Mindfulness-based Cognitive Therapy (MBCT) is a manualised psychosocial, group-based 8 week course specifically designed for people with a history of depression. This study responds to the huge growth in the credibility of MBCT as a therapeutic option in the NHS as well as a rise in the popularity and awareness of mindfulness-based interventions (MBIs). This study is based on semi-structured interviews (N=38) with stakeholders in the field of MBIs in Sussex, and an online survey of Sussex NHS Foundation Trust (SPFT) staff (N=203), as part of a wider collaborative ethnography embedded within the Trust. It contributes to existing literature on the efficacy of MBIs by exploring existing provision and follow-up support, reviewing the perceived benefits and costs of embedding MBCT into the health services. This study has a particular focus on participants of a recent SPFT Randomised Controlled Trial (RCT) ‘Mindfulness for Voices' that investigated the efficacy of this therapy for people who hear distressing voices. This study brings together both the empirical and theoretical with its focus on mindfulness as a therapeutic technique that epitomises links between the mind, the body and society. This study draws on sociological work on embodiment and emotion in order to understand the experience of innovation as well as of MBIs – starting from the observation that many of those leading this area of research and implementation are also practising mindfulness. Furthermore, this study maps the theoretical shift from a narrow medical model of mental illness to one that characterises emotional health within a holistic and integrated paradigm, and which is influencing and shaping current practice. Key findings from this study are that MBIs, and MBCT in particular, can be beneficial to a diverse range of stakeholders within Sussex, including patient groups that were previously excluded from ‘talking cures' such as those with a diagnosis of psychosis. Factors that influence the acceptability, visibility and utilisation of an innovation such as MBCT include the role of opinion leaders and champions in garnering support, as well as the degree to which expectations about the future of this intervention are managed. Drawing on sociologies of knowledge and innovation in the health services, the case is used to show the use of experiential knowledge alongside evidence in bringing about innovation. Clinicians also work to develop accounts of the ‘values' at stake in MBIs; drawing on both evidence and experiential knowledge. The implementation of MBIs into the mainstream health service helps to illuminate some of these practices through being used to address conditions such as chronic pain and severe anxiety disorders which were hitherto seen as untreatable and characterised as ‘complex needs', or medically unexplained symptoms (MUS) and which can be stigmatising.

Section A: The effectiveness of acute phase psychological therapies for chronic major depression: A literature review. This review critically evaluates the literature pertaining to the use of psychotherapy for people experiencing moderate to severe chronic depression. It concludes that people with chronic major depression (CMD) experience a greater reduction in depressive symptoms from extended periods of treatments and from combined therapy, both in the form of psychotherapy and pharmacotherapy, but also integrative therapies which combine different therapeutic models and modalities. Section B: This study explored participants’ experiences of ways in which group person based cognitive therapy (PBCT) for people with chronic major depression facilitated or hindered therapeutic change. Qualitative methodology was used to explore the experiences of six participants who had completed the 12-week group. Transcripts of the semi-structured interviews were analysed using Interpretative Phenomenological Analysis. Five super-ordinate themes emerged: experiences of depression before the group; the group experience; perceived changes; role of external factors; desire for more. Participants reported a changing experience of depression with regard to the way in which they related to and managed their symptoms, viewed themselves, and managed challenging situations. This study indicates that PBCT may be a suitable intervention for adults with CMD, and enhances previous findings which suggest that briefer mindfulness practices may be more acceptable to people experiencing current symptoms of depression. Section C: In a critical appraisal of the study described in section B, this section discusses the author's learning and reflections pertaining to research skills developed, applying the findings to clinical practice, and gives consideration to further research.

Biological explanations of depression have been found to increase professional perceptions of the effectiveness of medical treatments and reduce the perceptions of the effectiveness of psychological therapy. Studies in lay populations have shown that biological explanations reduce perceptions of self-efficacy and control over depression symptoms. There is a lack of research examining the impact of causal models on clinicians’ attitudes. The current study aimed to explore whether clinicians’ causal models of a client’s depression can be biased by aetiological labelling and, in turn, whether clinicians’ causal models impact clinical judgements and attitudes. An experimental design was utilised, with one independent variable (labelling of the client’s depression) with three levels (biological, psychosocial and neutral). Outcomes measured causal beliefs, treatment effectiveness, control, clinical attitudes and perceived stigma in relation to a client vignette. Observational data were analysed to explore the effects of clinicians’ primary causal models on the outcome variables. Over 200 trainee clinical psychologists, across England, Scotland and Wales, took part in an online survey, presented using surveymonkey®. Where appropriate data were analysed using ANOVA. There was a small effect of the manipulation; labelling the depression as biological increased biological causal attributions and increased perceptions of the effectiveness of medical treatments. The exploratory analysis demonstrated substantial effects of strongly endorsing biological causal beliefs on judgements of medical treatments and client engagement. The results suggest that clinicians’ causal models of a client’s depression may bias clinical judgements. These findings are preliminary and further research is needed.

