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Theories of aggression have been proposed to differentiate the different types of aggression humans display and explain their causes. One way to describe aggression is to differentiate it into two subtypes: provoked and unprovoked. Provoked aggression is driven by a perceived threat and emotional arousal; it is known as "hot-blooded" aggression. Unprovoked aggression is goal-oriented and without emotional arousal; it is known as "cold-blooded" aggression. Notwithstanding the subtype, aggressive behaviour leads to both physical and psychological harm to the victim and sometimes punishment for the aggressors. This thesis examines the factors affecting unprovoked and provoked aggressions using a series of online experiments. Chapter 2 built and developed a new paradigm to assess unprovoked and provoked aggression: memory competition experiment. The memory competition tested unprovoked aggression by block and steal interference and tested provoked aggression by noise interference. Analysis indicated the proportion of steal interference was related to proactive aggression subscale in Reactive Proactive Aggression Questionnaire and participants were angrier when they used noise interference than used other interference or did not interfere. The results supported memory competition assessed unprovoked aggression by steal interference and provoked aggression by noise interference. Chapter 3 employed the memory competition experiment developed in Chapter 2, together with Difficulties in Emotion Regulation Scale and Connor-Davidson Resilience Scale to test the relationship among provoked aggression, psychological resilience, and emotion regulation. Psychological resilience buffered provoked aggression and maladaptive emotion regulation predicted it. Chapter 4, 5 and 6 explored unprovoked aggression in intergroup competition. Chapter 4 examined intergroup competition between pairs of participants coming from distinct social identities from one another. Competition between rival football fans was used as an experimental scenario to analyse unprovoked aggression. The result indicated only intergroup competition between rival social identities induced unprovoked aggression. Chapter 5 examined unprovoked aggression between rival football fans under different group norms (i.e. aggressive vs prosocial) and different ingroup positions (i.e. prototypical vs. peripheral). Unprovoked aggression increased when participants were assigned to a group where aggressive group norms where in place in comparison when the group had a prosocial group norm. Ingroup position moderated the extent to which participants aligned to the norm assigned to their group: prototypical group members were more likely to follow the group norms than peripheral group members. Chapter 6 tested whether individuals used unprovoked aggression to pursue their personal profits or maximise their group profits under different group norms. It supported the results from the last experiment that there was a reduction in aggression whenever unprovoked aggression that helped a rival group win the memory competition and made the participants' own group lose competition. In sum, the series of experiments built a new paradigm: memory competition to assess unprovoked and provoked aggression. Psychological resilience, emotion regulation, social identity, group norm, ingroup position and cost-benefit analysis were found to influence unprovoked and provoked aggression. The implication and limitation were discussed in the discussion chapter.

Parents of autistic children commonly report experiencing higher levels of stress, anxiety and depression compared to parents of typically developing children and parents of children with other various developmental conditions. Considering the worldwide increase in the prevalence of autism, understanding the experiences of these parents and how they cope with their child's condition has become increasingly important. Studies exploring parental experiences caring for their autistic child have yielded inconsistent results in relation to the impact certain factors have on their mental health. Part of this inconsistency might be explained by the tendency of previous studies to measure the effect of a single factor on parental mental health as well as investigating parental stress, anxiety and depression as a single outcome variable which could compromise the potential for research to clearly isolate and understand the specific factors that contribute to each mental health construct independently. Considering that it is more likely that there are multiple contributing factors which affect parental mental health, an analysis of the interplay between key factors linked to parental mental health issues will be better able to effectively assess the experiences of parents caring for an autistic child. Moreover, despite it being well established that caring for an autistic child can have a significant impact on parents despite their cultural background, the intricacy of this impact is not yet well understood across varying cultures since the bulk of research on the mental health of parents of autistic children is typically conducted in Western countries. To date, little research has investigated factors associated with the mental health of parents of autistic children in the Middle East. As such the overarching aim of this thesis was to explore how parental stress, anxiety and depression are impacted by different factors in a participant sample from Saudi Arabia through five quantitative studies. The first aim of this thesis was to explore the factors negatively affecting mental health in parents of autistic children in Saudi Arabia (Chapter 2 and 3). In chapter 2, the impact of child specific factors (i.e., challenging child behavior and autism symptom severity) on parental stress, anxiety and depression were explored. Results indicated that parents who rated their children as presenting with more severe autism symptomology also reported higher levels of stress, anxiety and depression. In order to gain a better understanding of the high levels of reported mental health issues in this group of parents, chapter 3 incorporated the factor of affiliate stigma to the previous factors investigated. Results from chapter 3 indicated that affiliate stigma was the only significant predictor of parental stress, anxiety and depression in this participant sample. Although it is common for parents with autistic children to report experiencing mental health issues, not all parents report such high levels of stress, anxiety and depression. As such, the second aim of this thesis was to explore how parents of autistic children from Saudi Arabia adaptively cope with their child's condition. In chapter 4, the buffering effect of parent-specific factors (i.e., resilience and religious coping) on parental mental health was explored. Results indicated that resilience was the only significant factor predicting lower levels of stress, anxiety and depression in this participant sample. In chapter 5, the impact of perceived social support on parental mental health was also investigated in order to explore the extent of which it could protect against stress, anxiety and depression. Results indicated that perceived social support had a positive impact on parental mental health, specifically when the source of social support was from a spouse/life partner. In Chapter 6 a more holistic approach was incorporated in order to explore the interplay between the previously investigated factors and their impact on parental mental health. The double ABC-X model was employed in this chapter for this purpose. Results from chapter 6 indicated that affiliate stigma was the only significant predictor of parental stress, anxiety and depression and that resilience and social support mediated the relationship between affiliate stigma and depression. However, only resilience was found to be a significant mediator in the relationship between stigma and anxiety. Although there are various factors associated with the mental health of parents of autistic children in Saudi Arabia, affiliate stigma seems to play a major role. Resilience has been shown to be a key protective factors against mental health issues in this participant sample. The results from this thesis have important implications for clinical practice and future research. It is evident that there is an urgent need for Saudi Arabia to tackle the issue of mental health stigma effectively, and for healthcare and intervention providers to help parents develop their resilience skills and encourage them to seek social support to ensure the overall wellbeing of both parent and child.

Severe mental health issues are a substantial contributor to the global disease burden, and a significant cause of maternal morbidity and mortality in the perinatal period, with a prevalence of 1 in every 1,000 births. Women with a diagnosis of severe mental health issues (SMHI) are at higher risk of suicide or being admitted to hospital in the postnatal period. In addition, having a SMHI diagnosis influences the mother's relationship with their infant which can have further implications for both. While maternity services in the UK have gradually adopted more responsibility for women with SMHI, there are several factors such as stigma, discrimination and isolation, social, economic and physical environment inequalities that challenges the care for them. Currently, there is a lack of understanding for SMHI mother's postnatal experiences. Thus, there is lack of evidence on how to best address these challenges for them and improve their postnatal experiences and ultimately help with reducing the risk of hospital readmissions or suicide. The goal of this research was to understand, explore and develop a theory-based model on the experiences of women with SMHI in relation to motherhood during the postnatal period. A constructive grounded theory was employed, which was underpinned by the theoretical perspective of symbolic interactionism. Ten women with SMHI were interviewed with the focus on their postnatal experiences in relation to motherhood. The semi structured interviews were conducted online, and participants were recruited from mental health hospitals in accordance with ethical approval standards. The age of participants were from 18 to 49 years with different social backgrounds. Data analysis was according to grounded theory method utilising a constant comparison approach, and theoretical sampling was facilitated by Mind genius software and Nvivo. The generated Resilience-Led Behavioural Model (RLBM) for supporting SMHI mothers in the postnatal period had three categories. 1. personal resilience associated with coping mechanisms, hopes and sleep deprivation; 2. social context, such as family support cultural and religious issues, and stigma affecting access to services and 3. childbirth experiences, including met and unmet needs, anxiety, fear, bonding and attachment. The core category was personal resilience, which seemed to have the greatest influence on participants experiences. They strived towards coping and adopting positive changes with effective support from families concerning their motherhood role. Accepting the reality of a situation, although it is unpleasant and uncomfortable, is a crucial component of cognitive flexibility. The RLBM highlights the behavioural changes and resilience adopted by women during their transition into motherhood. The RLBM, therefore, creates awareness and introduces new ways and ideas on coping for women with SMHI in relation to motherhood during the postnatal period.

As the world of work becomes more stressful so does the threat to employee well-being and productivity. Airline cabin crew are front line, safety conscious employees who are faced with a diverse range of job exposures and who operate in extreme situations whilst also managing varied levels of fatigue, sleep deprivation, jet lag, loneliness and around the clock shift patterns. The psychological well-being of aviation employees has been gaining more prominence in recent years due to an increase in fatal crashes and aircraft mishaps where pilots in particularly have suffered with mental health issues. Cabin crew however are often employees who are overlooked as they have differing exposures, demands and pressures associated with their role yet just like pilots they experience psychological challenges which can be detrimental to their well-being. Several theoretical models have been suggested which help to gain better understanding of employee stress and burnout with the JD-CS Model having most relevance to this study and its participants. A questionnaire was used to collect views from a sample of 1431 UK based cabin crew employed across seven different airlines representing full cost, low cost, and charter airline carriers. A small number of key informant interviews were also carried out with crew representatives. Some of the results from the study have detailed what the key stressors are for cabin crew in their day-to-day employment and have also linked to supporting the ISO strain of the JD-CS Model. Suggestions have been made as to how some of the stressors identified in this research can be better addressed within the aviation industry to promote a better level of well-being for all concerned.

This commentary argues that stereotypical representations of intellectual disability in cinema indirectly cause discriminatory behaviours towards people with intellectual disabilities that restrict their social interactions, agency and, in some cases, their human rights. These misrepresentations are so pervasive that they are accepted by many as truths. By acknowledging the medical model of disability, and application of the social and cultural models of disability, could an ethical approach to filmmaking practice be used in the creation of work that would inform, entertain, and change public perceptions of intellectual disability? My methodology would employ the principals of "considered filmmaking". Using academic rigour to research, consult with, and accurately represent adults with intellectual disabilities, a feature film could be made that rejects stereotypical representations for faithful portrayals of people with intellectual disabilities by authentically casting actors with those disabilities. The result of this research question was Sanctuary (2016): a romantic comedy about the forbidden love shared between a man with Down's Syndrome and a woman with epilepsy. Questions that evolved from the making, screening and distribution of the film informed the making of a documentary, Altered Thinking: An academic film essay (2020) which examines the context and history of ID in cinema, the methodologies of making Sanctuary and a critique of industry responses to inclusive and diverse film making. The work in this portfolio is critically investigated for its contribution to new knowledge and understanding in the fields of filmmaking practice and disability representation. Can "considered filmmaking" change public perceptions of, and give greater agency to, people with intellectual disabilities?

The present research explores the effects of school-based metacognition and mindfulness interventions to improve emotion regulation in primary school children. Children with effective emotion regulation skills have better outcomes in wellbeing, academic achievement and life-satisfaction. Improving regulation skills can help to prevent depression, anxiety and other mental health disorders. Previous literature suggests that emotion regulation can be improved by mindfulness interventions, delivered in primary-school settings. Mindfulness-Based Interventions (MBIs) tend to be a combination of taught material and meditative practice but it is unclear how each of these elements contribute to outcomes. Felver et al. (2016) suggested that an exploration of these different elements would be beneficial, and this exploration forms the basis of this thesis. A series of five quasi-randomised controlled trials were carried out to explore the effects of a classroom-based mindful meditation alone, and in combination with a structured thinking activity or a separate taught component. Finally the effectiveness of a pre-recorded integrated programme, combining mindful meditation and a taught component was examined. Measures were included on attentional outcomes (selective and sustained attention, and mindful awareness), cognitive appraisal (emotion recognition, anxiety and affect) and emotional response (academic outcomes, coping and anger). Each study included 9-11 year old children who attended mainstream schools. The findings from the experimental series suggest that mindfulness based interventions do significantly improve aspects of emotion regulation. However, mindfulness based interventions with a taught component (MBI+) are more effective than mindfulness alone. MBI+ showed improvement across attentional outcomes, cognitive appraisal and emotional response. This was the case for both classroom-based and pre-recorded delivery. To better understand the mechanisms of change, future research needs to provide in-depth, qualitative knowledge of pre-adolescent participants' application of mindfulness and metacognitive strategies. With the increasing mental health challenges evident in primary schools, due in part to the COVID 19 pandemic, the effectiveness and feasibility of a pre-recorded programme should be explored further. This mode of delivery would mitigate some of the challenges surrounding staff knowledge and expertise within the primary school environment.

