Wellness Recovery Action Planning (WRAP) is a self management system, designed to enable individuals develop a range of effective strategies for self-directed care. The present study evaluated the effectiveness of WRAP on the Depression and Anxiety levels of Adult Mental Health, and Acquired Brain Injury groups. This was measured via The Hospital Anxiety and Depression Scale (HADS), pre and post WRAP intervention. Waiting list control groups were included. Knowledge of Recovery was investigated using the Mental Health Recovery Measure (MHRM), while knowledge and application of WRAP was measured via the adapted Copeland scale. Results indicated significant, affirmative evidence in respect of each measure, suggesting initial support for the use of WRAP with both populations. Between-group differences were not observed, and WRAP uptake was no superior for either group. Results are discussed within the overall context of twenty-first century recovery, and implications for future practice.

Little is known about the romantic lives of individuals with autistic spectrum disorder (ASD). They are known to have difficulties in establishing such relationships, but there has been limited investigation, especially from a qualitative perspective. In the present study, eight young adult men (aged 21 to 29) with a diagnosis of Asperger’s syndrome (AS) were interviewed about their experience of romantic relationships. The data was analysed using interpretative phenomenological analysis (IPA). Four themes emerged from the analysis which were 1) hopes and expectations of being in a romantic relationships; 2) challenges in establishing a romantic relationship; 3) establishing a romantic relationship; and 4) the self, which relates to the impact that the participants’ experiences had on how they felt about themselves and their resulting psychological wellbeing. The findings suggest that romantic relationships mattered to these individuals, although for many, a number of real or anticipated barriers prevented them from establishing one. The results are discussed in relation to the existing literature and recommendations for counselling psychology practice, service development and future research are made.

There continues to be an over-representation of female offenders diagnosed with borderline personality disorder (BPD) within UK prisons (Sansone & Sansone, 2009). Dialectical Behavioural Therapy (DBT) has shown effectiveness in managing the symptomatology of BPD and has been adapted for a forensic context (Nee & Farman, 2005, Gee & Reed, 2013). There is limited qualitative data available pertaining to the experiences of clients within DBT programmes and none for a forensic context. Seven female prisoners completed semi-structured interviews regarding their experience of completing a 16-week DBT programme. Interpretive phenomenological analysis (IPA) illuminated six superordinate themes and 19 subordinate themes, which can be understood as features of personality and behavioural change. Superordinate themes were prison life, which highlighted an impact to life in prison through a reduction of prison disciplinary and risk procedures, and an increase in privilege levels. 'It's a struggle' represented the challenges participants faced and overcame. Increased connection to others illuminates the change in personal relationships participants experienced. Emotional awareness represents the participant's gain in understanding and managing emotions. Who am I? Depicts the increased understanding, acceptance and value participants experienced for themselves. The bigger picture represents the participant's ability to reflect upon and re-evaluate a situation, the increased awareness of another person's perspective, their increased understanding of consequences of their actions, and their future outlook on life. Themes are discussed in relation to the potential impact the DBT programme may have for people experiencing emotional and behavioural instability within the prison environment, suggesting engagement with DBT should be based upon individual case formulation rather than BPD diagnosis. The potential of DBT in addressing the government initiative the Offender Personality Disorder (OPD) strategy and recidivism is explored. Finally, the limitations to this study, recommendations for clinical practice, and future research needs are defined.

Resilience is a concept associated with the idea that some people seem to readily bounce back from adverse experiences. In order to identify the best methods to develop and sustain resilience in palliative care workers there is a need for greater understanding of how to measure the resilience construct. Despite an abundance of resilience models and theories, there is very little consensus on how resilience should be operationalised and measured. Furthermore, there are no empirical studies that explore the measurement of resilience as it pertains to the unique demands of the palliative care setting. Therefore this thesis presents four studies designed to explore the measurement of resilience in palliative care workers. All studies took place within the context of the UK palliative care sector using adult samples working in hospices, acute wards, and community settings. The first study was a systematic and methodological review of resilience measurement scales to understand how resilience is currently being conceptualised in the peer reviewed literature. The second study explored how resilience is currently operationalised through a joint factor analysis of resilience scales identified in Study One using a sample of human service (n=361) and palliative care (n=245) workers. The third study explored behaviours associated with resilience from the perspective of palliative care workers using template analysis (n=36). Results indicated that in addition to intrapersonal and interpersonal resources, palliative care workers identified procedural knowledge as a key resilience resource. Therefore, the fourth and final study presents the development and validation of a situational judgment test designed to measure a procedural knowledge resource associated with resilience in palliative care workers using a sample of subject matter experts (n=21), hospice workers (n=36), and workers from across the palliative care domain (244). Overall, findings suggest that due to the over-reliance on self-report resilience questionnaires there is a tendency to measure resilience as a trait rather than a person-situation interaction. In response to this, a new measurement approach was explored using a situational judgment test method. In the final chapter the overall findings are discussed in relation to both their theoretical and practical implications; and finally some directions for future research are suggested.

