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Concussion is widely considered a challenging injury to diagnose, assess and manage. Concussion definitions lack practicality, pitch-side assessments remain inconsistent, and key stakeholder knowledge and attitudes are poorly understood. In turn, risk reduction education strategies have lacked evidence-based foundations. These challenges are magnified within community youth participation where research has been sparse. Unlike professional cohorts, the frequency of concussions within youth community rugby has yet to be fully established. Contact sports such as rugby must address these challenges to ensure participant safety and promote sporting participation. This thesis aims to address these challenges. Collectively, the findings could then shape concussion education risk reduction interventions by governing bodies. Study One first assessed the frequency of reported head injuries in youth community rugby union. It then established the King-Devick tests utility as a tool for community sport-based medical staff and parents to chart cognitive recovery following head injury. A prospective cohort study of 489 players (U9-U18) was conducted at a community level rugby union club over four seasons. The reported head injuries following match play (12.7/1000hrs) were higher than any previously reported. Results indicated that the K-D Test was a practical tool for baseline, post injury and parentally supervised repeated testing within youth community Rugby Union. Study Two implemented the socio-technical systems approach employed by Clacy et al.(1) to identify the demographic of EFA's within English community youth rugby union and examine their understanding and perceived role/responsibilities of concussion management. A short (3 to 4 minute) audio-recorded survey was conducted on 40 Emergency First Aider's (EFA's). Despite limitations in current concussion understanding, the findings suggested EFA's may be suitable actors within UK youth community Rugby Union to foster improvements in concussion management and return to play (RTP) governance. Study Three utilised the novel Rugby Union Concussion Knowledge and Attitude Survey (RUCKAS-YOUTH) to assess the concussion knowledge and attitude of 515 UK school-based rugby participants. Developed in conjunction with the Rugby Football Union it forms the largest investigation of its kind to date. It is the first study to include a large number of female participants, document perceived completion of the RFU DBaH concussion education programme, and assess differences in state and private school attending participants concussion knowledge and attitude. The study provides a baseline from which to both direct and then evaluate future concussion risk reduction interventions. No broad association was found between participant knowledge and attitudes towards concussion safety in rugby.

Background: As a universal experience for midlife women, menopause represents a marker of aging and fertility loss that the evidence suggests may have a profound biopsychosocial impact. However, menopause is not well explored in psychological research, particularly in terms of the existential and spiritual questions it may raise for women. Aim: To address the gap in research knowledge in terms of understanding how women of faith may utilise their beliefs to make sense of menopause, or conversely, how menopause may challenge women's experience of their faith at this stage of life. Method: A qualitative study investigated the lived experience of six Christian women who were perimenopausal or up to five years postmenopausal. Data was collected by semi-structured interviews and analysed by interpretative phenomenological analysis (IPA). Findings: Three superordinate themes and nine sub-themes emerged, reflecting a sequence where the impact of menopause on identity and sense of self led to efforts to adjust and respond, which for most involved finding perspective through their faith, but this was not without struggle for some. Overall though, participants identified that their faith brought perspective and resilience to the challenges of menopause and most expressed a sense of hope for the future. The implications of the study for clinical practice and further research are discussed.

Menopause has until recently been somewhat of a taboo subject, particularly in the workplace where it is typically represented as a problem to be dealt with by individual women. Over the four-year timespan of this research project (2017-21) there has been a steadily increasing amount of media interest in menopause, mainly written by menopausal women themselves, which indicates both the timeliness of my research and its immediate relevance to the emerging discourse around all aspects of Menopause, specifically for working women. This is a cross-disciplinary practice-based PhD inquiry in Drama and Healthcare (Scenography and Menopause) which used ethnography-based theatre-making methods (Ethnotheatre) as a line of enquiry into Menopause for working women in the UK, geographically focused in South London. My Drama research is Scenography, emerging from my previous Theatre Design practice. The four scenographic performances staged the research questions, contextualised by literature and other performance practices, and the subsequent reflective analysis further developed the questions, which, in turn, became the foundations for the next performance. The first performance Prólogos (June 2017) was a short site-specific performance at St Mary's University. The second performance employed both scenographic and ethnotheatre methods (verbatim use of interview material) to create Puzzled, shown at Croydon Council's Diversity Awareness Conference (April 2018). Women of Brockwell (missing statue), the third performance (June 2019) was a public installation in Brockwell Park, South London. The final performance (January 2020) synthesised both scenography and ethnotheatre outcomes into a theatre production CHANGING IN PUBLIC in St Mary's University Theatre. This investigation has used a 'bricolage' of research methods, employing ethnographic methods of interviewing (spoken, written and visual) as the tools from which to create scenographic ethnotheatre, using 'make-reflect-remake' iterative cycles to develop the practice, which has been further refined into 'make-reflect-re-contextualise-remake'. The questions for my research are concerned with public expressions of the menopause (both cultural and personal) and how a form of applied scenography can be extended to develop an ethnography-based performance within a post-dramatic theatre framework, allowing for a primary language of visuals and other sensory experiences to engage the spectator, rather than privileging the dramatic text. My research deals with real world cross-disciplinary problem-solving and the practice outcomes represent a new direction for Scenography and Ethnotheatre.

Background: Roughly 14 million people (1 in 5) are estimated to live in poverty in the UK (JRF, 2017). Those in poverty are more likely to experience mental health problems compared to their wealthier counterparts (Collins et al., 2011). Researchers found that when therapy is tailored to be sensitive to poverty, focuses on economic stressors or when therapists are considerate of economic difficulties, it is more helpful. Rationale: Research exploring the perspectives of individuals providing therapy for those in poverty is limited. However, previous work has shown that how UK Psychologists conceptualise the relationship between poverty and mental health impacts the therapeutic interventions used (Sams, 2008). The perspective of US psychologists revealed that significant therapeutic adaptions are often made (Borges, 2014). In comparison, data indicates that UK psychotherapists also make adaptations, yet these are less extreme than in the US (Ballo, 2020). With poverty in the UK set to increase (Belfield et al., 2017), there is a need to provide appropriate interventions, especially as Counselling Psychologists often work in organisations/sectors providing therapy to those in poverty (DCoP, 2018; Rethink Mental Illness, 2020). CoP's commitment to social justice and diversity leads to Counselling Psychologists being well positioned to devise effective interventions (Eleftheriadou, 2010, Cooper, 2009). However, the perspectives of UK Counselling Psychologists are almost completely absent. Therefore, this research aims to investigate how Counselling Psychologists tailor therapy to facilitate therapeutic work with those in poverty. Methodology and main findings: Interpretative phenomenological analysis (IPA) was used for the current research. Six semi-structured interviews were conducted with Counselling Psychologists working with those experiencing poverty. Three superordinate themes emerged from the analysis: Awareness of the relationship between poverty and mental health, Resources that are drawn upon, and Adapting practice in the light of economic differentials. Conclusions and implications: This study highlighted that traditional and/or manualised ways of delivering therapy to those experiencing poverty may not be helpful or appropriate for this population. The present findings highlight the importance of flexibility within therapeutic work. A significant finding to emerge was that the more extreme the experience of poverty was for the client, the more extreme the therapeutic boundary adaptation. The discussion describes these findings in relation to the wider literature and explores implications for Counselling Psychology Training, Practice and the Wider Community.

The research topic for this PhD thesis focuses on the topology prediction of beta-barrel transmembrane proteins. Transmembrane proteins adopt various conformations that are about the functions that they provide. The two most predominant classes are alpha-helix bundles and beta-barrel transmembrane proteins. Alpha-helix proteins are present in larger numbers than beta-barrel transmembrane proteins in structure databases. Therefore, there is a need to find computational tools that can predict and detect the structure of beta-barrel transmembrane proteins. Transmembrane proteins are used for active transport across the membrane or signal transduction. Knowing the importance of their roles, it becomes essential to understand the structures of the proteins. Transmembrane proteins are also a significant focus for new drug discovery. Transmembrane beta-barrel proteins play critical roles in the translocation machinery, pore formation, membrane anchoring, and ion exchange. In bioinformatics, many years of research have been spent on the topology prediction of transmembrane alpha-helices. The efforts to TMB (transmembrane beta-barrel) proteins topology prediction have been overshadowed, and the prediction accuracy could be improved with further research. Various methodologies have been developed in the past to predict TMB proteins topology. Methods developed in the literature that are available include turn identification, hydrophobicity profiles, rule-based prediction, HMM (Hidden Markov model), ANN (Artificial Neural Networks), radial basis function networks, or combinations of methods. The use of cascading classifier has never been fully explored. This research presents and evaluates approaches such as ANN (Artificial Neural Networks), KNN (K-Nearest Neighbors, SVM (Support Vector Machines), and a novel approach to TMB topology prediction with the use of a cascading classifier. Computer simulations have been implemented in MATLAB, and the results have been evaluated. Data were collected from various datasets and pre-processed for each machine learning technique. A deep neural network was built with an input layer, hidden layers, and an output. Optimisation of the cascading classifier was mainly obtained by optimising each machine learning algorithm used and by starting using the parameters that gave the best results for each machine learning algorithm. The cascading classifier results show that the proposed methodology predicts transmembrane beta-barrel proteins topologies with high accuracy for randomly selected proteins. Using the cascading classifier approach, the best overall accuracy is 76.3%, with a precision of 0.831 and recall or probability of detection of 0.799 for TMB topology prediction. The accuracy of 76.3% is achieved using a two-layers cascading classifier. By constructing and using various machine-learning frameworks, systems were developed to analyse the TMB topologies with significant robustness. We have presented several experimental findings that may be useful for future research. Using the cascading classifier, we used a novel approach for the topology prediction of TMB proteins.

Introduction: The UAE youths' frequency of being more obese is twice to be thrice greater than the published international standards. The United Arab Emirates schoolchildren/youth (ages 1018) are said to be 1.8 times more obese than those in the United States, according to statistics from the First United States National Health and Nutrition Examination Survey. According to World Health Organisation report, the UAE has been classified as the second highest for obesity rates in the world. As a result of these obesity statistics among the youths, there are associated diseases, which tend to plague the UAE adults later including cardiovascular diseases, diabetes, hypertension and others, Immanuel, and Cynthia (2017). There is a dearth of research on obesity in the Gulf Cooperation Council (GCC) countries and the UAE in particular. In addition, there is quasi absence of quality and frequency of health and obesity awareness campaigns about the risks engendered by obesity, as excess adiposity is a key independent risk factor for the future development of many diseases such as heart disease and diabetes. Population studies using representative samples need to accurately and effectively estimate the psychosocial, social, economic, and lifestyle factors that lead to obesity and their impact on public health, especially on adolescents. Specific aims: The study aims to investigate the association between socio-demographic characteristics, body image, and self- esteem, specifically: a. To explore determinants of Obesity/BMI among adolescents in the UAE/Abu Dhabi. b. To explore the relationship between socio-demographic factors and BMI among adolescents in Abu Dhabi, UAE. c. To explore the associations of body image and self-esteem with BMI among adolescents in Abu Dhabi, UAE. d. To examine the effect of various socio-demographic factors on body image and self esteem amongst adolescents in Abu Dhabi, UAE. e. To investigate whether body image and self-esteem mediates the relationship between socio-demographic factors and BMI. Methods: Using a cross sectional study design, a random representative sample of adolescents' (N=1,181; 48.8% males) aged 14-17 years was recruited from public and private schools in Abu Dhabi, during the academic year 2011-2012. Participants completed a questionnaire collecting socio-demographic, Health Behavior in School-aged Children (HBSC), Rosenberg Self-Esteem Scale (RSE), and Body Image Satisfaction Questionnaire (BSQ) data. Body mass index-derived estimates of obesity were calculated using international cut-off: the World Health Organization (WHO). Results: The overall prevalence of Overweight and Obesity (30.4%) was about three times higher than the prevalence of Underweight (9.4%). Multivariate regression confirmed that BS was positively associated with adolescents' overweight and obesity, also it was the most significant superior predictor in the BMI regression model. SE was negatively associated with adolescent overweight and obesity. Moreover, Dieting, Parent's obesity, Watch TV, and Often Fell Lonely were identified as positive correlates of adolescent obesity, where, Parent's Education, Excellent Health, Breakfast, Physically Activities, and Monthly Income were identified as negative associate of adolescent obesity. In addition, BS, and SE mediate the association between most of socio-demographic factors and BMI. Conclusions: This study confirms a high prevalence of overweight and obesity among adolescents aged 14-17 years in Abu Dhabi. Our findings revealed adolescents with high BMI were those who were dissatisfied with their body shape, and had low self esteem. It is necessary to plan actions aimed as reinforcing and increasing self-esteem, focusing on the adolescents' with overweight and obesity problems. This is the first study in Abu Dhabi that estimates the relationship between BMI and socio demographic factors through the mediations of BS and SE, as it has contributed to the body of existing knowledge and a better understanding of mediating affect from UAE culture. One of the most important and strongest findings of this research is the establishment of the first model in Abu Dhabi that contains most types of independent variables, including social, Eating-Dieting, psychological, physical, and economic, that can predict in highly accurate the BMI value of adolescents according to various criteria. However, there is still a huge lack of research on overweight and obesity in the United Arab Emirates, as this study only focus on adolescents aged 14-17 in Abu Dhabi, and before generalizing the results to the entire population, I recommend that other future studies will include all of these categories UAE population. Not just residents of Abu Dhabi. In addition, more mediation research in this area should be conducted to educate the people of the UAE on the importance of these studies.