The ageing population has led to a range of societal issues, and research needs to identify ways to promote healthy ageing and independent living for longer. One such area of interest in this area is diet and supplementation, which has focused on improving aspects of psychological and psychical health in older adults. However, there have been clear methodological limitations within this research, including stringent inclusion criteria and no measure of dietary intake. Furthermore, nutraceutical research has focused on very specific outcome measures which do not have clear real-world applicability. This programme of work aimed to address these limitations, and further knowledge in the area by taking novel approaches to assess and improve everyday functioning in older adults. The first experimental study reported in Chapter 2 aimed to explore older adults' own views of their perceived levels of everyday functioning and in which areas they would like to see improvements. It was identified through thematic analysis that older adults reported difficulties with a range of activities (such as recreational hobbies and household tasks) which stemmed from underlying health and mobility issues. Furthermore, the themes found within this study were used as a guide to design outcome measures for the subsequent intervention (Chapter 3), with the aim to undertake a participant-led approach to study design. Chapter 3 reports an experimental, randomised, placebo-controlled, double blind parallel groups study, investigating the effects of a multivitamin supplement on everyday functioning in older adults. This trial was designed to improve on issues with previous trials, and to incorporate areas highlighted as important to older adults in Chapter 2. Results showed that 12-week multivitamin supplement improved feelings of friendliness in females and reduce measures of prolonged stress reactivity and emotional loneliness in males. Furthermore, a range of interactions were found between habitual dietary intake and multivitamin supplementation, indicating that supplementation may be more effective in those with lower nutritional intake. Chapter 4 explored how habitual dietary intake before supplementation effected everyday function outcomes. The aim of this was to both add to the vast literature in this area and to fully understand interaction found within Chapter 3. Surprisingly results of this study showed that those below the mean intake of various vitamins and minerals (in this sample) performed more favourably on everyday function outcomes. Suggesting that there may be an inverted U shape curve in relation to vitamin and mineral intake and favourable outcomes in everyday functioning, which warrants further exploration. Finally, Chapter 5 reports a naturalistic repeated measures design, exploring the effects of COVID-19 lockdown on everyday function in older adults. It was shown that the government lockdown in response to the COVID 19 pandemic had largely negative implications for wellbeing, mood, perceived stress and memory in older adults, but there were improvements in general health, physical activity and social interaction. There are clear applications going forward for ways to minimise harmful side effects of stressful situations in older adults. Overall, this programme of work has clear and important implications. As well as implications already mentioned in this abstract, it highlights that multivitamin supplementation in older adults may have the potential to elicit positive effects on everyday functioning. With these effects being even more pronounced in those who have worse diet, suggesting supplementation should be recommended in older adults who do not consume adequate levels of vitamins and minerals.

One in eight UK Armed Forces personnel will seek healthcare from military services for a mental health related issue (Ministry of Defence, 2020). Furthermore, the presence of a mental health illness is the second most leading cause of divorce within the serving military population. A review of the literature found only one qualitative study exploring the experiences of UK military spouses 'providing informal care to wounded, injured or sick (WIS) personnel' (Thandi et al, 2016; p 1). However, it is noted that not all the WIS personnel in this study had a mental health issue. There appears to be no current qualitative research which specifically explores military spouses' experiences of living alongside a UK serving partner with a mental health issue. This study therefore aimed to explore the military spouse's lived experience with a view to understanding and informing future developments of supportive strategies specific to military spouses. The study used a qualitative, biographical methodology, collecting data through life stories. Two face-to-face semi-structured interviews took place with nine military spouse who were recruited through military spouse networks and snowballing. The military spouses were all married to UK Army personnel across a range of ranks. Lieblich et al.'s (1998) work offers framework for analytical pluralism, which encompasses both the completeness of the story and the generation of themes or categories. Following Lieblich et al.'s (1998) two-stage life story analysis approach, the participants' stories are presented in the stages 'in the beginning', changing times' and 'this is me'. Using Lieblich et al.'s (1998) categorical - content approach, six overarching categories were identified. The study is the first of its kind within the UK. Several original contributions to knowledge arose. The study emphasizes how the mood status of the military spouse is affected by their serving partners mental health status. The study also illustrates the military spouse experience in the period before diagnosis. The study highlights the challenges faced, relationship protective factors and the effects on the marital relationship. It emphasizes the need for support and inclusion strategies of the military spouse from treatment services, in order to keep the military spouse well, provide vital support and aid the recovery journey of their serving partner. The study illustrates the lack of both formal and informal support because of the perceived stigma and fear of being judged. Finally, the convergence of findings facilitated the generation of a conceptual U-curve illustration depicting the trajectory of the military spouse's journey of living alongside their serving partner during a mental health issue.

Language is inherently ambiguous. Words or phrases often share multiple possible meanings, and changes to the circumstances of a conversation can alter how a person chooses to produce (and interpret) language. This is especially important in the context of health communication because talking about human health is sensitive, increasing the potential for ambiguity (and therefore misunderstandings). This thesis examined pragmatic (contextual) factors that influence the production and comprehension of ambiguous language within a health context. To achieve this goal, we applied the principles of Experimental Pragmatics by manipulating the social circumstances surrounding three ambiguous language forms. Specifically, we examined the use and interpretation of (1) Uncertainty Terms (e.g., 'perhaps' or 'maybe'), (2) Quantifiers (e.g., 'some' or '1-in-X') and (3) Generic generalisations (e.g., 'music helps old people'). Across eight pre-registered Open Science experiments (N = 4143), we found that contextual factors significantly affect language production and comprehension. Speakers will be subtly indirect when delivering uncertain threatening news, rather than using explicit uncertainty terms such as 'possibly'. Speakers also use quantifiers such as 'some' or 'many' to manage threat, by downplaying the likelihood they communicate. The '1-in-X' bias and the severity bias cause overestimations of health risk, but they do so independently. Severe outcomes are not considered more likely to occur when they are qualified with a proportional quantifier (e.g., 'a few'). Finally, universal generics (e.g., 'supplement improves function in men') are inviting to writers motivated by appeal, but they risk exaggerating the importance and generality of research findings. The use and interpretation of speech is governed to a large extent by context, so our findings carry implications for effectively communicating health information to the public. The delicate nature of discussing human health offers an opportune window into the psychology of language.

The stilbene polyphenol resveratrol has been shown to interact with several health-promoting mechanisms, which might impact cognitive performance. However previous research has indicated that resveratrol supplementation is not able to impact cognitive performance in young, healthy adults; despite consistent ability to modulate cerebral blood flow. Recent work suggests that resveratrol supplementation may be more beneficial in individuals who are compromised by age, disease, or overweight status. Specifically, obese individuals are characterised by a multitude of health issues including sustained inflammation, elevated cholesterol levels; excessive fat accumulation and neuroinflammation; here resveratrol supplementation offers a therapeutic option. Moreover, a recent shift in literature focus indicates the importance of gut microbial composition on host-health; and specifically, how this can be modified by dietary intervention. Obesity is associated with dysbiosis of the microbiota, disruption to the intestinal barrier and exacerbated pro-inflammatory response; where it is hypothesised that polyphenol intervention may have the capability to modulate microbial composition and exert health-promoting effects. With said health promoting effects of polyphenolic-gut-modulation potentially also extending to cognitive function, via the gutbrain-axis. Therefore, the two randomised, placebo-controlled, double-blind intervention trials included in this thesis aimed to investigate the effects of resveratrol supplementation on cognitive function, cerebral blood flow, inflammation and gastrointestinal microbiota in healthy adults of varying weight status. The key findings here indicate that as in young, healthy adults, resveratrol supplementation results in clear modulation of CBF in healthy overweight-obese adults. Furthermore, it confirms that within this population, resveratrol is unable to exert cognitive enhancing effects, with limited evidence of a detrimental effect observed. Limited changes in microbial composition indicate that this is likely a promising avenue for future investigations of either resveratrol or other polyphenolic or dietary intervention.

Background and Objectives: Literature from a number of domains suggests that intrasexual selection has been a strong mechanism in shaping men's traits and behaviour. Due to the physical conflict that men have historically engaged in with each other, it is theorised that we have developed cognitive mechanisms to assess physical dominance from a variety of cues. The aims of this thesis are to understand how physical dominance is encoded into the walking gait of men, and investigate how observers decode these cues. Design: All studies were quantitative and contained two stages, a stimuli creation and ratings of the stimuli. Stimuli creation utilised motion capture techniques to gather movement in a precise and digitised way. This involved placing 39 retroreflective markers on the major joints of the body to capture each body segment with six degrees of freedom. These were transformed into featureless avatars using professional animation software to ensure that anthropometric or other visual features (e.g., build, weight, hair, clothing) were not on display. Methods: Stimuli was presented to participants across four studies to rate on physical dominance and likelihood of crossing the road to avoid the man. Results: It was found that ratings of physical dominance had a consistent link with the strength and physical size of the man, where stronger and physically larger men were rated higher in physical dominance and were more likely to be avoided if they approached the observer on a dark night. Preliminary biomechanical analyses suggests that a pendulum like movement between the mid-hip and mid-back strongly increased perceptions of physical dominance. Participants were also able to differentiate between baseline and threatening walks in studies three and four, suggesting that men alter their movements when confronting an opponent. Conclusion: Overall, the findings suggest that men alter their movement when acting in a threatening manner, their build is clearly encoded into their gait, and the amount of swing in their motion may be a key factor in observer's perceptions of their dominance. Together, this thesis provides vital new knowledge into our understanding of how men have evolved to display physical dominance and that we can decode these cues and take action.

The study of expertise helps us not only understand outstanding expert feats, but also processes and mechanisms leading to and underlying expert performance. In this thesis topic of expertise is approached through multiple perspectives, utilizing both experimental and correlational designs. In order to provide more precise, sensitive and robust data analyses, multilevel, structural equation and Bayesian modelling has been used throughout all of the studies conducted for this thesis. In Study 1 (Chapter 2) the importance of kinetic, domain-specific knowledge, for experts ability of anticipation has been demonstrated by comparing anticipatory ability of expert (N=10) versus non-expert handball goalkeepers (N=10). This study emphasizes necessity of utilization of movement analysis for choosing parts of movement sequences relevant for anticipation; as well as necessity of combining outcome measures (accuracy and reaction time) for deepening our interpretation and understanding of underpinning cognitive processes. In addition to that, two studies (Studies 2 and 3 in Chapters 3 and 4, respectively) underline the role conative factors play in expert performance, practice and development of expertise. Analyses conducted on performance, practice and grit data (Study 2, Chapter 3), collected on a sample of elite youth Australian soccer athletes (N=388), showed that grit has a sizeable positive influence on performance (β=.44), and its influence is both direct and indirect (through practice). Furthermore, in Study 3 (Chapter 4) grit has been shown to influence acquisition of practice during early development, differentiating among the players of different skill and leading to snowballing effects of the amount of accumulated practice hours. Finally, in Study 4 (Chapter 5), an analysis was conducted of real-life performance data of NBA players (N=400), and age-related changes in the performance, over the span of players' careers, showing that greater pre-peak increase (up to the age of 27) in performance was followed by shallower and slower post-peak decline, regardless of the position players' played. These findings not only help better understanding of expert performance, its development and retainment throughout lifespan, but also have the potential to extend beyond the laboratory by adding to the creation of training regimes and talent identification/development programs.

Across multiple domains, higher levels of psychological flexibility have been found to be associated with lower levels of stress and higher levels of performance. Psychological flexibility is also thought to be related to coping style, with those higher in psychological flexibility thought to use more approach and less avoidant coping strategies. However, evidence to date is largely based on cross-sectional correlations and/or artificial stressors, meaning that the nature of these relationships are unclear. The primary aim of this study was to examine whether and how psychological flexibility relates to stress and perceived performance, using university exam stress and performance as an opportunistic, predictable, real-world testbed. A secondary aim was to examine whether baseline psychological flexibility was predictive of the strategies that people use to cope with stress. A further aim in the extended paper was to examine whether the effects of psychological flexibility on stress are attributable to differential coping responses. Ninety-two undergraduate students were recruited to the study. A prospective longitudinal design was utilised to consider the relationships between psychological flexibility, stress and performance. The relationship between psychological flexibility and coping was also considered. There were four data collection points, with participants completing measures on psychological flexibility, stress, coping styles and wellbeing at each timepoint. At the timepoint which coincided with their perceived most important exam, participants were also asked questions on their perceived performance. Multilevel modelling was used to analyse the relationship between psychological flexibility and stress as well as coping styles. Correlational analyses were run to analyse the relationship between baseline psychological flexibility and perceived performance. A multilevel mediation was run in order to examine whether the relationships between psychological flexibility and stress could be attributable to differential coping responses. Psychological flexibility was found to be associated with lower levels of stress at baseline. However, during the stressor, there was no interaction effect between psychological flexibility and stress. The magnitude and direction of observed correlations indicated that psychological flexibility may enable individuals to harness stress and (potentially through this) to perceive that they had performed better in their exams - although there was limited power for these latter analyses. Psychological flexibility was associated with less use of avoidant style coping strategies. However, whilst psychological flexibility seems to overlap with coping strategies, the mediational analyses provide support for the hypothesis that psychological flexibility is independent of coping strategies. Therefore, rather than psychological flexibility being the absence of avoidant coping and/or the presence of approach coping, psychological flexibility appears to be characterised by taking effective action. As psychological flexibility is malleable, it may be a suitable target for intervention to promote an increased ability to harness stress. Future research could focus on the utility of ACT based interventions and track the influence of increased psychological flexibility on an individual's stress and performance.

