Psychology Theses

The main aim of this study was to identify the prevalence of stress and burnout in a sample of Irish helpline volunteers. A further aim was to investigate both the factors that contribute to and that help manage stress and burnout. Many helplines have reported difficulties with volunteer numbers, and up to recently they regularly lost as many as were gained. Although stress and burnout are recognised as leading causes of high organisational turnover, no empirical studies have examined this issue in the Irish helpline volunteer. Eighty-five helpline volunteers, sixty-five females and twenty males, whose ages ranged from 19 to 78 years (mean age = 44.46, SD = 15.95) took part in the study. They represented four Dublin based helpline organisations. Preliminary interviews identified a number of factors that were incorporated into a questionnaire, which was a modified version of the measure devised by Cyr & Dowrick (1991). This examined factors that contribute to and help manage stress and burnout in the current context. Additional measures of motivation, empathy, psychological well-being, burnout, support, and coping approaches were also used. Results show that volunteers experience low overall levels of stress and burnout. However, up to a third of volunteers gave cause for concern. Some volunteers exhibited high levels of stress and burnout with a proportion exhibiting clinical levels of distress. In addition, the study found that age, Job factors and Personal factors contributed most to stress and burnout and that personal factors and volunteer group factors helped most to manage that experience. Results are discussed in terms of their implications for helpline organisations, and some strategies are suggested for reducing stress and burnout in helpline volunteers such as ongoing training, an annual stress audit and the introduction of a recognition and rewards system.

The population of Irish cancer survivors is ever-increasing due to the success of modern treatments and earlier detection of the disease. However, there is little evidence in Ireland regarding post-treatment survivors’ service needs. The major aims of this research were to profile a sample of post-treatment survivors, assess their quality of life and health service needs and develop a rehabilitation programme to address those needs. To develop such a programme, two exploratory studies were conducted. Study 1 was a qualitative study of survivors, their carers and health professionals (N = 56). It investigated the factors impacting on post-treatment quality of life from a number of perspectives. It found that cancer and its treatment impacts on the survivors’ quality of life in multiple life domains, that survivors need post-treatment services and that health professionals need to be educated regarding survivorship issues. Study 2 was a comprehensive survey and needs analysis of post-treatment breast, prostate, colorectal and lung cancer survivors (N = 262). It found that although most survivors recovered very well after cancer treatment, up to 26% had significant difficulties with quality of life functioning and symptoms and 33% had anxiety scores above the normal range. In terms of lifestyle, 35% had reduced their physical activity levels, 13% continued to smoke, 51% were overweight and the majority had a poor diet. These findings informed the development and implementation of Study 3 – a multidisciplinary and integrated pilot rehabilitation programme. This 8-week programme used Hope Therapy as a scaffold to support psychosocial, physical activity and dietary change (N = 38). This positive approach to enhancing quality of life and facilitating psychosocial adjustment and health behaviour change was successful in significantly impacting on quality of life, increasing hopeful thinking, physical activity levels, fitness, strength, vitamin C and fibre intake in the treatment group. Significant reductions in anxiety, weight, saturated fat and overall calories consumed were also found. A programme evaluation by participants and the delivery team endorsed the efficacy of the programme. This research represents the first step in developing a theory-based, positive, integrated, bio-psychosocial approach to adjustment after cancer. Recommendations for the future development of formal survivorship services in Ireland are made including the development and dissemination of high quality information about post-treatment issues to cancer survivors and health care professionals.