Background and aim: The aim of the current research was to explore the experience of Second Generation West African Men (SGWAM) seeking therapy for the first time for psychological distress in the UK. This was as a response to the lack of data on how this rapidly growing population in the UK (Stahl et al, 2017), whose wellbeing have not been paid attention to (Abouguendia & Noels, 2001) seek professional help for psychological distress. The current study attempted to address the gap in research by looking at the experience of seeking professional help for the first time amongst SGWAM. Methodology: Semi-structured interviews were carried out with six SGWAM aged 27 to 31 who had sought psychological therapies for emotional distress as adults. The interviews were analysed using Interpretative Phenomenological Analysis (IPA). Findings: From the analysis, three superordinate themes emerged. These were "Predisposing factors to not seeking help or expressing distress" (which looks at the participants' upbringing and culture in relations to expressing emotional distress and seeking help), "Manifestation of predisposing factors within the self" (discusses how the predisposing factors may have played a role in delaying seeking help) and "Journey to engaging with professional help" (refers to factors that were considered by the participants before they engaged with a practitioner). Conclusions: The findings suggest that the SGWAM's upbringing within West African households and their identity as men has the potential to make the expression of emotions and asking for help challenging. The importance of seeing a practitioner who is an African descended male that they can relate to is also stressed. Suggestions are made in regards to how practitioners and services can address other factors which makes seeking help early a challenge. The final section includes suggestions for future research as well as limitations of the current study.

Literature review: The therapeutic relationship is considered a pivotal underpinning of counselling psychology and is a key determinant of positive therapeutic outcomes in various forms of therapy. Health care professionals (HCPs) utilise the therapeutic relationship within acute mental health settings (AMHS); however, little is known about how this is achieved, particularly with people experiencing symptoms of psychosis who have often experienced interpersonal trauma in their history. Rationale: There are various discourse resources relating to the therapeutic relationship, AMHS, and psychosis that HCPs draw on to construct their sense-making of; the patient, their professional role, the institution of AMHS and the diagnosis of psychosis. However, there has been no research to date that has explored how HCPs use discursive processes to make sense of the therapeutic relationships they form within this setting and with people experiencing psychosis. Method: Six semi-structured interviews were conducted with nurses and counselling psychologists, who had experiences of working in AMHS and with people experiencing psychosis. These were transcribed and analysed using Critical Discursive Psychology (CDP; Potter and Wetherell, 1986). Findings: Four interpretive repertoires were identified within the data: the therapeutic relationship bridges the mental health system and the person experiencing psychosis; the therapeutic relationship as a means to manage psychotic experiences with a boundaried, yet flexible approach; meeting the person experiencing psychosis through the therapeutic relationship; and the therapeutic relationship is more than just a dyad - the MDT. Limitations of this research were addressed, implications for future research and clinical practice were highlighted, and reflexivity was employed and conveyed throughout this work.

Background/Aims: When considering culture, existing literature has identified that there is a key decline in help-seeking behaviour particularly within the South Asian community. However, there is a gap within the literature regarding Sikh men's perspectives of the concepts of therapy. The research explores help-seeking behaviour of Sikh men from the Sikh community. Through this, the aim has been to explore what factors contribute to deciding whether one should seek therapy, which can help understand what impedes or encourages that process. Design/Method: Verbatim accounts of semi-structured interviews were analysed using a constructivist grounded theory approach. The participants were eight Sikh men aged between 18 to 33 years. Four out of the eight participants had experienced some form of psychological therapy, whilst the other four had considered approaching psychological services but never received any therapy. Findings: The findings demonstrated high-level components in describing the highly complex processes a Sikh man identifies with when deciding whether to seek therapeutic help. During the process of analysis three core constructs: 'Barriers from within', 'External barriers' and 'Opening up the barriers' emerged. Conclusions: The model captures how much a Sikh man must consider prior to making a decision about their own mental health. The theory that emerged from this research provides insight into the help-seeking style of the Sikh culture, to help Counselling Psychologists and other health professionals working with this client group to develop culture-specific interventions.

Background/Aims: The aim of the proposed research is to explore the experiences of second-generation Pakistani Muslim (SGPM hereafter) therapists practicing Cognitive Behavioural Therapy (CBT) with ethnically similar clients, that is, Pakistani Muslim (PM) clients. This exploration will be made against the backdrop of relevant literature and current arguments. Studies have highlighted the significance of religion and culture for SGPMs and the need to produce culturally sensitive interventions for this group. The key findings from the quantitative and qualitative studies have highlighted a gap in knowledge between Islam and culture and the delivery of CBT in relation to the professional and/or cultural identity of the therapist. Design/Method: Verbatim accounts of six semi-structured interviews were analysed using Interpretive Phenomenological Analysis (IPA). Participants were SGPM therapists aged between 28 and 46 who had worked with ethnically similar clients in the UK. Findings: Three superordinate themes were generated: 'Intra-cultural influences', which refers to factors such as relatability and trust, language, gender and communal anxieties - all of which reflect the salience of collectivism in Pakistani culture; 'Professional Compass', which refers to impartiality in sessions and a consideration of religious factors; and finally, 'Negotiating CBT Boundaries', which refers to therapist and client frustrations and limitations and a need for integration. Conclusions: Participants' accounts highlighted that they seemed able to work with their PM clients allowing for an open and honest space in which to traverse cultural and religious terrain. Given the saturation of PM society by both religion and culture, participants - using their personal understanding - sensitively created an effective therapeutic dialogue. This was generated by weaving together CBT parameters and cultural/religious influences. This involved working towards congruency by achieving both an integrative approach and developing a comprehensive outlook, accepting the therapist- and the client-melded worldview. This study implies further questions; in whether there are gendered elements and whether matching the culture of therapists and clients should be extended to other minority groups in order to enhance both therapeutic dialogue and outcomes.

Social camouflaging has recently attracted much attention as a coping strategy in autistic individuals and has been associated with mental health difficulties. In an attempt to appear socially competent and to prevent others from noticing their social challenges, autistic individuals may hide their ASD traits (Hull et al., 2017). Traditionally, camouflaging has been found to occur more frequently in females and it has been researched more widely in adults, younger children and in the female presentation (Hull et al., 2017; Lai et al., 2011; Lai et al., 2016; Dean et al., 2017; Tierney et al., 2016; Bargiela et al., 2016) despite emerging research evidence suggesting that autistic young males also do camouflage their ASD traits during social interactions (Carrington & Graham, 2001; Carrington et al., 2003; Humphrey & Lewis 2008; Huws & Jones, 2015). As there is limited research on males and specifically adolescents, this study focuses on the autistic young male presentation. Eight autistic male adolescents have been interviewed via semi-structured interviews and the results were analysed using Interpretative Phenomenological Analysis (IPA). All participants were recruited from a Children and Adolescents Mental Health Neurodevelopmental Service (CAMHS NDS). The themes emerged included experiences of friendships and socialisation, common interests, strategies when making friends and socialising, ASD diagnosis and experiences of socialisation and experiences of camouflaging. This study adds to existing knowledge by offering novel descriptions of autistic young males employing camouflaging strategies during peers' interactions, alongside their motivations, functions, and the impact on their self-identity. Overall, most of the boys camouflaged their ASD associated traits in order to fit in, pass as normal and blend in with peers; however, they were aware of the toll this might take on their self-identity. This study proposes important clinical implications. Further investigation of this phenomenon across the spectrum and all genders is necessary to inform clinical and educational practices for the younger autistic population.

After the recent change in the diagnostic criteria of autism, sensory issues have been acknowledged as more than just an associated symptom of the condition. Current literature explored the social, emotional, and physical consequences of unusual sensory experiences on the lives of autistic individuals and gave an insight into the needs of this population. Literature also suggested a possible effect of emotional states on the sensory experiences of autistic individuals. In order to explore autistic individuals' experience of emotions on their sensory world, three autistic individuals were recruited and interviewed through semi-structured interviews, in person and via Skype. Interpretative Phenomenological Analysis was used to analyse the data and four main themes emerged: (1) experiencing sensations and emotions, (2) coping with consequences, (3) making sense: "the base part of what I have to do in my everyday life", and (4) the process of describing. The findings were discussed in the context of existing literature and theories. The key finding was that negative and extreme positive emotions increase sensory sensitivity in autistic individuals, whereas mild positive emotions decrease sensory sensitivity. The intensity and unpredictability of situations and stimuli also increase sensory sensitivity. The effect reported by participants was consistent with previous studies, but also provided new insight regarding the impact of positive emotional states on sensory experience in autism. Any implications for practice and an evaluation of the study were discussed and recommendations for future research were made.

Background: Mental health policy promoting the notion of self-management and the patient as the expert welcomed the advent of peer support (Watson, 2017; Gillard, 2019), which is now regarded as the fastest growing profession within mental health services (Rebeiro Gruhl et al., 2016). Research has noted the benefits of using peer support workers (PSWs) to encourage service user (SU) involvement by using their shared identity to improve mental health, well-being and confidence (Gillard et al., 2013; Simpson et al., 2018; Davidson et al., 2012). Rationale: With increased numbers of PSWs employed within the NHS, it is essential to understand how PSWs develop/construct their occupational identity (OI). Employment has been shown to positively affect individuals well-being by affording them a sense of identity and purpose. How OI is experienced during development and then maintained will be the focus of this research. Methodology and main findings: An Interpretative Phenomenological Analysis (IPA) was adopted for this research. Three superordinate themes were generated from the semi-structured interviews and analysis: 1) Symbiotic Green Shoots of Identity; 2) The Occupied Self; 3) A Limited and Limiting Role. The findings provide a timeline of how participants developed their OI, highlighting the life-changing events that led to a greater sense of self and a more meaningful life. By feeling accomplished at work, being future-orientated and having a solid OI provided participants with the motivation to spread their metaphorical wings and explore the transferability of their skills. However, despite participants significant experience of performing the role, they were met with a series of organisational hurdles that appeared to invalidate their OI outside of the originating organisation.

