Inter-rater reliability (IRR) of the Structured Assessment of Violence Risk in Youth (SAVRY) amongst mental health professionals was explored. Participants (n=22) rated vignettes varying in violence severity and gender (case characteristics). Professional characteristics including perception of their confidence and objectivity in ratings were measured. Using ICC1 scores, the IRR was low for items when interpreted using the 95% confidence interval but much higher using individual ICC scores. Case characteristics did not conclusively affect ratings. Self-reported confidence in ratings was not associated with increased reliability. This suggests that professionals completing risk assessments are likely to benefit from ongoing training.

Objectives: To evaluate the feasibility of a peer delivered wellbeing intervention for pupils within a Scottish secondary school setting comparing peer-trained class facilitators and CBT-trained class facilitators. To gather feedback on the experience of being a class facilitator. Design: A pre-post, mixed-methods design was utilised. Setting: Religious Moral Citizenship and Education (RMCE) classes in a Scottish secondary school. Participants: Nineteen sixth year class facilitators were recruited and randomly allocated to peer-led (N = 10) or CBT (N = 9) training. Eight classes of third year secondary school pupils were allocated to two conditions. Four classes (n = 100) taught by peer-trained class facilitators and four classes (n = 95) taught by CBT-trained class facilitators Intervention: ‘My Big Life’ is a shortened, simplified version of the Living Life to the Full (LLTTF) young person’s course. My Big Life’ contains four sessions centred upon feelings, behaviour, thinking and problem solving. It was delivered over four weeks by the class facilitators. Outcome measures: The Warwick-Edinburgh Mental Well-being Scale (WEMWBS) was administered at baseline, post-intervention and three-month follow-up. The Training Acceptability Rating Scale was administered to the class facilitators post training and to the 3rd year students’ post-intervention. Two focus groups were completed post-intervention with the peer-trained class facilitators (n = 4) and CBT trained class facilitators (n = 3). Results: There was a significant improvement in wellbeing for pupils with initial low well-being scores provided with training by CBT trained class facilitators (p = 0.01). Overall, those with lower initial wellbeing scores showed greater improvement than those with initial high wellbeing scores. Pupils rated the intervention as being beneficial. Class facilitators identified a number of benefits from participating in the programme. Difficulties and suggested improvements were also highlighted. Conclusions: A short intervention delivered by student class facilitators can lead to wellbeing improvements, particularly for those with lower initial wellbeing scores. Peer-led training appeared to be as effective as CBT led training and suggests that peer training may be an effective model to transfer skills to further year groups. However, further research is warranted in order to make more substantial recommendations.

Introduction: Women in prison (WiP) in Scotland are six times more likely to have a hospitalised head injury (HI) than the general population and have higher relative risk of HI than men in prison. HI is linked to increased violent offending and poorer prison rehabilitation outcomes. This study aimed to explore the epidemiology of HI in WiP and identify any unmet needs. Methods: A retrospective cross-sectional design was utilised. 62 WiP were recruited from three Scottish prisons. Self-reported cause and severity of HIs, offending characteristics and comorbidities were recorded. Results: 88.7% of participants had a HI and 77.3% experienced periods of repeated blows to the head. Most likely cause of HI was assault. 68.4% of repeated HI episodes were caused by intimate partner violence (IPV). Number of HIs with LOC was significantly associated with number of arrests (rs=.398, p=.001; moderate effect size, 95% CI [.17, .61] and time in prison (rs=.299, p=.027; moderate effect size, 95% CI [.05, .54]). Participants with HI were significantly more likely to report violent offences than those with no HI, regardless of the HI severity (p=.043, odds ratio: 6.61, 95% CI [1.09, 40.3]). 86.5% of participants experienced HI before their first offence, indicating it may play a role in offending. Average age of first HI was 11 years, which links to poorer outcomes than adulthood HI. Conclusions: There were high rates of HI in WiP. HI was associated with offending characteristics and trauma. Further research is required with bigger sample sizes to confirm the role of HI in offending. Interventions for WiP may need to be adapted for HI populations and trauma-informed.

