Studies investigating harm avoidance and incompleteness in obsessive-compulsive disorder (OCD) have been limited to the use of questionnaire measures and behavioural tasks. Despite their utility, these methodologies are unable to capture cognitions that are not readily accessible through introspection or that are difficult to articulate, as they operate on a more visceral level. The current study explored harm avoidance and incompleteness using an implicit measure, the Implicit Relational Assessment Procedure (IRAP). Three behavioural tasks based on the main symptom dimensions (contamination/washing, checking, symmetry/ordering) and a series of self-report measures were used for comparative and validation purposes. The group with high obsessive-compulsive tendencies demonstrated no negative bias towards harm avoidance/incompleteness–related stimuli. No associations were identified between scores on the implicit measure and the explicit measures (questionnaires and behavioural task). The findings are interpreted in the light of extant literature with reference to the limitations of the current study.

Well-being indicators are often conceptualized either as positive feeling (e.g. happiness), positive functioning (e.g. meaning, involvement, competence), or a combination of the two. Several measures of well-being have been developed based on this distinction, with lower-order factors (e.g. happiness, meaning) loading on separate higher-order factors (e.g. positive feeling and positive functioning). However, some limitations have been identified in the lower-order factor structure of current well-being questionnaires. Furthermore, recent evidence indicates that a single higher-order or general factor adequately explains most of the variation in well-being data. This dissertation presents the development and initial validation of a questionnaire, which attempts to overcome some limitations in the lower-order structure of previous questionnaires and assumes the presence of a single general factor of well-being. Following a review of current measures, commonalities among them were identified and, based on these points of agreement, the general factor was conceptualized as a set of subjective experiences and evaluations, which are relatively stable and interpreted as symptoms of good mental health. Fourteen constructs were identified as common lower-order indicators of well-being across measures: happiness, vitality, calmness, optimism, involvement, self-awareness, self-acceptance, self-worth, competence, development, purpose, significance, self-congruence and connection. The hypothesized properties of the higher- and lower-order factors were then tested in three studies. Study 1 developed an item pool and assessed the adequacy of its content by consulting a panel of six academics with expertise in well-being research. Studies 2 and 3 recruited two adult North American samples (total N = 1,496) to assess the questionnaire’s psychometric properties, and specifically its dimensionality, reliability, measurement invariance, and relationships with external criteria. Each lower-order scale fit a unidimensional model and all fourteen scales fit a correlated-factors model as well as higher-order and bifactor models. Evidence of measurement invariance was found across gender, age and a longitudinal period of 5 weeks. Lower- and higher-order scale scores showed adequate internal and test-retest reliabilities. Finally, lower- and higher-order scale scores showed strong associations with previous measures of similar constructs and lower associations with measures of distinct constructs. The questionnaire aims to contribute to future research both as a global measure of well-being as well as a collection of fourteen individual health-related scales.