Relational issues are common reasons people seek psychological help, hereunder issues regarding romance, where many people struggle with dating and relationship formation. This is often due to a fear of emotional intimacy expressed as avoidance of emotional and physical closeness, explained in part by attachment theory. The present study is a qualitative investigation into what therapeutic interventions psychological practitioners employ when they encounter clients who experience avoidance attachment patterns in dating and relationship formation. Taking a point of departure in attachment theory the paper considers how secondary attachment avoidance patterns, or emotional deactivation strategies, contribute to these difficulties and argues a need to clarify what therapeutic interventions clinicians' practice to remedy the adverse effects of avoidance patterns in intimacy. While some therapies incorporate attachment theory in their approach to alleviating attachmentrelated issues, it is less clear what practitioners can do to service people specifically displaying intimacy avoidance in romance. Adopting a critical realist perspective, this paper aims to disseminate a complementary lens to the psychological profession in approaching psychological therapy for this specific demographic. A thematic analysis carried out on ten semi-structured interviews with highly experienced practitioners revealed four themes relating to interventions employed in therapy; 'Create awareness of avoidance and build psychological capacity to tolerate difficult emotions through process and techniques', 'Use self and the therapeutic relationship as a conduit to change avoidance patterns', 'Apply measured humanity to heal and restore trust in intimacy' and 'Contextual and conceptual positioning in therapy'. Sub-themes to each intervention are considered and their implications discussed.

Parkour is an exciting, complex and at times risky art form in the sporting world. Officially incorporated as a sport in the UK in 2017 (Parkour UK, 2019) but born in France almost 30 years ago (Belle, 2009). Parkour consists of practitioners finding a route through predominantly urban terrain, mastering various physical and psychological skills to overcome obstacles in the most efficient, effective way possible (Belle, 2009). Although initially proposed as a noncompetitive discipline, it is now headed for the Olympics in 2022 (Gillen, 2020). Possibly due to the relative novelty of parkour and the buzz surrounding it, little to no research to date has reviewed the deterrents, hurdles and various physical, mental, emotional and social stressors that practitioners may experience during parkour training, that is in direct relationship with the discipline's practice and delivery hurdles. The main aim of this study was to explore accounts of parkour practitioners who no longer engage in the sport, to gain deeper insight into their experience of parkour training and the processes leading up to their stopping. The subsequent aim was to co-construct an explanatory grounded theory (GT) of the process. The study adopted a social constructivist GT methodology (Charmaz, 2010), initially using purposeful sampling, and recruiting four parkour practitioners. Refining the developing theory further, theoretical sampling was adopted, recruiting four further parkour practitioners and one gymnast for theoretical sampling. Overall, nine participants informed the co-constructed final GT model. The psychosocioemotional process co-constructed from the data indicated that participants experienced several forms of losses that were paradoxical. The losses could be attributed to an experience opposite to that anticipated, which in turn, over time, cost them a lack of progression (LoP) as opposed to meeting their needs. This led to such a significant struggle, it forced them to cope in various ways, eventually resulting in a behavioural outcome of stopping training or contemplative re-entry. Participants, therefore, appeared to suffer a complex process of 'paradoxically losing while journeying through parkour', influenced by the factors that had initially influenced them to enter parkour. The intrapsychic conflict of 'anticipated gaining' through parkour practice versus 'risk of losing' appeared to lead to a rupture in their sense of self. The findings from this study provide very important insights into parkour practitioners experiences of LoP, the re-traumatisation that seems to occur, the rupture participants often experienced in their sense of self, and the important recommendations that participants and researcher believed could help reduce such outcomes in the future. A longitudinal, traumabased, person-centred model of LoP such as the one proposed in this thesis could help inform practitioners, coaches and counselling or other psychological professionals who are involved primarily in parkour, and beyond. This study's conceptualisation of a parkour specific model, informed by pluralistic counselling psychology is particularly important as the sport moves towards elite competition. Additionally, it adds to existing sports stress and burnout management literature. The translational implication of this LoP model could lead to more systemic changes in sports culture as well as increased congruence within parkour multidisciplinary team structures. The LoP model potentially enhances intervention delivery within and outside of competition resulting in more holistic coaching practices, increasing practitioner training satisfaction and overall partitioner well-being. Full implications for practice, training and the counselling/psychological profession will be discussed further, in addition to the study's limitations and recommendations for further research.

Background: People who are attracted to more than one gender are often grouped together in research under the bisexual umbrella (Flanders, 2017). This has been valuable when investigating issues potentially faced by these groups, such as erasure and poor health outcomes, as well as in the context of bisexual activism. However, grouping people under the bisexual umbrella may carry the risk of overlooking individual differences and findings suggest differences between bisexual and pansexual participants, suggesting a need for further knowledge about pansexuality. Aims: This study aimed to gain a rich understanding of the ways in which pansexual people experience pansexuality. It also sought to contribute to the health professions by offering some insights into what may possibly be experienced by pansexual people. Methodology: Semi structured interviews were completed with six pansexual people. The data was analysed using Interpretative Phenomenological Analysis (IPA). Findings: Three superordinate themes (The pansexual label as an anchor; feeling 'boxed in'; and a label that defies labels) and ten subthemes emerged. Conclusion: The findings indicated the concept of feeling 'boxed in' as central to all of the superordinate themes in the study. A societal lack of awareness of both pansexual as an emerging, less 'mainstream' sexuality, and of gender identity outside the binary led to the strategic use of the bisexual label in order to manage stigma and invalidation. However, participants felt that the bisexual label was incongruent with their felt sense of identity because they favoured a label that explicitly acknowledged gender diversity. This led to a feeling of being erased. The current study provides a foundational knowledge of the under researched area of pansexuality. Future research could aim to further explore the impact of intersectionality, and experiences of healthcare settings for pansexual people.

Malaria is a potentially fatal parasitic disease that is endemic in 109 countries and threatens over 2.4 billion people, representing 40% of the global population. While there has been a gradual decrease in the number of fatalities resulting from the disease in recent decades, this progress is now under serious risk of being reversed as a result of the parasite developing resistance to the currently available chemotherapies. This has led to a new impetus to look for new antimalarial drugs that have different modes of action to the ones that are currently available. This thesis contains the following areas of research: 1) The design and synthesis of various compounds of the classes substituted benzyl-αhydroxy phosphonates, substituted benzyl-α-methylene phosphonates, substituted benzyl-α-hydroxy phosphonic acids and substituted benzyl-α-amino phosphonic acids. These compounds are intended to target one of the recently hypothesised antimalarial drug development targets, Pf-glutamate dehydrogenase (PfGDH). 2) The synthesised compounds were then tested for their antimalarial activity against the P. falciparum strains 3D7 and Dd2. Furthermore, the synthesised compounds were tested against other parasitic organisms, Trypanosoma brucei, Trypanosoma cruzi and Leishmania major.

Firefighters are at elevated risk of cardiovascular disease and myocardial infarction. Overweight and obesity prevalence in this occupational group may be greater than in the general population. This is the first nutrition-based study for UK firefighters, involving 28 fire stations and 575 firefighters based in London. This study was designed to develop population specific tools: body composition reference charts, a validated food frequency questionnaire (FFQ) and a cookery book for use in a multicomponent worksite intervention. The validity of BMI for classification of firefighter adiposity status was investigated. Combined prevalence of male firefighter (n=497) overweight and obesity by BMI was 80%, which contrasted widely with the adiposity indices: percentage body fat (BF%) (63%), waist circumference (WC) (43%) and waist-to-height-ratio (WHtR) (59%). Female firefighters (n=78) exhibited lower combined prevalence of overweight and obesity compared to the male firefighters: BMI (43%), BF% (18%), WC (36%) and WHtR (27%). However, misclassification caused by BMI was widespread for both sexes, showing BMI's specificity to be particularly poor, leading to high rates of false positives. This represents the first study to assess the adiposity of UK female firefighters and the first to comprehensively identify BMI to generate widespread misclassification of UK firefighters. Following this, a novel body composition reference system for UK firefighters was developed. This took the form of centile reference curves illustrating age-related changes in fat mass and skeletal muscle mass of firefighters, offering an improvement upon the limitations of BMI and BF%. Overweight and obesity cut-offs were defined at the 85th and 95th centiles which were chosen due to relative suitability and good agreement (97%; Kappa 0.86, p< 0.001) between the BF% reference curves and the fat-mass index reference curves at these centiles. A novel FFQ was developed via population specific modification of the EPIC-Norfolk FFQ and validated against three 24hr recalls. Correlations between the methods were significant (p< 0.01) for energy (r=0.42), carbohydrate (r=0.42), protein (r=0.42), fat (r=0.35), fibre (r=0.34), saturated fatty acids (r=0.36), monounsaturated fatty acids (r=0.32), polyunsaturated fatty acids (r=0.24, p=0.05), vitamin C (r=0.26), calcium (r=0.45), iron (r=0.38) and sodium (r=0.32). Bland-Altman (BA) analyses indicated good agreement between methods for energy and each nutrient, with an average of 96% of cases falling between the limits of agreement. Cross-quartile analysis identified a low mean rate of misclassification (4.2%). In terms of reproducibility, the mean correlation between repeat administrations was 0.7 (p< 0.01), with >95% of cases falling between the BA limits of agreement. This constitutes the first FFQ validated for UK firefighters. A worksite cookery workshop intervention and accompanying cookery book were developed and tested, demonstrating practical methods of healthy meal preparation along with environmental modification suggestions designed to ameliorate the established obesogenic food environment. This resulted in several key significant (p< 0.01) improvements to the mess, including 8 firefighting watches reinstating smaller plates, 10 watches leaving leftovers in the kitchen, 11 watches incorporating wholegrain products and 8 watches switching to making sauces/soups from scratch. Finally, the efficacy of a fire station-based nutrition intervention was tested in a cluster-controlled trial. This encompassed group education on non-communicable disease risk factors and the health benefits of adopting a Mediterranean diet. Dietary assessment was undertaken utilising the newly developed FFQ, which informed personalised nutrition consultation for each participant. Mixed design ANOVAS demonstrated significant improvements at 4-months post-intervention (p< 0.01) in daily mean intakes of energy (-244 kcal), total fat (-12 g), saturated fatty acids (-5g), sodium (-311 mg), sugars, preserves and snacks (-19 g). This contributed to concomitant mean body composition improvements in fat mass (-2 kg), BF% (-1.7%), WC (-1.7 cm), weight (-1.7 kg), BMI (-0.5 kg/m2), mood (+0.9) and energy level (+1.2) compared with the control group increasing in WC (+1.9 cm). In conclusion, the population specific tools can be utilised in a worksite intervention which led to improvements in nutrient intake and body composition. The external validity of the tools, along with the intervention's high level of feasibility further renders it suitable for rollout on a national level.

This qualitative research study seeks to explore how experienced therapists - the majority of whom are Cognitive Behavioural Therapists - understand humour; and how they use it in the treatment of Obsessive-Compulsive Disorder (OCD). Between two and three per cent of the population have OCD and the World Health Organization ranks it in the top ten most disabling illnesses. However, forty per cent of obsessive-compulsive clients who engage in Cognitive Behavioural Therapy (CBT) for OCD either refuse, do not finish or fail to benefit from treatment. At the same time, research indicates that the therapeutic alliance is the primary driver for client change in therapy; and that humorous interventions help to strengthen this alliance. Data from semi-structured interviews with eight participants were analysed using Willig's abbreviated grounded theory method (2013) and a tentative model was constructed. Humour is presented as an expression of paradox in OCD (it being at once illogical, distressing and dangerous; as well as creative, informative and absurd). Participants continuously assess the type and function of humour used in session. 'Light' and soothing humour promotes constructive outcomes (distancing while closely bonded, playfulness, normalising, reframing); while 'dark' and provocative humour risks negative results (defending, offending, rupturing). When making decisions about humour use, participants have regard to both in-the-moment, and longer term, feedback on the strength of the therapeutic relationship; as well as certain individual differences (religion, class, gender, age, etc. of the client) and intrapsychic variables (the participant's own experience, training and professional reputation). The implications for theory and practice are discussed, with an emphasis on enhancing knowledge in the field of counselling psychology. Recommendations for future research are also made.