Objective: The aim of the present study was to explore the experiences of family relationships during adolescence from the perspective of adolescents with cystic fibrosis, family caregivers and health-professionals. Methods: In-depth semi-structured interviews were conducted with three adolescents with cystic fibrosis (aged 15-18), two mothers and two health-professionals. Results: Thematic analysis produced three themes, each with two sub-themes. Theme 1: family coping (using avoidant coping to manage the challenges of CF and the availability of support), theme 2: roles and boundaries (how these are adapted in families and the transition of these during adolescence), and theme 3: managing adolescence versus managing adolescents (adolescents balancing CF life with teen life and families balancing family and adolescent developmental tasks). Conclusions: Although the sample was small, results suggest the importance that each individual family’s psychological needs are understood and appropriate support offered if required. Support to initiate difficult conversations and interventions aimed at the whole family may help to manage the psychological distress that can occur during stressful times such as adolescence.

Background: A critique of the traditional two-factor model of recovery style suggests that it does not fully take into account the range of strategies people use in their recovery. A third style of ‘ruminative preoccupation’ is proposed in addition to the existing styles of ‘integration’ and ‘sealing over’. In addition, current tools used to measure recovery style lack construct validity and have limitations such as being outdated or using a simplistic format. The Narrative Recovery Style Scale (NRSS) is a novel method of evaluating recovery style, using interview transcripts to provide a three-dimensional measurement of an individual’s style. Aim: The primary aim of this study was to validate and examine the psychometric properties of the NRSS in a mixed clinical sample of individuals with serious mental illness. Method: 36 participants with either schizophrenia (n=13), bipolar disorder (n=9), or complex trauma (n=14) were recruited to the study from community mental health services in Glasgow. Participants were interviewed using the Narrative Interview for Compassion-Revised (NCS-R), a recorded semi-structured interview designed to measure participants’ experiences of compassion towards the self, from self to others and from others to self. This was transcribed and the NRSS was applied to the narrative in order to obtain recovery style ratings. We examined the relationship between the NRSS and the Recovery Style Questionnaire (RSQ), the Coping Inventory for Stressful Situations (CISS) and the Psychosis Attachment Measure (PAM). Results: No associations were found between the NRSS subscales and the RSQ, the CISS, or the PAM. Regarding the internal structure of the scale, the integration subscale was found to be negatively correlated with the sealing over subscale. No relationship was found between the other subscales. Regarding the characteristics of the sample, a number of significant differences between the diagnostic groups were noted including age, IQ, occupation, attachment avoidance, coping, and RSQ recovery style. Conclusions: Although the results do not support the validity of the NRSS as a three-dimensional measure of recovery style, there are various methodological factors which may have influenced the study results. We recommend the development of a specifically constructed interview designed to activate recovery style, upon which the NRSS can be more reliably applied. A re-examination of the NRSS scoring strategy may also increase the research utility and strengthen the reliability of the measure.

