This study explored the narratives people living with sickle cell disorder construct to explain how the experience of employment influences their identity and subsequently their quality of life. Nine individuals with sickle cell disorder were interviewed and gave detailed autobiographical narratives which were transcribed and processed using narratives analysis. Participants were 4 men and 5 women aged between 22 and 60 years. Participants' passion for their job roles was illustrated by their positive work identities. Earlier experiences were felt to be influential on drive and resilience to work challenges. In the narratives, poor understanding of sickle cell disorder by organisations and reduced ability to manage their condition impacted physical health; psychological and emotional wellbeing; social and cultural experiences. This study has implications for the clinical practice and future research of adults living with sickle cell disorder, contributing to the broadening general understanding of sickle cell disorder.

Dominant narratives about psychosis portray individuals as lonely, dangerous and unable to contribute to society. Such views may be incorporated into an individual’s personal story and are associated with negative outcomes for personal and clinical recovery. Art-making is associated with personal meaning-making and alternative forms of expression. It is therefore considered potentially relevant to narrative modification. Adult service-users with psychosis participated in a gallery-based art-making intervention. At interview, participants used their self-created images to help tell their story. Literary, experience-centred and culturally-oriented lenses were used to analyse narratives. Turning-points as modifiers of stigmatised dominant narratives were explored, as was how the intervention supported recovery. Art-making was associated with achievement, challenge and satisfaction. Story-telling using visual and verbal means opened up stories and alternative perspectives for participants. Recovery-principles including hope and aspiration were supported, identified through goals and recognition of achievement. Sharing experiences with others with similar experiences was viewed as impacting positively on mental-health. The intervention represented effective partnership working between NHS services and a gallery in overcoming barriers to accessing the arts, for people with psychosis. Achievements in art-making and narrating experience using visual and verbal means offered alternatives to personally limiting and illness-dominated narratives.

Disasters are stressors and Post-disaster psychological interventions (PDIs) are designed to promote resiliency in affected populations; there is no supportive evidence that such interventions are effective in reducing or preventing clinical symptoms of PSTD. The purpose of this study was to explore how vicariously exposed Japanese citizens living in the UK responded to Japan's 2011 disaster, and how their responses may support the aims of PDIs and resiliency. A qualitative design using a snowball sampling method and semi-structured interview was conducted and analysed using grounded theory. Participants (n=18; m = 3, f = 15), who had lived in the UK for an average of 13.3 years, attended face to face interviews. They reflected on their thoughts, feelings, and behaviours from first hearing of the disaster. A preliminary grounded theory revealed the psychological process of appraisal and identification as drivers of establishing safety, helping responses and the development of a disaster narrative. The resultant theory supported the aims of PDIs, but highlighted the potential of disaster ‘victims’ utilising existing skills in the disaster to create a personal narrative of self-efficacy (resilience) in overcome feeling of helplessness in the disaster context. William James noted this phenomena during his experience of the San Francisco earthquake of 1906.

A grounded theory exploration of cultural and spiritual influences on adjustment in adolescents with liver disease. The evidence-base for adjustment in adolescents with liver disease is minimal, but treatment non-adherence in adolescent liver transplant recipients is known to range between 17-53%, increasing medical complication risks. Evidence has also shown that spirituality impacts on illness perceptions and behaviours of adolescents with other diseases. In this study, ten semi-structured interviews were conducted with 16-24 years olds, recruited from a regional liver clinic in the UK. Half were liver transplant recipients. The study found that navigating cultural expectations was challenging, particularly around education, employment and socialising (e.g. participation with peers and avoiding alcohol). Several participants reported an illness-related spiritual or socio-cultural crisis, sometimes resulting in non-adherence. This seemed to be followed by a turning point, eventually leading to a state of acceptance, personal development and possibly, spiritual growth. Trusted individuals were often instrumental in helping participants to overcome difficulties. However, for some, adjustment was transitory. As such, this appeared to be a cyclical process, entangled with universal adolescent developmental tasks. The study concluded that more exploration is required on treatment adherence and overall functioning in adolescents with liver disease, taking into account socio-cultural and spiritual influences.

This study investigated the relationship between unsupportive stressor-specific reactions to the disclosure of HIV and posttraumatic growth (PTG). Thirty-eight participants were recruited online and via non-statutory organisations. The sample was predominantly young, white, male, gay and HIV was well controlled with medication. Results showed that unsupportive reactions were not correlated with PTG. However, there was a significant indirect effect through total cognitive processing. This was broken down into a two-mediator model which was also significant. It showed that unsupportive reactions trigger intrusive rumination which, in turn, prompts deliberate rumination eventually leading to PTG. Further analysis showed that models using individual subscales of the unsupportive social interactions inventory (distancing, and bumbling subscales) also produced a significant indirect effect in, both one and two, mediator models. When the indirect effects of cognitive processing were accounted for, the negative direct effect of unsupportive interactions on PTG became significant. The findings suggest that unsupportive reactions to the disclosure of HIV may act as another ‘traumatic event’ and shows similar cognitive consequences. They also suggest that there is an alternative path to PTG, other than cognitive processing, which has not yet been identified in the literature and requires further investigation.