Due to extended military commitments and deployments to Iraq and Afghanistan over the last 20 years, the ferocity of combat has led to some serving members of the military returning home with physical and mental health issues including Post Traumatic Stress Disorder (PTSD). Many of these individuals are parents and their PTSD diagnosis is likely to have a significant impact on their children. Much of the research which has been undertaken in relation to military families points to a lack of supportive structures post combat operations and highlights poor family integration and functioning leaving many children within the military community at risk of presenting with behavioural, emotional and mental health issues. Young carers are a group of children and young people who provide a vital role within their families and their communities by providing unpaid care to a family member over prolonged periods of time. It is not known how many children and young people within the military community undertake caring responsibilities and to date no studies have explored the emotional impact of being a young carer to a veteran parent with PTSD or investigated the impact that providing care has on child/parent relationships. This study sought to identify the lived experience of young carers of veterans with combat related PTSD by investigating their own perspectives as well as the perspectives of their mothers. Narrative inquiry was used to capture the narratives of the young carers in order to understand the emotional impact that caring had on them and how it impacted on their relationship with the parent with PTSD. The narratives of the young carers' mothers were also captured. This enabled the researcher to produce stories of how young carers who were caring for a veteran parent with PTSD were able to renegotiate family life and family relationships and manage their emotions post diagnosis. The theoretical lens of this study is situated in Symbolic Interactionism (Bulmer, 1969), an ontological assumption based on the belief that reality is 'socially constructed', and an emic epistemological foundation built on subjective lived experience. The study investigated how the young carers orientated their thoughts, feelings and emotions based on their activities of daily living and their interactions with their families, friends, and their community, whilst providing care for a veteran parent with combat related PTSD. Interviews were used to capture and explore the participants' narratives. Using Narrative Inquiry as a qualitative method and subsequently inquiring into the meaning of the narratives furthered understanding of family relationships and roles undertaken within the family environment. It also furthered understanding of what it is like to care for a parent with PTSD by capturing the emotional costs for the child by considering their lives pre-PTSD presentation as well as post-PTSD diagnosis. Qualitative interviews with 4 young carers from 3 families and their mothers were used to address the aims of the study. The young carers, two girls and two boys who were aged between 12 and 16 years of age were all providing care to a veteran father or stepfather, but they did not necessarily identify as 'young carers'. The findings of this study suggest there may be common experiences amongst young carers who care for a veteran with PTSD. All of the participants' emotional health was adversely affected by being a young carer to a father/stepfather with a PTSD diagnosis as was their social connectedness and the functionality of their family. However, whilst the young carers within this study all shared similar experiences in terms of providing care for a father with a diagnosis of PTSD due to military combat exposure, each family, and each young carers' experience was unique. The findings suggest there is a need for policy makers and service providers to devise a universal definition of 'what' a young carer is in order to aid identification of young carers in military families. There is also a need to provide specific service provision for young carers from the military community so we can better meet their unique needs. This should be co- constructed with young carers themselves and their views should inform future policy developments. The findings suggest those who provide support to young carers and their families may also benefit from military awareness training.

Objectives: Design: Focus group session with British Association of Art Therapists regional group; narrative literature review; international survey; development of a treatment manual and validation via expert panel using rubrics, qualitative questionnaires, and Reflexive Thematic Analysis. Participants: International Art Psychotherapists; expert panel members including people with lived experience. Main analysis tools: Hierarchical cluster analysis, SPSS, rubrics and Reflexive Thematic Analysis. Adults who have complex trauma can experience mental ill health that invariably results in significant restrictive impact upon their lives. The purpose of this study was to identify what components and contexts of Art Psychotherapy practice support recovery and healing for people who have compromised mental health resulting from experiences of complex trauma. Four stages within the study were completed, consisting of a focus group and narrative literature review; an international survey; the development of a therapeutic treatment manual; and the validation of the manual which included the completion of rubrics, narrative interviews and Reflexive Thematic Analysis. International Art Psychotherapists treating people with complex trauma were invited to answer four categories of questions: participant information, environment, practical/clinical components, and additional information. Whilst there is a good evidence base for the uses and effectiveness of Art Psychotherapy in general, there has been little causal analysis of which mechanisms and contexts of Art Psychotherapy can prove effective. The survey data identified that expert practitioners consider positive therapeutic impact to be associated with specific art medium, the therapeutic environment, and clinically informed approaches. The focus group, narrative literature review, the findings from the international survey, and clinical experience and expertise informed the development of a therapeutic treatment manual, Unification Neuro-informed Trauma Reconsolidation Art Psychotherapy (UNTRAP).

This research is the first to investigate the experiences of Saudi female international doctoral students accompanied by their families in the UK. It is also the first study to explore Saudi third culture kids' (TCKs) and their mothers' perspectives about their re-entry experiences in the homeland. Using a qualitative approach and applying models of cross-cultural acculturation and adaptation, cultural dimensions and resilience, the research presents an in depth exploration of varied aspects of participants' adaptation and resilience, as well as those of their family companions. Also, the consequences of the cross-cultural experiences in the host and home countries were reported. Interviews were conducted in three studies and responses were analysed using thematic analysis. A systematic review of previous research was used to identify the research focus and sample for the first study which explored the experiences of Saudi female doctoral students while studying in the UK. In the second study, Saudi student-mothers shared their experiences of parenting and family life while studying in the UK. In the third study, the experiences of Saudi children after the families' return to Saudi Arabia were explored through interviews with mothers and their children. Several individual and societal variables influenced the Saudi female students' and their companions' experiences in both the host and home countries. Key features across the three studies were the central role of family, and religion in shaping the women's adaptation and resilience. Family emerged as a subject of their concerns and challenges in home and host country, while also being perceived as a source of emotional and instrumental support. Religion and religious identity were strongly present in the women's articulations of their personal strengths and positive experiences, and it aided them in achieving psychological and sociocultural adaptation. Both negative and positive consequences of the adaptation experiences in the host country were identified for the women, their spouses and children. These consequences were more apparent on the children than on their parents. Return to the VI homeland highlighted the presence of a third culture identity in these children. As returnees, Saudi 'third culture kids' experienced several challenges in school as well as in social life. The implications of this research are beneficial to service providers, both in host and home countries, to improve services to support Saudi female students and their adult and child companions before, during, and after their cross-cultural journey.

Schizophrenia and psychosis-spectrum disorders are devastating for the affected individual and pose a considerable burden on society. High levels of schizotypy, a collection of traits such as unusual perceptual experiences, cognitive disorganisation, and social anhedonia, have long been recognised as risk factor for the development of schizophrenia, with a substantial prevalence of high schizotypy observed in non-clinical population. Psychological and physiological stress reactivity have been identified as potential mechanisms for moderating vulnerability for the development of psychopathology, leading to the proposal of the diathesis or vulnerability-stress model of schizophrenia. However, only little research exists assessing the stress response in schizotypy, exposing a gap in our understanding of the interactions between factors of vulnerability and resilience in schizotypy. Therefore, this thesis aimed to comprehensively explore the relationship between schizotypy levels in non-clinical populations and the core vulnerability-stress model factors such as genetic risk represented by minor haplotype of FKBP5 (a gene associated with endocrine stress response), epigenetic markers such as methylation levels of FKBP5, early life adversity, chronic stress, as well as resilience factors, such as perceived levels of resilience and coping strategies. In a set of five studies perception of early life stressors, recent life stressors, acute laboratory stressor (Trier Social Stress Test), chronic stressors, and a real-life stressor (COVID-19 pandemic) as well as perceived resilience and coping preferences were investigated in the context of schizotypy. For the first time, not only acute salivary cortisol levels but also chronic levels of cortisol, DHEA and of other related steroids were measured in hair of individuals preselected for high and low schizotypy, using the state-of-the-art techniques such as ELISA and LC-MS/MS. Overall, and in line with the initial hypotheses, high schizotypy levels, in partial interaction with genetic predisposition and environmental adversity, were associated with higher stress sensitivity and poorer stress management than low schizotypy levels. This was characterised by attenuated physiological and increased psychological response to acute and chronic stressors, as well as perception of higher vulnerability and lower resilience. Increased stress perception was associated with all schizotypy subscales. All but negative schizotypy subscales were associated with acute and chronic cortisol response. A prospective-design study over six months identified the increased use of maladaptive coping strategies to mediate the relationship between schizotypy and levels of depression and anxiety. Contrary to the hypothesis, no direct genetic effect of stress-associated genotype of FKBP5 or FKBP5 methylation on schizotypy were found. However, an interaction effect between minor FKBP5 haplotype and childhood trauma showing lower schizotypy levels was observed, suggesting a potential protective effect of minor FKBP5 haplotype in the context of low to moderate early adversity. Based on these findings, an extended vulnerability-stress model of stress response in schizotypy was proposed to incorporate possible molecular and behavioural mechanisms. Thus, the present thesis contributes to a more comprehensive understanding of the relationships between schizotypy, stress response, and resilience. This knowledge might facilitate future development of more individualised and targeted interventions to improve stress management in high schizotypy and lower vulnerability to developing psychosis in some individuals.

The aim of the current thesis was to investigate the views of senior stakeholders, staff, parents and children on the operation of the Kitchen Social holiday programme and the potential impacts on parents and children's wellbeing. This thesis also aimed to examine the impacts of the Kitchen Social holiday programme on children's nutritional intake and children's physical and sedentary activity levels. This thesis is important as it provides a novel insight into a holiday programme which supports low-income families who may be experiencing holiday food insecurity. A mixed methods research design was utilised in this thesis for an initial qualitative research study which informed the following two quantitative studies. Study 1 involved a qualitative research design to explore the views of senior and key stakeholders on the operation of Kitchen Social and the potential impacts that this has on the wellbeing of children and parents. The findings of Study 1 show that hubs involved in the Kitchen Social programme differ in the delivery and organisation, yet all hubs are required to adhere to the Kitchen Social guidelines. Study 1 also demonstrates that the holiday hubs have a positive impact on the wellbeing of parents and children due to the increased opportunities to socialise, learn, take part in enriching, creative and physical activities, receive childcare in a safe environment, and access nutritious food. However, the benefits service users gain from attending the hubs may differ depending on the hub they attend. Study 1 considered the need for holiday hubs to receive government funding for hubs to be sustainable and expand to support more families who may benefit from attending a holiday hub. Study 2 investigated the number of, and amount of time children spend in physical and sedentary activity levels during the school summer holidays when children attend a holiday hub compared to the school term. Study 2 also investigated children's adherence to Physical Activity Guidelines and the amount of energy children expend during the school summer holidays when children attend a holiday hub compared to the school term. Children (N=37) aged 10-14 years old completed the amended Youth Physical Activity Questionnaire (YPAQ) on two separate occasions: once during the school summer holidays and once during the school term. The Y-PAQ collected data on the type and time spent in physical and sedentary activities across 3 consecutive days, prior to the day of completion. The Youth Compendium of Physical Activities allowed the researcher to estimate the amount of energy expended from activities. The findings demonstrated that children participated in a higher number of physical activities for a longer amount of time, and sedentary activities for a shorter amount of time during the school summer holidays compared to the school term. Yet, there was no difference in the number of children adhering to PA guidelines, and the amount of energy children expended during the holiday hub versus school term time. Study 3 viewed the impact of holiday hub attendance on children's diet quality and adherence to the School Food Standards (SFS) using a quantitative research design. Data on the food and drink intake of children (N=56) aged 7-16 years old was gathered from children using a 24-hour recall method. Children recalled the food and drink they consumed the prior day from waking up to falling asleep that evening on two separate occasions; once based on an attending hub day and once based on a non-attending hub day. The Young Persons Food Atlas was used to ensure data on portion sizes, cooking methods and brands were collected. The results of Study 3 showed that children's diet quality improved and children more closely adhered to the SFS on an attending hub day versus a non-attending hub day. The studies in this thesis offer insight into the operation and potential benefits of a holiday programme to inform stakeholders involved in organising, implementing and delivering a holiday programme across the UK. These study findings are well-timed as the government has recently announced funding for the Holiday Food and Activity programme across England. This thesis also highlights future studies to provide further knowledge on the best practice of operating and delivering a holiday programme.