Introduction: Existing literature suggests that the perceived understanding nurses have of behaviours in dementia can influence how they respond to persons with dementia (PsWD) (Todd & Watts, 2005; Eriksson & Saveman, 2002; Dupuis, 2012). Their responses can be influenced by a range of factors, such as organisational pressures (Stacey et al., 2010) and staff burnout (Edvardsson et al., 2008). However, this is likely to have an impact on PsWD’s quality of life and sense of self (Kitwood, 1997). Absent from literature is the psychological process nurses go through to make sense of and respond to behaviours that could help to provide comprehensive knowledge of the complexities involved. Furthermore, there are very few research studies looking at nurses’ experiences in inpatient dementia care, where the environment is very different to a long-term care setting. Aim: To explore how inpatient psychiatric nurses make sense of and respond to behaviours in dementia. Design: A qualitative methodological design was used. Method: Eight inpatient psychiatric nurses were recruited from two National Health Service (NHS) sites across one Trust. Semi structured interviews were conducted, transcribed and then analysed using Interpretative Phenomenological Analysis (Smith et al., 2009). Quality was assessed using criteria specifically developed for IPA (Smith, 2011). A reflective diary was kept throughout the research process, which included examples of reflexivity. Results: Four interrelated superordinate themes were identified, with no one theme taking primacy over another. These four themes were: ‘Effort to sense make’, (which consisted of three subthemes: Trial and error, Drawing on existing knowledge and “Putting myself in his shoes”), ‘Pressures of the organisation’, ‘Balancing personal and professional selves: The underlying emotional connection’ and ‘”Looking back on it…”’. Discussion: This study adds to the current research base by identifying that sense making is a dynamic process, which occurs through a range of psychological processes. It can change moment-by-moment, dependent on the influences on the nurse, such as environmental pressures and the personal and professional negotiations that occur. When sense making was psychologically and socially informed, the corresponding response resulted in less overall distress for PsWD. The study further adds to existing research through identifying an emotional connection with the patient, which can either be conscious or unconscious. Those that demonstrated a conscious empathic emotional connection appeared to be the ones that were more likely to want to reconnect with patients, following a need to disconnect in-line with professional duties. The study findings are important from a research and clinical point of view, as nurses need to be supported to move flexibly through a range of emotional connections. Furthermore, a managerial approach that promotes reflective space and supervision is likely to increase psychologically informed sense making, which is specifically important given the positive impact this has on both staff and PsWD’s wellbeing.

The study aimed to explore the processes people go through when diagnosed with ADHD in adulthood from a psychological perspective. ADHD has recently been recognised as affecting adults. Limitations exist in the breadth and depth of qualitative research into the experiences of those receiving an ADHD diagnosis in adulthood. Existing research is largely descriptive, with a prominent focus on pharmacological treatment. As such, psychological processes have not been sufficiently explored. Without ADHD-specific models of adjustment, the literature on identity, cognitive adaptation and stigma is examined. A qualitative methodology was employed taking a critical realist perspective. A purposive sample of twelve participants was recruited through adult mental health services. Each participant took part in one digitally recorded, semi-structured interview where experiences were explored. A mixed inductive-deductive thematic analysis of the transcribed interviews was conducted following the Braun and Clarke (2006) six-stage methodological process. Three master themes were identified with subthemes: (1) Looking back: different, faulty; relief and regret; reframing; (2) Looking inwards (with acceptance); and (3) Looking outwards: labelling: disability, stigma and social comparisons. The study highlighted participants’ attempts to make sense of their past experiences considering the diagnosis, reflect on the effect the diagnosis had on their sense of self and identity and consider the positives and negatives of sharing their diagnosis. Participants also compared themselves with others and some reflected on ADHD being a shared experience within families. The current research has highlighted the contradictory nature of the diagnosis; that an ADHD diagnosis was necessary to access support and acknowledge people’s experiences (and potentially attribute past behaviours and experiences to ADHD rather than personal failure) but there remains a struggle with the sense of self, the way people are viewed by others (e.g. feeling stigmatised) and the permanence of being or having ADHD forever. This highlights the importance of supporting people to understand their interpretation of the diagnosis and target intervention in the adjustment process. Pre- and post-diagnostic support and contact with others who have been through the process would be beneficial. The study also highlights the need for further anti-stigma campaigns. A number of methodological limitations is discussed. Future research is necessary to explore models of attribution and interventions about the interpretation of the diagnosis and self-concept. The thesis ends with a personal reflection about my research journey and a discussion about diagnosis.