The aim of this thesis was to develop and evaluate a mobile app-based mental health intervention for adolescents. This project took place across five phases. Phase 1 involved reviewing the youth mental health literature, which indicated that emotional self-awareness (ESA) and use of positive coping strategies were key protective factors in youth mental health that had potential to be targeted as part of youth mental health interventions. It also indicated that the existing evidence base pertaining to the use of mobile apps in youth mental health was poor. Phase 2 was a focus group study with young people aged 15-16 years (N=34, 40% female), assessing their needs from mental health mobile apps. Safety, engagement and functionality emerged as key factors that should be considered in the development of mobile app-based interventions for young people. Social interaction, awareness, accessibility, gender and young people in control were also identified as important. Findings from the focus groups informed Phase 3, which was the development of a mobile app-based intervention called ‘CopeSmart’, following established intervention development guidelines. Phase 4 was a small-scale feasibility study with 15-17 years olds (N=43, 88% female), who downloaded the CopeSmart app and used it over a one-week period and then completed self-report questionnaires pertaining to their experiences of using the app. Findings suggested that the app had potential as a feasible mental health intervention medium, with the majority of young people identifying it as at least somewhat useful and displaying a moderate level of engagement with it. Phase 5a was a large-scale effectiveness evaluation of the app using a cluster randomized controlled trial (RCT) methodology. Ten schools took part, randomized either to the intervention (N=6) or the control (N=4) condition. Participants were 15-18 year olds (Nintervention=385, Ncontrol=175; 62% female). Those in the intervention group downloaded the app and were encouraged to use it daily over a four-week period. The control group received no treatment. All participants completed questionnaires containing standardised measures of ESA, coping, distress, wellbeing and help-seeking at pre-test, post-test and 8-10 week follow up. Linear regressions confirmed that higher levels of ESA and use of positive coping strategies predicted more positive well-being outcomes. Multilevel modeling, conducted on both an intention to treat and a per protocol basis, revealed no significant changes in intervention group over time compared to the control group, indicating the intervention was not effective. The app itself captured data pertaining to user engagement and recorded users responses to questions about their daily experience of problems, coping and mood states. These data were captured for 208 participants (64% female) and were analysed as part of Phase 5b. Overall findings from across the five phases provide important insights into the role of mobile apps in youth mental health and are discussed in relation to their theoretical and practical implications for future research and practice in this area.

1. Objectives: The main aim of this study was to determine if there was a positive relationship between prosocial video game use and prosocial behaviour in Irish children and adolescents. In addition this study had three related objectives: to determine if prosocial video game use was positively associated with empathy in children and adolescents; to determine if the relationship between prosocial video game use and prosocial behaviour remained significant after controlling for theoretically relevant variables such as sociodemographic variables and weekly game play; to determine if there was a negative relationship between violent video game use and prosocial behaviour in children and adolescents.2. Method: This study had a cross-sectional correlational design. Data were collected from 538 9-15 year old children and adolescents between March and December 2014. Participants completed measures of empathy, prosocial behaviour and video game habits. Teachers rated the prosocial behaviour of participants. The socio-economic status of participants was also recorded.3. Results: Multiple linear regressions were conducted on these data using two models. Prosocial video game use was positively associated with empathy and affective relationships in Models 1 and 2. This association remained significant after controlling for gender, age, violent video game use, socio-economic status and school status (disadvantaged/non-disadvantaged) in Model 1. Weekly game play was controlled for alongside the aforementioned independent variables in Model 2.4. Conclusions: These findings provide evidence that prosocial video game use could develop empathic concern and improve affective relationships in a diverse population of youth.

Mental health concerns affect approximately 20% of adolescents worldwide, many of which can be linked to one’s sense of self. However, many psychological accounts of self have been shown to be poorly defined and lacking in strong theoretical foundations. The present thesis investigates the relationship between the self and adolescent mental health using evidence from Contextual Behavioural Science (CBS), which offers a coherent theory of self and identifies empirically testable units. Overall this body of research aims to empirically examine the theoretical assumptions of the CBS account of self at multiple levels of analysis and test the practical application of this with an adolescent population, while addressing issues identified across previous investigations. Study 1 tested the ability of a model of the three senses of self (self-as-content; self-as-process; self-as-context) to predict overall mental health in adolescents. A significant model emerged with all three predictor variables contributing significantly. Study 2, tested a clinical application of this theory through a brief school based intervention, targeting the development of a healthy sense of self as articulated by CBS. Study 2 results revealed no significant improvements following this intervention, compared to a theory of mind intervention and a no intervention control group. Study 3 examined these senses of self and other relevant behaviours (e.g. relating to others) in samples of adolescent textual responses using a qualitative behavioural measure. Consistent with Study 1, higher self-as-process was related to lower depression and lower anxiety for female participants, while lower rigid self-as-content was related to higher well being. Due to insufficient occurrences of self-as-context this relationship could not be examined reliably. Results also showed how one relates to others and ability to identify emotions have important implications for mental health, well-being, and psychological flexibility. Finally, study 4 involved a fine-grained investigation into the 2 types of self-as-context (distinction and hierarchy) at a naturally occurring level in a sample of older adolescents. Study results showed that self-as-hierarchy was significantly predictive of lower stress and depression, and that self-as-distinction was not predictive of mental health. Psychological flexibility was not found to mediate this relationship. Overall these findings make a unique and important contribution to the CBS literature. Findings are discussed in terms of theoretical and practical implications for how this body of evidence may serve to guide future empirical work