Individuals with schizophrenia show deficits in theory of mind (ToM), however the nature of these deficits in individuals with paranoid symptoms is unclear. This study examined whether ToM ability in individuals with paranoid schizophrenia varied according to the emotional valence of items within ToM tasks. Eight participants with a diagnosis of paranoid schizophrenia (patient group) and eight healthy controls completed two ToM tasks, the revised Eyes Test and a newly developed mental state reasoning task (New ToM Measure). Controls were significantly more accurate than the patient group on both tasks (revised Eyes Test: t (14) = 4.48, p = .001, d = 2.24, New ToM Measure: t (14) = 3.63, p = .003, d = 1.82). There was evidence of a trend for a mediating role of emotional valence in the patient group on the revised Eyes Test, although contrary to the study’s hypothesis, patients were more accurate on positive items than threat items (t (7) = 2.19, p = .07, d = 1.01). There was no evidence of a mediating role of emotional valence on the New ToM Measure. This study provides further evidence of ToM deficits in individuals with schizophrenia. The mixed evidence for the mediating role of emotional valence is discussed in relation to existing literature and the study’s limitations.

Background: A number of core processes have been identified to be involved in Dramatherapy approaches and they are believed to be essential in effecting change (Jones 1996). However, limited research in this area highlights the need for a greater understanding of the therapeutic processes important in facilitating change. Aims: The study aims to investigate the core processes involved in change across dramatherapeutic approaches and models. Method: Seven dramatherapists and seven Dramatherapy clients were interviewed about their experiences of Dramatherapy. Using a grounded theory method a theoretical model emerged that identifies key processes involved in change. Results: Three core themes emerged from the data: working within a safe distance; being allowed and allowing self to play and try out new ways of being; actively creating and physically experiencing. Key change mechanisms were also discovered, these included: developing new awareness and finding a language to communicate. Discussion: Contributions and implications for practice are discussed in relation to the way in which change occurs, for example, new awareness can be seen in the context of increased reflective functioning and mind mindedness. Future research suggestions include further exploration of the key themes identified using a Delphi approach. Specific aspects of change such as a potential increase in reflective functioning after Dramatherapy also warrants further investigation. Key words: Dramatherapy; grounded theory; change processes; client perceptions.

Background & Aims: Research suggests that severe head injury can result in a poorer quality of life compared to the general population. This is attributed to a reduction in the quantity and quality of social relationships, reduced leisure activities, symptoms of depression and anxiety, and low self-efficacy. In recent years this literature has been growing and there has been a development of head injury specific, health-related quality of life outcome measures; however, qualitative research which explores the views of people with head injury and their relatives or carers is limited. This study explores the subjective experience of quality of life following head injury, and similarities and differences between self and proxy reports. Methods: Participants included four adults with a severe head injury living in the community and a relative or carer who knows them well. Participants and their carers took part in semi-structured interviews relating to their perceptions of quality of life, and analysis was conducted using an Interpretative Phenomenological Analysis (IPA) approach. Results & Conclusions: Overall, the head injured participants and their relatives reported having a good quality of life. The emergent themes related to this were ‘daily functioning’, ‘relationships’, and ‘moving on’. Convergence was identified between self and proxy reports of quality of life. Factors found to be important in the experience of good quality of life after head injury were: a ‘sense of purpose’; supportive ‘relationships’; and a focus on ‘moving on’ from the injury. The identification of factors associated with good quality of life sets the current study apart from existing literature which has focused on factors associated with poor quality of life. The study also demonstrates that it is possible for those who have experienced a severe head injury to self-report and reflect on a range of factors relating to their quality of life.