Background: The impact of trauma on mental health is well established, but the specific effects of trauma relating to war or conflict and how this manifests behaviourally is less well understood. This research sought to investigate the impact of conflict and non-conflict related experiences on mental health outcomes and intra-familial aggression in the context of the north of Ireland following the thirty year Troubles conflict. This research is of value as previous research in this area suggests that traumatic symptoms and disproportionately high suicide rates are a current trans-generational issue in the north of Ireland. A better understanding of the impact of particular traumas is important in developing effective treatment facilities for addressing these widespread issues which could improve quality of life across those directly and indirectly affected by conflict. Aims and Objectives: The main purpose of this thesis was to investigate the impact of conflict and non-conflict related experiences on mental health and behaviour in the north of Ireland. Civilians were the focus of the quantitative section of this research, and ex-political prisoners and internees were the focus of the qualitative component. The main research questions were: • Are trauma measures which are widely utilised in assessing for PTSD suitable for assessing conflict related trauma in the north of Ireland (chapter 2) • Do conflict related trauma or non-conflict related traumas predict increased aggression within families and other difficulties in a civilian sample from the north of Ireland? (chapter 3) • What are the main themes of experience reported by ex-prisoners or internees, are these similar or different and how have these experiences impacted on individuals? (chapter 4) • Does psychologically based therapy reduce traumatic symptoms in people affected by conflict? (chapter 5) • An exploration of a CBT based treatment for an individual with mental illness and history of conflict and non-conflict related trauma; what complexities remain in the area of treatment for conflict related trauma? (chapter 6) Methods: A critique of trauma measures and methods was undertaken in chapter 2 in order to investigate the utility of particular tools in culturally specific regions and where traumas are specifically conflict related. In chapter 3, an empirical research study investigating the experiences of a community sample from the north of Ireland who lived through the Troubles conflict was undertaken using a quantitative approach. In chapter 4, qualitative analysis of semi-structure interviews with ex-political prisoners and internees of the conflict in the north of Ireland was carried out. In chapter 5 a meta-analysis explored the effectiveness of therapeutic interventions for conflict related trauma. Finally a case study was completed to explore the effectiveness of a CBT treatment programme on an individual with mental illness and conflict and non-conflict related trauma. Overall findings: • In chapter 2, it was found that several measures used to assess for PTSD relating to other experiences which are not conflict specific may be of limited value in assessing for conflict related trauma, as they often require an individual to focus on a particular incident and don’t consider the pervasive nature of living through conflict. Culturally specific factors were found to be important in designing measures for particular regions. The Troubles Related Experiences Questionnaire (TREQ - Dorahy et al., 2007) was found to be effective in gathering a picture of Troubles related experiences specifically, but an additional PTSD measure may be required to relate these experiences to mental health outcomes. • In chapter 3, 93% of respondents reported at least one Troubles related experience and half suggested the impact on their communities were 'significant.' Only 10% reported the Troubles had no impact on them personally. 17% of participants met the threshold for provisional PTSD diagnosis using a cut-off estimate validated for civilians on the Post-traumatic stress disorder checklist (PCL-C). Various traumatic experiences including being beaten by a partner or caregiver, and various Troubles related experiences predicted the development of PTSD. PTSD in turn was associated with increased aggression towards partners and children and suicidality. Older people were less likely to acknowledge adverse pathology than younger people, despite experiencing more traumas. • In chapter 4, themes including positive and negative coping, camaraderie, loss and Troubles related stressors and experiences were shared by all interviewees. Ex-prisoners appeared to report greater experiences of loss and a greater impact of their experiences than internees. Internees were troubled by not having a release date which they found particularly stressful. • In chapter 5, meta-analysis results suggest that a broad range of therapeutic approaches including cognitive behavioural therapy, narrative exposure therapy and psychotherapy significantly reduced symptoms of post-traumatic stress disorder in people affected by conflict compared to untreated controls. • In chapter 6, an individual CBT approach was effective in reducing anxiety and increasing self-esteem in an individual with complex PTSD, both conflict and non-conflict related. The complexities in identifying treatment targets and addressing symptoms in those with complex backgrounds and multiple traumas are discussed. Conclusion: PTSD appears to predict aggression within families and mental health problems in a sample from the north of Ireland. Both conflict related and non-conflict related traumas were predictive of PTSD. Therapy appears to be effective in reducing trauma symptoms where the primary trauma is conflict related. It is difficult to disentangle the contribution of one type of trauma from another in treatment where there is complex PTSD. There is no one-size-fits-all treatment pathway for trauma, particularly in a post-conflict society and therefore in any future treatment facilities consideration should be given to individual needs.

