Background: The rate of obesity in adolescents is rising, presenting both physical and psychological difficulties. To date, biomedical literature has dominated with few studies investigating quality of life in adolescents following surgery. Aims: To critically evaluate the quality of life outcomes of adolescents after bariatric surgery. Specifically, changes in physical health, perceptions of self-image and mood disorders are considered. Method: PsycINFO, Medline Ovid, Scopus and Web of Science were searched, along with citation and reference list searches of identified articles. Eleven articles met the inclusion criteria. Results: An increase in self-image and reduction in depression is indicated up to one year following surgery. Furthermore, a reduction in BMI and obesity related comorbidities were reported. Conclusion: Despite improvements in physical health, self-image and mood in the short term, longer term outcomes remain equivocal. This review highlights the need for longer term follow up studies to ascertain if such benefits are sustainable. Such research is particularly pertinent given the increasing prevalence of obese adolescents accessing bariatric surgery as a means to manage their weight.

This thesis comprises three chapters exploring health professionals’ experiences and attitudes regarding diagnoses that challenge mental health services. The first chapter is a systematic literature review investigating the impact of training on staff attitudes towards personality disorder. Eleven articles were reviewed and critically evaluated. Despite inconsistencies in the data and a number of methodological concerns, there is evidence to suggest that training is effective in improving staff members’ cognitive and affective attitudes towards personality disorder, and their therapeutic engagement with service users. Clinical and research implications are discussed in relation to developing staff training packages regarding personality disorder. The second chapter is a qualitative study of mental health nurses’ experiences of caring for adults with autism spectrum disorder (ASD) in acute inpatient services. Semi-structured interviews were conducted with seven nurses and the transcripts were analysed using Interpretative Phenomenological Analysis. The two major themes that emerged from the data indicated that nurses felt confused and unable to make sense of autistic presentations, but were able to overcome these challenges by focusing on their core nursing values and providing person-centred care. Overall, the findings highlight mental health nurses’ lack of knowledge about ASD. Clinical implications are discussed in relation to developing staff members’ skills and confidence in working with this client group. In the third chapter, personal reflections on the research process are discussed, with a particular focus on stigma and stereotyping in mental health services. These include the evolution of my own perspective and a consideration of the role of clinical psychologists in supporting staff.

Research has recognised the importance of understanding the chronic pain experience using a biopsychosocial model. This approach acknowledges the impact of cognitive factors on psychosocial adjustment to chronic pain. This literature review explores the difficulties encountered by individuals adapting to a life with pain. It evaluates the evidence pertaining to the idea that beliefs about illness and coping strategies affect psychosocial outcome in chronic pain. The review considers the role of cognitive factors in self-regulating illness using the Common-Sense Model of Illness Representations (CSM). An evaluation of this model as it applies to chronic conditions is provided. Reviewing the literature reveals that despite numerous studies examining the CSM in chronic illness, there is a paucity of research applying it specifically to chronic pain. This review highlights the potential usefulness of exploring the CSM in this population in order to consider both the empirical value of the CSM and gain further knowledge regarding useful psychotherapeutic interventions in chronic pain. On this basis, the present study sought to investigate the CSM in a sample of adults with chronic pain. A significant relationship between a number of illness representations (beliefs about illness) and psychosocial outcomes was found. A subset of these met criteria for mediation. The findings imply that particular illness representations (identity, consequences and emotional representation) are associated with the coping strategy catastrophising, which in turn is associated with an increased tendency for depression, anxiety and reduced quality of life. Due to the cross-sectional design, causal inferences cannot be made. However, the findings imply partial support for the CSM in a chronic pain population. Directions for future research are highlighted, as well as implications for psychotherapeutic interventions which could help reduce unhelpful beliefs and maladaptive coping strategies.

This thesis consists of two volumes: a clinical and a research volume. The clinical volume contains five clinical practice reports; the research volume contains a systematic review and an empirical study. The systematic review explores the effectiveness of cognitive rehabilitation of problem-solving, planning and reasoning in people with traumatic brain injury. The findings suggest that Short-Term Executive Plus (STEP) can decrease executive dysfunction and improve problem-solving, however, more research would strengthen the findings. Evidence for the use of ‘gist reasoning’ training is growing. Training multitasking remains an approach with insufficient evidence to support it. Finally, although the findings in relation to telephone counselling seem promising, more research could help to clarify its effectiveness. The empirical study aimed to establish whether the Iowa Gambling Task (IGT) adds to the predictive potential of three tests of executive function in the assessment of capacity to take part in research in people with acquired brain injury. Stroop errors on the inhibition task and Wisconsin Card Sorting Test (WCST) total errors emerged as potential screening tools; the IGT was not among the predictors. Suggestions for future research are provided. Replication with a larger sample is needed to confirm the findings.