We can detect faces more rapidly and efficiently compared to non-face object categories (Bell et al., 2008; Crouzet, 2011), even when only partial information is visible (Tang et al., 2014). Face inversion impairs our ability to recognise faces. The key to understand this effect is to determine what special face features are processed and how coding of these features is affected by face inversion. Previous studies from our lab showed coding of the contralateral eye in an upright face detection task, which was maximal around the N170 recorded at posterior-lateral electrodes (Ince et al., 2016b; Rousselet et al., 2014). In chapter 2, we used the Bubble technique to determine whether brain responses also reflect the processing of eyes in inverted faces and how it does so in a simple face detection task. The results suggest that in upright and inverted faces alike the N170 reflects coding of the contralateral eye, but face inversion quantitatively weakens the early processing of the contralateral eye, specifically in the transition between the P1 and the N170 and delays this local feature coding. Group and individual results support this claim. First, regardless of face orientation, the N170 coded the eyes contralateral to the posterior-lateral electrodes, which was the case in all participants. Second, face inversion delayed coding of contralateral eye information. Third, time course analysis of contralateral eye coding revealed weaker contralateral eye coding for inverted compared to upright faces in the transition between the P1 and the N170. Fourth, single-trial EEG responses were driven by the corresponding single-trial visibility of the left eye. The N170 amplitude was larger and latency shorter as the left eye visibility increased in upright and upside-down faces for the majority of participants. However, for images of faces, eye position and face orientation were confounded, i.e., the upper visual field usually contains eyes in upright faces; in upside-down faces lower visual field contains eyes. Thus, the impaired processing of the contralateral eye by inversion might be simply attributed to that face inversion removes the eyes away from upper visual filed. In chapter 3, we manipulated three vertical locations of images in which eyes are presented in upper, centre and lower visual field relative to fixation cross (the centre of the screen) so that in upright and inverted faces the eyes can shift from the upper to the lower visual field. We used the similar technique as in chapter 2 during a face detection task. First, we found 2 that regardless of face orientation and position, the modulations of ERPs recorded at the posterior-lateral electrodes were associated with the contralateral eye. This suggests that coding of the contralateral eye underlying the N170. Second, face inversion delayed processing of the contralateral eye when the eyes of faces were presented in the same position, Above, Below or at the Centre of the screen. Also, in the early N170, most of our participants showed weakened contralateral eye sensitivity by inversion of faces, of which the eyes appeared in the same position. The results suggest that face inversion related changes in processing of the contralateral eye cannot be simply considered as the results of differences of eye position. The scan-paths traced by human eye movements are similar to the low-level computation saliency maps produced by contrast based computer vision algorithms (Itti et al., 1998). This evidence leads us to a question of whether the coding function to encode the eyes is due to the significance in the eye regions. In chapter 4, we aim to answer the question. We introduced two altered version of original faces: normalised and reversed contrast faces in a face detection task - removing eye saliency (Simoncelli and Olshausen, 2001) and reversing face contrast polarity (Gilad et al., 2009) in a simple face detection task. In each face condition, we observed ERPs, that recorded at contralateral posterior lateral electrodes, were sensitive to eye regions. Both contrast manipulations delayed and reduced eye sensitivity during the rising part of the N170, roughly 120 – 160 ms post-stimulus onset. Also, there were no such differences between two contrast-manipulated faces. These results were observed in the majority of participants. They suggest that the processing of contralateral eye is due partially to low-level factors and may reflect feature processing in the early N170.

Introduction: Developing educational based interventions for head injury (HI) awareness within prison is a key area to support the growth of brain injury services for people at risk of HI. Prevalence rates of HI in the prison population are higher than the general population and associated with offending behaviour. Aims: To explore what prisoners know about symptoms and long-term effects of HI and develop a low-cost single-session psychoeducational group about HI which can be delivered to large numbers in prisons. Methods: A pre-post design recruiting male prisoners aged 18 and over serving a custodial sentence. The study had three stages; screening appointment (T1; N = 34), one-hour psychoeducation group about the symptoms and long-term effects of HI (T2; N = 19) and one-month follow-up appointment (T3; N = 11). HI knowledge was assessed by two open-ended measures (vignettes) and one close ended measure (HI symptom check list) at T1, T2 and T3. Two scores were calculated for participant knowledge as measured by their responses to vignettes; score 1 was number of symptoms or effects of HI which corresponded with the forced choice responses from the symptom checklist and score 2 was the number of symptoms or effects of HI which corresponded with the HI symptom checklist or symptoms or consequences of HI listed in SIGN 110 and 130. Rating scales were used to assess aggression and impulsivity at T1 and T3. Within-subject comparisons were made across study stages to evaluate the effectiveness of the intervention. Results: Participant HI knowledge significantly increased from T1 to T2 (Score 1; d = 0.91, 95% CI [0.36, 1.46], and Score 2; d = 0.99, 95% CI [0.38, 1.60]) and was sustained at T3 (Score 1; d = 1.27, 95% CI [0.44, 2.11], and Score 2; r = 0.60). There were no improvements in ratings of aggression and impulsivity (T1 to T3). A between-group comparison of severity of HI and HI knowledge indicated knowledge was moderately greater for those with mild than moderate-severe HI. Conclusions: The psychoeducational group increased prisoners’ knowledge of HI and is an initial step towards the development an intervention suitable for delivery in Scottish prisons by NHS staff.