Background: It is well recognised that eating a poor quality diet can lead to a number of long term health conditions and premature mortality. In response, a variety of materials, offering healthy eating advice from both state and commercial sources, have been produced in the UK to help and encourage people to eat well and avoid diet related health issues. However, a large proportion of the population still suffer from long term conditions which could have been avoided through an improved diet. The aim of this research was to consider how healthy eating advice is relayed to the public and how people relate to it by exploring how healthy eating is socially constructed in the 21st century in the East of England. The research aimed to uncover the discourses used in healthy eating texts in the UK, how people positioned themselves in relation to these discourses and the power relations between institutions and the UK public. Method: A Foucauldian Discourse Analysis was applied to a range of healthy eating texts from both state and commercial sources. In addition, five focus groups were carried out to determine how the participants positioned themselves within the text's discourses and their sense of trust in the materials. Findings: The analysis of the texts uncovered a combination of discourses including scientific, thermodynamic, natural, childcare, medical and moral discourses which offered up subject positions to their readers in relation to moral citizenship and personal responsibility. Through the use of bio-power, foods within the texts appeared to be categorised as 'good' or 'bad' foods in which bad foods were considered to be risky to health due to their nutritional composition. Most of the texts assumed people have the agency to follow the text's advice and failed to consider the readers' personal context. Focus group findings revealed that many participants felt that healthy eating should be based on common sense and ideally it is better to listen to your body to understand what it needs and there is no one size fits all approach such as that presented in the texts.

Research indicates the trans population experiences significantly higher levels of mental health difficulties and suicidal ideation compared with the rest of the population. Existing literature relating specifically to psychological therapists is explored and four main gaps identified. These gaps surround lack of support for the trans community, long waiting times, the urgency of need often leading to self-prescription of hormones, and the compromising gate-keeping roles of professionals working with this population. Seven participants, who had all made the decision to take hormones, were interviewed. Semi-structured interviews addressed their help seeking behaviour and decision making process to take hormones, as well as their experiences of the system and the professionals in it. Fewer participants than desired were recruited, and the abbreviated version of grounded theory was therefore implemented. The decision-making behind that and its potential consequences are discussed. Using grounded theory, a stage model of the decision-making process to take hormones was drawn, and four categories and 14 subcategories identified. The categories were "identity frustration", "meeting the gatekept world", "survival mechanisms", and "escalating identity crisis". In discussing these results, the main problems indicated by the results of these findings regarded the mismatch between the urgent need for treatment trans people have, systemic issues of long waiting times, and a general sense of a gap between trans people and the professionals working with them, enforcing gatekeeper roles and feelings of being misunderstood and unsupported. Implications for counselling psychology practice and suggestions for further research are discussed.

Rationale: There is a strong amount of evidence that suggests that the therapeutic relationship is an important aspect of psychological therapy and important in terms of positive outcomes and a significant contributor towards change and valued above any one technique. However, there is limited amount of qualitative research that has focused on how individuals with a diagnosis of Schizophrenia experience the therapeutic relationship. African/Caribbean's are more likely than white and other ethnic groups to be diagnosed with Schizophrenia and tend to have poorer therapeutic outcomes. Yet very few studies that have examined the experiences of this group, in psychological therapy. Aim: This thesis aimed to address this gap by exploring how African - Caribbean individuals with a diagnosis of Schizophrenia, experience the therapeutic relationship in psychological therapy. Method: Semi-structured interviews were conducted with five participants. Transcripts were analysed using Interpretative Phenomenological Analysis. Findings: Three superordinate themes emerged; Never Condemned (Love without Judgement); A chance to be heard (Fear vs Freedom); Separation from the therapeutic relationship. A description of these superordinate themes and the nine related subordinate themes are discussed. The finding indicate that the therapeutic environment enabled the establishment of a strong therapeutic relationship. Implications for clinical practice are discussed.

Background: Current Anorexia Nervosa (AN) research concurs early clinical descriptions of an eating disorder depicted for some individuals as an 'internal voice' (Tierney & Fox, 2010). The internal voice referenced in AN literature has more recently been referred to as the anorexic voice (AV). For the most part, the AV is recognised as internally generated, importantly, it is often reported as an experience altogether alien to one`s sense of self, distinct from one`s inner thoughts and dialogue hence why it is called a 'voice'. Often depicted as hostile and intense, the AV is considered omnipotent, powerful and negative in relation to AN pathology (Noordenbos & Van Geest, 2017; Pugh & Waller, 2016; Pugh, 2020). These depictions of the AV have been largely valuable when investigating symptom severity as well as in the context of AV contributions to AN relapse. Much is still unknown about this phenomenon as awareness of its influential role in AN has emerged primarily in the past decade. Largely absent from AN literature are the intricacies of individual experience of the AV over the course of the entire AN illness trajectory (from onset, through maintenance, relapse and recovery) as recounted in first person narrative accounts. This suggests aspects of the AV currently overlooked could be unearthed by means of qualitative investigation and further contribute to the existing knowledgebase of both this phenomenon and its connection to AN. Aims: The study aimed to gain a rich and detailed understanding of the way in which individuals with AN experience the AV. This study aimed to capture the AV experience from the point of illness onset through to recovery, it also sought to provide the health professions with helpful insights into what individuals with AN who report an AV are possibly experiencing. Methodology: Six semi-structured interviews were conducted with women who identified as recovered from AN and who confirmed an experience of the AV in conjunction with their illness. The verbatim transcripts were analysed by using Interpretative Phenomenological Analysis (IPA). Findings: Three superordinate themes (The Perils of Self-Acceptance During Puberty; The Anorexic Voice Battleground; Healing Through Compassion) and ten subordinate themes emerged. Conclusions: The findings indicated an experience of the AV as closely aligned with AN symptom emergence. The AV was referred to as a separate internal 'voice', depicted by participants as unique from other inner thoughts and dialogue. Initially experienced as benevolently enticing AN engagement, as illness progressed, AV presence became malevolent. Eventually, the demanding AV narrative began to feel controlling, particularly within treatment when participants strived for a life without AN. Amidst feeling controlled by the AV, participants experienced a greater emergence of self-directed compassion during the recovery process. Participants relayed their experience of self-directed compassion as healing, an antidote to AV hostility. Participants reported how the AV presence was not directly addressed in treatment and so after treatment ended, the AV presences remained. The current study provides a foundational knowledge of the under researched area of the AV as experienced in conjunction with AN illness from first person narrative accounts. The findings, future recommendations and conclusions within this study are discussed in reference to the praxis of Counselling Psychology (CoP) and are applicable to aiding other health professions working with this clinical population.

Background: Rates of psychological distress in patients facing end-of-life and receiving palliative care are significant. The prevalence rate for all mood disorders in one meta-analytic study was 29% (Mitchell et al., 2011). Interest in mindfulness meditation has increased exponentially over the past decade (AMRA, 2020). Meta-analyses in healthcare have consistently demonstrated increases in positive mood states and quality of life (Gotink et al., 2015). Few studies have explored the role of mindfulness with patients receiving palliative care. When they have, the mindfulness training component has usually been brief. Due to the growing popularity of mindfulness, patients who require palliative care will increasingly have had some exposure to mindfulness before becoming seriously ill. This study sought to pre-empt this societal shift. Aim: To explore the role of mindfulness, especially in relation to symptom burden, with patients who had been practicing mindfulness for a minimum of six months prior to recruitment. Method: Four participants met the inclusion criteria, and each engaged in a semi-structured interview. Interviews were analysed using Interpretative Phenomenological Analysis (IPA; Smith et al., 2009) to understand the psychological essence of their experiences. Findings: Four superordinate themes were identified: i). An altered relationship to pain; ii). Regulating thoughts and emotions; iii). A paradigm shift; and iv). Cultivating and sustaining mindfulness. These themes reflect previously proposed 'mechanisms of mindfulness' (Hölzel et al., 2011; Vago and Silbersweig, 2012) but also represent some novel findings within a palliative care context. For example, mindfulness appeared to inform a more appropriate use of medication and also impacted patients' relationships in positive ways. These themes are discussed in relation to the existing literature. Finally, the limitations of this study along with implications for future clinical practice and research are outlined.

Maternal nutrition is essential to the well being of mother and baby during pregnancy and beyond. It is necessary for effective placental accretion, foetal growth and development and optimal pregnancy outcomes. Adequate nutrition becomes even more critical when pregnancies are complicated with diabetes of any type which includes type 2 diabetes mellitus (T2 DM) and gestational diabetes mellitus (GDM). Complementary to other lifestyle factors, nutrition forms the cornerstone for achieving euglycemia to reduce potential maternal and foetal risks associated with diabetes in pregnancy such as macrosomia, hypertensive disorders and preterm birth. T2 DM and GDM are characterised by insulin resistance which affects effective beta cells function in the secretion and synthesis of insulin. Additionally, reduced levels of arachidonic acids (AA) (omega 6 fatty acids) and docosahexaenoic acids (DHA) (omega 3 fatty acids) have been found in maternal red blood cells in pregnancies complicated with diabetes. AA and DHA cannot be produced by the body and must be ingested by the mother. Foetal demands for these fatty acids are high and these are transferred by placental selection from maternal to placental circulation. It is reported that diabetes impairs the activity of delta-6 and delta-5 desaturases which are enzymes necessary for the synthesis of AA & DHA. Recent studies have reported significantly lower levels of AA & DHA in the red blood cells of pregnant women with GDM and T2 DM, resulting in a depletion in placental uptake and transfer of these fatty acids to the foetus and adequate supply for the mother, which if remains untreated, may have adverse impact on maternal, foetal and neonatal health in the short- and long-term. Therefore, women in these high risk groups need to effectively engage with health care professionals (HCPs) involved in their care and the services offered to them. Insulin therapy and supplementation with these essential fatty acids may correct this depletion. However, the impact on pregnancy outcome remains unknown. Newham is one of the most deprived boroughs of London and has a high prevalence and incidence of diabetes. Therefore, by evaluating the pregnancy outcomes of women with T2 DM and GDM after supplementation with essential fatty acids (EFAs), the local service needs would be better understood, and vital answers would be provided to optimise the pregnancy outcomes for this client-group which already has complex health needs.

Background: Class is a topic that is increasingly being explored within Counselling Psychology. Within IAPT settings a proportion of clients seen are from working class backgrounds, some of whom may be living in poverty. Rationale: There is a gap in the research around how counselling psychologists construct doing therapy with working class clients, and class based issues more widely. Method: Semi structured interviews were conducted with five counselling psychologists with experience in, or currently working in, IAPT settings. The interviews were analysed using Foucauldian discourse analysis, which takes into account structural hierarchies beyond the text. Findings: Three main discourses emerged from the data: 'class is seen and heard, but not talked or thought about', 'intrusion of poverty' and 'mind the gap'. These discourses were explored in their historical and political contexts in line with FDA principles. Each discourse has implications for counselling psychologists, their working class clients, and wider society.

This professional doctorate is made up of a systematic review, a research project, consultancy report, professional skills report, teaching and training plan, teaching and training evaluation, teaching and training recording, and an intervention report , as detailed in the course handbook for the Professional Doctorate in Health Psychology (edition 2015/2016) completed over a period of four and a half years. As I continue to develop into a dynamic and evidence-based clinician, teacher and researcher, I appreciate the opportunities I have had on the professional doctorate, to work with a range of clients in different contexts. These have enabled me to evolve into a professional and ethical health psychologist, applying appropriate theories in practice, challenging my assumptions and increasing my self-efficacy as a reflexive scientist-practitioner. I have strived to gain work experience in a variety of settings and over the 4.5-year period have worked within the NHS, the charity sector, in industry, as a member of a public health committee and in my role as a teacher and trainer. This diversity has contributed to my progress, and taught me the practical challenges of funding, sustainability and applying health psychology in a political climate.

Background: HIV positive immigrant African mothers living in the UK are likely to experience a decline in their mental and physical health. The women often encounter multiple challenges which need to be explored and understood to improve the health outcomes for themselves and their families. Aims: The study aims to bridge the gap in the literature by exploring how Immigrant African mothers experience living with HIV in the UK. Methodology: A qualitative approach was used to generate in-depth data. Interpretative phenomenological analysis (IPA) was chosen to explore the lived experience, focusing on a small, homogeneous cohort. Using semi-structured interviews, six accounts were recorded, transcribed and analysed for meaning and sense-making. Results: The analysis generated three main superordinate themes. These included 'Quest for Survival', 'Impact of diagnosis on identity', and "It's there, but HIV is not me ...". Superordinate themes encompass themes and sub-themes which are reflected in psychological theories and literature. Implications of study findings: The findings could help to develop specialist training for healthcare professionals around engaging these women and their families in early testing for HIV, adherence to treatment, and challenge stigma. This study might inform counselling psychologists about the background beliefs and cultural norms that influence these women when attending therapy and offers an insight into the areas of work that may need to be addressed therapeutically. A further implication of this study was the importance of approaching African community leaders/elders around education for women who are living with HIV in the UK and addressing barriers to accessing healthcare.