Background: Previous research has explored the impacts of empathically engaging with client trauma accounts on therapists. The majority of this has been quantitative, guided by measures of secondary traumatic stress symptoms or belief-disruptions consistent with Constructivist Self-Development Theory (CSDT). Results have been inconsistent and interpretation is affected by methodological shortcomings. There have also been differences in findings between qualitative and quantitative approaches. Whilst most quantitative measures focus on the negative impacts of trauma work, qualitative studies have revealed the presence of positive impacts; referred to as vicarious posttraumatic growth. A review of previous literature, addressing their methodological limitations, is presented. Aims: This study had four aims. The first was to explore the occurrence of the five belief areas, consistent with CSDT (trust, safety, esteem, control, intimacy), within qualitative evidence. The second was to measure implicit constructions of participants’ belief systems to determine whether they constructed themselves as more similar to a client struggling with trauma. The third was to triangulate qualitative findings with quantitative measures widely used in the vicarious trauma literature to determine whether there is consistency in results. The final aim (presented in the extended paper only) was to use an inductive analysis to explore any areas of importance in participant accounts that were not covered by CSDT. Methodology: Participants were 10 Trainee Clinical Psychologists and 10 Qualified Mental Health Professionals working for the National Health Service (Clinical Psychologists, Social worker, Psychiatrist & Psychiatric Nurse). They were recruited using purposive sampling from three Doctoral courses and two NHS trusts. Repertory grids were followed by semi-structured interviews exploring trauma work experiences. Psychometrics, including a measure of belief disruption, Trauma and Attachment Beliefs Scale (TABS), were completed at the end of the interviews. Principal Findings: Directive content analysis revealed evidence for all CSDT belief-areas, although some were more frequently identified than others. Positive and negative beliefs co-occurred, suggesting vicarious trauma and vicarious posttraumatic growth can occur in parallel, for both trainee and qualified therapists. Some differences between groups are discussed. Repertory grids suggested both groups construed themselves as least similar to clients struggling with trauma and more similar to clients experiencing posttraumatic growth. Data triangulation revealed some inconsistencies between the TABS and qualitative data. This may be due to the TABS using global statements, whereas qualitative data address specific examples and contexts that the beliefs related to. Finally, the inductive thematic analysis revealed two super-themes: impact and active coping. Participants acknowledged the negative impacts of trauma work but often related this to a process of normalisation, accepting that this was part of their role, which helped them deal with this. Conclusions & Clinical Implications: The finding that positive and negative beliefs can co-occur, as well as the inconsistencies between qualitative and quantitative data, has implications for measures like the TABS which focus only on negative impacts of trauma work. This study is exploratory, and the first to compare British trainees and qualified therapists, therefore further research is required to determine the relevance of these findings. A critical reflection of the research process is provided.

Stalking has been linked to intimate partner violence (IPV) in a number of ways, with some researchers suggesting stalking is part of the cycle of abuse. However, the extent of the association and potential reasons behind the connection are still unknown. The main aim of this thesis is to explore potential explanations for the association between stalking and IPV. Following an introduction in Chapter One, Chapter Two comprises of an empirical research study that examined whether IPV offenders perceive stalking differently to non-IPV offenders and non-offenders. It was hypothesised that IPV offenders may be more likely to engage in stalking due to limited understanding of the behaviours and how serious and harmful they can be. Although the results provided further evidence for the association between IPV and stalking due to the prevalence of stalking within the IPV sample, the primary hypothesis was not supported. This suggests alternative factors may contribute to the connection. Therefore, Chapters Three and Four explore the characteristics of former intimate and non-intimate stalkers. Specifically, Chapter Three comprises of a systematic review exploring the individual and relationship characteristics associated with unwanted pursuit and stalking following the termination of intimate relationships, while Chapter Four presents a case study of a non-intimate stalker. The characteristics identified throughout these studies are compared to the existing literature relating to risk factors for IPV throughout the general discussion of this thesis (Chapter Six), with a number of similarities emerging. Researchers have theorised that attachment may contribute to the connection between stalking and IPV. Therefore, an appraisal of a popular attachment measure utilised within the case study in Chapter Four is presented in Chapter Five. Finally, Chapter Six draws all of the information in the thesis together, providing an overall discussion of the associations between IPV and stalking, outlining implications for practice and providing suggestions for future research.