Background: There is a growing awareness of gambling as a public health issue in Great Britain, whereby harm occurring from gambling extends beyond individuals with a diagnosis of gambling disorder. Gambling marketing has been highlighted as something which may contribute towards gambling harm. The gambling industry in Great Britain is placing increasing focus upon marketing their products on social media. However, minimal research has focused on how gambling is marketed on social media in Great Britain or how bettors respond to such marketing. Methods: An observational approach was taken within the first two studies in order to assess: the types of content included within gambling marketing on social media, the underlying messages of such content, the types of bets advertised and the success of advertised bets. An interpretative phenomenological analysis was carried out upon qualitative data from 10 frequent gamblers to explore how they think about gambling marketing. Two quantitative, online experimental studies were also carried out to assess how regular bettors respond to examples of advertisements on social media and whether social media can be used to effectively promote safer gambling. Findings: Concerns were highlighted about both the frequency and content of social media marketing. Bets included within marketing were largely unsuccessful and simulation data highlighted that the chances of making money upon advertised bets decreased as the number of bets included within the simulations increased. Gambling affiliate marketing was highlighted as a specific concern, given their large number of direct advertisements and their positioning as 'betting communities'. Bettors were found to place increased confidence in affiliate marketing for specific types of bets. They also perceived marketing as something that they could take advantage of to increase their chances of winning, whilst acting as a risk factor for those perceived as being vulnerable. Receiving safer gambling messages on social media for two weeks led to a reduction in gambling behaviour compared to the previous two weeks, however further research is needed to clarify whether the messages were responsible for the observed changes. Conclusions: Findings highlight numerous ways in which social media marketing has the potential to contribute towards gambling harm. Increased regulation of both operator and affiliate marketing is required to ensure such marketing is conducted in an open and safe manner.

The study involved two separate groups of young people aged between 16-19, all of whom had been excluded from mainstream education and identified as 'vulnerable' due to perceived behavioural, social or emotional difficulties. Ten participants engaged in a relationship-building programme involving horses, that had previously had a positive impact on similar groups of young people. Over a period of three months, the participants shared their experiences of achievement and purpose through their authentic, unique interactions and relationships with horses, and effective communication with others. They gained first-hand experience of the size, difference and potential power of the horse; an 'other' through which each participant could re-encounter their self (Levinas, 1961). The data reveals that these experiences elicited feelings of wonder, elation, anxiety, fear, frustration and empowerment. Through learning to recognise horses' non-verbal clues, young people developed greater capacity to appreciate the ways in which horses communicate their emotions or intentions, and to respond sensitively. They learned how to coordinate their experiences, feelings and non-verbal language in order to form a partnership of kinaesthetic empathy, rather than a dynamic characterised only by dominance or submission. This was balanced with an awareness that they needed to be consistently attentive, or the balance of expectations and control might shift. This mixed method ethnographic study gathered and examined data from focus groups and interviews. In addition, it employed statistics derived from the Rosenberg Self-Esteem Scale (Rosenberg, 1965). The data were collected at three points: before, during and after the programme. Field notes and photo elicitation (Rose, 2012) provided additional sources of information throughout the study. Findings indicate that the transformational value of interacting with horses has social and psychological benefits. The self-reported increases in confidence, new coping strategies and personal insights that the young participants developed during the programme, along with improved self-esteem scores, suggest that such activity can channel young people's interest and motivation into a sense of eudaimonia, meaningful and rewarding outcomes, and the development of a range of transferable skills.

Iron is an essential nutrient required for numerous biological processes, particularly concerning brain function. However, iron deficiency is the most prevalent nutrient deficiency worldwide. Although previous research regarding the effects of iron status and iron supplementation on psychological and physiological outcomes is extensive, there are several methodological limitations relating to heterogeneity in iron status cut-offs, sample populations, and supplementation dosage, duration and formulations. Research has also largely focused on iron deficiency anaemia with less known about non-anaemic iron deficiency (NAID), despite the increased prevalence of NAID among women of reproductive age. Therefore, this thesis aimed to investigate iron status and the effects of iron bis-glycinate chelate supplementation on cognitive function, subjective fatigue, mood and wellbeing in iron sufficient (IS) and NAID women of reproductive age. Vitamin C co supplementation was also explored as well as any differential effects of this on cognitive function, subjective fatigue, mood and wellbeing. Chapter 2 describes a cross-sectional study that explored the association of haemoglobin and serum ferritin with cognition, subjective mood, fatigue and wellbeing whilst controlling for the confounding effects of dietary iron, menstrual blood loss, physical activity and body mass index. Chapter 3 describes a systematic review of findings from randomised controlled trials investigating the effects of iron supplementation on cognitive function, mood, fatigue and/or wellbeing in women of reproductive age. Chapters 4 and 5 describe randomised, placebo-controlled, parallel groups trials of a 16-week intervention with iron bis-glycinate chelate or iron/vitamin C co-supplementation. Effects on cognition, subjective mood, fatigue and wellbeing (Chapter 4) and cerebral haemodynamics and whole-body energy metabolism at rest and during cognitive demand (Chapter 5) were assessed in IS and NAID females. Serum ferritin concentrations were positively associated with emotional functioning and mental health. Although iron status improved following iron/vitamin C co-supplementation, treatment effects of both iron and iron/vitamin C were limited and mixed. Iron treatment alone reduced feelings of depression and total mood disturbance yet engendered an unexpected reduction in physical component summary scores. However, iron/vitamin C treatment resulted in improved serial subtraction accuracy whilst increased total haemoglobin concentrations were found during cognitive demand for NAID women compared to IS women. Taken together, these findings suggest that iron treatment can be beneficial for certain aspects of psychological functioning and that the lack of cognitive differences between NAID and IS women of reproductive age may be due to cerebral haemodynamic compensation.

Emotion dysregulation is central to bipolar disorder and is also experienced by people considered to be at risk of mania. Several models of bipolar disorder, such as the Depression Avoidance Account (Abraham, 1911; Neale, 1988), Positive Emotion Persistence (Gruber, 2011) and Integrative Cognitive Model of mood swings (Mansell et al., 2007) highlight the relevance of use of emotion regulation strategies to the development and maintenance of mood symptoms. It is therefore suggested that understanding how emotion regulation relates to affect outcomes in the context of mania risk may help to identify people at risk of transition to bipolar disorder. Previous work has typically focused on the influence of negative affect regulation; however, the strategies used in response to positive affect are also understood to be relevant to general well-being and psychopathology, particularly bipolar disorder, but are less extensively researched. Additionally, where these associations have been explored, findings are often mixed, possibly as a result of lack of consideration of potential contextual moderators of the influence of emotion regulation strategies on affect, notably the beliefs individuals endorse about the malleability of emotions, and their social, and situational settings. In addition to a systematic review that presents extant evidence relating to emotion regulation in mania risk, four studies were conducted to 1) explore the potential moderating role of use of positive emotion regulation strategies on the associations between mania risk and affect outcomes, 2) assess how beliefs about emotion malleability relate to mania risk and use of positive emotion regulation strategies, and investigate if 3) social and 4) situational contexts moderate the relationships between use of these strategies, mania risk and affect outcomes. Findings suggest that mania risk and emotion regulation strategies share similar associations with affect, however these relationships are independent rather than moderating. Additionally, trait tendencies to use specific strategies appear to be more influential that context-specific regulation, however further research exploring dynamic associations between contextual factors with high-risk populations is needed.

Depression is a major mental health problem in the UK and is particularly problematic within older adults. In addition, tackling the symptoms of depression in older adults is hindered by specific barriers that older adults face in the access of mental health care. Mobile mental health interventions (MMHIs) provide a number of benefits for the delivery of mental health interventions due to their accessibility and thus, are able to overcome a number of barriers to mental health treatment. Existing research has explored ways in which use of MMHIs can be encouraged among a wide variety of demographic groups, including students, adolescents and adults, along with the psychological determinants of future use of MMHIs. However, older adults are seldom included in such research, despite being an age group that could benefit from MMHIs. This thesis aimed to address these gaps by investigating factors which may hinder older adults' access to such interventions and explore how older adults' perceptions of MMHIs may be improved. These research objectives were explored using a mixed methods approach. First, this thesis qualitatively explored the psychological barriers that older adults who use technology may experience in the uptake and use of MMHIs. These findings laid the foundation for a series of three quantitative, survey-based studies. The second study took a quantitative approach in investigating the influence of these barriers on their attitudes towards MMHIs, and identified perception of data security, perceived effort expectancy and awareness of mobile mental health as key determinants of attitudes. Next, the Technology Acceptance Model (TAM) was applied to the three identified determinants of attitudes to present an adapted Technology Acceptance Model. In this adapted model, perception of data security was a valuable addition and showed significant associations to attitudes and intention to use MMHIs for older adults. Finally, an experimental study was conducted to compare the effects of different types of information about data security practices on improving older adult's intentions to use MMHIs, and their attitudes towards them. This thesis has resulted in new knowledge about factors which are important for older adults in the uptake of MMHIs and highlights the role that perceptions of data security, expected effort requirement and awareness of current interventions might play in shaping their uptake by older adults. These findings are discussed in the context of existing literature and the implications for theory, current mental health care delivery and design of MMHIs.

Measures of sexual interest have been fraught with issues, such as being susceptible to manipulation and not easily portable. Indirect measures aim to overcome this by being less transparent, and thus supposedly harder to manipulate (Schmidt, Banse, & Imhoff, 2015). However, as many exist, it is hard to know which is the most effective. Due to the variance in the reliability and validity of current measures, a more comprehensive and easy-to use method of assessing sexual interest is required. The present research attempts to solve this problem by using an emerging indirect measure - namely, an approach-avoidance task (AAT) - to measure sexual interest, implemented via a tablet PC. This thesis is original in both applying approach-avoidance procedures to the measurement of sexual interest, as well as implementing AATs on a tablet PC. Across six studies, the tablet AAT was rigorously tested, varying the exact methodology, including the instructions and stimuli, in order to determine the most optimal version. The first two studies used explicit instructions whereby participants had to evaluate the stimulus content (i.e., sexual attraction). The first study demonstrated that the AAT was somewhat effective at assessing age-specific preferences, but not sex-specific preferences, which was unexpected. The second study (which did not include child images) mainly demonstrated results that were contrary to what was expected (i.e., more avoidance for preferred images). Subsequent studies used implicit instructions whereby a directional cue indicated swipe direction. The third study's results were not in line with predictions, but this was most likely an artefact of the design. The fourth study also had mixed results, however, it appeared that the 'response time' was more in line with predictions, compared with the 'movement time' variable. The unexpected results from the fourth study (which largely replicated the methodology from another approach-avoidance that produced expected results by Piqueras- ii Fiszman, Kraus, & Spence, 2014) may have been due to an issue with the stimuli. Therefore, a survey was conducted for the fifth study to assess the attractiveness of the stimuli. These ratings were then used to reanalyse the data from the prior studies to determine whether the sexual attractiveness (or lack thereof) of the stimuli had an impact on the approach-avoidance reactions. However, it was found that sexual attractiveness did not have an effect. The sixth and final study aimed to test whether the equipment (tablet PC) was inappropriate for conducting an AAT, or whether an AAT was inappropriate method for assessing sexual interest. This was done by comparing the tablet PC AAT to a traditional joystick AAT. This sixth study also produced results that were not in line with predictions. The discussion chapter of this thesis thoroughly explores potential explanations as to why the application of approach-avoidance procedures to sexual interest was unsuccessful. This covers methodological considerations, such as the equipment, stimuli, instructions, and study sample, as well as wider considerations, such as the 'file drawer' issue and application of open science. The thesis concludes with recommendations for future research, including a discussion surrounding the utility (or futility) of continuing to research the AAT as a measure of sexual interest.

The current project explores the nature of embodiment, specifically how affective associations of physical posture interact with emotion in language. Previous research has established that perceptual and motor information is encoded alongside semantic representation, and physical feedback is used to support cognition. Evidence suggests that emotion is also embodied. Muscle feedback from the face is used to support recognition of valence in language. Observational studies also show that open and slumped body posture are associated with positive and negative emotion, respectively. However, little research investigates experimentally induced posture. Additionally, research typically employs self-referent and autobiographical language with little consideration for experimental control over language stimuli. The current projects makes important steps toward developing and validating controlled linguistic materials for emotion research. Further, the project aims to extend previously observed facilitation from facial feedback to the full body. Three repeated measures experiments compared the effects of open and slumped posture on three cognitive measures: explicit recognition of valence from sentences, memory of affective details from sentences, and memory from text. Results indicate that positive, but not negative or neutral sentences are susceptible to the influence of posture. Interestingly, explicit processing of emotion, i.e., recognising valence, was inhibited by open posture, while implicit access during the memory task revealed the classic facilitation effects proposed by embodiment research. Body feedback did not affect comprehension and memory from full text. These results are discussed in relation to three main claims. First, embodiment of emotion is observable in sentence processing, although potentially limited to specific valence types. Second, explicit and implicit processes require different levels of activation, and implicit, automatic access that does not involve conscious awareness of the emotive content is more reflective of the neural priming effects proposed by embodiment models. Third, the linguistic and conceptual complexity of longer text formats preclude embodied effects due to increased confounds from visual imagery, metaphor and other processes that do involve perceptual and sensory information, but not internal bodily feedback, and are thus not susceptible to the posture manipulations employed here. Finally, implications for future research involve continued validation and refinement of the language materials used for emotion research, with additional consideration for concreteness and imagery ratings, as well as embodied properties on the word level. Research should also consider exploring the bidirectional interplay between language and posture further.