Background: Outcome monitoring (OM) has been shown to support client progress in psychotherapy (Lutz et al., 2015). For the most part, this has taken place through the nomothetic tradition, which involves the client responding to a global and standardised checklist of psychological functioning (Alves, 2016). The idiographic tradition, however, represents an alternative whereby clients construct and rate progress against their own items, within a standardised questionnaire format (Sales & Alves, 2016). Idiographic measures take one of two forms: problem‐focused and goal‐focused. Problem‐focused measures ask clients to identify the difficulties, issues, or concerns that they want to overcome, and then to rate the extent of these problems. By contrast, goal-focused measures, or goal-based practices (GBP), invite clients to pinpoint the objectives that they would like to strive toward, and then the degree to which they have achieved them (Lloyd et al., 2019). For the latter, emerging evidence supports the validity, reliability and clinical utility of GBP (e.g., Di Malta et al., 2019; Lindhiem et al., 2016; Lloyd et al., 2019; Smith, 1994; Tyron & Winograd, 2011). Rationale: Despite the significance that GBP may have for psychotherapy, there is a paucity of qualitative studies exploring how psychological therapists experience working with GBP with their clients. Given that pluralistic therapy (Cooper & McLeod, 2011) represents a specific form of therapy that fosters acceptance of therapeutic diversity, as well as a focus on explicit goal discussion and agreement, it seemed prudent to explore how therapists make sense of GBP within this framework. Methodology and Results: Interpretative phenomenological analysis (IPA) was selected for this research. Eight semi-structured interviews were conducted with psychological therapists working with GBP within pluralistic private practice. Three superordinate themes emerged from analysing the transcripts: a) a pathway through the jungle; b) invalidating the therapeutic journey; c) maintaining the clientled story. Results suggested that GBP could aid the therapeutic partnership through the monitoring of progress, by providing focus and increasing positive affect. However, GBP had the potential to detract from the client's frame of reference, to jeopardise the therapeutic containment of sessions and to increase the client's feeling of failure. The theme of 'maintaining the client-led story' emerged from the results as an antidote to what was experienced as non-humanistic GBP. Relational GBP entailed practitioners preserving time for therapy, reflecting on their own goals and agendas for their clients and maintaining principal focus on the therapeutic relationship; establishing this first and foremost, as a means to support their clients to create meaningful goals, which led to change. Conclusion & Implications: GBP can enhance psychotherapeutic work but cannot be separated from the primacy of the therapeutic relationship. Approaches to GBP, which dichotomise positive and negative aspects are likely to overlook therapeutic processes, which are vital to ensure GBP is collaborative and meaningful for the client. Results are discussed with reference to wider literature and the identity, ethos and praxis of Counselling Psychology (CoP).

This thesis describes colon targeted, fast dissolving delivery systems prepared through electrospraying and electrospinning. An overview of relevant literature on electrospraying and electrospinning is given at the start. Biodegradable polymer polyvinylpyrrolidone (PVP), and polycaprolactone (PCL) were used in the projects to produce nanomaterials using simple and straight forward techniques of electrospinning and electrospraying. In the first project, preparation, and characterization of PCL and PVP nanoparticles, using coaxial electrospraying was carried out. Electrosprayed nanocomposite coaxial nanoparticles with polyvinylpyrrolidone 10000 (PVP10) in the shell and polycaprolactone (PCL) 14000 in the core, were fabricated. Spherical, fiber-free particles were obtained with 5% solutions of polyvinylpyrrolidone. Confirmation of the presence of polycaprolactone inside the polyvinylpyrrolidone particles remained a challenge. Due to time constraints further work on this aspect of the project was abandoned, but a useful outcome was that low molecular weight PVP (av. mw10 kDa) could be used to prepare particles less than 100 nm. For the second project, hemin was selected for preparation of formulations for treatment of anaemia, as current treatments have side effects like gastric irritation and low bioavailability. Electrospun nanofibers and electrosprayed nanoparticles were tailored to enhance cellular uptake of low bioavailability drugs (hemin). DMF and MeOH was used to make hemin soluble. PVP-360 and eudragit L 100 were initially selected to make hemin formulations by electrospinning. A variety of electrospinning conditions were attempted and optimal conditions for producing high quality fibers were found to be 0.5 mL/hr, 14 cm (distance) and 12.22 kV (voltage) for PVP/1% (w/w) hemin fibers. Preliminary dissolution tests showed that PVP/ hemin fibres completely dissolved in PBS within 10 minutes. Whereas eudragit/hemin fibres took 2 to 3 days to dissolve. PVP-360 made hemin dissolve successfully in PBS, so further development was focused on developing PVP formulations. DLS (Dynamic light scattering) gave two or three sizes of populations in biological media. The proportion of aggregates increased as the concentration of hemin increased which might be due to hydrogen bond between PVP and hemin.

Anti-Muslim prejudice (AMP) practices since 9/11, have cemented its place in history of becoming commonplace and show no signs of abating (Hankir, Ali, Siddique, Carrick & Zaman, 2019). Research since then has focussed on factors that influence and exacerbate AMP practices such as the media (Kurebwa & Muchakabarwa, 2019) and the consequences of AMP practices on the wellbeing of those directly and indirectly affected (Abu-Ras, Suárez & Abu-Bader, 2018). Research has begun to focus on how to combat AMP practice using the profession of counselling psychology in the USA (Bhattacharyya, Ashby & Goodman, 2014); which has spurred research in the UK on advocating for social justice within the profession of counselling psychology (Rhodes, 2016). However, research has recently begun to go beyond the negative outcomes of AMP practices and towards illuminating strategies to overcome AMP practices (Tahseen, Ahmed & Ahmed, 2019), yet, there seems to lack an in-depth exploration of the intricacies of these strategies and the potential outcomes of enlisting such strategies. There is also a lack of understanding in how counselling psychologists experience and manage AMP practices which could illuminate potential strategies for members of society to enlist that are of greater benefit to one's wellbeing. The central aim of this study was to explore accounts of counselling psychologists experience of AMP practices including how and in what forms AMP practices find them and how they process, manage and approach AMP practices. The second aim was to co-construct an explanatory grounded theory of this process. Adopting a constructivist grounded theory approach (Charmaz, 2006), this study employed purposeful sampling to recruit eight counselling psychologists and one clinical psychologist as part of theoretical sampling to refine and develop the grounded theory using semi-structured interviews. Developed from the psychological processes that were co-constructed from the data indicated that three factors were influencing AMP practices finding participants which together increased sensitisation to experiencing AMP resulting in the experience of AMP as costing the self in two distinct ways, psycho-emotionally and systemically. The outcome of which was processed through two separate means, either through acknowledging or disconnecting from the experience of AMP. The consequences of processing AMP through those two means influenced the pathways towards managing one's experience of AMP, either through reflecting which was experienced to have benefits or deflecting pathway which was experienced to have costs. Participants outlined how a reflective pathway is built over time and with experience and due to its benefits, participants felt they underwent a positive change in their relationship to AMP practices. This stands apart from a deflecting pathway that is found to negatively re-affect participants when exposed to AMP practices. Participants, therefore, appeared to go through a myriad of complex processes in how they experience and manage AMP practices over their lifespan both psychologically concerning their sense of self and belonging in a society that accepts and rejects them. The findings from this study provide important insights into how counselling psychologists experience AMP practices, the changes they undergo in how they try and manage such experiences, including the rupture in relationships between colleagues, friends, family and towards their sense of self. Furthermore, the findings outline recommendations from participants and research which has shown that AMP practices cannot continue to be ignored and the need to move towards preventative and proactive measures in line with social justice work to help reduce such negative experiences from repeating for current and future generations of Muslims.

Increasing concerns about obesity and related metabolic risk have demanded better measures to identify individuals who are at higher health risk. This is particularly important in minority ethnic groups, especially those with a South Asian (SA) heritage. Variation in body composition between ethnicities is important in identifying risk. For example, South Asians have a characteristic body composition with a higher proportion of body fat, lower skeletal muscle mass (SMM) and a tendency to accumulate body fat (BF) in the abdominal region at equivalent BMI’s compared with those of a Caucasian heritage. The higher percentage of body fat (BF%) in SA children tends to track into adult life and consequently increases the risk of type 2 diabetes and cardiovascular disease. Across infancy, childhood, adolescence and even young adulthood, overweight and obesity are defined using statistically derived cut-off values, typically using centile charts based upon age and gender specific reference data. It remains a challenge to define optimum reference cut-offs for any body composition or anthropometric variable because of the age-related changes in growth and body composition which occurs during the growth and maturation. In view of this continuing challenge, the aim of this study was to extend the work previously undertaken in this research group to develop a full range of growth references for better characterisation of body composition in the UK SA population for the 4-21 years age range. Up until now, there had been a gap in data for adolescents and young adults between 16 to 21 years of age, hence the objective of this study was to generate SA- specific centile curves for anthropometric measurements (height, weight, BMI, waist circumference (WC), leg length and sitting height) and body composition measures (fat mass (FM, BF%), fat-free mass (FFM) and skeletal muscle mass (SMM) between the ages 16 to 21 years. This was a field-based study where anthropometric measurements of 546 participants were collected from volunteers from a SA background living in the UK. Single-frequency bioelectrical impedance analysis technology was used for assessment of body composition. Body composition and anthropometric data were used to construct the gender and ethnic specific centile curves using the LMS method for all variables. Comparison of centile charts with equivalent data for Caucasians was performed. It was found that mean height (172.5 cm for male, 159.3 cm for female) for both genders and mean weight for female (57.8 kg) of the population group was lower (as determined by numerical difference in SD score) compared to the UK 1990 reference. Sitting height increased with increasing age whereas there was no or minimal increase in leg length with increasing age. Participants from the SA ethnic group had (numerically) higher WC and slightly high BMI compared to reference population. At equivalent BMIs, SA tended to have a greater WC. BF% in females increased steadily from 6 to 21 years of age while in males BF% decreased after puberty, most likely reflecting the sex hormone driven changes in body composition during adolescence. FM (kg) increased with increasing age and was similar in both genders. At the 50th centile, SA had a lower SMM compared with Caucasians for all age groups in both genders. In conclusion, this study provides a range of assessment tools in the form of SA specific reference centile charts for children, adolescents and young adults in the UK and are the first set of reference centile charts for anthropometric measurements and body composition in this population group. The findings indicate that the pattern of body composition and anthropometry differs in the SA population compared to their UK Caucasian counterparts. These reference charts will allow health practitioners and researchers to measure and plot child and adolescent growth, development and measures of metabolic risk for this population group, allowing for comparisons with reference data for the same gender and age.

As the second largest religion in the world, Islam has a following of over 1.8 billion people worldwide, with approximately 3 million Muslims living in the UK. Muslims and the Arab world have contributed to psychology and mental health as early as the period between the 7th and 13th centuries (Wael-Mohamed, 2012). Analysis of the existing research suggests Muslim men with psychological difficulties underutilise mental health services in the UK and research conducted with Muslim men is scarce when compared with studies focusing on Muslim women (Wael-Mohamed, 2012). With religious texts supporting and recognizing the importance of psychological awareness, and with the influence of Muslims within the psychological field, it is important to understand how followers of this faith view and experience psychological well-being and mental health issues. The participants were seven second generation Muslim men from different backgrounds, aged between 20 to 34, who had received no therapy. Semi structured interviews were analysed using interpretative phenomenological analysis. Three superordinate themes were found: "Perceived stigma from community" - which explores the views of therapy and mental health from within the communities, "Mental health issues as seen from an Islamic perspective" - which looks into the influence of God, the devil and Jinn and the alternatives to therapy, "Intergenerational conflict and masculinity within Islam" - which discusses the masculine identity of Muslim men and the difficulties between second generation and first generation Muslim men. The study suggests a community psychology approach be utilised for issues highlighted within the Muslim communities. Counselling psychologists could interact on a personal level and visit Muslim communities to increase awareness and engage in positive discussions around mental health. Furthermore, more training to bring awareness of cross cultural and religious demographics is suggested for counselling psychologists.

