Introduction: Adherence to prescribed medication is crucial to effective treatment in many chronic conditions, and particularly for individuals diagnosed with psychosis. Health Psychology has traditionally provided robust models that have been employed to explore adherence in numerous chronic conditions. However, research using these models to explore adherence to anti-psychotic medication is scarce. This study looked to implement the science and evidence base of Health Psychology while exploring determinants of adherence to anti-psychotic medication. Method: In this longitudinal questionnaire study, data was collected at two-time points, six months apart. One hundred and ten individuals participated in the baseline stage. Adherence to antipsychotic medication was measured using the Medication Adherence Rating Scale. Social support, illness perceptions, illicit drug use and side effects were assessed using the Duke Functional Social Support Questionnaire, The Brief Illness Perception Questionnaire, The Drug Abuse Screening Test and The Glasgow Anti-Psychotic Side Effect Scale Questionnaires respectively. Analysis of Variance and Correlation analyses were conducted to explore associations between these factors and adherence, while the potential predictive capacity of these factors was examined through Multiple Regressions. Results: Social Support, Treatment Control and Personal Control were significantly associated with adherence, while Treatment Control (β=.407 [.405-.095], p=.000) and Social Support (β=.282 [.682-.214], p=.002) were demonstrated to be a significant determinant of adherence to anti-psychotic medication. Conclusion: Adherence to anti-psychotic medication presents with a unique set of challenges and is a complex phenomenon influenced by a number of parameters. Levels of social support and treatment control are significant determinants of adherence to anti-psychotic medication. Efforts to enhance social support and personal control can be employed in future interventions designed to increase adherence. Treatment Control is an important factor and the Self Regulation Model has the aptitude to be employed in future research. There is potential for prospective research to apply Health Psychology theories, frameworks and principles to not only scrutinise adherence within mental health settings but also develop behaviour change interventions that target identified risk factors for non-adherence.

Quantitative research has shown that individuals who report intrusive memories of traumatic events often experience psychological distress. There is a need for qualitatively focused research, which would allow for an understanding of how therapists construct and make sense of their clients' intrusive trauma memories in the context of the clients' psychological distress. The research involved face to face semi-structured interview with nine qualified psychologists about their experience of working with trauma clients. The data were analysed using constructivist grounded theory (Charmaz, 2006). The research study facilitated nuanced understanding of clients' trauma memories from the perspective of therapists. It explored the process of the therapists looking within to make sense of the impact of their clients' trauma experiences on them. It also allowed the researcher to examine how the therapist changes as a result of their engagement with trauma clients. Grounded theory analysis demonstrated that therapists constructed some important categories. These include; trauma memories as threat to sense of self, appraisal processes of trauma memories, discovering survival strategies, therapists' process in therapy with clients, therapists changing and reflecting as a result of trauma work and therapist discovering coping strategies. The findings indicate that trauma work also brings some rewards and privileges in the form of strength, growth, and empowerment. The research findings have important implications for policy and practice, service quality, and the well-being of therapists and their clients.

Homelessness is experienced by considerable numbers of people throughout the UK. Research convincingly demonstrates the multiple and frequent difficulties that people who are homeless face, including: limited support networks, mental and physical health difficulties, problems associated with substance use, and social exclusion. There is a lack of research however, that explores their strengths, resilience, and ability to cope with adversity. Many services arguably parallel this trend and focus on risk management and treatment strategies that target perceived pathology and vulnerability characteristics. The study contributed to strengths-based research and explored the psychological processes associated with a sense of manageability of people who were homeless. This unique line of research enquiry was guided by the study’s systematic review. In-depth interviews were conducted with eight adult males who temporarily resided at a homeless hostel in Wales. Interpretative Phenomenological Analysis was used to identify themes. Processes that both enhanced and detracted from manageability were inferred. In particular, self-efficacy and self-esteem seemed important to sustain and promote the well-being of participants, and influenced actions towards future transition out of homelessness. There was evidence to suggest that these constructs were closely associated with participants’ relationship experiences. The study supports the core components of Rutter’s (1985; 2013) conceptualization of resilience. Intervention strategies were discussed in relation to the findings, but primarily, services were encouraged to promote supportive relationships for homeless people, as these can foster self-efficacy and self-esteem processes that are hypothesised to mediate resilience, and encourage people’s social inclusion. Further culturally sensitive research of resilience processes is recommended.