The ability to discriminate the direction of another person’s attention is an important skill in social interaction. Accurate discernment of where someone else is attending permits joint attention, an ability that emerges early in human development and is integral to the development of language and on some accounts theory of mind. Joint attention is a collaborative attentional state that involves shared attention upon an object or location in the environment. Before any shift in the observers attention takes place, they must first perceive where the other person attending in space. The direction of another person’s eye gaze, head orientation, body orientation, and hand pointing are social directional that aid perceptual discrimination of the direction of another person’s attention. Converging evidence supports high-level visual representation of some of these cues. Despite the important role that pointing plays in the development of social cognition, visual perception of pointing has received little attention in research. The aims of this thesis were to examine visual perception of these social directional cues and the relationship between the primary cues that elicit joint attention. These aims were achieved by examining how adults discern the direction of these cues and in turn reorient their attention towards the locus of another’s attention. Chapter 1 reviews the literature on the perception of social attention. Chapter 2 investigates hierarchical integration of left and right body and head orientations. Chapter 3 examines visual representation of hand pointing direction. In Chapter 4 modulation of spatial orienting of attention by social directional cue type and gender of viewer is examined. Chapter 5 examines observers’ ability to discern the direction of pointing at an object in space. The implications for understanding social perception are considered in Chapter 6.

This thesis investigates the neurocognitive (especially, attentional) mechanisms underlying “motor imagery” (MI), a cognitive ability that involves consciously performing an action in the mind without physically executing associated movements. Research shows that the systematic use of MI (or “mental practice”; MP) can enhance the functioning of motor systems and improve skilled behaviour (e.g., in sport, medicine, music and neurorehabilitation). The most popular explanation for this MI/MP effect on skill learning/performance stems from motor simulation theory (MST; Jeannerod, 1994, 2001, 2006a). Briefly, MST claims that MI and physical movement are “functionally equivalent” because they purportedly share motor representations, activate similar neuroanatomical structures, and rely on the same functional mechanisms. Unfortunately, despite their seminal nature, the tenets of MST have received surprisingly little critical scrutiny. Therefore, the cognitive mechanisms alleged to underlie MI remain unclear. The three papers reported in this thesis sought to fill this gap in research on MI. The first paper critically reviews evidence cited for MST and evaluates the extent to which it accounts for the cognitive mechanisms underlying MI. The second paper investigates the role of attentional/mental effort (as measured by pupil dilation) in expert pianists’ ability to maintain vivid and accurate MI of movements of differing complexity. It concludes that imagined movements that are both complex and fast may require levels of attention that are not sufficiently allocated during MI for accurate performance. The third paper investigates the effect of movement inhibition on attentional processes (as measured by pupil dilation) during MI. It suggests that the inhibitory mechanisms underlying MI may be implemented by multiple routes. Following a critical discussion of these findings, methodological limitations are acknowledged and potentially fruitful new directions for research on MI are identified.

