological assessment and treatment of individuals with a bipolar disorder are discussed.

Psychosis is a term used to describe a range of experiences often associated with significant distress. Interpretative Phenomenological Analysis (IPA) is a qualitative method which focuses on the first person perspective to understand lived experience and how an individual makes sense of that experience. There has been a growth in the use of IPA to explore psychosis. The first paper is a systematic review assessing the quality of IPA studies which explore the subjective experience of psychosis from a range of different perspectives, including service user, family and professional. This review identified examples of high quality research which adhered to the principles of IPA. However, the field is currently limited by a lack of reflexive practice, thus improvements in reflexivity are encouraged. The exploration of different perspectives, for example sibling or friend, to further understand the systemic experience and impact of psychosis is recommended for future research. This review concluded that JP A is a useful tool to explore psychosis. The second paper presents an IPA st1.ldy that explored the internal processes in recovery in psychosis, with particular consideration of the potential roles of self-criticism and self-compass ion. The results indicate that the process of self-.acceptance following experiences of psychosis was central to recovery. The internal process of self-to-self relating contributed to two maintenance cycles. Self-criticism was identified as maintaining distressing experiences of psychosis. In contrast, compassionate self-acceptance and empowered action resulted in progress in recovery and for some participants' growth. Thus it is proposed that therapeutic approaches which promote compassionate self-acceptance may facilitate recovery and potentially growth. The novel finding of growth following enduring experiences of psychosis indicates a fruitful area for future research and demands active engagement from services to promote not only recovery but also psychological growth following psychosis

Bipolar disorder is a difficult disorder which can significantly impact upon an individual's physical, psychological and functional wellbeing. The progress made in developing effective psychological interventions for other severe and enduring mental health conditions is yet to be matched by advances in the psychological treatment of bipolar disorder. Two areas of emerging research have show.n promise: the association between personal goals and risk of mania; and the identification of intrusive mental imagery during the mood states defining bipolar disorder. Gaining an increased understanding of the cognitive processes involved in mania could inform the development of new treatment models for bipolar disorder. The review paper critically evaluates the literature investigating the association between personal goals and risk of mania, plus evidence for a role of future cognition in anxiety, depression and bipolar disorder. The review concludes that future research should more specifically investigate the relevance of goals to a psychiatric population of individuals with bipolar disorder and that mental imagery appears to play a role in the maintenance of mood disorders. Future research endeavours should bridge the gap that is evident between these diverse fields of enquiry. The empirical paper investigates the experience of mental imagery during periods of positive mood among individuals with bipolar disorder or unipolar disorder. All participants (n=36) reported experiencing intrusive mental imagery during their last period of positive mood. The predicted differences between- and within- groups in the frequency and properties of their imagery and thoughts were not found, although trends were in the predicted direction. There was a significant difference between the groups on a measure of goal-striving. Content analysis of each participant's most significant image yielded a range of interesting findings. Despite its limitations, this study provides evidence of theoretical and clinical interest, thus further research with a larger sample size is warranted.

This study explores the effectiveness of “In-Sight”, a holistic recovery-based group training for people with bipolar disorder. Drawn from professional therapies and lived experience of the user-researcher who is diagnosed with having the illness, the training was delivered over 12 weekly sessions. Within a case study approach, an experimental design incorporated pilot (eight participants), main study (five) and control groups (six). Participants with a wide range of DSM-IV bipolar disorders were sought. Three non-bipolar participants experiencing severe mood swings were maintained in the pilot. One bipolar pilot participant later trained as the main study group co-facilitator in delivering the training. Self-report scales measured mood, coping, empowerment and quality of life pre-, post- and six months post-training. Semi-structured interviews noted individual change within the same time frame. Mental health professional interviews, medical note analysis and user-researcher observations also informed the study. Findings from self-report questionnaires indicated promising evidence that participants experienced improved mood stability, symptom severity, coping and quality of life and greater empowerment. A model has emerged to illustrate the various course components that appeared to benefit participants (user-led approach, self-help iii group format, illness management techniques, interpersonal skills development, healthy lifestyle, structure and planning, and intellectual change of perspective). The model illustrates how these components appeared to impact upon coping strategies, in turn leading to greater mood stability, maintaining wellness and personal development resulting in greater empowerment, improved outlook on self and the future and improved quality of life over time. The three non-bipolar pilot participants also appeared to benefit from the training compared to controls albeit to a lesser degree than the bipolar participants. The co-facilitator showed evidence of the greatest improvement. Four controls indicated evidence of continued use of poor coping and risk of further deterioration in illness, of whom two experienced major episodes with psychosis. Two controls indicated slight improvements. The “In-Sight” training is proposed as a step towards a more comprehensive approach for recovery from bipolar disorder informing the development of a new Expert Patients Programme in the UK.