Background: The Marschak Interaction Method (MIM; Marschak, 1960) is a video-based observational assessment of parent-child interactions and relationships (Lindaman, Booth, & Chambers, 2000). Parents are videotaped while they engage with their child in a series of play-based tasks, followed by a therapist-guided reflective review of the interaction. This process is intended to highlight areas of strength and difficulty within parent-child interactions to be addressed in subsequent therapeutic intervention; however, initial reports suggest that the MIM may have additional therapeutic utility beyond this rather narrow application (Lindaman et al. 2000). There is a growing evidence base for the use of video-feedback in family interventions to improve the quality of parent-child interactions (Fukkink, 2008). Such approaches are believed to enhance parental reflective capacity and sensitivity to their child’s needs, thus supporting more positive parenting behaviour (Svanberg, 2009). The MIM is similar in its approach to other video-feedback interventions, and so conceivably may effect comparable therapeutic action; however little is known about parents’ experiences of the MIM. Aims: This study aimed to explore the therapeutic nature of the MIM through interpretative phenomenological analysis (IPA) of parents’ and caregivers’ experiences. Methods: In-depth interviews were conducted with six parents and primary caregivers who had participated in the MIM as part of on-going therapeutic assessment and intervention with their child. Results: Analysis of participant accounts identified five key themes concerning; their experiences of the MIM interactional procedure, reflective and emotional processes and the therapeutic factors that supported these, and subsequent attitude and behaviour change. Conclusions: Findings suggest that the MIM has potential therapeutic utility as a brief video-feedback intervention to support positive parent-child interactions. This therapeutic hypothesis is discussed in relation to current theoretical explanations for the efficacy of video-feedback interventions in child and family mental healthcare practice. Further research is needed to test the clinical effectiveness of the MIM in improving parent-child outcomes.

Objective: There is a growing body of research which demonstrates positive effects of Acceptance and Commitment Therapy (ACT) on a diverse range of psychological disorders (e.g. chronic pain, depression, psychosis). Several reviews suggest that ACT may benefit people struggling to adjust to life following a Traumatic Brain Injury; however there are no published treatment trials using ACT with this group. The present study examined the feasibility of an intervention trial of ACT for people with severe Traumatic Brain Injury (TBI) treated in an inpatient rehabilitation centre. The findings informed recommendations made for the design and conduct of a larger study. Method: Mixed quantitative and qualitative methods were used including Focus Groups and questionnaire measures. Data were collected from patients and unit staff at multiple time points across three research sites. Focus Group data were analysed using thematic analysis in accord with best practice guidelines. Questionnaires and forms completed by the staff in order to establish application of inclusion/exclusion criteria and participant flow were analysed descriptively to get an indication of the acceptability of features of the study protocol. Results; Focus group findings indicated that due to cognitive deficits exhibited by participants, they perceived the ACT intervention as being too complex, and a number of amendments were suggested to support participants with cognitive deficits in future trials such as increasing repetition of key processes during intervention. Further suggestions were made in relation to future conduct of the study protocol such as revising the inclusion/exclusion criteria, family involvement in data collection, and provision of easy read materials to clients. Results indicated that participants had no issue with the randomisation design, there were no adverse events associated with the study protocol or intervention. Conclusions: Further piloting of the amended intervention protocol in line with recommendations made in this study is recommended prior to drawing any conclusion with regard the suitability and acceptable of ACT with people with a severe TBI in an inpatient facility. Further research should consider the amendments to the study protocol as recommended in this study.