Little research has been undertaken with women with an Intellectual Disability (ID) who have experienced secure services, and there is a similar picture with the registered nurses (RNs) who support them. Secure services (SS) support people with an ID who may have experienced the criminal justice system (CJS), need security and/or have a health need. The overall aim of this study was to explore the experiences of women with an ID (the women) within secure services and how registered nurses (the nurses) support those women. The principal research question in the research was 'What are the experiences of women with an intellectual disability within secure services and how do the nurses support them?' The objectives were to: 1. Develop innovative qualitative methodological approaches in exploratory research with female patients who have an ID and are in secure services. 2. Explore the treatment of women with ID by secure services based on the lived experiences as told by the women and the nurses. 3. Discover, through the stories of women and the nurses, the nature and provision of significant support provided to or accessed by women with an ID in secure settings. 4. Find out what the nurses' perspectives are about their preparation and practice for working in female ID secure services. 5. To make recommendations for the future with suggestions and guidance for women with an ID in secure services, their families, researchers, staff working in women's secure ID services, educators, and service provision. There were two research sites in the study, both located in the North East of England. Women with an ID who have previously accessed or are currently accessing secure services; registered nurses (male or female) who have supported the women in the past or are currently supporting the women in secure services, were eligible to take part. Participants were recruited from both research sites, this included twelve nurses who were all female and eight women (n=20). This research adopted a narrative approach using semi-structured interviews carried out by the researcher. The study was designed to include participants who required the presence of staff, which may have otherwise thwarted participation in some research studies. The constant presence of staff may have conflicted with the confidential relationship between researchers and participants. Moreover, gathering data from the women with staff present, enabled the researcher to conduct interviews and utilise a blended approach of interview styles. An approach that created a unique and innovative methodological approach to conducting semi structured interviews with participants who have an ID, and staff are required to be present. The corpus of raw data gathered from the semi-structured interviews was analysed and generated into codes, candidate themes, then themes as adapted from Braun and Clarke's (2006) model of Thematic Analysis. This was inductive in nature and meant a creative, organic approach to coding and theme development could be taken, likened to Big Q data analysis. The themes were not waiting to be found (as in small q data analysis), the researcher was able to create the themes from generating the data and retain the narrative in its purist form. The analysed data formed overarching themes from all the participants, which in some instances were shared themes from the women and the nurses. The themes are presented in this thesis chronologically; the past, present and future. The past shows how the participants have had a complex journey with services over a prolonged period of time, which in turn has shaped their identity. The present shows the current experience, relationships, and gender to be existing issues in the lives of the participants. The future highlights the long-term views and aspirations held by the participants. The recommendations in this research are aimed at women with an ID and their families, future researchers in the field of ID, staff working in women's secure ID services, educators, and future service provision. This research has produced a unique contribution to the body of knowledge in the field of women with an ID and the nurses who support them. By providing an innovative methodological approach to conducting research with participants who have an ID and may otherwise be excluded from participating in research. This research recommends a blended approach to conducting semi-structured interviews and a new way to hear from women with an ID, which is best described in the acronym INTREPID (interviewing using a narrative approach with a third-party present, for conducting research ethically with participants who have intellectual disabilities.

Background: The perceived role and identity of the military family is shifting alongside new policies and models from the Ministry of Defence, increasing flexibility of serving personnel and encouraging stability. Data from the last five years suggests that approximately 24% of military families are already living geographically dispersed from the serving member of their family, although it is unclear as to where these families reside. Separation is central to dispersed military family life, however, current evidence is limited to the effect of operational deployments on spouses and children. Due to the large number of military families estimated to be living dispersed, and lack of research focusing on how this affects family psychological and social well-being, this study aims to explore the psycho-social impact of intermittent separation on dispersed military families. Design: A mixed methods, Explanatory Sequential Design was utilised with two phases and employed Pragmatism as the underpinning methodology. The purpose of the first phase was to provide an understanding on what is already known about dispersed military families and separation. Phase 1a involved a systematic narrative review to answer the question: what is the impact of separation on military families? Phase 1b reported geospatial analysis of publicly available data to determine if there was a suitable proxy variable for the geolocation of dispersed military families. Phase 2 provided primary research findings through semi-structured interviews with spouses, partners, and children of UK military personnel. Phase 1a: The systematic narrative review critically evaluated existing literature on the impact of separation on military. Databases were searched for papers available between January 2001 and July 2018. Papers were excluded if: not written in the English language, were about relationship issues or problems, were about wounded injured or sick personnel, were about pregnancy or postpartum, were about veterans or transition, looked at interventions or the use/development of services, focussed on child or sibling deployment, or were about domestic violence or maltreatment. Eighteen papers were accepted for use in the systematic narrative review. Six main themes were generated through thematic analysis from the papers reviewed: Stress, Depression, Psychological Well-Being, Relationships, Support and Life Experiences. Review findings indicated that military families' experiences impact their psychological well-being during military-induced separations with specific increases in stress, depression, and anxiety symptoms. Communication and relationships were also affected, but social support can mitigate the psychological effects of separations. Higher levels of social support were significantly associated with better psychological health, fewer depressive symptoms, and lower levels of stress. Phase 1b: Phase 1b explored existing publicly available data to determine if there was an appropriate proxy dataset for the geolocation of dispersed military families. Multiple datasets were examined measuring the locations of military personnel, Census data on the Armed Forces household reference person, and data on Service Child Pupil Premium (SPP). Geospatial analysis was carried out to visualise the data at the local authority level. A family estimate was created using SPP data and fertility estimates. In order to consider a proxy variable for dispersed military families, the SPP family estimate and data on the location of military personnel were considered. Data was isolated for local authority areas where there were no military personnel but there was an estimate of military families. This isolated dataset tentatively represented the geolocation of dispersed military families across England. However, there were too many caveats to the data to be a plausible proxy variable. Consequently, findings from Phase 1b argued that there is no publicly available dataset that can act as a suitable proxy for the geolocation of dispersed military families due to the number of limitations on the data. Phase 2: As a result of the findings from Phase 1, Phase 2 sought to explore the psycho-social impact of intermittent separation on dispersed military families through primary research. Twenty-eight semi-structured interviews were carried out with civilian spouses, partners, and children of dispersed UK military personnel over the age of 16; to gain a greater understanding of their experiences. Five themes were generated through Framework Analysis: Identity, Loneliness, Well-Being, Familial Relationships and Accessing Support. Interview findings indicated that dispersed military families experience a number of challenges as a result of separation. The perceived view and lack of understanding of dispersed military families in both civilian and military community was at the centre of participants' experiences. Consequently, this affected how participants viewed themselves, suggesting fluctuation in identifying with the military and how they access support networks. Participants' ability to cope with separation was critically linked to their outlook on the dispersal. A normalisation of the dispersal was reported by those with prior dispersal experience. An acceptance of their situation or a positive outlook helped to alleviate some of the negative consequences of separation along with appropriate support networks. Regardless, participants were clear that dispersal was challenging, and this was exacerbated by the intermittent nature of the separation. Conclusions: By integrating the findings from Phase 1 and Phase 2, six overarching concepts were discussed in terms of existing theories and research: Military Identity, Loneliness, Stability and Dispersal, Psychological Well-Being, Resilience and Coping and Social Support. These concepts help begin to develop an understanding of the psychological and social impact of intermittent separation on dispersed military families. Throughout the research, recommendations were generated to indicate what could be done to support dispersed military families. These include focussing on qualitative research methods to assess the impact of separation on military families; accurate recording of information on military families on MOD JPA system; greater inclusion of dispersed military families in military community; and greater access to information and support and raising awareness.

From 1988, the National Health Service have offered all women, aged in between 25-64, routine cervical screening to detect precancerous abnormalities within the cervix. This screening programme is estimated to prevent around 5,000 cases of cervical cancer each year. Past research has highlighted socioeconomic inequalities in participation, whereby those living in the most deprived areas are least likely to attend in line with guidelines. However, the reasons behind these inequalities are not clear and existing interventions to increase uptake do not adequately take the socioeconomic context into account. As such, this thesis aimed to a) understand factors influencing participation for those living in areas of high relative deprivation and b) develop tailored intervention strategies to facilitate timely attendance within this group. Following guidance from the Medical Research Council on developing complex interventions, a multimethod, qualitative programme of research was conducted to highlight the perspectives of women living in areas of high relative deprivation. A systematic review (Study1), one-on-one interviews (Study 2) and a qualitative online survey (Study 3) were conducted to provide in-depth insight into key factors influencing participation. Focus groups (Study 4a) with service users and interviews with health-related professionals (Study 4b) were then conducted to consider how these factors contribute to the observed socioeconomic inequalities in participation and consider ways in which any barriers might be best addressed. Findings across studies were then systematically combined with behavioural theory (Study 5) to develop an understanding of what needs to change for the target behaviour to occur and identify appropriate intervention components and strategies. Findings suggested that cervical screening participation is determined by a complex accumulation of interrelating, multi-level factors. Application of the Theoretical Domains Framework suggested that Social Influence, Environmental context and resources and Emotion were the top three areas of influence most often mentioned by participants. Application of the COM-B model suggested that, to encourage timely attendance, changes were needed at in terms of women's capability, opportunity and motivation to screen. Using guidance from the Behaviour Change Wheel and the Behaviour Change Taxonomy v1, these findings were then linked with intervention options and components likely to influence change within the target population and several intervention strategies were recommended. This research is the first to use the Behaviour Change Wheel to systematically combine behavioural theory and the perspectives of the community in understanding and addressing socioeconomic inequalities in routine cervical screening participation. These findings can be used to further test and develop a range of novel interventions, and/or refine existing interventions, which aim to increase cervical screening attendance within areas of high relative deprivation.

Autism is a lifelong developmental condition, diagnosed on the basis of persistent social communication deficits and repetitive, restrictive patterns of behaviour. Autistic people form a heterogenous group, but many experience challenges compared to non-autistic people. Identifying and diagnosing autistic people can be beneficial in helping them to better understand themselves, and to access support and interventions. Not all autistic people are diagnosed however, and one group which is disproportionately affected is people with learning disability. Screening tools have the potential to facilitate and speed up diagnosis by highlighting those who should be assessed in more detail. Many existing screening tools are largely inaccessible to people with learning disability due to the level of language required to complete them. The overall aim of the thesis is to facilitate the diagnosis and support of people with autism, in particular those with learning disability, by developing more accessible screening tools. Chapter One provides an overview of the main issues to consider in the screening and diagnosis of autism, in those with and without learning disability. Chapter Two outlines the adaption of the Autism- Spectrum Quotient (AQ), with the aim of developing a more accessible version (AccAQ). The language of the AQ is simplified, and line drawings are added to enhance understanding. The results indicate that the original AQ and the adapted versions are equivalent in many ways, but the AccAQ still requires the person completing it to have some verbal communication, comprehension, and literacy skills. Chapter Three reports on a systematic review into the psychometric properties of autism screening tools used with people with learning disability. The review found that the majority of tools were lacking comprehensive validity and reliability data, were not specifically designed for use with people with learning disability, and required the input of an informant. Chapters Four to Six discuss the development of a new autism screening tool, which was designed specifically for people with learning disability and does not require the input of a third-party informant. Chapter Four reports on the results of interviews with stakeholders about the current autism diagnostic pathway, the role of screening as a part of the diagnostic process and the properties that would be desirable in a new screening tool to ensure it is both accessible and useful. Overall, this study highlighted the need for such a tool to have good psychometric properties, be clinically useful, user friendly, cost-effective, and minimize demands on users and those being screened. Chapter Five explored the literature that provided a theoretical basis for the inclusion of particular items within a behavioural screening tool. These are items that will prompt reactions which are indicative of the presence or absence of autistic traits: the concepts of empathy, mimicry, and contagion. These ideas are operationalised in a series of pilot studies which use existing video clips as stimuli and ask participants to self-report their responses to the videos. The results of a machine learning analysis, using cforest, showed that the self-reported responses were broadly predictive of the person's AQ score and provided proof of concept of the idea of a behavioural screening tool. Chapter Six extended this work. Here a set of custom stimuli were created and were viewed by autistic and non-autistic participants, with and without learning disability. Their reactions to these were self-reported and video recorded, and subsequently coded. The results indicated that, while scores on the behavioural screen could not discriminate between autistic and non-autistic participants, or predict self-reported AQ score, they did predict informant AQ scores. Overall, the thesis makes a novel and significant contribution to the literature by identifying tools which are currently available to screen for autism in people with learning disability, alongside adapting the AQ to be more accessible to a wider range of people. It provides proof of concept for a behavioural screening tool for autism, which is specifically designed for people with learning disability, that integrates stakeholder views and theoretical literature during its initial development and testing.

