Psychology Theses

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.

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.

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.

Intersectionality is concerned with processes of power and oppression emerging at the intersections of social categories such as gender and ethnicity. Given the psychological impact of oppression and inequality, understanding intersectional effects on health outcomes is of relevance to practice and policy. While intersectionality is a growing framework in clinical psychology, its application to adolescent mental health is still under-researched. The present thesis thus sought to examine the effects of social categories, processes, and determinants within intersectionality’s framework, on adolescent mental health outcomes. Firstly, to explore mental health more deeply as experienced through the complex social category of ethnicity, a qualitative systematic review of 17 academic and non-academic studies centralising adolescents’ voices was conducted. The narrative synthesis highlighted contexts, processes, and determinants effecting the mental health of adolescents from ethnically and culturally diverse backgrounds, notably discrimination, social inequalities, and interpersonal connection. However, unique intersectional effects were not explicitly examined in this study. Thus, a quantitative empirical study was conducted in an Irish secondary-school sample of 9,011 adolescents from diverse backgrounds to examine the intersectional effects of gender, sexual orientation, ethnicity, and disability on adolescent mental health. Multilevel Analysis of Individual Heterogeneity and Discriminatory Analysis (MAIHDA) examined the intersectional effects of these social categories on mental health outcomes, and a series of fixed-effects models were also conducted to investigate the individual effects of social categories and risk/protective determinants on adolescents’ mental health. Significant intersectional effects were not observed for the four social categories. Instead, significant effects for determinants such as bullying, discrimination, and connectedness to school emerged, reflecting the systematic review. The present thesis demonstrated that while it is important to remain cognisant of intersectionality, there are salient determinants reflecting oppression and inequality that warrant practice and policy attention in the interest of adolescent health and wellbeing.

Recent shifts towards a neurodiversity perspective of autism have highlighted misunderstandings regarding Autistic people’s social interaction. In the area of prosocial behaviour (e.g., helping, sharing, comforting), diagnostic criteria and tools suggest that Autistic children lack prosocial capacities. However, evidence has indicated conflicting outcomes. Therefore, in the face of mixed theory and evidence, further research is needed. The overarching aim of this thesis was to clarify our understanding and increase knowledge about Autistic children’s prosocial behaviour and associated predictors. To meet these aims, Study 1 outlines a systematic review of published peer reviewed literature. Twenty-nine studies presented in 31 articles are reviewed. Study quality limitations and the various methodologies used to-date are outlined. A narrative synthesis of reviewed studies reveals positive findings regarding the frequency of Autistic children’s prosocial behaviour when compared to neurotypical children. Observations via the synthesis include numerous predictors of prosocial behaviour and identified differences in Autistic children’s approach to the behaviour. By collating this diverse body of literature, the review serves as a useful entry-point into the field and should prove a valuable resource for Autistic individuals, researchers and practitioners. Study 2 met the aims of the thesis through empirical examination of the prosocial behaviour of 51 children with Autistic characteristics via parent-report measures. Findings revealed increased prosocial behaviour with age, and towards familiar targets with whom increased empathy was experienced. Findings contribute to the evidence base that highlights the social context of Autistic social interaction. Recommendations are provided for clinical practice and research including a neurodiversity-affirmative position which celebrates Autistic differences. A relational approach towards assessment, intervention and future research is further advised. Overall, the present thesis highlights the prosocial strengths and potential of Autistic children, and the numerous ways their prosocial behaviour can be supported.

Perinatal mental health problems are a common experience for women and their families, and are associated with a significant and enduring burden of illness for the mother and her infant. Specialist Perinatal Mental Health Services have recently been established in Ireland following the publication of a model of care in 2017. At the time of conducting this research programme, Specialist Perinatal Mental Health Services in Ireland were operational, but a Mother and Baby Unit had yet to be established as part of these services. This research programme reports on two independent research studies which sought to contribute to the development of the Specialist Perinatal Mental Health Services in Ireland, and the wider evidence base on perinatal mental health services. Study one outlines an updated systematic review on the outcomes of Mother and Baby Units. Twenty-two papers were included in the final review. Findings indicate that admission to a Mother and Baby Unit benefits maternal mental health, the mother-infant relationship and infant health and development, further supporting the rationale for the provision of Mother and Baby Unit services in Ireland. Study two outlines a qualitative study exploring the relevance of an attachment informed model of mental health service design and delivery to Specialist Perinatal Mental Health Services in Ireland. Fourteen perinatal mental health professionals participated in semi-structured interviews in the study. Findings of this study indicated that the practices of perinatal mental health professionals and the service delivery procedures were in line with an attachment informed model of mental health service delivery and design, supporting the appropriateness of attachment informed service delivery and design in meeting the needs of this population. The findings from these studies have important implications for the provision of perinatal mental health services in Ireland, including demonstrating the evidence for services which respond to the needs of both the mother and infant during this vulnerable period in their lives.