The impact of severe mental illness on the individual and their family can be substantial. In addition to living with the vagaries of a condition that can be of unpredictable duration and severity, individuals and their families may also have to live with public perceptions that can be devaluing, discriminatory or indeed hostile. The purpose of this thesis is to examine the impact of severe mental illness on the individual and their key relatives using a social cognitive perspective. Chapter 1 provides a review of the mechanisms and consequences of stigma and discrimination in severe mental illness, and explores ideas for intervention that are predicated upon empirical research findings. Chapter 2 examines the pattern of desynchrony between lay representations of severe mental illness held by individuals, their carers, and a sample of the general public. It also highlights the association between aspects of perceived stigma and divergent patient-parent representations of schizophrenia. Chapter 3 adopts a self-regulation theory approach to distress in the relatives of people diagnosed with schizophrenia and concludes that aspects of the self-regulation approach, (perceptions of psychosis, coping, and primary appraisals) have some utility as a framework to understand distress in the carers of people diagnosed with schizophrenia. Finally, chapter 4 reflects on the research process and discusses the development and course of the research. It also provides some further reflections by participants on the experience of severe mental illness.

Recent statistics have suggested that a proportion of drivers are killed or seriously injured on UK roads due to feeling nervous, uncertain or panicked whilst driving. The literature into negative emotions has primarily focused on the relationship between anger and driving. Not including the literature on driving phobias and fears after a motor vehicle accident, the literature on the relationship between anxiety and driving is limited and inconclusive. The aim of the thesis was to investigate the effects of both state and trait anxiety on driving behaviours and autonomic reactions using studies with varying methodologies. Chapter 2 describes a questionnaire study, which found that whilst driving anxiety can have a substantial impact on anxiety related thoughts, behaviours and active avoidance, trait anxiety had slightly differential effects regarding social concerns, aggressive reactions and anxiety and avoidance of specific driving situations. Chapter 3 established, in a laboratory study, that whilst trait anxiety predicted various self-reported driving reactions, it did not affect levels of behavioural or autonomic reactions to driving video stimuli. Chapter 4 expands on these findings with a study that demonstrated reductions in high frequency heart rate variability, indicating a potential lack of emotional regulation within this context. The research was then taken into a simulated environment, where state and trait anxiety were investigated. The studies reported in Chapters 6 and 7 found limited impacts of threatening instructional sets on levels of state anxiety, but demonstrated that increases in state anxiety could lead to changes in behaviour and skin conductance levels. Finally, a simulator study reported in Chapter 8 demonstrated that whilst trait anxiety did not affect driving behaviours, it did affect levels of attentional control and processing efficiency. This leads into a discussion of the theoretical and practical implications of these findings. Particular focus is given to the benefits of interventions and exposure therapies, and it is argued that different types of intervention would be more beneficial depending on levels of state or trait anxiety.

This thesis examines the cognitive-psychological theory of autism, specifically the "theory of mind" account. According to this theory, autistic people lack the ability to attribute mental states to other people and this underlies their social communication difficulties. In the introductory chapters, autism is described, followed by a consideration of different theoretical accounts of the normal child's theory of mind and empirical evidence on the autistic child's theory of mind. Finally, the introduction discusses whether the different theoretical accounts can explain autism. A series of experiments are then described which investigated normal and autistic children's ability to understand knowledge as a mental state. Experiment 1 established a baseline for the subsequent experiments and included three groups of normal children with mean ages of four years nine months, five years nine months and six years nine months. In this experiment the children's ability to differentiate the cognitive mental terms "know" and "guess" with reference to their own and another person's mental states was examined. Results of this experiment indicated that all three groups of children could differentiate "know" and "guess" in reference to their own and another person's mental state. Experiments 2 and 3 compared the ability to differentiate "know" from "guess" with reference to their own and another persons mental state of high language level autistic children, low language level autistic children, children with Down's syndrome, four-year- old and five-year-old normal children. Results of these experiments showed that the high language level autistic children were able to refer to their and another person's mental state of knowledge. In addition the results were related to a number of measures of language ability. Experiment 4 compared the ability to attribute knowledge and ignorance to themselves and another person of high language level autistic children, low language level autistic children, four-year-old and five-year-old normal children. In one task the experimental question involved the mental term "know", in another task, the term "could help" was used. Results of this experiment showed that all four groups of children performed significantly better in the "know" task than in the "help" task. Performances on the tasks was again related to the children's language skills. The thesis reaches two main conclusions. First that autistic children do not totally lack a theory of mind, since high language level autistic children were able to refer to their and another person's knowledge state. Second, autistic children's language level is a strong predictor of their performance on theory of mind tasks. The thesis concludes by discussing a number of issues involved in autism research and indicating future directions for research.