The aim of this study is to investigate the role of the internet within the area of mental health support. The first paper reviews the current literature surrounding the use of the internet for self-help and intervention purposes. It highlights investigations into the outcomes, benefits and disadvantages in using this medium for support and therapeutic input. It also highlights the implications within clinical psychology for future research and service development. This is presented in terms of on-going interventions and support, as well as for use within a 'stepped-care' model of service delivery. The second paper presents an empirical investigation into users' experiences of using online support groups concerned with self-harming behaviour. The literature surrounding this area was noted as particularly sparse. The study uses a mixed method incorporating both quantitative and qualitative analysis. Exploration into the responses towards individuals who disclose self-harming behaviour is also performed using a simulated online forum post to which participants 'role-played' replies. The third paper presents a reflective account of the research process. It includes reflection around the area of using the internet as a research tool. It also specifically highlights a methodological critique of the empirical methods with reference to online ethical research guidelines presented by the British Psychological Society (BPS, 2007). Personal reflections on the process, and dealing with a potentially distressing subject matter are also discussed.

Family caregivers are significant in the care of people with dementia, whilst the changes that occur as a result of dementia impact on both the person with dementia and family caregivers. As this caregiving is set within a significant social relationship, it is important to explore the factors within this social context that may both support and compromise the caregiver. The current thesis sought to explore the impact of social emotions and social identities within this caregiving context. Chapter 1 presents a systematic review of the literature exploring the self-conscious emotions of guilt and shame within the dementia family caregiver. It explores the emotional and cognitive experience of caring for a person with dementia within the context of this social relationship. Broadly, findings highlight the negative influence of the caregiver’s self-conscious emotions, on relationships and connection to the Person with Dementia (PwD) and others. Methodological limitations are outlined with regards the clarity of the results whilst clinical implications and suggestions for future research are discussed. Chapter 2 presents a qualitative research investigation exploring the construction of identity in dementia caregivers’ contributions to an online support forum. The analysis focuses on identities apparent within talk about the dementia caregiving relationship. This analysis reveals the construction of two prominent and interacting identities, that of ‘fragile self’ and ‘fighter self.’ The potential clinical implications of identity exploration for caregivers are discussed. Chapter 3 offers a reflective account of my experience of the research process in relation to my own social relationships.

This thesis examines the relationship between coeliac disease (CD) and disordered eating attitudes and behaviours. The literature review describes the development of a theoretical model of disordered eating in CD that will be evaluated throughout this thesis. Chapter Three reports the results of a study that found a high prevalence of disordered eating in CD. Chapter Four reports the results of a qualitative study; participants in this study discussed an increased concern around food that affected their eating patterns. Chapter Five describes the development and validation of the CD Food Attitudes and Behaviours Scale (CD-FAB), which was designed to assess the increased food concerns reported in CD. Chapter Six reports the results of an online survey that explored the correlates of this tool; participants with increased food concerns were more psychologically distressed and had an impaired quality of life. Chapter Seven reports the results of a laboratory study that explored the relationship between food concerns, food intake and cognitive processes related to eating. Overall, this thesis provides novel experimental and theoretical insights into the relationship between CD and disordered eating. The findings have implications for the management and treatment of people with CD.

The Centre, a Charity founded by the Author in 1993, offers arts therapies interventions - Art, Dance Movement, Drama and Music - to clients of all ages and needs. This research represents an attempt to determine which modality of arts therapy should be recommended to any client on referral. A programme of each of the 4 arts therapies in sequence was offered to 109 clients of varying age and needs, in 10 Locations within the local conurbation. Four aims were identified for each client and the effectiveness of the arts therapies intervention was measured both quantitatively and qualitatively. Analysis revealed that although there was no one over all result, an average of 89.6% clients reported over all improvement at the end of the programme. Indications suggested the most successful aim addressed was enjoyment, although the most common aim identified was to be able to work in a group. Interventions of music therapy with male clients were the most effective for enhancement of self-esteem. Other, sometimes unexpected, results provide the basis for recommendations to referrers and guidance for providers of arts therapies services.