This research provides the first direct assessment of human values and value-expressive behaviours based on their conceptual meaning. Chapter 1 provides a brief history of the study of human values and dissects the dominant contemporary theory of values, the Theory of Basic Human Values, proposed by Shalom Schwartz. I also discuss methodological approaches used to assess the structure of human values, and the nature of concepts and categorization. In Chapter 2, seven studies containing data from nine samples in two countries (United Kingdom and Brazil) asked participants to compare the meaning of different values found within Schwartz’s influential quasi-circumplex model of values. Different methods were used across the studies, including direct similarity judgment tasks, pile sorting, and spatial arrangement. The results of these diverse conceptual assessments corresponded to spatial configurations that are broadly convergent with Schwartz’s model, both between and within participants. In Chapter 3, four studies were conducted using British samples, asking participants to make direct comparisons between value-expressive behaviours and different levels of mental representations of values (e.g., value types, higher order values). Some of the methods used in Chapter 2 were also used for these studies. It was an open question whether the structure from Schwartz’s value model would be replicated by the spatial plane composed of value-expressive behaviours. The spatial configurations from these studies broadly converged with Schwartz's structure, and also provided a novel point of view of how values and behaviours are related based on how people interpret them. Finally, in Chapter 4, I discuss the contributions of this research, its implications, limitations, and future directions.

The brain requires a constant supply of glucose and oxygen to meet metabolic needs at rest and during increased activity. If blood flow is disrupted, or if tissue has difficulty extracting or metabolising nutrients, cell damage or death may occur. Vascular and metabolic impairments in Multiple Sclerosis (MS) are hypothesised to contribute to disease progression. This thesis develops empirical measures of neurovascular coupling using the relationship between magnetoencephalography (MEG) and functional Magnetic Resonance Imaging (fMRI). Visual MEG and fMRI responses were reduced in MS. The relationship between them was unchanged suggesting preserved neurovascular coupling. Addressing the same questions with a naturalistic movie stimulus in MS, no coupling differences were found. In a healthy population, results show neurovascular coupling is dependent on brain region and frequency of neural oscillations. Under the hypothesis of reduced cerebral metabolic rate of O2 (CMRO2) contributing to damage in MS, we quantified baseline CMRO2 and cerebral blood flow (CBF), amongst other parameters. This is the first application of dual-calibrated fMRI in MS, involving biophysical modelling of fMRI signals in response to changing inspired CO2 and O2. Reduced baseline CBF and CMRO2 were found in MS, correlating with lesion and grey matter volumes. Relative visual-induced CBF and CMRO2 signals were investigated in MS; a reduction in CBF was found in a small visual region but no visual CMRO2 changes were found, or differences in CBF-CMRO2 coupling. Baseline CBF and CMRO2 signals predicted visual stimulus responses, in both groups. As an alternative to externally supplied gases, we used a breath-hold design to create a CMRO2 movie time-series but report no significant relationships between CMRO2 and MEG. Quantitative functional imaging can detect impairments in resting and stimulus-induced neural oscillations, blood flow and oxygen metabolism in MS, which should be explored further to understand their exact role in disease progression.

Mindfulness is a meditation practice and personality trait that concerns the extent to which an individual attends to present-moment experience in an open and non-judgemental manner. Mindfulness has been associated with a wealth of benefits for both psychological and physical wellbeing. With respect to eating behaviour, mindfulness has been linked with more favourable eating practices and positive outcomes for weight management, encompassing reduced energy intake, greater intake of fruit and vegetables, lower BMI, and greater success in weight loss efforts. In order to best apply mindfulness to eating and weight management a greater understanding of the mechanisms underlying the relationship between mindfulness and eating would be beneficial. Here, I investigated these mechanisms by focusing on the extent to which mindfulness may allow greater self-regulation of eating behaviour. Across six studies I used a variety of methods to examine processes of self-regulation in relation to mindfulness in the context of eating behaviour. This included investigating the mediating role of executive function in determining food consumption following a mindfulness induction, as well as implementing food cueing paradigms that manipulated the need for self-control to observe effects of dispositional mindfulness on eating behaviour. Finally, I examined the cognitive accessibility of dieting goals and motivational styles of behavioural regulation in relation to mindfulness and how they predicted weight and diet outcomes across time. Overall, the effects of mindfulness on eating behaviour were nuanced and complex. Rather than simply reducing energy intake per se, mindfulness may increase healthy food choices or act as a moderator of effects, and its benefits may be overridden by the motivational state of hunger. I found no evidence for enhanced self-control in the form of executive function or accessibility of dieting goals as being a mechanism underlying the effects of mindfulness. Instead, mindfulness may be predictive of slower responses to food stimuli and specific styles of behavioural regulation which represent more deliberative self-regulation rather than automatic self-control.