Background: Critical care is the term used to encompass ‘intensive care units’, ‘intensive treatment units’ and ‘high dependency units’. These units provide expert care for critically ill patients who require constant, close monitoring and specialist nursing to keep them alive. Previous research has shown that admission to critical care can be a frightening, upsetting and traumatic experience. Haematological cancer patients who receive a haematopoietic stem cell transplant (HSCT) frequently require admission to critical care as a result of this potentially curative but extremely aggressive treatment. No previous research has explored the unique experience of HSCT patients admitted to critical care. Aim: To gain an in-depth understanding of the experience of cancer patients’ admission to critical care. Methods: Five HSCT patients who had been admitted to critical care completed semi-structured interviews. Transcripts were analysed using Interpretative Phenomenological Analysis. Results: Six superordinate themes were identified: gaps in recollection, unreal experiences, being in the right place, unexpected and unprepared, role of family and life after critical care. It was clear that despite the patients recalling potentially distressing experiences from their stay in critical care, they had no regrets about having the transplant and viewed their admission as being worth it. Themes are discussed in relation to relevant literature. Conclusions: This study offered a unique insight into the experience of being admitted to critical care following stem cell transplant. Implications for the treatment and care of cancer patients admitted to critical care are discussed.

Background: The prevalence of mental ill-health and problem behaviour within the intellectually disabled population is reported to range from 30 to 50%. However, the longer term outcomes of mental ill-health and problem behaviour, such as persistence, new onset, remission and resilience, are unknown. Accordingly, the factors predictive of such outcomes are also unknown. Aims: To determine the long term outcomes of mental ill-health and problem behaviour, and the factors predictive of and associated with such outcomes, over a 10 year time-period in a cohort of adults with mild to profound intellectual disabilities. Method: A population-based cohort of adults with intellectual disabilities (n=100) was investigated at three time points over a 10 year period. Data were collected using a range of measures. Descriptive statistics were derived and regression analyses performed to determine factors predictive of outcomes. Results: The rate of psychopathology was found to have increased in the cohort over the 10 year period. Factors predictive of this increase were experiencing an angry interaction and trusting to share a secret with only one person, or anyone. The majority of the cohort experienced episodic mental ill-health, with relapse being predicted by being female and experiencing life events. New onset of mental ill-health was predicted by experiencing life events, and resilience was predicted by not experiencing life events and having urinary continence. Problem behaviours were persistent in 50%, with 50% remitting. New onset of problem behaviours was predicted by not experiencing life events, and resilience was predicted by having mild intellectual disabilities, not experiencing an angry interaction and having more than one close friend. Small but significant negative correlations were found between psychopathology and participation in social, leisure, and peer activities. Findings should be interpreted with caution due to the small sample size. Conclusions: The present study is the only existing longitudinal investigation following an adult cohort with mild to profound intellectual disabilities, at several time points over a 10 year period. Therefore, future research is needed to confirm findings. Given the increase in psychopathology, more effective monitoring, treatment and intervention is needed.

No description available.

Due to highly active anti-retroviral therapy (HAART) becoming available to perinatally acquired HIV positive (PAHIV+) individuals early in their lives, they were given the opportunity to live much longer than those born before them, with many now reaching adulthood. Literature suggests PAHIV positive adults may have faced stressors which increase chances of developing mental health problems for example, familial death, family disruption, stigma and negative environmental characteristics. Additionally, PAHIV+ adults live with the knowledge they have a sexually transmissible infection, even if they have never had sex, suggesting the chance of unique psychological challenges for this cohort. Semi-structured interviews were conducted between May and June 2015 with 8 PAHIV+ participant’s (five females, three males) aged 23 – 29 years, who attend an HIV charitable organisation. Interviews were analysed utilising Interpretative Phenomenological Analysis (IPA). This research aimed to illuminate and make sense of PAHIV+ individual’s experience of reaching adulthood. One overarching theme; ‘Evolving journey’ and five super-ordinate themes; ‘The changing responsibility of self’, ‘Reflecting on a difficult childhood’, ‘The stigma barrier’, ‘Development of sense of self’ and ‘Managing uncertainty’ were found. An interpretation of the participant’s experience is presented in the final analysis. These findings have important implications for all HCP’s supporting the psychosocial needs of PAHIV+ adults. Applicability of findings to the field of Counselling Psychology and considerations for future research are considered.