This thesis is presented in two volumes. Volume I is the research component consisting of a literature review and empirical paper each concerned with the effectiveness of psychosocial interventions on cancer treatment-related distress and symptoms. Volume II is the written clinical component, comprising five Clinical Practice Reports. Volume I The literature review is a systematic evaluation and critique of empirical research published since 1990 to evaluate the effectiveness of psychosocial interventions on distress, symptoms and quality of life specifically in relation to cancer treatment. Thirty-one relevant studies were identified evaluating 38 different interventions. The review included an assessment of the quality of the interventions and study designs of included studies. Interventions were grouped into relaxation, cognitive-behavioural, hypnosis and supportive interventions. … The empirical paper presents a pilot study designed to evaluate the effectiveness of a psychological preparation session on women’s distress prior to and following invasive internal radiotherapy treatment for gynaecological cancers. This brief intervention was found to prevent further deterioration in anxiety and depression prior to treatment. Significantly more patients in the control group were found to experience greater anxiety and depression prior to treatment compared to the intervention group. The limitations of this empirical study, suggestions for future research and clinical implications are also discussed.

This thesis used simultaneous electroencephalogram (EEG) and functional magnetic resonance imaging (fMRI) to investigate both epilepsy and sleep. Initially, EEG-fMRI was used in a cohort of patients with complex epilepsy referred from a tertiary epilepsy clinic for both pre-surgical evaluation and diagnostic reasons. The results suggest a limited utility of EEG-fMRI in the epilepsy clinic with a very complex patient group. Following on, investigation of early blood oxygen level dependent (BOLD) signal changes in a group of patients with focal epilepsy demonstrated potentially meaningful BOLD changes occurring six seconds prior to interictal epileptiform discharges, and modelling less than this six seconds can result in overlap of the haemodynamic response function used to model BOLD changes. The same analysis was used to model endogenously occurring sleep paroxysms; K-complexes (KCs), vertex sharp waves (VSWs) and sleep spindles (SSs), finding early BOLD signal changes with SSs in group data. Finally, KCs and VSWs were investigated in more detail in a group of participants under both sleep deprived and non-deprived conditions, demonstrating an increase in overall activation for both KCs and VSWs following sleep deprivation. Overall, we find early BOLD changes are not restricted to pathological events and sleep deprivation can enhance BOLD responses.

Unilateral neglect (UN) frequently occurs following stroke, and the presence of neglect can adversely affect functional recovery. It is important that physiotherapists are able to assess the common manifestations of neglect, and to provide effective rehabilitation for these patients. The main aims of this thesis were (i) to investigate how physiotherapists in the UK assess and treat visual neglect, (ii) to design and pilot a new test battery for assessing neglect at the impairment and activity levels, for use by therapists in the clinical setting, (iii) to establish the extent of reliability of three common tests for unilateral visual neglect, and (iv) to evaluate whether scanning and cueing, and limb activation strategies, would reduce unilateral visual neglect (UVN) in elderly stroke patients. The findings showed that (i) observation was the most frequently reported method to assess UVN, and that some effective strategies known to reduce UVN were infrequently listed by respondents; (ii) the Everyday Test Battery demonstrated validity and reliability in a small sample of elderly stroke patient with UVN; (iii) the Star Cancellation and Line Bisection tests, and the Baking Tray task demonstrated acceptable test-retest stability, which was highest when used with stroke patients with moderate to severe UVN; (iv) a significant reduction in UVN, in at least one of three tests for UVN, was demonstrated, in a series of single case experimental designs, by 10 of the 12 stroke patients who received one or other of the two treatment approaches stated above. The implications of this research are that clinical tests which enable assessment of neglect at the impairment and activity levels should be routinely used by physiotherapists in clinical practice, that results of repeated testing for neglect may need to be cautiously interpreted due to variability of performance over time, and that scanning and cueing, and limb activation strategies offer promise in the rehabilitation of elderly stroke patients suffering from UVN.