Background: Suicidal ideation is a prominent presentation across mental health services. Presentations are both very complex and individual to each person. Services are under increased pressure to provide assessment and intervention for people experiencing suicidal ideation. Aims: This thesis explored suicidal ideation as a presentation to general emergency health services and mental health services. Method: Two related studies were completed. The first, a systematic review reporting on hospital presenting suicidal ideation. The systematic review of 27 relevant studies reports on the characteristics, medical history and medical treatment of people presenting to hospital with suicidal ideation. The second is comprised of a file audit including presentations to a mental health emergency service for the calendar year 2020 followed by explorative qualitative interviews with 10 service users presenting to mental health services for assessment of suicidal ideation. Results: The systematic review highlights the variability in presentations of suicidal behaviour and the limitations in relation to inconsistent assessment and treatment approaches. The file audit of the mental health service revealed the average age of presentations was 35.4, the gender split was 48.6% Male to 51.3% Female, the most prominent presenting complaint was low mood and suicidal ideation, 17% of people presenting with intermittent risk, 79% amount of people were directed to CMHT for further support and EUPD was the most common diagnosis given. The interview data identified five major themes with subthemes within them. 1. Complex presenting needs, 2. Interactions with staff, 3. Emotional experience of attending the service, 4. A missing piece – psychology or talk therapy, 5. Service limitations and recommendations. Conclusion: Evidence suggests there is a desire for additional services for people with suicidal ideation, specifically psychological therapies and trauma informed assessment and intervention. Future research could examine the role of suicide specific interventions in assessment and treatment of suicidality.

Background: Distinct sensory processing patterns have been shown to occur for both Autistic children and adolescents and individuals with Obsessive Compulsive Disorder (OCD). There are also elevated rates of OCD in autism. It has therefore been suggested that sensory processing may be an important focal point for understanding the relationship between autism and OCD. Aim: The overarching aim of this research programme is to explore the relationship between autism, OCD and sensory processing patterns, and the interplay between them. Two studies were designed with this research aim in mind. Study one: Study one is a systematic review which aimed to explore relationships between psychological features in autism and sensory processing patterns in children and adolescents. Nine studies were evaluated for methodological rigor and reporting quality, and results were systematically analysed using narrative synthesis. Sensory processing patterns were found to correlate with a range of psychological constructs. Further research which includes direct experiences of Autistic children and adults is needed to extend these findings. Study two: Study two examines the relationship between features of autism, OCD and sensory processing in children and adolescents (n = 65), measured using diagnostic interviews and parent-reported questionnaires. Correlational analyses and follow up regression analysis were performed. Findings indicate that OCD and autism have significant relationships with sensory processing patterns, but not with each other. Social and communication-related features of autism in particular appear to be related to sensory processing. OCD traits were found to be associated with hypersensitivity to sensory input, which has been suggested by both previous research and anecdotal clinical evidence. Conclusions: Findings from this research support the significance of distinct sensory processing patterns as having a significant association with both autism and OCD, which has important clinical and theoretical implications. Although OCD and autism are known to commonly occur with each other, a significant relationship between them was not established by this research programme. Future research should explore the lived experience and perspective of Autistic individuals.

The current thesis aimed to explore the parent-child relationship in Autistic children and adolescents, and the implications this relationship has on child development. The thesis consists of two studies, a systematic review and an empirical study, which look at two aspects of parent-child relationships in Autism. In the systematic review, the correlates of the parent-child attachment relationship in Autism were examined, with mixed findings. Language, play, and developmental level seemed to have associations with attachment, while little research investigated internalising and externalising symptoms. The empirical study examined the relationship between parental affective attitudes, Autistic characteristics, and internalising and externalising symptoms. Results demonstrated high rates of internalising and externalising symptoms in this Irish population, however there were very few associations between parental affective attitudes and Autistic characteristics or co-occurring symptoms. Limitations regarding both studies are outlined, and clinical implications and avenues for future research are discussed.

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.

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.

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.

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.

This thesis presents a multimethod programme of research that aimed to further current understanding of psychosocial aspects of adolescent idiopathic scoliosis, a paediatric spinal condition characterized by a sideways curvature of the spine. The first study comprised a qualitative exploration into adolescents’ experiences of living with idiopathic scoliosis at the presurgical stage of treatment (N = 14). Four key themes were developed, including “Proceeding with Caution,” “Am I Different?” “An Emotional Journey,” and “No Pain, No Gain.” The second study examined the contribution of psychosocial processes to variation in health-related quality of life and body image outcomes among adolescents with idiopathic scoliosis (N = 115). Findings demonstrated that coping strategies were significantly associated with health-related quality of life among this patient group, and several appearance-related cognitions were significantly associated with body image satisfaction and disturbance. The third study comprised a systematic review and synthesis of the literature pertaining to parents’ information needs, treatment concerns, and psychological wellbeing in the context of their child’s adolescent idiopathic scoliosis. The fourth and final study was a qualitative exploration of parents’ experiences in relation to their child’s idiopathic scoliosis from diagnosis to presurgical preparation (N = 20), which resulted in three main themes including “Fear of the Unknown,” “Maintaining Normality,” and “Navigating the Patient Pathway.” Together, these studies make a number of significant contributions to the literature on psychosocial aspects of adolescent idiopathic scoliosis, and provide implications for research and practice in line with a patient and family-centered approach.