Background: Carers who identify as ‘Black’ are a group that is thought to experience exclusion and marginalisation within existing services (JCPMH, 2014). Whilst, there is some research that explores caregiving attitudes, experiences and needs of BME family carers, it is documented that little is known about knowledge or awareness and uptake of counselling services. Further it has been empirically noted that individuals from BME groups are less likely to access counselling services than White British people. This would suggest that this is an underrepresented area of research, particularly within the UK. Thus, the present study is concerned with the experience of Black carers with a focus on wellbeing and how they ‘cope’ in relation to their caring role. Method: Semi-structured interviews were conducted with a purposive sample of six carers who identified as Black. Participants accounts of their lived experiences were recorded, verbatim transcribed and analysed using Interpretive Phenomenological Analysis (IPA). Results: Three themes were identified: ‘Being a carer’, ‘Being Black’ and ‘Being a Black Carer’. Although, separate from each other each theme is all part of the repertoire highlighting that although they are different from each other, they are also related to each other. These master themes are not opposites, but different yet integrated parts of Carers who identify as ‘Black’. Conclusion: The findings indicated that the experience of wellbeing for Black carers is predominantly influenced by cultural identity and perceptions. This research supports existing literature on carers who identify as Black. The findings of this research offer some useful implications for practice and service provision. Seeking to understand what constitutes and contributes to the experiences of carers who identify as Black.

Background: The gambling industry is a multi-billion pound industry offering diverse opportunities to gamble. The majority of the UK adult population has gambled at some point in their lives with 1-2% having a gambling problem and with males being significantly more likely to become problem gamblers than females. The literature suggests that money plays a complex role in the lives of problem gamblers and may be used as a way of increasing self-image as well as compensating for aspects deemed to be missing in their lives. Aims: This study seeks to explore the experience of money for UK-based males identifying as problem gamblers, providing them with a voice to articulate their subjective experience, which in turn may help to contribute towards better understanding of problem gamblers’ distress, improving treatment outcomes and informing evidence-based research. Methodology: Semi-structured interviews were completed with six men who met the inclusion criteria for this study. The transcripts were then analysed using Interpretative Phenomenological Analysis (IPA). Findings: A total of three master themes and nine subthemes were identified through the analysis process. The master themes identified were: Money as a Drug, Money and the Perception of the Self, and Money and the Relationship With Others. Conclusions: The findings suggest that ‘control’, ‘self-worth’ and ‘a lack of attachment to the father’ emerged from the interviews as themes. Money appears to play a pivotal role in enabling the participants to try and prove their sense of worth and wish to remain in control, using winning as a measure of self-worth despite its drastic consequences. Recommendations for both clinical practice and future research are outlined.

Disordered eating is becoming increasingly prevalent among the general population and patterns are said to have substantial emotional, physical and psychosocial problems. This study examined emotional processes and helping relationships among people with experiences of disordered eating. Disordered eating as a way of regulating negative emotional states (e.g. Ganley, 1989), resulting from a misinterpretation of hunger signals (e.g. Bruch, 1973), or disinhibited and restrained eating during negative emotions (e.g. Herman & Polivy, 1984) are mechanisms highlighted and cited within the eating disorder literature. Qualitative studies focus on phenomenological and interpretative perspectives (e.g. Fox & Power, 2009; Cooper et al., 2004), and research among a nonclinical sample often selects participants on the basis of weight categories or diagnoses which are developed and implemented by researchers and clinicians (e.g. Hernandez-Hons & Woolley, 2012). However, there is an absence of theory of sufferers' experiences and dated examination of processes involved in help-seeking behaviours that also considers the social, cultural and economic factors influencing the problems in the person's life (e.g. Anderson, 1999; Raisanen & Hunt, 2014). Eight self-selected individuals were interviewed and their narratives were analysed using Charmaz's (2006, 2011) social constructivist adaptation of Grounded Theory. Finding a 'fit' between narratives emerges as a core category, supported by taking the 'disorder' out of the 'eating' and the consideration of the social context in which problems occur. The Grounded Theory Model also identifies the role of the other in creating the context for having a 'therapeutic conversation'. Relationships between categories and subcategories are examined and quotations are presented across participants' narratives. Attention is paid to the researcher's and participants' reflexivity in this intersubjective process. The research findings are explored in relation to existing psychological theory and positioned as guidance for those working with people with disordered eating experiences that do not meet diagnostic criteria. The research implications are positioned within the current context of access to psychological therapy and suggest a framework for meeting client needs.

Rationale: There is a higher prevalence of mental health problems for gay men, who experience higher rates of depression, substance misuse problems and suicide. Gay men use therapy at higher rates than the general population, but are also more likely to report unsatisfactory experiences in therapy - otherwise known as ruptures. There is a lack of research not only on the client perspective of ruptures but also within specific minority groups such as gay men, and therefore it remains unknown how they experience ruptures in therapy. This study aims to offer insights into this area to deepen understanding and produce new knowledge about whether the experience of ruptures in the therapeutic relationship is different for gay men and, if so, how. Methodology: Interpretative phenomenological analysis was used to explore seven gay men's experiences of ruptures/difficulties in the relationship with their therapists. Data was gathered using semi-structured face-to-face interviews. Findings: The analysis yielded three master themes: 1) The origins of the rupture: therapist as invalidating threat to gay identity and self, 2) Rupture as process of struggling to defend gay identity and the self, and 3) Negotiating reparation and/or closure of the rupture. The key finding was that participants attributed the cause of the rupture to therapist homophobia and/or lack of therapist understanding on gay issues, which presented additional barriers to the therapeutic process, and meant that participants edited out aspects of their gay identity in therapy. The study also found that rupture overlaps with the difficulties commonly experienced as part of the therapeutic process, making it difficult to define rupture. The researcher links the findings to minority stress theory, and suggests that an over-emphasis on the transferential relationship in therapy, and rigidity in therapeutic approach, can impede the collaborative process that is more likely to lead to reparation with this client group, especially when they are at an early stage in their gay identity development. The findings indicate that participants' rupture experiences are compounded by both projections of their internalised fears of homophobia onto their therapist and a lack of therapist understanding of the therapeutic needs of gay men. The limitations of the study are discussed, and the implications for practice, research and training are discussed in light of the findings.

Microvesicles (MVs) are shed to the extracellular environment upon activation by both normal and diseased cells. Increasing evidence has shown that cancer cell-derived MVs carry pathogenic components, such as proteins, messenger RNAs, microRNAs, long non-coding RNAs, DNAs, lipids, and transcriptional factors, which can mediate paracrine signaling in the tumor microenvironment, and that they are thus highly capable of altering the function of the recipient cells. MVs released from tumour cells are thought to play an important role in cancer metastasis. Most carcinomas are derived from epithelial cell lines, which normally adhere together tightly to form the structural foundations of many organs. Epithelial Mesenchymal Transition (EMT) has been linked to malignancy in many carcinomas of epithelial origin. In this study, I look at the role of PC3 (Prostate Cancer cell line) derived MVs in the induction of EMT in PNT2 (normal prostate) cells. Uptake of PKH26-labelled PC3-derived MVs by recipient cells was greater at a low pH of 5.4 and was dependent on MV-based protein and phosphatidylserine interaction with recipient cells. Biochemical and morphological changes, indicative of EMT, (elongation, increased expression of mesenchymal marker Vimentin and reduced expression of epithelial marker, E-cadherin) were observed using fluorescent microscopy and flow cytometry. To further investigate the protein cargo of PC3, PNT2 and the transformed PNT2 (tPNT2) cells and their respective MVs LC-MS/MS analysis was carried out. Around 1290 proteins were identified collectively in all the samples. Pathway analysis tools such as DAVID, PANTHER, KEGG and STRING were used to analyse the protein data. Importantly this study identified key proteins in PC3 MVs that may have contributed to the process of EMT, such as integrins which play a vital role in the biology of invasive carcinoma and setting up a pre-metastatic niche.

Northern Cypriots follow a unique diet and little existing literature has documented this. One component, black olive oil (BOO) is distinct from other olive oils in terms of its taste, appearance and its manufacture. The aim of this research was to assess whether BOO, and other components of the diet can influence outcomes for breast cancer (BC) patients in Northern Cyprus, and to assess attitudes and dietary habits of BC patients during recovery. The research was undertaken in North Cyprus and and investigated the dietary habits of a cohort of 140 BC patients with a view to assessing compliance to the Mediterranean diet and BOO consumption. The patients were assigned to two groups, those actively undergoing treatment for BC or those who had stopped being treated for three years or more. It was found that participants frequently consumed olive oil, which is a basic feature of the Mediterranean diet. An enhanced Mediterranean Diet Score (MDS) was significantly correlated with age, education, physical activity, total energy intake, protein, fat, carbohydrate, fatty acids and cholesterol. Similar to previous research, this study concluded that there is a relationship between improved breast cancer biomarkers and olive oil consumption, indicating that high olive oil consumption may aid recovery. A correlation was seen between monounsaturated fatty acid (MUFA) and oleic acid consumption with significantly reduced CEA BC biomarkers. There was also a statistically significant reduction in CA15-3 CB biomarker associated with the consumption of BOO in the active treatment group, but not with in the treatment stopped group. This study is the first to be conducted on the eating habits of BC patients, with a focus on the dietary awareness in relation to BC and the consumption of BOO, in North Cyprus. Interviews from a cross-section of 14 BC patients were analysed qualitatively using interpretative phenomenological analysis (1PA). Results indicated that participants were confused regarding what dietary advice to follow, and variety of sources was used. Widepsread uses of the internet to gain information as well as local opinion were noted. The views of patients on black olive oil fell into two groups: 1) that black olive oil was preferred because of its distinct taste and smell and 2) that black olive oil was not preferred because of its distinct taste and smell. The results indicate a need for clear professional advice on diet, as an aid to BC recovery. The work ends with nutritional analysis of black olive oil and the effects of BOO polyphenols on BC and hepatoma cells and their growth rate. The level of polyphenols in BOO was found to be much lower than in extra virgin olive oil (EVOO) and they had less anti-oxidant activity. It was however found that BOO polyphenols inhibited growth of breast cancer cells at lower concentrations compared with polyphenols from traditional EVOO. Moreover polyphenols extracted from one source of BOO could selectively inhibit growth of BC cell lines compared with a non-cancerous control cell line. The results of this study has shed light on, and identified the need for, further studies on BOO to understand its relationship to human health.

Background/Aim: There has been a great deal of research looking at the effects of the holocaust on survivors and their children. However, there is far less research focused on the third generation of holocaust survivors. There has been little research on this topic from a Counselling Psychology perspective and studies looking particularly at the Jewish population in the United Kingdom are scarce. This research aims to bridge this gap and explore the experiences of being a grandchild of a holocaust survivor and how this may influence the way they make sense of their lives. Method: Semi-structured interviews of six participants were analysed using Interpretative Phenomenological Analysis. Findings: Through analysis three superordinate themes emerged; Holocaust at the core of identity; Salience of family influences within life; internal conflict over sense of purpose: burden vs honour. Nine subordinate themes were also generated and discussed. Conclusion: Participants highlighted the importance of their grandparent's trauma in their everyday life. There was a belief that the holocaust was central to their identity and participants emphasised the internal conflict over whether this legacy was a burden or an honour. It is suggested that clinicians working with individuals in the UK who have grandparents that experienced the holocaust, take these familial experiences into consideration when conducting therapeutic interventions.