The increasing burden on behavioural healthcare services and major unmet need for care necessitate the development and evaluation of innovative resources to target prevalent, burdensome and costly behavioural health problems. Contextual CBT provides a conceptual framework that is ripe for innovative scientific inquiry and encompasses therapeutic approaches with the scope intervene for a range of topographically dissimilar but functionally similar outcomes. The programme of research reported in this thesis focused on developing and evaluating innovative resources to extend the reach, enhance the effectiveness and advance the evaluation of contextual CBT interventions. Study 1 focused on the first overarching aim of this programme of research: evaluating the evidence base for novel eHealth treatments that have the potential to extend the reach of contextual CBTs. A systematic review and meta-analysis was conducted to determine the efficacy and acceptability of contextual CBT eHealth treatments as stand-alone interventions for improving common mental health outcomes. Twenty-one randomised controlled trials were included in the review. Findings revealed that the treatments were acceptable and efficacious in improving common mental health outcomes including anxiety, depression, and quality of life, but not more so than comparison interventions. Study 2 focused on the second overarching aim of this programme of research: developing and evaluating an innovative blended intervention with the potential to enhance the effectiveness of contextual CBT. This study built upon its predecessor by investigating the efficacy of a treatment that combined eHealth and traditional face-to-face contextual CBT for the most common substance use problem: smoking. One hundred fifty adults smoking 10 or more cigarettes per day were randomly assigned to six weekly group sessions of behavioural support, ACT, or ACT combined with the smartphone application. Findings revealed that the blended intervention was acceptable to participants and efficacious in promoting smoking reduction, acceptance, and present-moment awareness at post-treatment. Smoking cessation outcomes, however, were comparable to the comparison interventions. Study 3 focused on the final overarching aim of this programme of research: developing and evaluating an innovative resource that holds promise in advancing the evaluation of contextual CBT interventions. This study investigated the preliminary psychometric properties of a novel measure of a primary target of the contextual CBT interventions evaluated in Studies 1 and 2: valued living. A separate sample of 150 adults participated in this psychometric evaluation of the Values Wheel. Findings provided preliminary support for the psychometric properties of the Values Wheel as an idiographic and weighted measure of valued living. The three studies reported in this thesis were published in peer-reviewed academic journals. The publications have made original contributions to the scientific knowledge, substantiated and supported existing literature, and given rise to active research in the field. The publications also have several implications for contextual CBT practitioners. Limitations and directions for future research are discussed.

Overall, this thesis presents a theoretical model of the cognitive mechanisms involved in analgesic MLIs, followed by three empirical studies. The scoping review presented in Chapter 2 introduces a comprehensive overview of five cognitive mechanisms and how they fit together to form the Cognitive Vitality Model. Initially, at a lower level, music captures our attention. Following this a person uses their Cognitive Agency to actively engage with the music listening experience. Processes of Enjoyment and Meaning Making, contribute to an intrinsically rewarding experience which motivates the person to continue listening until they become completely absorbed in the music. When patients become fully immersed they integrate the music with their pain, which makes it less unpleasant and less intense. Instead the person becomes more connected with aspects of their self that are reflected in the music, which leads to a strengthened sense of self, and ultimately a greater level of Cognitive Vitality. The development of the Cognitive Vitality Model helped to generate testable hypotheses in relation to the relative impact of each specific mechanism. Based on the findings from the scoping review presented in Chapter 2, empirical methods were to explore three specific mechanisms (Automated Attention, Cognitive Agency and Enjoyment and Meaning Making). The impact of Cognitive Agency was demonstrated in the audio feature analysis presented in Chapter 3 which identified that people choose music with different intramusical features compared to music chosen by experimenters. Subsequently, the limit of Automated Attention was highlighted in the behavioural experiment presented in Chapter 4 which highlighted that intramusical features alone cannot account for the analgesic effects of music listening. Importantly this was the first study to isolate the role of making a choice on the analgesic benefits of music listening, independently but alongside the benefits attributable to Enjoyment. Accordingly, top-down processes in music interventions should be continued to be explored in the context of music-based pain management strategies. Lastly the field study presented in Chapter 5 was used to examine the external validity of the Cognitive Vitality Model with a clinical population. Chronic pain patients were in agreement that musical absorption mediates the analgesic benefits of self-chosen music, and helps to elicit a strengthened sense of self. While one of the main strengths of this thesis is that it provides an overarching evidence-based model of the cognitive mechanisms involved in MLIs it is important to recognize some of the methodological limitations including the validity of using Spotify audio features from a psychological perspective. Areas for future research in this area were dutifully considered in light of current conceptualisations of enjoyment and the potential for additional behavioural experiments. Overall, these findings contribute greater insight into the cognitive mechanisms involved in mediating the analgesic benefits of self-chosen music.