Autistic people experience increased rates of mental health conditions and symptoms compared to their non-autistic peers; autistic women and trans people perhaps more so. However, there is not yet a consensus as to why this is the case. Through the lens of the neurodiversity paradigm, the present thesis aimed to develop an understanding of the factors that impact autistic people’s mental health, from the perspective of autistic people themselves. First, this thesis presents a systematic review and thematic synthesis of the perspectives of autistic females on what experiences have impacted their mental health and wellbeing. Findings suggested that the biological and psychological factors associated with being autistic interact with a variety of environmental and social factors, in turn shaping wellbeing and mental health outcomes. Second, an empirical mixed-methods study is presented, which investigated mental health experiences and the factors that contributed to mental health and wellbeing in mixed-gender samples. The qualitative phase consisted of semi-structured interviews with 20 autistic adults and the quantitative phase investigated key factors identified by interviewees in a sample of 236 autistic adults using standardised questionnaires. High levels of depressive and anxiety symptoms and low levels of wellbeing were reported. Autistic cisgender women reported higher levels of anxiety, while autistic trans people reported more depressive symptoms. Feelings of exclusion and isolation, childhood bullying, autism-related stigma and challenges related to the neurotypical environment were all found to predict mental health and wellbeing. Overall, the findings of the present thesis point to the need for community adaptations or interventions to create a more accessible and accepting society, as well as improvements in service provision for autistic adults.

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.

Background: The opening of the National Violence Reduction Unit (NVRU) in November 2018 represented a significant shift in how serious violence is managed under the Violently Disruptive Prisoner (VDP) policy in the Irish Prison Service (IPS). Previously, practice under the VDP policy was operationally-driven, and focused primarily on containing the violence of these prisoners through isolative, restrictive and physically secure measures. Contrastingly, current practice in the NVRU, now home to all VDP policy prisoners, aims to be psychologically-informed in various ways. In January 2018, the British Psychological Society’s (BPS) Division of Clinical Psychology (DCP) published the Power Threat Meaning Framework (PTMF). The PTMF aims to provide a holistic way of understanding the origins, experiences and expressions of emotional distress and troubled/troubling behaviour, which contrasts to the dominant psychiatric diagnostic model. The related literature has also advocated for more holistic understandings of prison violence, with most existing theories (e.g. importation theory, deprivation theory) stratified to singular levels of understanding. Objectives: This thesis had dual theoretical and applied aims. It aimed to explore the empirical utility of the PTMF, primarily as a holistic alternative for understanding the origins, experiences and expressions of prison violence. Simultaneously, it aimed to explore prisoners’ and prison officers’ experiences and perspectives of the previous and current VDP policy, through the lens of the PTMF. Methods: This thesis is comprised of four studies. Study one involved a scoping review of the empirical PTMF evidence-base which has emerged in the five years since its publication (n = 17). Study two qualitatively explored prisoners’ (n = 4) and prison officers’ (n = 13) experiences of the previous VDP policy, using thematic analysis (TA) to generate a detailed description of what the previous VDP policy was like, why it was like this, how it was working, and how it could change. Study three qualitatively explored NVRU prisoners’ (n = 3) self-understandings of the origins, experiences and expressions of their violent behaviour. It used a hybrid inductive and deductive approach to TA to identify both a priori elements of the PTMF, and novel additions, in these narratives. Study four adopted the same methodology as study three, this time exploring NVRU prison officers’ (n = 13) understandings of the prisoners with whom they worked. Results: Study one identified a diverse empirical evidence-base which used the PTMF in five main ways: (1) PTMF-informed data collection, (2) PTMF-informed data analysis, (3) exploring experiences of/views on the PTMF, (4) evaluating PTMF-informed formulation, and (5) evaluating PTMF-informed interventions. Study two described the previous VDP policy through nine themes: (1) describing VDP policy prisoners, (2) staff characteristics and approaches, (3) describing the VDP policy regime, (4) the social environment, (5) the occupational environment, (6) function of the VDP policy, (7) impact of the VDP policy, (8) factors influencing violence, and (9) responding to violence. Studies three and four described prisoners’ and prison officers’ respective understandings of the origins, experiences and expressions of violence through six themes: (1) power, (2) threat, (3) meaning, (4) threat response, (5) function of threat response, and (6) moderating factors. These studies offer both unique contributions and integrated learnings, including the complexity of violence; intertwined cycles of adversity, trauma and violence; and the unique contributions and shared insights of prisoners and prison officers. Conclusions: These findings are contextualised within the strengths (e.g. novel theoretical framework, innovative methodology) and limitations (e.g. sample sizes and profiles, timeline of research) of this thesis. Potential implications and future directions for theory (e.g. value of holistic understandings), research (e.g. importance of adaptive methodologies), policy (e.g. benefits of psychologically-informed aims) and practice (e.g. value of prison officer perspectives) are considered.

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.

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.

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.