Higher education and the dynamic environment that it operates within has been well documented, with many factors impacting upon the effectiveness of the sector. At the forefront of such strategic thinking, is how universities interact and engage with their students. This thesis investigates student engagement with the UK higher education sector, focusing on staff and student opinions beyond academic engagement, taking a holistic approach that research has suggested is lacking. Three empirical studies were undertaking to investigate: the role of staff and students within engagement activities; and the benefits and barriers to student engagement. Study one involved a qualitative analysis (n=14) interviewing staff that worked in a UK university and had a role in student engagement. A focus group methodology (n=21) was utilised for study two exploring student opinions of engagement. Study three involved an online questionnaire (n= 1,411) examining student views on advantages and barriers to engagement activity. The results revealed that both staff and students agreed that student engagement resulted in many benefits for the individual, university and society. Staff working in higher education stated that potential barriers to universities engaging with their students included resourcing, issues related to operational, process and systems. Students suggested that the main barriers preventing students engaging at university were: transitioning to university; other commitments; financial constraints; mental health issues; lack of confidence and motivation; learning difficulties; lack of support; cultural differences; class size; difficulty in joining clubs; and staff buy-in. The findings reveal 4 different types of students that are grouped based upon: the type of engagement activity they undertake; the role they perceive of students within engagement; benefits and barriers to engagement. In line with the requirements of a professional doctorate, recommendations have been suggested to aid organisational policy regarding student engagement within higher education.

The ongoing development and ubiquitous spread of technology has brought with it new threats and opportunities for online victimisation. Although human factors cyber-security research continues to try to mitigate these threats through the application of behavioural science, some users, such as older adults, remain at particular risk of cyber-attacks, and yet remain heavily under-represented in the extant literature base. This thesis outlines a mixed methods approach to understanding older adult cyber-security vulnerability. The thesis began by identifying a range of technological changes that take place during the transition into retirement. Each of these changes offered avenues for subsequent cyber-security vulnerability. Through conducting a large-scale online survey in retired older adults, these retirement related factors were shown to be associated with engagement in risky online cyber-security behaviours. It was identified that the strongest predictor of these was an individual’s computer self-doubt. A second qualitative study found that older adults see cyber-security as a stressful subject and demonstrated both: the factors that influenced their confidence in relation to engaging in cyber-security behaviours, as well as their reasons for disengaging from cyber-security behaviours. A scale was developed to further understand older adult’s security related stress, which was applied to understand their coping behaviours when faced with a cyber-security challenge. This was effective at predicting older adults’ engagement in dysfunctional coping, highlighting how security stress might promote cyber-security vulnerability. Finally, the research applied the transactional theory of stress and coping to older adults’ cyber-security, demonstrating its effectiveness in predicting both dysfunctional and problem focussed coping strategies. The thesis provides new knowledge as to the factors which promote cyber-security vulnerability in older adults and outlines specific avenues as to how this vulnerability might manifest. Throughout this thesis, recommendations for policy makers, developers and future research are made and discussed in the context of existing literature.

Less than one percent of the population has been estimated to have been diagnosed with a severe mental illness (SMI), of which 80%-86% are will require ongoing need for support. Recent figures show that one in ten people has a caring role, with such roles being shown to have a negative impact on carer health. The growth and popularity of the internet (or world wide web) suggests that this could be a useful medium for support provision, and this has been reflected in recent policy. Previous literature has outlined the valuable contribution carers have in caring for their ill relative and the negative impact this can have on carer health. The use of web-based resources can further promote carer empowerment, increase access to support for their emotional wellbeing and to assist in the management of the caring role. The research informing this thesis aimed to explore factors which constitute effective web-based support for carers of individuals with an SMI. Eight carers and six mental health professionals participated in the research study, which adopted a mixed-method approach within a conceptual framework informed by a critical realist stance. Data was collected using qualitative comparative analysis of health-focused questionnaires and research diaries, and thematic analysis of qualitative interviews. Analysis resulted in five key themes: 1.) Expertise via experience 2.) Empowerment through knowledge 3.) Connection, understanding and advice online 4.) Personal preference: considering the accessibility of the internet, and 5.) The landscape of carer support. Further analysis included the identification of generative mechanisms and contexts influencing the use of and impact of web-based resource usage on carer wellbeing and quality of life. This thesis presents the process and findings of the research study, culminating in the suggestion and presentation of a framework designed to be of utility in the construction and evaluation of web-based needs-aligned intervention/support for carers of individuals with SMI. The framework is aligned to the key themes emerging from data analysis. Potential directions for further research and development within the area of web-based provision for carers and family members are summarised.

There is a magnitude of technical controls which do more than half the job of securing the organisation. The rest falls on the employees. Employees are considered the weakest link in the security chain of the organisation this is primarily because they are the easiest to compromise. This could be due to external motivators, such as become a victim of social engineering or personal emotional motivators, such a disgruntled employee. It is most often the case that an employee gets blamed for a security breach. Security researchers fight from both employees and managements side and blame each other for being the problem. It is necessary to address this gap between policymakers and employees. And this study attempts to do that. Two studies were conducted. The 1st study was a qualitative semi structured interview. From which I created a conceptual model. This model was used in preparing the 2nd study, which was a quantitative survey. The data from the survey was then used to create Structural equation model using SPSS and AMOS. Differences in their perceptions of policymakers and employees and postulated relationship of these differences (constructs) with constructs of Protection Motivation Theory. Which we then confirmed using Structural equation model. Key finding was usability of a tailored policy was used as a moderator to see its effect on all the relationship constructs. Use of a tailored policy dampened the relationships Perception of information security (POIS) and Threat appraisal (TA), between POIS and Coping appraisal (CA), between POIS and Behavioural intent (BI), and POIS and Actual behaviour (AB). It also dampened the relationship between perception of organisational interventions (POOI) and BI. It strengthened the relationship between, POOI and TA, POOI and CA, POOI and AB. Use of a tailored policy dampened the relationship between, TA and BI, but strengthened between CA and BI, CA and AB and TA and AB. This research addresses these differences between policymakers and employees, across different organisations with varying organisational security levels, viz. low, medium and high security organisations and posits that through a tailored security policy security compliance behaviour can be improved.

Within a social, political and educational narrative of stigma and exclusion relating to autism, this study engaged an autoethnographic participatory action research (APAR) approach to explore communication in families of young people on the autism spectrum. By engaging in collaborative learning within and between five families, the research process centred autistic young people in their families as co-researchers. Through communicative action and enaction, families explored what communication looked like in their family. Mothers established a collaborative learning group. Across a 10-month period they met and discussed communication, reflecting on their family communication interactions. These meetings and reflective journals, which held artefacts from young people and stories and reflections on family communication interaction, provided our data. Through this research assemblage of words, bodies, families and homes we recognised the more-than-verbal dialogues of embodied and enmeshed communication interactions. Analysis exposed the importance of communicative space as a catalyst to the inclusion of embodiment, connections and self-narrative of autistic young people in communicative enaction. Homes provided liminal spaces of mutual becoming through enacting collaborative learning.

Omega-3 polyunsaturated fatty acids (n-3 PUFAs) are ‘essential’ fatty acids that cannot be manufactured de novo within the body and must be obtained via the diet, with the n-3 PUFAs docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) previously being found to have a wide range of bioactive properties within the body and particularly on brain function. However, in the UK and several other western nations, n-3 PUFA intake is found to fall below government and health organisation guidelines. Although previous research into the effects of n-3 PUFA intake and physiological and psychological outcomes is extensive, the previous research can be criticised for several methodological limitations relating to supplementation lengths, population samples, formulations of the supplements and placing little focus on the bioavailability and uptake of the fatty acids across the supplementation period. Therefore this thesis aimed to address the previous limitations identified within the research area to more accurately examine the effects of both a DHA- and EPA-rich supplement on measures of cerebral blood flow, sleep, memory consolidation, cognition and mood. Chapter 3 describes an intervention study that employs a near-infrared spectroscopy (NIRS) neuroimaging technique capable of measuring gross changes in cerebral haemodynamics across a 26 week supplementation period, a factor missing from the previous research conducted thus far. Chapter 4 describes a 26 week intervention study that measured parameters of sleep via subjective rating scales, actigraphy watches and urinary 6sulphatoxymelatonin (aMT6s). Chapter 5 describes a novel 26 week intervention study that aimed to measure overnight memory consolidation via completion of learning and recall tasks before and after sleeping. Finally, Chapter 6 describes a 26 week intervention study measuring aspects of episodic memory, working memory, information processing speed, executive function, attention and global cognition. The intervention studies that comprise this thesis include the first investigations that administer self-micro-emulsifying delivery system (SMEDS) formulated DHA- and EPA-rich supplements, designed to increase fatty acid bioavailability, dosed at bed-time, in healthy, young adults aged 25-49. Notably, there is evidence to suggest that supplementation with both the DHA-rich and EPA-rich treatments show a trend towards reducing the quantities of oxygenated haemoglobin during completion of serial subtraction tasks, interpreted as an increase in neural efficiency. N-3 PUFAs, particularly DHA, also improved objective measurements of sleep whilst the EPA-rich treatment improved global cognitive function and improved reaction times during both executive functioning and episodic memory tasks. Taken together, these findings suggest that 26 weeks’ n-3 PUFA supplementation is beneficial for a number of psychological and physiological brain parameters in healthy, young adult samples.

This programme of research investigated children's cognitive performance, academic achievement and wellbeing in association with their participation in primary school-based interventions in which healthy lifestyle/positive choices messages were delivered through classroom learning and physical activity. A positive correlation was found between the time children spent in moderate-to-vigorous physical activity during intervention sessions and their post-session long-term memory performance (Study 2). Taking a more chronic perspective of intervention participation, in a quasi-experiment testing whether children experienced improvements in cognitive performance, academic achievement and wellbeing over and above those of a control group, results were inconclusive but potentially suggestive of increases in reading and mathematics achievement for the intervention group at the conclusion of the 6-week programme (Study 3). Finally, qualitative data from interviews/focus groups with stakeholders including children, parents and school staff showed that interventions were viewed favourably in relation to children's engagement and outcomes (Study 4); pupils enjoyed their participation, particularly in the physical activity, and they were thought to benefit in terms of their wellbeing and personal development (e.g. increased healthy lifestyle knowledge, enhanced self-esteem). Parents did however feel that they themselves were not well informed about the interventions and that they could have reinforced programme messages had they known more. In the long term, these findings will assist in informing policy and practice regarding school provision of healthy lifestyle and physical activity opportunities, for instance supporting their inclusion in the timetable despite pressures for schools to prioritise core curriculum subjects. The thesis contributes to the literature in its focus on cognitive performance and academic achievement, outcomes not often measured for physical activity and positive choices interventions. It also recognises a lack of consistency in the measurement of cognitive performance in the existing research, with Study 1 piloting a cognitive test battery for use in school settings.