Seclusion is used in increasingly recovery-oriented adult mental health services. No studies have specifically explored psychologists’ perspectives and experiences of seclusion or the perspectives and experiences of staff and service users on seclusion in the context of recovery-oriented practice. This thesis aimed to address these gaps. A systematic review of 27 studies explored the extent to which principles of recovery were evident in the perspectives and experiences of staff and service users on seclusion. Limited findings of seclusion being consistent with recovery principles were consistently accompanied by greater evidence that seclusion was perceived as directly opposing these. Service user perceptions placed seclusion and recovery at greater odds than staff perceptions. A qualitative hermeneutic phenomenological study adopting a social constructivist perspective was conducted. This explored the roles of Irish psychologists in the process of seclusion, their perspectives on seclusion, its use in recovery-oriented practice and related professional practice issues that may arise. Semi-structured interviews with 17 psychologists were analysed using reflexive thematic analysis. Twenty-four themes clustered within four overarching themes were identified. Seclusion was perceived as a peripheral topic within their work and Irish psychology more broadly. Seclusion was considered problematic and largely inconsistent with recovery, but occasionally necessary at present. Participants perceived that systemic factors influenced practice in relation to the topic, including often limited multi-disciplinary shared care and recovery-orientation in services. Overall the findings highlight the importance of reflective practice and point to changes to partially reconcile seclusion and recovery. They underscore the need to openly acknowledge the reality of conflicting priorities that cannot be easily reconciled (e.g. safety v rights, care v control) and the importance of conscientiously balancing needs to ensure ethical practice. The findings suggest that psychologists are well-suited to participate in local and national discussions on the complexities of using seclusion in recovery-oriented practice.

In Ireland, multidisciplinary teams (MDTs) such as those comprising healthcare and social care professionals, as well as senior managers, are tasked with the implementation of the national deinstitutionalisation programme for people with disabilities in Ireland. The main aim of this study was to explore the decision-making processes of MDTs who were involved in transferring adults with an intellectual disability (ID) to dispersed housing in the community. The objectives of the study were as follows: (1) to determine what decision-making processes were used by MDTs when transferring an adult with an ID from congregated settings to dispersed housing in the community; and (2) to determine the factors that MDTs considered in their discussions when transferring an adult with an ID to dispersed housing in the community. This study adopted an exploratory multiple-case study research design. Twenty-eight MDT members from five service providers participated in five different focus group discussions and five senior managers were interviewed from each of the service providers. Findings indicated that four of the five MDTs in focus groups used six decision-making task processes when considering transferring an adult with an ID to community housing. The sequential pattern of the decision-making task processes of describing, recommending and planning were the most frequently used, followed by predicting and explaining. The least used decision-making task process was constructing hypothesis. MDTs considered a myriad of factors when making decisions to move adults with an ID from campus-based to community-based settings. Five overarching themes emerged namely, client profile, deinstitutionalisation, resources, person-centredness and ethos. The present study has contributed to the body of knowledge by identifying the Naturalistic Decision-Making (NDM) framework as a suitable framework that could be used by MDTs for exploring the task decision-making processes. The present study also highlighted theoretical and practical implications applicable to MDTs’ decision-making process within the ID field, as well as implications for policy in the deinstitutionalisation process within the Irish context.

Background: There is debate about the selection, sequencing and delivery of trauma interventions to meet complex clinical need in trauma populations. One suggestion is the implementation of a phase-orientated treatment, whereby a stabilisation phase precedes a trauma-focused intervention in the form of exposure therapy. Phase-orientated models however remain equivocal, with a lack of consensus as to effectiveness of these models or indeed the therapeutic modalities to be included in such interventions. Method: Two studies were conducted as part of this thesis. Firstly, a systematic review and meta-analysis of existing qualitative and quantitative data on standalone stabilisation interventions and stabilisation followed by trauma-focused therapy (i.e. phase-orientated approach) was undertaken. Secondly, an empirical qualitative study aimed to explore the impact of trauma on participant’s lives before and after completing a phase-orientated ‘Trauma Programme’. The study also endeavoured to understand the role of a compassion-based approach in relating to trauma at pre and post intervention stages. Qualitative content analysis was used to examine the qualitative data. Results: Systematic Review: 31 studies met predefined criteria. A narrative synthesis of qualitative studies yielded three themes which indicated that group stabilisation interventions are helpful for reducing trauma symptoms and in preparing for trauma-focused therapy. Two further themes captured the challenges associated with implementing a stabilisation intervention. A meta-analysis revealed a medium effect size for PTSD symptom reduction using stabilisation interventions. This effect size was reduced when utilising only randomised controlled trial (RCT) stabilisation data. A large effect size was found for phase-orientated quantitative studies and this large effect size was maintained using RCT data. There was tentative evidence that phase-orientated treatment is more effective than standalone stabilisation, with a small effect size. Empirical Study: 20 semi-structured interviews were conducted at pre and post intervention stages with 10 participants with complex trauma presentations. The pre-intervention data gave rise to 4 themes which indicated that trauma exposure in childhood had a widespread negative and distressing impact on participant’s psychological functioning. 5 themes emerged from the post-intervention data which endorsed the trauma intervention in terms of assuaging the emotional distress associated with trauma. A Compassion Focused Therapy (CFT) model is reported as helpful in intervening with core symptoms associated with complex trauma such as guilt, shame and self-criticism. Conclusion: Overall, the results from the systematic review and the empirical study support the value of a phase-orientated model in reducing and alleviating posttraumatic stress disorder symptoms. The combination of stabilisation and exposure therapy was salient in the findings on the Trauma Programme. CFT is discussed in consideration of its use within phase-orientated interventions for trauma. Limitations and areas requiring further research are outlined.