This thesis is structured as three chapters which explore the subject of religion and mental health for both professionals and public. Chapter one reviews the published literature examining professional’s engagement with religion within the mental health system in the United Kingdom. Evidence suggests that professionals view religion as important in mental health care, however a number of key fundamental barriers at the macro- and micro-level influence engagement. Barriers include lack of engagement within the corporate context; ethical considerations and dilemmas in clinical practice; and issues in daily practice. Professionals require stronger guidance to feel supported. Training institutions need to address religion within teaching and organisations must be aware of the ethical dilemma professionals face. Chapter two presents an empirical study examining the influence psychosocial forces of religiosity and spirituality have on suicide. The study was in the form of a cross-sectional e-survey design using a range of psychometrically valid self-report measures. A general population sample of 231 participants from different faith and non-faith backgrounds participated. Results found that religious participants had higher levels of depression and suicidal thoughts than non-religious participants. However, differences were not found between groups, suggesting that it is not belief systems per se, but other psycho-social factors which are more important. Religious participants were found to have higher levels of religiosity and spirituality, moreover, negative religious coping and forgiveness appear to have a significant influence on psychological distress. Implications of the findings are discussed, along with suggestions for future research. Chapter three provides reflections on the research process and my personal and professional development through the course.

Informal carers are pertinent in supporting people with dementia. The impact of a diagnosis impacts on the person with dementia, their carers and their social relationship. Caring can be influenced by wider social relationships, the present thesis sought to explore the role of social support within the context of dementia. Chapter 1 presents a qualitative systematic review of the literature exploring dementia carers' experiences of online support groups. It explores how social relationships with others in a similar situation, over the internet, can support carers with the caring role. The main themes that were drawn out from the studies reviewed were group bonding, emotional support and information gathering, as well as carer perceptions of the unique advantages and disadvantages of online support groups. A critical analysis highlighted methodological limitations with regards to the clarity of the results. Clinical implications and suggestions for future research are also discussed. Chapter 2 presents a qualitative investigation exploring the construction of identity in carers of people with dementia when interacting in a face-to-face social support group. The study considers the impact of a diagnosis of dementia on carer identity within social relationships and the analysis focusses on the construction of identities within the social context of a support group. The analysis revealed the construction of a group identity that occurs when carers align with the group. The action of this identity is discussed, along with the clinical implications and future research directions. Chapter 3 puts forward my reflective account of the research experience in relation to the construction of my own identities in social relationships.

A plethora of research exists upon psychological models, interventions and approaches. An increasing evidence base examining patient variables also continues to evolve. Therapist factors, however, have received less attention. Considering aspects of the therapist has previously been seen by some as navel-gazing, thereby suggesting that it may add little value to clinical practice. Irrespective of this, the therapist undeniably plays a critical part in engendering change and helping patients achieve positive outcomes. Discounting the influence of the therapist therefore neglects an important variable in clinical practice. A closer consideration of factors affecting therapists and therapists' impact upon clinical practice may therefore clarify the significance of therapist variables. Chapter one The first chapter offers a critical appraisal of the research literature examining therapist factors associated with the therapeutic alliance. The research denotes that therapist activities and characteristics are both positively and negatively related to alliance. Methodological limitations of studies are examined. Chapter two The second chapter presents an empirical study exploring clinicians' experiences of post-qualification training in Intensive Experiential Dynamic Psychotherapy, using Interpretative Phenomenological Analysis. Three super-ordinate themes emerged from the analysis: training as transforming the self, professional effects of training and group supervision as facilitating feedback. Implications for clinical training are discussed. Chapter three The third chapter explores the lead author's reflections which emerged during the research process. These led to insights of a personal and professional nature.