The aim of this study was to investigate the role of self-compassion, self-criticism and brooding as mediators between insecure attachment and depression in a multimediational model. Additional aims were to investigate whether self-compassion and self-criticism were independent predictors of depression and whether self compassion could protect against depression through reducing self-criticism and brooding. Three hundred and fifty six participants selected through convenience sampling completed measures of attachment, self-criticism, self-compassion, brooding and depression as part of an online survey. Multiple regression showed self-criticism and self-compassion independently predicted depression. Multimediational analysis found that the relationship between anxious attachment and depression was fully mediated by self-criticism, brooding and self compassion. The relationship between avoidant attachment and depression was partially mediated by hated self-criticism and brooding. Hated self-criticism and brooding partially mediated between self-compassion and depression. This study linked the related areas of self-compassion and attachment, the findings add to evidence supporting the potential value of compassion-focused therapies and further clinical and theoretical implications are discussed.

Mental health problems in pregnancy and the postnatal period can have long-term negative effects on women and their children. A key barrier to helping women in this period is the low level of identification of mental health problems. Depression has commonly been screened for using the Whooley Questions or Edinburgh Postnatal Depression Scale (EPDS) but women may experience a broad range of symptoms of distress not captured by these measures. The research reported in this dissertation was designed to address several aims. The first strand aimed to explore women's experiences of postnatal mental health problems and how they conceptualise their symptoms. The focus of the first qualitative study was the lived experience of 17 women who had experienced psychological distress in the first postnatal year, and used interpretative phenomenological analysis. The second qualitative study used thematic analysis with the same sample to explore different symptoms of distress and women's experiences of being assessed for these. The second strand reviewed and evaluated currently existing measures of commonly reported affective symptoms with a view to informing future assessment. A systematic review found a lack of measures of anxiety designed for or validated sufficiently with perinatal women. Factor analyses of the EPDS then explored the structure of depression and anxiety symptoms in the perinatal period in the Avon Longitudinal Study of Parents and Children (N = 11,195 – 12,166). Results suggested symptom clusters of anhedonia, depression and anxiety. Finally, validity of the CORE-10, a short measure of psychological distress was evaluated in a sample of 366 pregnant women. The CORE-10 showed promising psychometric properties. Anxiety was the most reported symptom. Overall findings suggest that perinatal women need to be assessed for a variety of mental health problems and that further work is needed to identify the most effective assessment tool and process.

Section A summarises theory and research relevant to understanding the interaction between intimate-partnership and depressive relapse. Interpersonal theories of depression are introduced. Following this, extant empirical studies examining the effects of interpersonal processes on depressive relapse are critically evaluated. As these studies do not consider how depressive relapse might affect the intimate-partner over time, a separate body of literature examining the impact of depression on intimate-partners is reviewed. Limitations and gaps in the existing evidence-base are discussed, and areas for future research are outlined, such as studies to understand the bidirectional interaction and to explore alternative interventions that enable both partners to cope with relapses. Section B presents a Grounded Theory study of the process of engaging in mindfulness-based cognitive therapy (MBCT), which is a relapse prevention strategy for depression, as an intimate-partnership. Twelve participants took part in a semi-structured interview about their experience of the MBCT course. These data were triangulated with sessional data from an MBCT course and facilitator validation. The proposed theory captured the ‘process of learning new mindfulness skills together’. While intimate-partnerships who engaged in an MBCT course seemed to learn similar mindfulness skills as in individual MBCT courses, learning as a partnership seemed to facilitate home practice, attendance and a sense of mutual support, which led to unique outcomes for the partnership and their sense of responsibility for each others’ wellbeing. Limitations and implications are discussed. Section C provides a critical appraisal of the process of conducting this research study, including the researcher’s learning experience, implications for clinical practice and future research.

Section A presents a literature review of the issues and challenges facing fathers in the postnatal period, in the context of an historical marginalisation of fathers in the study of child development. The review leads to a specific focus on the limited research evidencing the increased risk fathers face to their mental health, when coping with a partner's admission to a Mother and Baby Unit (MBU). Section B Fathers' experience of the joint admission of a partner and child to an MBU has been the subject of limited research, despite initial findings suggesting fathers are at increased risk of postnatal paternal mental health difficulties. This qualitative study aimed to explore the lived experience of fathers in this context, to inform the validity of future research in the area. Interpretative phenomenological analysis was carried out following semi-structured interviews with six fathers in south east England. Five master themes showed that these fathers experienced the onset of their partners' postnatal mental health difficulties as unexpected and traumatic. Fathers needed to acknowledge limits in their ability to help, and the necessity of calling on specialist services. During admission, fathers felt pulled physically and emotionally between managing their own needs, and the needs of their partner and new baby. Themes showing the MBU admission challenged their fathering role and identity were contrasted with the importance fathers placed in treatment needing to be a 'family affair', inclusive and supportive of the father, and mindful of the impacts on the couple relationship. The impact of culture on fathers' adjustment to involvement at the MBU was noteworthy. In conclusion, this research helps understand the importance of including the father where appropriate in a mother's recovery programme, and helping the father define a role alongside the clinical team. The findings of the study validate the efforts of government policy to build effective family focused perinatal services. Section C sets out the journey taken from the ethnographic inception of the research idea, through dilemmas encountered in carrying out the study, to reflections on what was learnt during the process.