Section A reviews and synthesizes the extant literature on adherence to clinical guidelines, with specific reference to the use of CBT self-help interventions as a mainstay within the IAPT programme. The review also evaluates the utility of one psychological framework, namely the theory of planned behaviour (TPB), in assessing the cognitive factors that may be most associated with compliance in this context. The review ends by suggesting an avenue for future research. Section B In spite of evidence for their efficacy and effectiveness as well as the recommendations of NICE, CBT self-help materials are not used routinely or used as an intervention in their own right in mental health services. Aims: This cross-sectional study set out to assess whether the main constructs of the TPB, namely, attitudes, subjective norms (SN) and perceived behavioural control (PBC), as well as past use, self-help training and demographic characteristics, could predict IAPT psychological well-being practitioners’ (PWPs) intention to use CBT self-help materials in their clinical practice. Method: A convenience sample of PWPs (n=94) completed a web-based, mixed closed and open-response questionnaire, which was developed from an earlier elicitation study with a sub-sample of their colleagues. The data generated were analyzed by linear, multiple regression, mediation, and qualitative analyses. Results: The TPB’s main constructs predicted PWPs’ intention to use self-help materials in their clinical work, with attitude being most significant. Past use of self-help materials emerged as both a direct predictor of intention, as well as indirectly related to intention, independent of the mediating effects of the main constructs. The overall extended TPB model explained a respectable 70% of the variance in intention. However, neither self-help training nor demographic factors were associated with PWPs’ intention. Conclusion: It is recommended that future research could extend the methodology to prospective, longitudinal investigations of PWPs’ actual use of self-help materials. It is hoped that this would further elucidate the cognitive factors that are involved in PWPs’ decision-making when they are actually using the materials. Section C sets out and answers four specific questions that guide a reflective critical appraisal of the processes involved in the execution of this research project.

Section A consists of a critical review examining the research evidence relating to the effectiveness of reflective practice groups for staff in psychiatric inpatient settings, and the role of psychologically trained practitioners in providing facilitation using psychological formulations. Section B. The role of applied psychologists working in inpatient services is developing with a greater emphasis on providing support and consultation to staff teams. The research suggests that psychologically trained practitioners who facilitate reflective practice groups using psychological formulations can assist staff in developing a deeper understanding of patients’ difficulties, with the potential for improved treatment outcomes. This study aimed to address some of the gaps in the research by exploring the experiences of acute psychiatric inpatient ward staff attending reflective practice groups facilitated by psychologically trained practitioners. Using semi-structured interviews, nine multidisciplinary staff from four acute wards participated in the study. Grounded theory methodology was applied to investigate how staff experienced, processed, and operationalised psychological knowledge in their clinical practice. The results suggested staff increased their psychological understanding through a process of guided reflection, development of theory-practice links, and validation. This enhanced a capacity for mentalization, which generated a more compassionate and empathic stance. The clinical, theoretical and research implications are presented. Section C presents a critical appraisal of the research process.

An up to date, psychometrically robust measure of the level of community participation of adults with intellectual disabilities was not in existence, despite research identifying community participation as an important aspect of quality of life. The current research aimed to bring up to date, revise and revalidate the Guernsey Community Participation and Leisure Assessment (GCPLA; Baker, 2000). Adults with intellectual disabilities, carers and relevant experts were consulted in creating a 46-item GCPLA-R. The measure was then tested and the data from 153 adults with intellectual disabilities were analysed for their factor structure and psychometric properties. A stable set of factors emerged from factor analysis describing three different clusters of community participation activities. A full and a brief version of the scale were produced, each containing the three sub-scales. Both the 22-item and 46-item GCPLA-R were found to have satisfactory reliability. Scores on the GCPLA-R were related to challenging behaviour and adaptive behaviour in theoretically consistent ways, and were correlated with scores on comparable measures. The 46-item GCPLA-R was selected for publication due to its stronger face and content validity. The outcome of the analyses is discussed, along with limitations and implications for future research and clinical practice.

Coping with dementia has generally been conceptualised at an individual rather than relational level. In couples coping with chronic illness, dyadic coping models involving shared appraisals of stress and coping have been explored. This study aimed to explore dyadic coping in couples living with dementia. Qualitative framework analysis methodology was used to analyse data from nine joint interviews with spouse dyads living with dementia. Six main themes were identified: ‘Dementia awareness and ownership’, ‘Emotional closeness’, ‘Responsibility’, ‘Individual needs and difficulties’, ‘Individual coping by people with dementia’, and ‘Wider social context’. Findings suggested couples coping with dementia may utilise dyadic coping strategies, with couples maintaining closeness associated with sustaining joint coping. However, the impact of dementia upon a lack of shared dementia awareness and ownership, and loss of shared responsibility for coping, was associated with a lack of shared appraisals of stress and dyadic coping.

The study aimed to develop a theory of the possible links between voice-hearing and self-harm. Twelve semi-structured interviews were conducted with participants living in the community and in a secure forensic setting. All participants had experience of both voice-hearing and self-harm. A grounded theory of possible links was developed from participants’ accounts of their experiences. All participants described self-harm as way of coping with negative voices and of regulating painful emotions. Some described it as a response to a fear of judgement from others, as a form of control or as a means of seeking help. The results suggest that there are numerous links between voice-hearing and self-harm. Predominantly, self-harm seems to function as a way to cope with individual voice-hearing experience. Help should focus on triggers to distress and ways to cope. Training for healthcare staff could usefully be provided by service users, focusing on the importance of being non-judgemental. Future research could examine tactile and visual experiences in relation to self-harm too, clinician perspectives on the links between voice-hearing and self-harm, and service user perspectives on the emotional availability of clinicians.