Objectives: Three studies addressed the effectiveness of a preventative Acceptance and Commitment Therapy (ACT) training for university students and university employees. The studies aimed to explore whether changes in participants' psychological well-being would be mediated by the mechanisms of change theorized as central in ACT. Design and Method: The studies adopted an embedded mixed method, repeated-measures randomised controlled trial design. In the first study 65 participants recruited from a university student population were randomly assigned to one of two conditions: 1) a training day (6 hours) based on Acceptance 'and Commitment Therapy (ACT); 2) a waiting-list control group. The intervention was delivered to groups of participants. Participants in both conditions were required to complete outcome and mediation measures at baseline (Time 1), at one month (Time 2) and two months after the training (Time 3). At two months post, participants in the intervention group were also asked to provide written feedback reflecting on the impact of the training. The second and third studies utilised similar methodology. Specifically, in the second study, 71 participants were recruited from a university student population, and in the third study 68 participants were recruited from the university workforce. Assessments were completed at similar time points as in the first study. Results: The first study (students) resulted in significant between-group differences on mental health variables at one month benefiting the intervention group. The second study (students) indicated beneficial improvements in the intervention group's mental health at two months post intervention. There was some evidence of ACT-consistent mediation in these studies. The third study (employees) failed to identify significant improvements for participants in the ACT condition although participants in the waiting list group had evidenced deterioration of their mental health at one-month. Participants across studies described the experienced impact of the intervention and noted barriers of engaging with the training skills. Conclusions: Brief ACT preventative interventions could be of potential value as prophylactic approaches. The study identified a requirement of a longer intervention format to enhance engagement with training skills. The study outlines recommendations for improvements of future preventative ACT projects.

Images comprising clusters of objects can induce aversion and certain symptoms of anxiety, fear and disgust (so-called “trypophobia”) in about 13% of the population. This thesis is an investigation of the stimulus and response characteristics of the condition. First, a symptom questionnaire (Trypophobia Questionnaire) was developed and validated based on reports of different categories of symptoms. The questionnaire demonstrated a single construct that predicted discomfort from trypophobic images, but not neutral or unpleasant images, and did not correlate with anxiety. Second, filtering images reduced the excess energy at mid-range spatial frequencies (previously associated with both trypophobic and uncomfortable images). Relative to unfiltered trypophobic images, the discomfort from filtered images experienced by observers with high TQ scores was less than that experienced with neutral images, and by observers with low TQ scores. Clusters of concave objects (holes) did not induce significantly more discomfort than clusters of convex objects (bumps), suggesting that trypophobia (previously referred to as “fear of holes”) involves clusters not of holes but of objects with particular spectral profile involving excess energy at mid-range spatial frequencies. These visual characteristics have been previously shown to induce discomfort and a strong cortical oxygenation. The same abnormal oxygenation occurred for trypophobic images, but only for individuals with high TQ scores. Three lines of evidence suggest that trypophobia is a response of disgust rather than fear: (1) trypophobia was associated with an aversion to spiders, and not snakes; (2) trypophobic stimuli did not produce a bias in the subjective estimation of stimulus duration but (3) increased the heart rate and its variability. Fear inducing stimuli generally give effects opposite to those listed as 2 and 3. In conclusion, trypophobia is a reaction of disgust to clusters of objects with particular spectral profile that may resemble contamination sources (e.g., skin lesions).

Patterns have been identified in the careers literature that suggest there has been a change from traditional to contemporary careers over time (Sullivan & Baruch, 2009). More recent research has seen definitions of career success being shaped to acknowledge the variety of career paths that now exist. Recent definitions therefore, often refer to the achievement of desirable work-related outcomes at any point in an individual’s work experiences over time (Arthur, Khapova & Wilderom, 2005), as opposed to achievements that are associated with the end of an individual’s career. However, it is argued that occupational context continues to play an important role in defining careers and subsequent career success. Despite this, literature on gender and careers continues to advocate key differences in the success of males and females, regardless of occupational context. Predictors of male career success include objective indicators such as salary, promotions and hierarchical position; whereas subjective criteria, such as helping others and maintaining a work-life balance are thought to be more important to females (McDonald, Brown & Bradley, 2005; Ng et al, 2005). In contrast, many studies have focused on gender-segregated occupations and indicate that women experience discrimination and disadvantage in relation to success in male-dominated environments (Dann, 1995; Demaiter & Adams, 2009). However, despite a small body of research that documents mixed experiences of males in female-dominated occupations, career success of males in this context is yet to be explored. This thesis therefore aimed to address the gap in the current knowledge by conducting an in-depth exploration of male definitions of career success in one professional and one non-professional female-dominated occupation. A qualitative methodology was adopted in response to calls from the career success literature to utilise this approach to uncover personal meanings of success. First, a series of semi-structured interviews were conducted with a purposive sample of male primary school teachers (n=15) and university administrators (n=19) to explore personal definitions of success, motivations for entry and experience of working in a female- xi dominated environment. Findings suggest that male definitions of success related to complex themes of personal, professional, social and life success, in contrast to objective and subjective categories in the existing literature. It was apparent that success was considered to be a fluid concept that could be achieved on a continuous basis in line with occupational and organisational influence. The second phase of the case study evaluated career interventions available to males in primary schools and universities in relation to personal definitions of success. Semi-structured interviews were conducted with an opportunity sample of representatives from male’s employing organisations, including n=4 members of Senior Leadership Teams from primary schools and n=9 managers and personnel staff from universities. Themes that emerged suggested individual and organisational definitions of career success were conflicting at times. Specifically, career interventions did not always complement the achievement of success. Rather, males referred to the benefits of informal organisational mechanisms to support their achievement of success, such as communication, socialising and information sharing, which organisations did not appear to be aware of. Overall, the case study provides a critique of the literature on generic predictors of male success by reconceptualising definitions to include themes of personal, professional, social and life success. Implications of the key findings are discussed and avenues for future research and applications to practice are considered.