A growing body of research has been designed to further our understanding of how single bouts of exercise affect cognitive performance. Early work in this area led to the identification of several moderating factors that influence the exercise-cognition interaction, with two of these being exercise intensity and fitness level. The positive effects of moderate-intensity are well accepted having received substantial support in the literature. Due to receiving much less attention however, there is currently no clear consensus on the effects of high-intensity exercise, though theoretical, experimental and anecdotal literature converges towards an impairment in cognitive function. Compared to moderate intensities, strenuous exercise places much greater physiological demands on the human body and thus it has been suggested that individuals of greater fitness levels, and those accustomed to high-intensities that have undergone years of training and adaption, may respond differently to strenuous intensities compared to normal populations. Many sporting paradigms involve prolonged exercise, congested tournament fixtures and involve weeks of intensive training and thus the influence of these stressors on cognitive function and mood, energy and fatigue states in trained populations holds important implications for sports performance. The current PhD programme aimed to examine different strenuous exercise paradigms on cognitive function, mood, energy and fatigue states in trained sporting individuals, with a particular focus on three exercise models; prolonged exercise, congested exercise and intensified training. The series of investigations that set out to address this aim have led to many novel and interesting findings. To begin, study one conducted the first systematic review in this area of the literature. Amongst highlighting the limited research, evaluation of the existing literature suggested little effect of acute strenuous exercise on measures requiring simple cognitive processing in trained populations, but found there to be more ambiguity surrounding top-down higher-order processes. This is particularly interesting, as the exercise-cognition literature has predominantly focussed on simple processes; consequently, this chapter called for the assessment of multiple cognitive domains in future studies. The first experimental study, presented in Chapter 3, examined a prolonged strenuous exercise bout on cognitive function, mood, energy and fatigue states. In support of the previous chapter's conclusions, a negative effect on executive function was found alongside reductions in mood and energy and significant increases in both physical and mental fatigue. Building on this, Chapter 4 explored the effect of repeated strenuous exercise bouts over two days on cognitive function, mood, energy and fatigue states. Results indicated that one day of congested strenuous exercise leads to a reduction in inhibitory response accuracy and choice reaction time in addition to having negative effects on mood, energy and fatigue states. The final experimental study of this thesis, presented in Chapter 5, investigated cognitive performance, mood, energy, fatigue, perceived sleep and physical performance during and following a chronic intensified training period. This paradigm led to significant reductions in physical performance and mood during the training weeks; however, cognitive function and sleep were not affected. The practical implications of each study are discussed in each respective chapter and highlight how the results can be applied in relevant situations. Collectively, the findings of this thesis provide novel information surrounding the effects of strenuous exercise on cognitive function, mood, energy and fatigue states in trained sporting populations. The current work has shown domain specific effects of strenuous exercise with a particular effect on top-down higher order cognitive processes. Similarly, deteriorations were observed in mood and energy states in each empirical chapter alongside significant increases in mental fatigue. Further work is required to: elucidate the mechanisms by which strenuous exercise exert these effects; to determine if these effects are observed in further exercise paradigms; and to identify methods by which cognitive function, mood, energy and fatigue states can be maintained in situations dependent upon optimal cognitive performance.

In the UK, schools are gradually embracing their responsibility to cater for young people's mental wellbeing. Exploring young people's Mental Health Literacy (MHL) is an area however that is still in its infancy. Specific focus has explored young people's literacy of the condition of psychosis, considering how useful it is to provide biomedical information as a MHL intervention within schools. Such an approach reduces a more holistic understanding of mental illness and portrays young people as illiterate. My goal is instead to value young people as competent social agents with existing social and personal meaning in their understanding of mental illness. A peer research methodological approach has given young people the chance to explore their views and opinions without adult influence. Thirteen PRs (Peer Researchers) were involved in focus group sessions from two Further Education Colleges in the North East of England: 1) To explore young people's own understandings of psychosis 2) To explore what aims young people may feel psychosis literacy should address and 3) To explore what strategies young people believe would be the most useful to cater for young people's educational and health needs. AR-led (Adult Researcher) and PR-led data has been assessed for the influence of demand characteristics, adding new understanding of how young people socially constructed their responses according to an adult or non-adult audience. The need to understand young people's social, cultural, and personal meanings attached to psychosis have been an important first step to help appreciate what holistic methods and content of literacy would be most meaningful and right for young people. Nevertheless, an emphasis on academic attainment in schools and the influence of key stakeholders' views and opinions (including teachers and parents) may challenge the viability of implementing any form of psychosis literacy within the school environment. It is likely that adult concerns would remain and form a barrier towards listening to the voice of young people's views and opinions in favour of their own agenda.

This thesis explored the influence of leadership incivility upon employees, with the aim of understanding individual experiences and developing organisational interventions. The research was undertaken within an acute NHS Trust setting, where through the author's professional work, the issue of lack of confidence in dealing with uncivil leadership became apparent. Recent research has explored incivility within different workplaces, but studies within the clinical setting are limited, and incivility within the Allied Health Professionals (AHPs), including Physiotherapy, is a current literature gap. A qualitative exploration of uncivil leadership was undertaken within the NHS Trust, and template analysis used to analyse data from semi structured interviews (N=20) conducted within the Physiotherapy department. The findings were presented and discussed in relation to 6 key themes, of "What it feels like to work with these leaders", "Hierarchy", "Why they behave that way", "Patient care", "Workplace culture and culture of leadership" and "Challenging the behaviours" (study 1). These themes informed the basis and design of an organisational intervention to give AHPs increased confidence in managing situations with uncivil behaviour. The intervention examined different strategies and coping techniques, ranging from directly challenging the uncivil individual, to learning to live with the behaviour through various techniques. A quasi-experimental study (study 2) consisted of pre and post measurements among AHPs in the NHS Trust. Participants completed a survey prior to the intervention (T1) and then after the intervention workshop (T2), split into an experimental group (n=50) and a control group (n=23). Measures of confidence (self-efficacy), Resilience (CD-RISC) were analysed using two-way mixed ANOVA'S. Measures of confidence in having a challenging conversation across different groups in the workplace, and in two different situations were analysed with paired t-tests. The intervention was successful and levels of confidence and resilience in having a challenging conversation significantly increased after the intervention. The results also demonstrated a significant increase in the confidence of the participants in having challenging conversations, across the groups and within different situations, so when the uncivil behaviour was directed at themselves or their team. Overall, the research programme contributes an evidence base for interventions to develop confidence and resilience in challenging uncivil behaviour of those in senior leadership positions.

The aim of the current thesis was to undertake a mixed methods investigation of holiday clubs looking at location, implementation, delivery and impact. Study 1 presents a quantitative investigation into the location of holiday clubs and the types of organisations delivering holiday provision. The findings show a multitude of organisations are responsible for implementing and delivering holiday provision and highlights a grassroots approach has established to respond to the challenges of the school holidays and deliver holiday provision to families. Holiday clubs are typically located in the most economically deprived communities however, there are gaps in this provision. Studies 2 and 3 provide a qualitative investigation to establish the overarching views on holiday provision from the perspectives of policymakers, key stakeholders, staff and holiday club users. Study 2 explores the views of policymakers and key stakeholders responsible for implementing and delivering programmes of holiday provision. The findings from Study 2 demonstrate that organisations have adopted a commission-led approach to deliver holiday provision and collaborate with a range of partners. Though barriers of implementing this provision were also highlighted. Study 3 explores the views of staff, parents and children on school holidays and holiday clubs. Findings from this study demonstrate that holiday clubs offer local support and provide a range of positive outcomes for staff, parents and children as well as the wider community. Study 4 presents a quantitative investigation to examine whether community organisations delivering holiday clubs are able to support the nutritional needs of children during the school holidays. The findings from this study are mixed and demonstrate that holiday clubs can establish environments that promote healthy dietary behaviour, albeit rather limited, and reduce the consumption of high energy drinks. The findings of this thesis highlight key areas of consideration for future research into holiday club provision, and for stakeholders involved in the implementation and delivery of holiday clubs.

Background and Objectives: Human mate choice is a complex, multi-faceted area of research. This thesis aims to investigate the contested relationship between facial appearance and fathering ability, based on the idea that women make a trade-off between a partner with good genes, and someone who will invest in the offspring. Additionally, a further investigation into sexual disgust at the prospect of mating with kin, with self-similar male faces as a proxy, to observe the Westermarck effect in action. The similarity of couples in appearance, personality, and genetics has been well documented, but less known is the similarity of body language of couples, and if they can be differentiated from pairs of strangers. Finally, a look into imprinting-like mechanism upon parental eye colour across individuals dating histories, as well as seeing if there is a self-similar preference for eye colour. Methods: Innovative technology is mixed with traditional survey methods (Chapters 5 and 6) in this thesis, including facial measurements and facial morphing (Chapters 2 and 3), electromyography measuring disgust (Chapter 3), and motion capture (Chapter 4). Results and Conclusions: We found that masculine fathers are not worse fathers, and that perceived masculinity has no association with structural masculinity in our sample, that self-reported disgust supports the Westermarck hypothesis that cues of kinship are unattractive after some similarity. We also found that couples move differently to strangers and can be identified as such, that individuals do not appear to actualise eye colour preference in dating partners, and that same-sex parent matching occurs more than opposite-sex parent eye colour matching. It is clear that there is much work still to do to disentangle the evolutionary aspects of human mate choice, but the use of novel methodology in this thesis adds further knowledge and clarity to some contentious areas of research, as well as new avenues.

Qualitative research methodology (drawing on the psychoanalytic interview method and metapsychology) was used to understand how women psychologically managed their breast cancer diagnosis and subsequent treatments. The purpose of the research was to explore what the women's psychological reactions were linked with. Clinical observation in an NHS Hospital's Breast Unit showed that the level of psychological distress amongst breast cancer patients often bore little or no relationship with the stage or prognosis of their illness. The research question was developed that if it was not the severity of physical illness or extent of treatment, then there could be some other factors, in a woman's life, which may determine the level of her distress. The purpose of this research was to explore, from a psychoanalytic point of view, these underlying, less obvious factors. Previous literature has concentrated on specific stages of illness, treatment or personality traits but failed to further investigate any additional underlying issues in a woman's life that her distress may be linked with. This study was given an ethical approval from NRES (REC). Ten women with newly found breast cancer were each offered four individual semi-structured interviews in different stages of their treatments. The data was managed in two ways. The first method investigated the whole illness process and what kind of psychological issues the different stages provoked in the patients as a group. The data was organised by NVivo software into five main categories according to thematic contents: 'Being Diagnosed', 'Having Treatments', 'Getting Support', 'Losses Endured' and 'Longterm Impact of Breast Cancer'. These main categories were divided into subcategories. The second method extracted short case summaries of individual patients. A questionnaire collected demographic information. The results strongly indicated that a loss of breast (or a part of it) provoked emotional connections with earlier unresolved losses and loneliness. Recommendation: these risk factors should be examined in patients with disproportionate distress, using short questionnaires, therapeutic consultations and staff members should be offered opportunities to develop 'listening skills'.

The UK-Communicative Development Inventory (CDI) is an adaptation of the MacArthur-Bates CDI questionnaires and has been newly developed, standardised and normed for British children between 8 - 18 months. This parent-report instrument assesses children's communication and language. Research in other languages has shown that CDI instruments assessing infant language show good stability with language up to the preschool years on a group level. However, the prediction of language delays/disorders for individual children was unsatisfactory. This research examined the predictive validity of the UK-CDI for the first time. The aim was to establish if the UK-CDI subscales (Gestures, Phrases Understood, Production and Comprehension) were associated with later language scores up to 36 months, if continuity of language depended on UK-CDI ability group (low, low-average, average-high, high), if other factors needed to be considered to predict later language, and if language delay at 24 or 36 months could be predicted for individual children using the UK-CDI at 12 or 18 months. Families were from the East Midlands (UK) and took part at four time points (N = 82). Parents completed the UK-CDI and Family Questionnaire at 12 and 18 months, the Lincoln Toddler CDI at 24 months and the 3-year parent report language measure and the British Ages and Stages communication subscale at 36 months. At 18 and 24 months, children also participated in standardised tests assessing language (Preschool Language Scales) and, cognitive and motor ability (Bayley Scales of Infant and Toddler Development). Results showed that UK-CDI scores at 12 and 18 months were correlated with language scores up to 36 months, albeit language was more stable from 18 months onwards. The associations were usually strongest with the same category at the closest follow-up testing. In addition, stronger correlations were found between UK-CDI scores and other parent-report measures compared to in-person assessments. When investigating the stability of language separately for ability group, language was most stable for high ability children. Furthermore, high ability children remained significantly better than low ability children on most language measures up to 36 months. However, low ability children improved over time in terms of vocabulary but continued to show slow grammar development. In addition, early language (UK-CDI scores) was the best predictor of future language. The other factors (i.e., prematurity, gender, SES, sibling status, ear infections, sleep, family risk of dyslexia or speech or language problems, cognitive and motor skills) influenced later language but their contributions were not consistent and depended on the outcome measure used and the time tested. Therefore, only UK-CDI scores at 12 and 18 months were used to predict language delay at 24 and 36 months using receiver operating characteristic curves. To achieve clinically useful levels of classification accuracy, the UK-CDI cut-off scores had to be higher than the norm-referenced 25th percentile. Depending on the criteria used for delay, Production and Gestures at 18 months predicted delay at 24 months and Production at 18 months predicted delay at 36 months. Implications of using high cut-off scores were discussed.