Emotional distress is now recognised as the sixth vital sign of cancer and as such is not unexpected at any stage along the disease trajectory. It has gradually become an aspect of the disease that is recognised, monitored, documented, and promptly treated in many healthcare systems worldwide. Psycho-oncology is the specialist field concerned with the emotional distress of cancer. It focuses on understanding and treating the psychological impact of the disease and providing effective psycho-social care to all those affected by it, including patients, their family and friends and indeed clinicians working in oncology. Psycho-oncology is fast becoming an integral part of cancer care as an active and valuable area of research and practice, thus providing more knowledge and support within this specific healthcare field. This study explored cancer patients' experience of their psycho-oncological care via the qualitative methodology, Interpretative Phenomenological Analysis (IPA). Exploring what psycho-oncology means to them and how it has impacted the cancer coping process, the study aims to further inform and develop research and practice in this specialist field. Much of the research thus far (both quantitative and qualitative) has investigated outcome measures and/or benefits of psychotherapeutic interventions used in cancer care. Studies have tended to be randomised controlled trials adhering to strict parameters of practice, including specific settings, models of therapy and number of therapy sessions. In order to gain a more subjective and ecologically valid understanding of this phenomenon, in-depth interviews were conducted with six cancer patients who have accessed and availed of psycho-oncology via different pathways within a real-life setting (the Republic of Ireland). Using IPA's analytic techniques, three master themes emerged from the data - Cancer Patient Needs; The Power of Talking and The Therapeutic Relationship (with each theme containing three corresponding sub-themes) - all of which capture the essence of this experience. Results of the data imply that therapist values, flexibility of care and relational processes are deemed most meaningful and of benefit to cancer patients. Someone who has a professional and personal understanding and experience of cancer and disease processes in addition to embodying humanistic core values emerged as key factors in affecting therapeutic experience and outcome. Implications for such findings suggest that training and practice for psychotherapists working in cancer care need to emphasise a "being with" rather than a "doing do" style of therapy, capacity to discuss existential concerns and have a strong knowledge and experience of cancer.

Background: The loss of balance between components of body composition is significantly linked to a wide range of adverse clinical outcomes. Whilst the sharp rise in the rate of adiposity-based chronic diseases has caused substantial health concerns across the globe, sarcopenia has emerged as an important risk factor for increased morbidity and mortality among the aging population. Therefore, assessment of body composition phenotypes using the conceptual model of metabolic capacity and metabolic load enables an insightful evaluation of metabolic homeostasis association with health outcomes. Nevertheless, the evidence on such associations in the adult population is still lacking. Objectives: To examine the relationship of anthropometric measures with total and segmental adiposity and muscularity; to investigate variations of blood pressure across body composition phenotypes; to explore the interaction effect of fatness and leanness on lung function, and to evaluate bidirectional association of lung function and blood pressure. Study design and subjects: This project was a cross-sectional study of fifty healthy adults (22 men, 28 women) aged 19-65 years old. Anthropometric, body composition (Tanita MC980 and InBody 720 segmental multifrequency bioelectric impedance analysers, and the BODPOD air displacement plethysmography system), blood pressure (OMRON M7 automated oscillometric monitor), grip strength (Takei 5001 analogue dynamometer) and spirometric (COSMED Quark PFT) measurements were carried out in Nutrition Physiology Laboratory at London Metropolitan University from 2016 to 2018. Statistical analysis: Moderation analyses of the associations between body composition, blood pressure and lung function were conducted by the PROCESS modelling tool for SPSS. Results: None of the anthropometric measures were exclusively related to muscle mass. Neck circumference (NC) and upper arm circumference (AC) were the strongest and a body shape index (ABSI) was the only negative predictor of total and segmental muscularity in the entire population. Also, waist to height ratio (WHtR), waist circumference (WC), waist to hip ratio (WHR) and body mass index (BMI) were all strong correlates of total, truncal, visceral and upper arm fatness. None of the anthropometric measurements showed moderate or strong correlations with lower limb fatness. Fat mass (FM) to fat-free mass (FFM) ratio was only significantly associated with diastolic pressure (DBP) (ꞵ=17.6, p<0.001) whereas truncal FM (TFM) to appendicular skeletal muscle mass (ASM) ratio was associated significantly with systolic pressure (SBP) (ꞵ=15.94, p<0.01), DBP (ꞵ=27.47, p<0.001) and pulse pressure (ꞵ=-11.38, p<0.01). Stature-normalised truncal and appendicular adiposity (TFMI, AFMI) impaired lung function (FEV1, FVC and FEF25-75%) respectively at high levels of truncal and appendicular muscularity (TSMI, ASMI). The negative impact of whole-body (high FM/FFM) and segmental (high TFM/ASM) metabolic overload on expiratory flow rate (FEV1) was respectively conditioned on low DBP and high SBP (ꞵ=- .104, p<0.01, ꞵ=-.163; p<0.001). Negative effect of increased FM/FFM and TFM/ASM on FEV1 and FVC was also operable at high levels of grip strength. There was a bidirectional association between lung function and systemic blood pressure. SBP and DBP were independently and negatively associated with FEV1 (ꞵ=-.011 and -.019; p<0.001) and FVC (ꞵ=-.011 and -.022; p<0.001). FEV1 and FVC demonstrated inverse associations with SBP (standardised ꞵ=-.38 and -.30; p<0.001) and DBP (standardised ꞵ=-.35 and -.40; p<0.001). Notably, the effect of FEV1 and FVC on SBP was operated at higher levels of visceral adiposity whilst their influence on DBP was conditioned on higher levels of FFMI. Conclusion: Whole-body and segmental metabolic homeostasis, pulmonary function and systemic blood pressure are complexly cross-linked. Therefore, phenotyping the individuals with or at risk of respiratory diseases and/or cardiometabolic disorders by their total and regional body composition, spirometric, and haemodynamic characteristics may result in more accurate risk stratification, personalised care and effective management strategies, leading to improved clinical outcomes, survival and quality of life.

Background: Borderline Personality Disorder (BPD) patients are considered among the most challenging groups to work with, being associated with impulsive risk-taking behaviours and difficulties engaging in the therapeutic alliance (Bender, 2005; Black, Blum, Pfohl, & Hale, 2004; Cruz & Soriano, 2014). It is apparent that many mental health professionals hold negative attitudes towards this group and report feeling underequipped to work with the challenges associated with BPD (Bland, 2003; Cleary et al., 2002; Shanks, Pfohl, Blum & Black, 2011). It is suggested that support workers, who require little to no formal training and are considered front line staff, provide a significant portion of care to this patient group (Kenward et al., 2001). However, there is little to no research focusing on understanding their role with young BPD patients and the impact they have on therapeutic outcomes. Aim: The following research aimed to explore the perceptions of support workers working with young BPD patients in inpatient services. It aimed to open up the discussion on what it is like to be a support worker in this environment and the challenges they may face, also hoping to enhance our understanding of any training and support needs required for effective therapeutic outcomes. This research may provide some insight into how support workers perceive their role, their attitudes towards young BPD patients, and how best to support them to achieve positive therapeutic alliances. Method: Semi-structured interviews were conducted with six participants. The transcripts were then analysed using Interpretative Phenomenological Analysis. Findings: Four superordinate themes emerged: Attachment, Boundaries and Ruptures; the Emotional Rollercoaster of Managing Selfharm; Co-existence of Hope and Hopelessness and Making a Difference. Eight subordinate themes, related to the initial superordinate themes, are discussed in further detail. The research highlights the challenges support workers face and the difficulty they have developing the therapeutic alliance with young BPD patients and the subsequent impact this could have on therapeutic outcomes. It suggests that the training and support needs of support workers are under emphasised and could be having an effect on the therapeutic outcomes for this patient population. This research makes implications for clinical practice bringing forwards the needs of support workers who have a front line role. Being an under-researched area, the potential for future research is plentiful.

Background/Objectives: According to census statistics of the United Kingdom (UK), people who identify as black Africans are now the largest black community group in Britain as opposed to those who identify as African Caribbean (ONS, 2015) and 2.3% of UK immigrants are Nigerian-born (Migration Observatory, 2017). Previous research reported that BME mothers in the UK do not access clinical and psychological services. Whilst there are a few studies exploring BME mothers’ experiences of Postnatal Depression (PND), there has been no research to date that has exclusively investigated the ‘lived’ experiences of the First Generation Nigerian Mothers (FGNMs) in relation to PND. This study is the first to investigate FGNMs’ postnatal depression experience in the UK. The study aimed to explore how FGNMs living in the UK experience PND, their experiences of available resources/treatment and the way they manage and cope with postnatal depression. Design/Method: A verbatim account of semi-structured interview data was analysed using Interpretative Phenomenological Analysis (IPA). The participants included six FGNMs aged between 30 and 45 who reported being formally diagnosed with PND by their GPs. Findings: Three main themes were generated in the process of the analysis: Sociocultural Factors (this talks about cultural expectations, perceptions of PND and adjusting to a different culture), Neglected Nurturer (this discusses the experiences of treatment) and Loneliness and Coping (this refers to lack of support and explores how PND was managed). Conclusions: The study suggests that the FGNMs encountered difficulties with their diagnosis, treatment and access to service for PND. All mothers felt a sense of cultural pressure and expectation to present as strong and resilient which impacted on early help-seeking. The mothers narrated concerns and negative experiences about how they were treated by healthcare professionals when they sought help and how their psychological needs were neglected, which contradicts previous research suggesting that BME groups do not seek support and are hard to engage. These findings could promote understanding and inform professionals about how to better support these mothers. Implication for clinical practice: The findings of the study suggest the need for healthcare professionals to provide equal and unbiased services and follow guidelines for care and referral in order to effectively treat the FGNMs. There is also need for a culturally-specific and psychosocial intervention rather than a predominantly medical model for supporting the mothers.

This portfolio and the accompanying competency folders contain over three years of reflective practice logs and demonstrate evidence of how I have met the required competencies for the Professional Doctorate in Health Psychology. In the form of four case studies, one systematic review and a research thesis conducted over a period of two years, it shows my range of knowledge and skills gained within Health Psychology. Further to this, it demonstrates how I have learnt practically to apply health psychology theory to a commissioned health improvement service in order to become a skilled Health Psychology Practitioner. The largest section of this portfolio is that of my research study (section C3) and reflecting back on the process of undertaking this, I can certainly see significant growth in skills as a researcher. I originally undertook the study because, as a weight management practitioner, I often came across obese patients who believed that they were food addicts. However, despite there being a large body of research looking at the topic, very little qualitative research existed which attempted to explore the experience of perceived food addiction in those trying to lose weight. Such research as was available took the approach that 'food addiction' could simply be mapped onto the existing criteria for substance use disorder rather than approaching it from a neutral standpoint which might allow unique features of the experience to come to light. During the process I found myself influenced by previous research and had repeatedly to remind myself of my original aims. The results of this study identified extreme uncontrolled eating behaviours that are not currently targeted in standard weight management interventions and which participants interpreted as food addiction. They also reported feeling stigmatised due to their belief in food addiction which posed as a barrier to seeking help. I believe that these are important findings and have implications both for those designing weight management interventions and for health care professionals in general. The systematic review I undertook (section C3.1) was particularly challenging for me because I had never undertaken one before. Although protocols do exist, I had to make some key preliminary decisions myself and often doubted my judgement. My review looked at the effectiveness of mindfulness-based interventions a range of physical and psychological measures relating to people with HIV. One decision I had to make was whether to include unpublished studies in my review. This was a difficult decision as in many ways it would have been simpler not to. However, given the existence of publication bias, I decided that I should include unpublished work in order to draw more balanced conclusions as to the effectiveness of these therapies. My review concluded that there is not enough evidence to recommend these interventions over the standard treatment as yet. I believe this, is itself an important finding as mindfulness is currently very popular in the media and this may mean individuals seek it out when it is not necessarily the most effective treatment option available to them. The competency which came most naturally to me was that of behaviour change interventions. I develop, implement and evaluate these regularly as part of my professional duties and believe that I am skilled in this area. The case study detailed in this portfolio (C2) was undertaken very early on in my training and was the first time I had decided upon the assessment, content of the intervention and evaluation process myself. I was pleased with the outcome of the intervention which targeted emotional eating and it has since been embedded in the standard weight management intervention provided by my employer. I have since gone on to develop other interventions in and out of my current job role and the processes set out in this competency have provided me with a framework for doing so effectively. I also very much enjoyed the teaching and training competency (section C5). The case study outlines a lecture I undertook at London Metropolitan University for MSc Health Psychology students. I developed my skills in creating teaching materials, such as PowerPoint presentations, significantly during this process as previously I had underestimated the importance of these in keeping students engaged. I learnt to take all different learning styles into account when planning a teaching session as I had previously assumed that the approach to which I respond well would suit everyone. I found the evaluation process challenging, particularly watching back footage of my teaching. However, this has allowed me to become more relaxed and natural during teaching which means that I can concentrate on the reactions of the students to the subject matter rather than worrying about how I personally am coming across to them. The consultancy competency (section C4) proved the most challenging for me but also allowed for the most development. The case study outlined in this portfolio was particularly difficult due to the unwillingness of the manager to be fully involved with the consultancy process. In hindsight I should have set clearer expectations at the outset and insisted that he met these throughout. I believe that it was also a mistake not to charge for my time; he may have valued the process and been more involved if he had been paying for it. This highlights how much I have developed since then in that I did not value my skills and time sufficiently, which is not the case today. I have since been involved in several pieces of consultancy work and have always charged for my time and have drawn up a clear contract before undertaking any work. These have been much more successful pieces of work and although the case study in this portfolio does not outline the most positive piece of consultancy work I have been involved in, it is certainly the one from which I learned the most. Section C1 outlines how I have developed my generic professional skills throughout my training to become a proficient Health Psychologist. I have been very fortunate to have been employed by such a supportive and innovative healthcare provider as they have given me the opportunity to gain experience in many areas and to work with a wide range of professionals. I can see a vast improvement in my skills and confidence between when I first undertook my training in 2014 and today. Reflective practice and supervision have been key in my development as well as continuing to take part in training and learning; I will maintain these practices during the entirety of my professional career.