The thesis investigates the theory that there were many physical and social factors inherent in the lives of the British in colonial India in the twentieth century which predisposed some of them to mental illness. It seeks to learn more about those individuals who became mentally distressed during their service to the Raj and the treatment they received. The study begins with an interrogation of the literature of the history of modern Western psychiatry and its relevance to colonial India between 1900 and 1947. With the use of contemporaneous text books and Indian professional medical journals it explores how psychiatry was implemented in the sub-continent. These considerations are followed by an exploration of the physical and social determinants of stress in such areas as climate and topography. It identifies the stressors associated with the artificial and archaic society of Britons in India, who are shown to be an ethnic minority determined to preserve their privileged position. The use of the cultural web, an investigative tool adapted from the study of organisational change, illustrates how the colonial rulers were incapable of changing their lifestyle as national and international developments began to impact on them as a community. Evidence is provided showing how the profession of psychiatric nursing was generally ignored by the colonial nursing establishment and often disparaged by doctors. Previously unseen medical case records from the European Mental Hospital at Ranchi in northern India give insight into the practice of psychiatrists and their attitudes to their patients. It identifies the rapidity with which methods of treatment newly developed in Europe were implemented at the hospital. The thesis concludes that there were many stressful factors in British life in colonial India which could lead to mental illness and identifies several topics suitable for further academic research. It also shows that the European Mental Hospital in India was in the forefront of international psychiatric practice in the 1920s and 1930s.

Background: Indiscriminate friendliness (IF) refers to a lack of reticence with unfamiliar adults and has been well documented in maltreated children. This risky behaviour is distinct from attachment insecurity and has been found to persist when care-giving quality improves. There is a lack of consistency in the literature regarding the importance of care-giving following adoption. Some studies suggest that care-giving quality is not related to IF, whilst others have suggested that the emotional availability of carers is predictive. This study aimed to establish if there is a relationship between EA and IF in a group of previously maltreated infants. Method: In a cross-sectional design, a subsample of infant-carer dyads (n = 55), that were recruited as part of an on-going RCT (Pritchett et al, 2013), were observed. Videos of meal and playtime activities were analysed using The EA Scales (Biringen, 1998). IF was measured, as part of the RCT, using a semi-structured interview. This tool also identifies children that in addition to IF, have no preferred attachment figure: IF (NA). Univariate correlation analyses and regression analyses were used to explore relationships between variables. Results: This study found that child emotional availability predicted indiscriminate friendliness, even when other associated factors (age and carer non-intrusiveness) were controlled for. A composite Carer EA score was not related to IF, but carer non-intrusiveness was significantly associated with IF. Conclusions: Child emotional availability is uniquely associated with indiscriminate friendliness in maltreated children. A specific care-giving factor (non-intrusiveness) was associated with indiscriminate friendliness. It is suggested that carer-child interactions are related to indiscriminate friendliness in maltreated children and may represent a useful target for intervention. Therefore, future research may wish to explore the amelioration of indiscriminate friendliness through an intervention focusing on the carer-child relationship.

Background: In comparison to other medical appointments, consultations regarding haematopoietic stem cell transplant (HSCT) tend to be emotional and longer due to the high volume and content of information exchanged between the patient and consultant. HSCT offers the potential to cure the cancer but also carries a multitude of life-threatening side effects. Existing research has shown that patients immediately forget the majority of information they receive in medical consultations thus resulting in misunderstandings about treatment, adjustments and about coping post transplant. Despite this, no previous research has evaluated cancer patients’ level of recall and understanding considering the volume of information they receive from doctors during consultation for HSCT. Aim: To create, within a haemato-oncology setting, a coding framework capable of evaluating the interaction between the patient and doctor in the HSCT consultation. Methods: The medical consultations of five HSCT patients who were eligible for HSCT were recorded and these patients subsequently completed semi-structured interviews. Transcripts were analysed using directed content analysis. A recall and understanding information template (RUIT) with an associated coding framework was developed and piloted. Results: The procedures undertaken in developing the RUIT demonstrate strong inter-rater reliability and content validity. Further testing, through piloting the instrument, indicated that the RUIT coding system has strong inter-rater agreement. However, disparity in the classification of some categories was also revealed. Cancer patient’s viewed the consultation as informative but also felt that both the content and volume of information they received were difficult to process. Conclusions: This study is the first qualitative investigation of cancer patients’ recall and understanding of content from a HSCT consultation through the unique development of a coding framework. Future use of the RUIT in clinical practice and recommendations for further research are discussed in relation to the relevant literature.