Background: Higher rates of cancer mortality exist for people with significant mental health difficulties (SMHD) compared to the general population. The systematic review aimed to identify and synthesise previous qualitative literature regarding barriers and facilitators to accessing and engaging with cancer care for people with SMHD. An empirical study explored the experiences of cancer care from the perspectives of participants with SMHD. Methods: (1) A systematic search across five databases was conducted in January 2021 followed by a narrative synthesis of six eligible studies (2) interviews with participants with SMHD from two hospital settings in Ireland and participants recruited via online mental health and/or cancer support organisations, based on their experiences of accessing and engaging cancer care were analysed thematically. Results: Key findings from the systematic review and the empirical study highlighted similar barriers and facilitators to accessing and engaging with cancer care for people with SMHD. The main barriers included: stigmatising attitudes from staff and family members and the fragmentation of mental health and cancer care delivery across healthcare disciplines. Key facilitators to care included: connection with mental health services, a stronger collaboration among healthcare professionals working across psychiatry and oncology settings and the development of a patient navigator role to facilitate stronger links between patients and healthcare services. Conclusions and clinical implications: Findings from the narrative synthesis and the empirical study provides further evidence for the importance of facilitating timely and integrated mental health and cancer care for patients with SMHD.

Adolescents and young adults with cancer (AYACs) have become recognised as a unique group in recent years. They differ in their biological, social and psychological experience of cancer compared to other groups. The unique developmental context and related challenges of being a young person with a cancer diagnosis can lead to a distinct and diverse set of psychosocial issues for this group. Existing research has attempted to explore these psychosocial needs and challenges and to develop appropriate and individualised interventions. However, the psychosocial needs of this group remain unmet, with ongoing calls for individualised supports for this group. This thesis sought to explore the psychosocial needs of AYACs across two empirical studies. The first study was a systematic review of the literature exploring the psychosocial needs of AYACs (22 papers included). The findings of this study provided an overview of the constellation of psychosocial needs of AYACs from the existing literature. The second empirical study adopted a qualitative approach to explore the experience of psychosocial needs of AYACs from their own perspective (n=5). The findings showed that AYACs experience a myriad of needs that appear to change over time and are impacted by factors such as stereotypes and individual contexts. Together, these two studies provided a well-rounded exploration of what the psychosocial needs of AYACs are and offered an in-depth understanding of these needs. The combined findings supported the idea of a changing constellation of psychosocial needs for AYACs in areas such as identity, relationships, mental health and autonomy and the idea that these vary according to a number of individual factors. The thesis considered the results of these studies in the context of existing literature. The main implications of the findings for clinical services, theory and future research included, for example, the role of clinical psychology, the importance of the developmental context and consideration of AYACs as individuals. These implications highlight the unique and important contribution of this research to the existing research in the area.