Treatment non-engagement in forensic settings is a major problem, which has been associated with increased recidivism and higher costs. This thesis aimed to evaluate existing methods of enhancing engagement, test an innovative motivational strategy to enhance engagement, and critically evaluate an effective measurement of engagement. Firstly, a systematic review and a meta-analysis of Randomised Controlled Trials (RCTs) was conducted to evaluate the effectiveness of Motivational Interviewing (MI). It was concluded that MI may be effective for engagement, but measurement of engagement is inconsistent and unreliable. Therefore, MI was integrated into a novel training package for staff in addition to a promising readiness model and a motivational assessment. The feasibility of such intervention was investigated for probation staff, and its preliminary effect on probationers’ group engagement was assessed using the Group Engagement Measure (GEM-27; Macgowan, 1997). Findings showed while it is generally feasible to implement such an intervention, it is possible that short training in such settings might not be as impactful due to organisational issues, staff burnout and external influences. However, GEM-27 showed promise with regards to being able to measure offender engagement. After critically reviewing its characteristics, with further research and modifications, it was concluded GEM could be widely used in forensic settings. In conclusion, advancements in evidence-based measures of engagement and forensic specific strategies to enhance offender engagement are the initial steps towards developing a comprehensive theory of offender engagement and increasing treatment effectiveness.

Although the issue of intimate partner violence (IPV) has received much attention, this has largely focused on adult relationships despite recent findings indicating that IPV is also a substantial problem in adolescent and young adult (AYA) relationships. Particularly, there has been little research conducted in the UK. The thesis followed a developmental pathway with each chapter mapping onto a different stage of development from early childhood to young adulthood. The thesis began with a case study that explored and mapped IPV with a specific individual and how her early experiences and attachment difficulties presented later in her intimate relationships. Specifically, the case study highlighted the client’s insecure anxious attachment style appeared to underpin her pattern of forming intimate relationships where she was at risk of being victimized, and later of perpetrating abuse. The importance of early environments and familial risk factors was then focused on in greater detail in the systematic review. The review highlighted that children who had been maltreated and those who were exposed to parental violence were at greater risk of being victims of IPV when they were older. Social learning theory was utilised as an approach to understand this as individuals may normalise aggressive behaviours they are exposed to as a child, leading to them becoming entrenched patterns of dealing with their own conflict as they grow up. The findings from the systematic review also highlighted the need to utilise a measure of conflict that was developed and validated with AYA, which was the focus of chapter 3 and in doing so moved further into the developmental pathway by focusing on adolescent conflict behaviours specifically. Finally, the research study looked at factors and prevalence rates involved in the re-victimization of IPV in AYA aged 16-24. Prevalence of emotional violence was highest, being endorsed by 40% of the study cohort. When focusing on re-victimization, it was found that coping style was not a predictor of IPV re-victimization in the current study population, although attitude to IPV and having a partner who utilised aggressive methods to deal with conflict were predictors. In conclusion, the findings provide greater context to AYA IPV in the UK, however early intervention work looking specifically at emotional violence and attitudes to IPV should be focused on in order to reduce the risk of re-victimization into young adulthood.

Psychotic phenomena are prevalent in non-clinical populations, with a continuum existing between psychotic-like experiences (PLEs) and incidence of clinical relevance. Phenomena-associated distress often demarcates a threshold whereby individuals seek help, and experiential risk factors are consistent at both ends of the continuum. Increased exposure to stressors may predict the transition from transient, to persistent and impairing psychotic-like symptoms. PLE-specific trajectories have been noted in the literature, with childhood bullying victimisation mooted to predict the development of paranoid thinking; paranoid thinking underlies some expressive violence. Whilst bullying victimisation is a cause for concern in itself, the cognitive and behavioural consequences for victims are potentially significant. Paranoid individuals can incorrectly appraise threat in neutral social situations, and employ maladaptive safety behaviours to reduce perceived danger. Such misperception of social events, and behavioural responses, could result in aggressive or violent actions towards others. The current thesis examines this topic.