The past two decades has seen an increased interest in, and awareness of, the ways in which cancer and concomitant treatments effects individuals and couples in terms of their expressions of sexuality and sexual health (incorporating psychosexual health) (Sadovsky & Bassoon et al, 2010, Greenwald &McCorkle, 2008, De Vocht, 2011). However, the research studies found focused on the impact on heterosexual individual's and couples, with a dearth of literature pertaining to the impact on lesbian and bisexual women affected by cancer. Although, the health care needs of individuals from sexual minority groups has begun to be recognised and addressed by practitioners (Stonewall, 2010, Davey, 2012), the lack of available literature to help guide practice in this area means that they often fail to recognise the needs of the lesbian women in their care. The aims of this study were therefore twofold, firstly to explore the sexuality, sexual health (incorporating psychosexual health) and relationship experiences of lesbian and bisexual women who have been diagnosed and received treatment for cancer. Secondly to use the outputs from the first aim, to develop a conceptual framework and model for practitioners working with lesbian and bisexual women in the fields of cancer care in regards to these areas. This study was designed with a research design which enabled the 'voices' of both the lesbian and bisexual women, and the cancer practitioners to be heard. The overarching research methodology was descriptive phenomenology, however, it became evident that the traditional approach taken in descriptive phenomenological studies (Giorgi, 1985, 2009, Rutherford & McIntyre et al, 2012) would not yield the breadth and depth of data needed to develop the conceptual framework. Therefore, as suggested by Mayoh & Onwegbuzie (2013) the concept of applying the steps that underpin action research throughout the phenomenologically inspired journey were used. As a starting point for the study, and to assess the readiness and preparation of practitioners in cancer care the views and experiences of both an expert panel and focus groups of specialist practitioners were sought on four occasions. The face to face interactions were supplemented with paper and online questionnaires. A documentary analysis of the United Kingdom (UK) government and healthcare professional organisations documents pertaining to the place of sexuality and sexual health within practice and education was undertaken to explore the actual practice situation. This was followed by review of undergraduate nursing and medical curriculum with a focus on the holistic assessment and management of sexuality and sexual health needs. In addition, the UK governmental and professional body Lesbian, Gay, Bisexual and Transgender (LGBT) specific directives for good patient care practice, together with the LGBT specific content within undergraduate nursing and medical curriculum were systematically analysed. The voices of lesbian and bisexual women affected by cancer - both survivors and partners provided a wealth of in-depth information through the individual interviews and online qualitative questionnaires. This gave new insights into and increased understanding of the issues faced by participants. It highlighted similarities and differences with and from the findings from the heterosexual studies, and provided the baseline from which the conceptual framework and model were developed. It was seen as essential that these had a theoretical basis that practitioners could accept and utilise and that it was incremental to recognise the longevity of the support and guidance sought by participants. When shared with practitioners the conceptual framework and model were well received and only minor refinements were needed. It does enable cancer care practitioners to offer more tailored care to the lesbian and bisexual women in their care. Especially in regards to the women's sexuality, sexual health (incorporating psychosexual health) and relationships, and has led to links and work with both Macmillan Cancer Support and Relate the UK's largest provider of relationship support.

Background. The rehabilitation of young offenders remains an important objective and presents increasing demands upon the criminal justice system. Creative methods have previously been seen as an add-on approach to offender behaviour programmes, often viewed as merely a means of increasing engagement and attendance. The main focus of this thesis explored how the arts, in particular drama, can positively contribute to the process of reducing reoffending behaviour and reoffending rates with male young offenders serving community sentences. Methods. The sample included in this thesis consisted of 72 male young offenders aged 10-18 years of age (mean age 15 years, SD = 1.66), referred by Birmingham Youth Offending Service over a period of 18 months, to the Recre8 company, which used the V2 method of drama based intervention. Data was gathered over three intervals: pre-intervention; post intervention; and at three months follow-up. The three main aims of the investigation were; (i) to see if the psychology based drama interventions could ensure offender engagement and attendance; (ii) to examine the effectiveness of the V2 model in relation to reducing or eliminating recidivism; and (iii) to explore what impact the V2 model had on the development of self-esteem, confidence and personal and social development of the young offender participants. The CRIME PICS II questionnaire was used to collect data about participants. Qualitative semi-structured interviews were undertaken with a sample of 10 offenders, asking them for their views on the V2 intervention programme at the three months follow-up stage. Results. A completion rate of 91.5% was demonstrated by offenders who took part in all of their sessions on the V2 programmes. There was shown to be a significant (P < 0.001) reduction in those classed as medium risk offenders at pre-intervention (60%) to low risk by three months follow-up (25%). A corresponding increase was observed in those classed as low risk at pre-intervention (40%) by the three months follow-up (75%). A repeated measures ANOVA was conducted on the preintervention post-intervention and follow-up scores on all five sub-scales of the CRIME PICS II questionnaires as well as Rosenberg's Self-Esteem Scale. Results showed significant positive improvements from preintervention to three months follow-up in all six measures (general attitude towards offending (G) p < .001; anticipation of reoffending (A) p < .001; victim hurt denial (V) p = .004; evaluation of crime as worthwhile (E) p < .001; perception of current life problems (P) p < .001 and Rosenberg's Self-Esteem Scale p = .054). The semi-structured interviews identified three main themes: 'Programme distinctiveness'; 'Going above and beyond'; and 'Change: "offending itself is stupid"'. Subthemes were identified for each of these and are discussed and explored further within the thesis. Conclusion. This thesis bridges the research gap in the areas of rehabilitating young male offenders, by utilising a mixed methods approach, highlighting the benefits of drama interventions, and in particular with low and medium risk offenders, producing a scientific framework to measure the impact of behavioural change with in a creative intervention. This research thesis contributes towards the literature around the arts and rehabilitation models for young male offenders.

Replicability of research findings is a key issue in psychology, and has been the subject of considerable discussion by researchers. Replication is crucial to scientific principles, and underpins the consistency and verifiability of findings on which the foundation of scientific theories are built. Consistency of effects can be assessed through the perspective of heterogeneity, which indicates whether multiple research results into the same phenomenon are underpinned by the same true effect size. We use this perspective here to address concerns regarding replicability, and explore the application of heterogeneity in novel ways. This PhD project therefore aimed to: i) examine the heterogeneity of empirical findings in psychology; ii) consider the impact of biases in the research process on estimations of heterogeneity; iii) determine the strongest effects in psychology and their heterogeneity, and; iv) apply the perspective of heterogeneity to an existing psychological debate, the origin of psychological sex differences. In our first study, a re-analysis of 150 meta-analyses from cognitive, organisational, and social psychology was used to provide estimates of typical levels heterogeneity in psychology. This was compared to heterogeneity levels found across 57 multiple close replications. Our first study showed that low heterogeneity is achievable in psychology, but that typically heterogeneity estimates are high. Our next study used computer simulations to show that these levels of observed heterogeneity cannot be due to bias from questionable research practices or publication bias. In study 2, we showed the importance of including heterogeneity alongside effect size when interpreting an effect, and illustrated that even the largest mean effects in psychology might not be consistent in direction under conditions of high heterogeneity. Finally, in study 3 we showed that heterogeneity could provide an informative new perspective to the arguments regarding the origin of psychological sex differences. We explored several possible factors that could underlie heterogeneity in research findings, and suggest that unreliable forms of measurement and low quality of metaanalyses could provide promising avenues for further investigation in this regard. Overall, this thesis has provided an overview of the application of heterogeneity to provide a new perspective on psychological research.

Understanding the world involves complex cognitive processes occurring and interacting within the mind. Traditionally, this has been thought of as analogous to computational processes, with strict rules that encapsulate obligatory and domain specific modules. Current theories of cognition suggest a radically different approach in that sensorimotor simulation forms a necessary basis of abstract and concrete knowledge. These theories suggest that the ability to represent knowledge relies not only on brain-based processing, but also on the embodied experiences of the cognizer in the environment. However, there remains little agreement as to the nature of such embodied representations, particularly at the level of what constrains their properties and their ability to interact with one another. This thesis focuses on how cross-representational interplay is made possible. Through an empirical dataset, a case for a conceptual interface is made, suggesting co-activated distinct representations may interact by means of a third-party mediating mechanism (e.g. a joint attentional bias). This is demonstrated across a range of experiments using concepts representing several conceptual knowledge domains from more abstract to more concrete, including concepts denoting numerical magnitude, spatial semantics, emotional valency, and manual affordances.

Sci-fi authors and start-ups alike claim that socially enabled technologies like companion robots will become widespread. However, current attempts to push companion robots to the market often end in failure, with consumers finding little value in the products offered. Technology acceptance frameworks describe factors that influence robot acceptance. It is unclear how to design a companion robot based on them, however, as they were derived from much more primitive, asocial technology. Based on two frameworks of robot acceptance as a starting point, this thesis highlights the value socially enabled technologies could bring as conveyed by the views and experiences of three user groups: the potential users of companion robots being exposed to adverts; the people who lived with smart speakers - a successful socially enabled technology with a dedicated embodiment; and the people who lived with companion robots long-term. By discussing both the frameworks of acceptance, and how real people used and anticipated real socially enabled technologies, this thesis draws broad considerations for companion robot designers concerning form factor, (non-)acceptance over time, robot's personality, trust, and human-robot relationships. The implication is for the valuable traits to be replicated in the future iterations of companion robots. Findings include the tension between familiarity and strangeness of robotic form factors and faces; the specifics of how socially enabled technologies fit and do not fit within existing frameworks of acceptance; the need for both authenticity and pro-activity in companion robot's personality; the differences between views and actions on security and trust towards autonomous devices in the domestic environment; and the construction of human-machine relationships between people and socially enabled technologies. These findings highlight the need to extend existing frameworks of robot acceptance to include unique factors pertaining to socially enabled technologies. They also highlight the need to highlight the value of companion robots, dismissing the assumption of automatic robot acceptance by people.

Online health information provides people with access to information, support and advice across a range of different health conditions. Although consumers and healthcare professionals (HCP's) acknowledge that people regard online health information as a key resource, a number of barriers prevent patients from disclosing and integrating the information into discussions with HCP's. Existing literature has focused almost exclusively on individuals with long term health conditions and has failed to consider how patients with short term conditions use online health information to support a broader range of health decisions including but not limited to treatment decisions. This thesis set out to specifically address these issues, by a) investigating how online health information is used to support a number of health related decisions across a range of short and long term health complaints, and b) whether intentions to integrate information into appointments with the HCP can be increased. These two research questions were explored using a mixed methods approach across five studies. The research aimed to qualitatively explore how individuals with short term and long term health conditions use online health information to inform a broad range of health decisions, and examine how this information is integrated into appointments with HCP's. These findings were then confirmed quantitatively with a larger, more diverse sample. HCP's were then asked about their experiences of internet informed patients and the role that online resources can play in decision making. These findings were fed into the development of an experimental study that aimed to increase intentions to integrate online health information into appointments with HCP's. The thesis findings showed that online health information informed a number of different health decisions. Specifically, narrative information containing the experiences of others empowered participants to make decisions and increased satisfaction with health decision making. Findings also identified discordance between patients' perceptions of HCP's attitudes towards internet informed patients, and the HCP's actual views, which prevented participants from integrating online health information into their medical appointments. An experimental study aimed to increase patient intentions to discuss online health information with HCP's, by manipulating versions of narrative health information. Findings showed that narrative information when paired with either a self-reflection component or discussion starter component but not both, increased participants' intentions to discuss online health information with their HCP. The theoretical and practical implications of these findings are discussed alongside suggestions for future research.

Background: Prevalence of dementia and especially Alzheimer's disease (AD) is increasing exponentially, both in the U.K. and more globally. Reliance on family carers of people living with AD (FCOPWA) to provide the backbone of care remains critical and continued reliance on such carers also represents current governmental policy. However, carers are vulnerable to salient health inequalities and chronic variable stress in particular as a direct consequence of taking on the carer role. The numbers of those family carers whose own health and wellbeing might be affected has reached unprecedented levels which are set to increase further in future. Aims: This study therefore aims to investigate ways in which FCOPWA can be optimally supported to maintain and sustain family care over the course of the AD trajectory. Research questions: 'What works' 'when' and 'in what circumstances' to enable the FCOPWA?' Design: this study adopted a scientific realist methodology to identify 'generative mechanisms' which support the long-term maintenance and sustenance of FCOPWA. A rapid realist review (RRR) is employed to investigate a comprehensive range of candidates for 'what enables the FCOPWA,' draw up a new conceptual framework based on 'what works' and formulate candidate Program Theories (CPTs) to be empirically tested. Testing comprised eighteen in-depth interviews with family carers to gather data which could be analysed to further investigate the CPTs. This led to the establishment of more specific and narrowly defined Program Theories (PTs). Findings: Five PTs emerged, presenting an adaptive carer pathway covering the three main stages of the AD trajectory. This adaptive pathway was underpinned by resilience as a key mechanism and facilitated by the adaptive and differentiated employment of a range of problem and emotion-focused coping approaches and strategies. Hope was also found to provide a pivotal positive and motivating influence throughout the FCOPWA. The pathway offered a way to promote the sustainability of FCOPWA. Conclusions: The adaptive pathway outlined by this study may also prove useful in similar adult care contexts beyond AD and dementia. Additionally, the three main emergent strands: resilience, coping and salutogenesis might be usefully combined to represent an alternative paradigm to the traditional Medical model as part of the solution to the burgeoning question of how diseases which are chronic and life-limiting but not life-threatening such as dementia, but also other diseases with similar criteria, can be better served and supported in future by health and social care system.