Background: Acceptance and Commitment Therapy (ACT) aims to help individuals live a life congruent to their values by cultivating psychological flexibility (PF); the ability to respond to experiences with acceptance and creativity. Concurrently, Compassion Focused Therapy (CFT) addresses the role of self-attacking cognitions on psychological difficulties. Recent work suggests that integrating aspects of CFT into an ACT approach (i.e. developing a person’s PF to self-attacking thoughts through self-compassion) may offer additional therapeutic value. There remains no assessment of this specific therapeutic process. Aims: The project aimed to develop and validate a new scale to assess flexibility of responses to self-critical thoughts (FoReST). Methods: Factor Analysis was used to explore factor structure of the FoReST in a convenience sample of 253 adults. Construct validity was explored by comparing FoReST with measures of similar constructs (PF, self-compassion, self-criticism) and potentially related outcomes (anxiety, depression, quality of life). Findings: Alternative 2-factor (‘unworkable action’ and ‘avoidance’) and 1-factor (‘unworkable action’) versions of the FoReST showed high concurrent validity with similar measures, good predictive validity for mental health and wellbeing outcomes and good internal consistency. The relative strengths and weaknesses of both versions are discussed. Recommendations: Findings indicate that the FoReST may offer a useful clinical and research tool for emerging forms of ACT for people high in self-criticism. Future research will be required to confirm the factor structure of the FoReST, confirm concurrent, predictive validity, test-retest reliability, and validate the scale in relevant clinical populations.

This thesis is submitted in partial fulfilment of the requirements for the degree of Doctorate in Clinical Psychology at the University of Birmingham. The thesis consists of two volumes which illustrate research (Volume I) and clinical work (Volume II). All identifying information has been anonymised to ensure confidentiality. Volume I This first volume contains three chapters. The first is a systematic review of the research literature regarding carers’ attributions of challenging behaviour in care-recipients with dementia. The second is a research study examining the association between spousal carers’ perceptions of relationship continuity, and their understanding and management of challenging behaviour, for partners with an acquired brain injury. The third is a public dissemination document providing an accessible overview of the research study. Volume II This second volume contains four clinical practice reports (CPRs) and an abstract of a fifth CPR which was presented orally. The first CPR describes the assessment and formulation of a 48-year-old man with mild learning disabilities who was experiencing anxiety and low mood, from cognitive behavioural and systemic perspectives. The second is a service evaluation of a dementia-friendly inpatient unit, identifying the barriers and facilitators to good care. The third is a single-case experimental design of a 33-year-old man in a medium-secure forensic service who experienced anxiety. The fourth describes a piece of leadership and consultation work, regarding how hospice staff cope with grief. The final CPR is an abstract of an oral presentation of a case study of a graded exposure intervention with a 16-year-old female.

Following a stroke there can be a large range of different deficits, with poor motor function and cognition being particularly important for outcome. Rehabilitation of these deficits is thus an important priority for clinicians. In this thesis, I present 5 experimental chapters aiming to generate cognitive and motor benefits for the stroke survivor. In Chapter 2, prolonged Mirror Therapy was applied to chronic stroke survivors. In Chapter 3, Mirror Therapy was applied in a home based for chronic stroke survivors. In both these Chapters 2 and 3 benefits in unimanual performance of the affected limb and functional improvements of daily activities are being reported. Chapter 4 considered the application of Mirror Therapy to early subacute stroke participants and tested the neural correlates behind any effect. Changes in brain activation within both the ipsi- and contralesional hemispheres were noted. Functional Electrical Stimulation was applied to chronic stroke patients in Chapter 5. Improvements in motor performance were noted, along with the amelioration of visuomotor neglect. Linked changes in activity in the ipsi- and contralesional hemispheres were again noted. Finally, in Chapter 6, Computer Progressive Attention Training was applied in early subacute stroke patients, comparing performance with patients who received no extra intervention. Importantly, the training not only improved the tested functions but also other cognitive processes not targeted in training (e.g., long-term memory). Taken together, the experimental work provides evidence of strategies that can be followed by clinicians to improve functional ability after stroke. In the final chapter the above findings are being discussed together with clinical implications of motor and cognitive rehabilitation approaches.