The promotion of positive psychological functioning is a major public health need and a key objective of clinical psychology. Cognitive and behavioural processes hold promise as means to this end, and process-based CBT provides a coherent system for their integration. The research programme described in this thesis investigated the promotion of positive functioning through such processes. Accordingly, three studies are reported and each explored the promotion of positive functioning through cognitive and behavioural processes. Study 1 focused on facilitating the application of processes to conceptualise cases in process-based CBT by evaluating a conceptual model. This model proposed resilience as a pathway through which transtherapeutic mindfulness processes promote positive mental health. Findings from this study provided empirical support for the model in a sample of 129 early adolescents. This publication helped lay a conceptual foundation for the subsequent studies in this research programme. Study 2 aimed to advance the process-based CBT agenda of distilling the literature on processes that promote of positive psychological functioning. In accordance, a systematic review and meta-analysis was conducted to elucidate the efficacy of mindfulness process in promoting resilience. The findings of 57 randomised controlled trials were synthesised and revealed that mindfulness processes are efficacious in promoting resilience, but not more so than comparison interventions. This set of findings provided an empirical basis for Study 3. Study 3 sought to extend the nascent empirical research on process-based CBT interventions. A cluster randomised controlled trial was conducted to evaluate the efficacy of an intervention which integrated the processes explored in the two preceding studies. Findings did not support the efficacy of this intervention in enhancing positive psychological functioning outcomes in a sample of 604 early adolescents. Collectively, the three studies contribute to the scientific literature and present a number of implications for the practice of clinical psychology.

Difficulties with Emotion Regulation (ER) has been linked to the expression of emotional and behavioural difficulties in children in the literature. Self-blame and blaming others have been conceptualised as two specific maladaptive cognitive ER strategies, which previous research has suggested are significantly related to psychopathology in children and adults. Despite this, and in comparison to other maladaptive cognitive ER strategies, relatively little investigation specifically focusing on these putative strategies has been carried out. Therefore, this thesis examines a synthesis of the current literature in relation to self-blame and other blame and their role in emotional and behavioural difficulties in children, as well as an empirical study assessing the role of parental emotion socialisation on blame ER strategies in children with emotional and behavioural difficulties. (i) A systematic review and meta-analysis assessing the use of self-blame and blaming others and their relationship with internalising and externalising behaviour in normative middle childhood was carried out. Ten studies assessing self-blame and internalising and externalising behaviour were examined. No studies assessing blaming others in this population met the search parameters. A positive correlation with a small-to-medium effect was found between self-blame and internalising and externalising behaviour. While not an intended outcome, all studies included in the meta-analysis examined self-blame in the context of interparental conflict. Implications of this are discussed in the thesis. (ii) . Sixty three parents of children with and without clinical diagnoses participated in a cross-sectional assessment study examining the role of parental emotion socialisation on blame ER strategies in children with emotional and behavioural difficulties. Findings suggested parents with parenting styles which included Punish and Override were more likely to identify that their children blamed others as an emotion regulation strategy. Males were also more likely to be identified as children who primarily blamed others. Potential implications of the research are discussed.

As the incidence of cognitive disorders increases, a growing number of episodic memory instruments are being introduced to the scientific literature to ensure accurate detection of impairment. The current thesis comprises two studies which sought to explore methodologies for the validation of auditory verbal episodic memory measures and to assess the validity of a new auditory verbal memory measure designed for use in an Irish population¬ - the EirPrVLT-12. Chapter one discusses the aging population, types of auditory verbal memory instruments and how research and clinical provision have evolved to improve the diagnosis and monitoring of cognitive disorders. Chapter two presents a systematic review which categorises methods of validating verbal memory instruments, including a sub-analysis for cross-cultural validation on six studies. The most reported validity types were discriminant and cultural validity with most studies using Receiver Operating Characteristic, Analysis of variance and correlations as statistical methods. Most cross-cultural validation studies used the back translation method of adaptation. Chapter three built on a previous normative study by aiming to validate the EirPrVLT-12 with a mixed clinical population. Convergent validity was weak to moderate when compared with the Logical Memory subtest (Wechsler Memory Scale-IV Edition). Divergent validity was assessed with weak to strong correlations seen when comparing the EirPrVLT-12 to non-memory subtests. The EirPrVLT-12 could discriminate between a clinical and a normative sample across all variables, except for the Forced Choice Recognition condition. Results indicated that EirPrVLT-12 performance may have been impacted by education level and socioeconomic status. The final chapter aims to integrate these findings and to provide recommendations for future research and clinical practice.