The objective with this doctorate thesis is to examine how clinicians work with the shift between the stabilisation-phase and the exposure-phase in PTSD-treatment. Specifically, the aim is to explore how clinicians conceptualise exposure-readiness and how they evaluate when clients are ready to initiate exposure-work. For this, semi-structured interviews with psychologist providing trauma-focused treatments in PTSD secondary care services within the NHS were conducted. Data was analysed using grounded theory, from which the core concept: "clinicians are managing their role and resources in relation to the treatment-model" emerged. This core concept was further expressed through interrelated components termed: 1. Clinicians view exposure-readiness to be determined by more than traditional stabilisation-work due to the psychological and social complexity of PTSD-clients. 2. Clinicians view that treatment needs to be more integrative as opposed to solely conducting trauma-therapies in order to meet clients' complex needs. 3. Clinicians advocate that the concept of exposure-readiness needs to be re-evaluated to make treatment more effective. 4. Clinicians feel that the prescribed treatment-model pose challenges to providing effective treatment. These findings will be discussed in relation to literature, along with the theoretical conceptualisation this data gave rise to. Qualitative research on how clinicians are working with exposure-readiness and the shift between the treatment phases in PTSD-treatment is limited. Therefore, this study helps to crystallise these elusive clinical processes, and constitutes a valuable scientific contribution which can help improve PTSD-treatment.

Background: Whilst involving IDC in the HDPP can reduce patients' length of stay and readmissions, research has shown that their inclusion is scarce. Limiting IDC participation in decisions relating to their needs or the welfare of those they care for can yield adverse repercussions for their mental-health, disrupt continuity of care, extend patients' hospital stay, and increase the likelihood of patients' readmission to hospital. Given these costs it is imperative to comprehend how this particular client-group thinks and feels about the hospital discharge planning phenomenon. Nevertheless, minimal studies have investigated this topic area. In response to this gap in knowledge, the present thesis investigated the experience of the hospital discharge planning process for informal caregivers of individuals with dementia. Method: Data was harvest from participants via the employment of face-to-face semistructured interviews which were later verbatim transcribed. Participants idiosyncratic narratives were examined and analysed using Interpretative Phenomenological Analysis. The participants were five informal caregivers of older patients with dementia aged between 52 and 71 who took part in their care-recipient' hospital discharge planning process. Findings: Three superordinate themes emerged from the IPA analysis: 1) the negative aspects of the discharge planning process 2) focus on relationships and 3) employing coping mechanisms to counteract taxing experiences. It appears that the challenges that participants encountered in their meetings with hospital personnel and the changes they experienced in their interactions with their care-recipients, coupled with the costs they incurred in their daily life, triggered in them a range of negative thoughts and feelings which diminished from their psychological wellbeing. This propelled the participants to employ various coping strategies in an attempt to alleviate their internal turmoil. However, the efficacy of these tactics was questionable. Conclusions: The experience of the HDPP for IDC comprises of multiple psychological dimensions. Nevertheless, the HDPP does not address IDC mental health needs. Therefore, this thesis suggests that counselling psychologists work as facilitators of psychological wellbeing on hospital wards. Such an initiative could provide caregivers access to mental health interventions in real time which they would struggle to attain in the community due to long waiting lists. Additionally, counselling psychologists and other applied psychologists should share their knowledge of therapy skills with hospital personnel in order to help staff form and maintain a nourishing relationship with IDC. Implications for future investigations and clinical work are also proposed.

The aims of the research were to investigate the population and diversity of lactic acid bacteria (LAB) in human breast milk, to assess the probiotic potential of the identified LAB, to examine the antimicrobial resistance profile of the LAB and to investigate the possible relationship between the identified bacterial population and diversity with stage of lactation, number of children and diet. Samples of breast milk were collected from 20 breast feeding mothers. Standard spread plating on MRS agar and MRS agar supplemented with L-cysteine HCl (MRS-cys) was used for the enumeration of the organisms. Phenotypic identification of 108 recovered isolates was carried out. All isolates were Gram positive and oxidase negative, some were catalase positive and others were catalase negative. Further identification was carried out by grouping the isolates using repetitive sequence based PCR (rep-PCR). A total of nineteen groups were generated from the rep-PCR DNA profiles. This was followed by genotypic identification using 16S rRNA gene sequencing. The 16S rRNA gene sequencing identified LAB and non-LAB. Most of the LAB isolates belonged to the Lactobacillus genus, the rest were Leuconostoc, Weissella, Streptococcus and Enterococcus spp. The non-LAB were Staphylococcus epidermidis and Staphylococcus hominis. To examine the potential probiotic characteristics of the isolates, at least one representative isolate from each species of LAB (11 in total) were selected and characterised through a series of experiments. Initially the acid and bile resistance of the selected isolates were studied. All eleven LAB showed good tolerance to low pH and high concentration of bile salt. The antimicrobial activity of the isolates was also assessed. Again all eleven LAB produced antibacterial metabolites that inhibited the growth of all the four indicator bacteria (Bacillus cereus, Escherichia coli, Salmonella Enteritidis and Staphylococcus aureus) in both unbuffered and buffered agar spot tests. The antimicrobial activity of the LAB using Agar well diffusion assay revealed antimicrobial properties of some of the studied LAB. The ability of the eleven selected LAB to produce exopolysaccharide, deconjugate bile salt and reduce cholesterol was investigated. The entire eleven LAB produced exopolysaccharide, deconjugate bile salt and reduce cholesterol. The phenotypic antimicrobial resistance profile of the eleven LAB was assessed. Furthermore, the genetic background of the phenotypic resistance was also investigated. All eleven LAB were sensitive to ciprofloxacin, gatifloxacin and quinupristin/dalfopristin and resistant to daptomycin. Most of the LAB were resistant to erythromycin, gentamicin tetracycline and vancomycin. Antimicrobial resistance genes for erythromycin and tetracycline were confirmed for three LAB.

Aim: The aim of the study was to investigate staff perspectives on verbal aggression. More specifically, it aimed to explore how staff experience and understand verbal aggression in an acute psychiatric ward, as well as their views on individual and organisational influences on the occurrence and maintenance of verbal aggression. Method: Individual semi-structured interviews were conducted with eight ward staff. The transcribed interview data was analysed in accordance with the principles of constructionist grounded theory (Charmaz, 2006). Findings: Incidents of verbal aggression were said to affect staff deeply on an emotional and psychological level. Participants described the organisational culture as one that normalised verbal aggression, and shared an awareness of an unspoken expectation that they should be able to cope with verbal aggression. Staff sought to alter their working practices to accommodate organisational expectations, which negatively influenced the staff-patient interactions, thereby perpetuating further verbally aggressive behaviour from patients. Conclusions: The themes observed in the study have conceptualised verbal aggression as more than a negative interaction on an individual level, highlighting the influence of organisational factors as having a significant bearing on staffs' psychological wellbeing and staff-patient relational dynamics. The clinical implications of the study are explored, followed by recommendations for future research.

Poor outcomes for many of those in treatment for substance use disorders (SUD) has raised interest in recovery-based approaches, positive psychology and the importance of flourishing, a quality defined as functioning positively in all realms of life. However, there is little research into approaches that focus on flourishing in SUD. This study evaluates The Rediscovery Process (TRP), a brief, recovery focussed approach for SUD. It teaches self-coaching techniques designed to increase flourishing and recovery capital (psychological health, physical health, quality of life, days at work, college, volunteering and housing status) and to reduce impulsivity. A mixed-methods approach was used, comprising of three studies. First, to evaluate the effect of the TRP on substance use, flourishing, impulsivity and recovery capital, a preliminary pilot study using a randomised wait-list controlled structure was conducted. 72 participants who had been formally diagnosed with single and poly-drug use issues, including, alcohol, opiate, cocaine, crack, cannabis and amphetamine were assigned to either immediately receive the intervention or to wait for the treatment, providing a wait-list control arm. Validated measures of substance use, flourishing, impulsivity and recovery capital were assessed pre- and 1 month post intervention. The results of the study showed that, compared to the wait-list control group, the TRP provided a significant decrease in alcohol use (the most commonly used substance in the study) and impulsivity, and an increase in flourishing and recovery capital. Due to the low numbers of those using other substances in the study, no other significant changes in use were identified. Associations between flourishing, impulsivity and alcohol usage were also evaluated and a significant moderate negative association between impulsivity and flourishing was found, an association which has not been previously reported. Second, once the intervention and wait-list groups had both received the intervention, a cohort study (n = 69) evaluated the sustainability of this combined group's changes. Validated measures of substance use, flourishing, impulsivity and recovery capital were assessed pre-, 1 and 3 months post-intervention. Impulsivity and alcohol use decreased significantly at 1 and 3 months post-intervention, compared to pre-intervention measurements. Flourishing and psychological health increased significantly at 1 and 3 months post-intervention, compared to pre-intervention measurements. No effect on outcomes was seen in the different referral routes for all analysed measures, at all time points, with the exception of impulsivity at 1month and QOL at 3-month. Associations between flourishing, impulsivity and alcohol usage were also evaluated and a highly significant strong association between a decrease in impulsivity and an increase in flourishing was found, however, no other significant associations were found. Third, a thematic analysis evaluation of participants' experience of the TRP identified two main themes (1) control and (2) flourishing. These themes reflected the value participants found in applying the approach to controlling substance use, emotional regulation, personal growth, empowerment and their sense of self. Many participants noted differences between this approach and those previously tried and the majority found the intervention effective. However, some did not find it of use and there was evidence of issues of a conflict between the concepts of this and other previously used models, which made adopting the new ideas difficult for some. These studies show that, compared to TAU, the TRP approach significantly reduced alcohol use and impulsivity and increased flourishing and elements of recovery capital and this was maintained over the 3 month period. This supports its place as an approach for those with SUD and opens the possibility of its inclusion within the range of positive psychology interventions for SUD. These results help bridge the gap between the more traditional focus of addressing the psycho-pathology in SUD and the newer interest in increasing flourishing. It is hoped that this study will encourage further research and a wider adoption of the flourishing concept and this new approach, in SUD.