Care farms seek to support and empower people who are in some way vulnerable by enabling them to engage with agricultural places and farming activities. Their numbers have increased substantially in the UK and elsewhere over the past decade, but there is a paucity of evidence concerning that which takes place, associated outcomes and consequential change. This mixed methods study investigated care farming from multiple perspectives in order to provide an enhanced understanding of overall impact. It was informed primarily by qualitative and quantitative data provided by service users and providers but also incorporates input from representatives of other significant stakeholder groups. The evidence of sixty seven care farmers highlighted the challenges associated with the initiation and development of sustainable enterprises, but simultaneously demonstrated this to be an activity that can benefit farming people and places. Altruistic intent was identified as a common denominator and care farming was found to have enabled both new and established farmers to engage with activities that support the land and develop community. Productive and consumptive elements interlink to provide multifaceted value. Agricultural and familial connections were presented as having been enabled, on-farm employment as having increased and farms as having regained their position as a social hub. Multivariate statistical analysis of health and well-being measure scores provided by two hundred and sixteen care farm participants identified statistically significant positive relationships (p<.001) between the amount of time that people had been attending care farms and subjective happiness, satisfaction with life and more generic mental well-being. Analysis of qualitative data suggested that service users often received support initially from the animals, plants and wider natural environment, but that people and associated social interactions were increasingly enjoyed and influential as time progressed. An assessment of the overall impact associated with an individual care farm was provided through the application of Social Return on Investment. This took account of all elements of associated change and assigned justified financial proxies so that overall value could be conceptualised. The analysis suggested that, for every £1 that was invested, there was a return that exceeded £3.50. Value was presented as having emanated from the natural, social, learning and physical elements of the care farm space, but consequential positive outcomes were also demonstrated to impact outside this space. This study found care farming to be a cost effective vehicle for enabling the improved health and well-being of both individuals and wider society. Associated dividends are apparent and it is hoped that this will help policy makers and service commissioners to recognise and understand the value that care farms provide.

Introduction: Cleft lip and palate (CL/P) is characterised as a birth defect or congenital anomaly which occurs in one in every 500-700 births globally. This research study explores the subjective, phenomenological experiences of eight women with CL/P using Interpretative Phenomenological Analysis (IPA) to determine how women experience and manage living with CL/P and to consider implications for counselling psychology. Quantitative and qualitative studies indicate the overall low psychological impact of being born with CL/P, but also show disparities and contradictions. This author was born with CL/P. Method: Ethical approval was obtained. Semi-structured interviews and open-ended questions were used. Eight women born with CL/P were recruited using purposive sampling. Participant accounts of their lived experiences were recorded and transcribed verbatim. Interviews took 73 to 120 minutes, (mean 90 minutes). Analysis Four themes were identified: 'The threatened self' explores the complexity inherent in the development of identity; 'being different to others' explores interpersonal experiences of participants; 'facing challenges' explores challenges and 'wishing things had been better' explores experiences which participants share as a means of acting as advocates for others. Discussion: My research supports existing CL/P literature. 'Wishing things had been better' has not been explored previously. I found that meaning-making is important for individuals with CL/P. I consider that it would be beneficial for CL/P to be conceptualised as a long-term condition requiring psychological support, and if adult CL/P should have improved access to support, including psychological, for key life events. I designed a check-list of issues to consider when working with a client with CL/P. This research has demonstrated that women's experiences of living with CL/P are multi-faceted and demonstrates a duality of experience in which being born with and living with CL/P throughout life may be thought of as both 'not a problem' and 'a problem' at different stages of life.