Mental health professionals are known to work in challenging and often stressful environments. Prior to the added complication of Covid-19 to service provision, burnout had been identified as an emergent critical issue in this context. This thesis sought to address a gap in the literature by clarifying the conceptual underpinnings of resilience in mental health service provision by investigating mental health professionals’ experience of resilience in their practice, and exploring the role of social identity processes therein. To address the aims of this thesis, a two-study approach was taken. Study 1 is a systematic review of qualitative empirical literature on mental health professionals’ experiences of resilience in their practice. Twenty six papers were included in the final review. Resilience was conceptualised as a dynamic, interactive phenomenon that is heavily influenced by social connection. Study 2 is a qualitative study exploring the influence of social identity processes on staff working in Irish regional approved centres during the Covid-19 crisis. Seventeen participants were interviewed in this study. Findings support conceptualisations of resilience as flexible and multidimensional in the context of mental health service provision, contingent on the dynamic interplay between multiple interconnected factors. Practitioners describe resilience as a shared process that occurs in relationship within a social ecological context. This thesis proposes that social identity can offer a useful theoretical framework for understanding the group dimension of resilience processes in mental health settings, wherein the application of social identity theory can provide an underlying explanation of how group identification can both strengthen and undermine collective resilience in a crisis. This thesis highlights the conceptual compatibility of resilience and social identity theory as both may represent complementary pathways to practitioner wellbeing that can help foster positive outcomes for staff, service users, and mental healthcare systems.

Sexual offences are often accompanied with some of the highest levels of societal disdain, with many considering it the most socially unacceptable and reprehensible crime. Due to this, families of people who commit sexual offences often face serious secondary consequences and stigma. This thesis explores the overall experience of having a family member commit a sexual offence. It reports on a systematic review of the available qualitative literature reflecting the experiences of families of sexual offenders, and on an empirical study that explores the narratives of nine female partners of men who have committed a sexual offence in Ireland. The systematic review and narrative synthesis produced six themes, The pain in discovery, The impact of media reporting and registration laws, The impact of the offence on relationships, and identities, The emotional and psychological consequences of the offence, The ways of coping with the conviction and Looking to the future. Using Interpretative Phenomenological Analysis the empirical study established four superordinate themes, Explosion! Life before to finding out-the initial fallout, Muddling through and making sense-the aftermath of finding out, Unwanted new experiences, and Silver linings and survival-an uncertain future. The results of both studies indicate the profound implications a person committing a sexual offence has on their family. The review reflects the existing knowledge base on the experience and highlights the current gaps in the literature. The empirical study reflects the importance of professionals adapting a trauma informed approach when working with these families who are often presenting with their own mental health needs. Families require both psychological and practical support in navigating the aftermath of the discovery of the sexual offending. Further research is needed to help inform public knowledge and policies, and assist in developing appropriate supports and services.

When an adolescent experiences a mental health difficulty they rarely seek help on their own and they frequently rely on their parents to access help and support. However, to date, the role of parents in adolescent help-seeking has been neglected. This research investigated parental help-seeking using a multi-method approach. Study one aimed to explore what factors influence parental help-seeking. Participants were 30 parents of adolescents: 23 mothers and seven fathers. The findings suggest seeking help is a complex process in which parents have to overcome a number of challenges (e.g. limited knowledge, systemic issues with the delivery of services, difficulties engaging their adolescent in services) in order to access appropriate help for their child. The results also suggest that theory needs to acknowledge the complexities of parental help seeking. Study two was informed by the results of study one. Study two tested the application of the Common-Sense Model of Illness Representations to explain how parents perceive adolescent distress and how this predicts intentions to seek help. The study employed an experimental design using video vignettes. The sample consisted of 1,176 parents of adolescents aged 10-19 years. Results showed that the model was useful for explaining parental help-seeking intentions. Parents were more likely to report intending to seek help if they believed that treatment could control the problem and if they believed the problem would have negative consequences for the adolescent. If parents believed the problem was in the control of the adolescent, they were less likely to intend to seek help. Study three was a systematic review of the literature of parental help-seeking interventions. Six electronic databases were searched from inception to May 2020 and eighteen studies met the inclusion criteria. The Behavioural Change Taxonomy was used to code behavioural change techniques, and “promising interventions” were identified using pre-established criteria. The most frequently identified Behavioural Change Taxonomies included a credible source delivering the intervention, supporting parents, and providing prompts/cues regarding services/appointments. Four interventions were identified as “promising” because of strong methodology, significant positive outcomes, and strong evidence-base. The findings from this body of research have enhanced our understanding of the parental help-seeking journey. The research also provides valuable insights regarding how parents can be better supported when seeking help for an adolescent mental health difficulty.