Background: The prevalence of sleep problems in head injury (HI) patients in the community is high. Previous research suggests that HI patients with sleep problems require longer stays in rehabilitation units and that arousal disturbance disrupts engagement with rehabilitation activities. The present study explored the prevalence and types of sleep problem in patients with severe HI undergoing inpatient rehabilitation and whether sleep problems affect rehabilitation. Methods: Actigraphy, a semi-structured sleep interview, and validated sleep measures were used to identify sleep problems (n=23). Information on rehabilitation, including percentage of goal achievement, frequency of aggressive behaviour, and engagement was collected retrospectively from staff and rehabilitation notes. Relevant factors including daytime sleepiness, fatigue, mood, and pain were explored. Results: Fifteen participants (65.2%) had sleep problems, of which ten (43.8%) met diagnostic criteria for a sleep disorder, whereas in five cases (21.7%) no potential cause for participants’ sleep problems was identified. Sleep disorders in the sample were insomnia (21.7%), post-traumatic hypersomnia (8.7%), circadian rhythm disorder(8.7%), sleep apnoea (4.3%), periodic limb movement disorder (4.3%), and rhythmic movement disorder (4.3%). Sleep quality was not significantly associated with rehabilitation variables, but was estimated by senior staff as interfering with rehabilitation in 26% of the sample.Poor sleep quality was associated with greater anxiety, fatigue, and daytime sleepiness. Conclusions: The majority of HI patients had sleep problems based on actigraphy and validated sleep measures. Poor sleep was associated with mood and arousal problems. Sleep problems may negatively affect the rehabilitation process and patients’ wellbeing. However, the current study was not sufficiently powered to detect significant associations between sleep and rehabilitation. Due to the small sample size, these results are preliminary.

Background: Obesity has reached epidemic proportions in the developed world; this has implications for quality of life and demand on healthcare systems. Current treatment approaches for obesity appear effective in achieving short-term weight loss for some, but gains are not always maintained long-term. Treatments for Binge Eating Disorder (BED) can reducing binging but are not shown to have a significant impact on body weight. Evidence suggests that current treatments lack effectiveness because they do not target the factors underlying chronic weight and eating problems. Aims: To investigate, from the perspective of the affected individual, the role of emotion regulation and coping in BED. Methods: Nine participants took part in a non-directive, semi-structured interview. All were classified as obese: four met criteria for BED. Interviews were transcribed and analysed using Interpretative Phenomenological Analysis. Results: Five main themes were found; 1) Early life experiences, 2) The development of weight problems, 3) Use of food, 4) Attitudes to coping and 5) Beliefs about self. Differences were noted across these key themes between the BED and non-BED group with those in the BED group relying more on maladaptive strategies for coping, having more negative childhood experiences and having more negative self-perceptions. The results of this study highlight the need for treatment to focus on increasing individual’s resources for managing emotions, by widening their coping strategies.

Background: Acceptance and Commitment Therapy (ACT) aids individuals to accept difficult experiences that may be beyond their control and commit to behaviour that is consistent with their values. Previous research highlights that ACT interventions can: improve mental health, reduce worker stress and engender effective learning and performance. Work engagement has been defined as having an energetic and effective connection to work activity. As yet, no studies have investigated whether ACT interventions lead to improvements in work engagement. Aim: To investigate the feasibility of using ACT at Work Training (ACTw) to improve mental well-being and foster work engagement in staff working in mental health services. Method: A prospective, non-randomised, cohort controlled, repeated measures design was utilised. The parameters of this feasibility trial were formulated around the PICO (population, intervention, control, outcome) framework. 25 staff were recruited to take part in ACTw. 20 staff were recruited separately to a control group. The control group did not receive any input. ACTw was implemented over three sessions. The Utrecht Work Engagement Scale, General Health Questionnaire, Michigan Job Satisfaction Scale and Hospital Anxiety and Depression Scale were administered as outcome measures, while the Acceptance and Action Questionnaire - measuring psychological flexibility - and the Valuing Questionnaire - measuring value based living - were administered as therapy-specific measures. Following the completion of baseline assessments, measures were conducted 6 and 10 weeks post-baseline. Results: Despite initial recruitment problems, ACTw and control group participants were successfully recruited. Positive feedback from those who completed ACTw, suggested the intervention was acceptable. However, a third of ACTw participants missed training sessions, which was related to work and personal stress factors. The lack of significant differences between ACTw and control participants’ in scores on outcome and therapy-specific measures across the time points does not provide support for treatment signal changes in these measures. However, the lack of significant differences in outcome measures may be due to the low number of individuals presenting with high stress and low work engagement levels. For the group as a whole, changes in stress, anxiety, depression and work engagement were significantly correlated with changes in therapy-specific measures i.e. measures of psychological flexibility and value based living. Conclusions: Results of this study highlight factors that will help inform a larger trial of ACTw for health professional staff. Suggestions for future implementation include considering a larger sample and catchment area, staff stress level, potential barriers to participation and implementation of change at an organisation level.