Mary John


Head of the School of Psychology
+44 (0)1483 689267
35 AD 04

Biography

University roles and responsibilities

  • Head of Department of Psychological Interventions
  • Programme Leader for PsychD Clinical Psychology
  • Senior Lecturer in Clinical Psychology

    Business, industry and community links

    Health Education England
    Mary is active in influencing on the training and workforces related to applied psychology.

    Research

    Research interests

    Research collaborations

    Research funding

    • Sussex Partnership NHS Trust Own account funding stream - Developing a Mindfulness App for young people. Collaboration with Prof Robin Banerjee Sussex University. 2013 Awarded.
    • Sussex Partnership NHS Trust Own account funding stream- Development of a recovery measure for young people 2009 Awarded.

    Courses I teach on

    Postgraduate research

    Clinical Psychology PsychD

    My publications

    Highlights

    Simonds. L, John, M, Fifie-Schaw. C., Willis, S., Taylor, H., Hand, H., Rahim., Winstanley, H., and Winton,H ( 2015 )Development and Validation of an Adolescent Shame -proness Scale. Psychological Assessment

    John, M (2015) Working with children chapter in Clinical Psychology (Topics in Applied Psychology) Routledge

    Mulligan, B., John, M., Coombes, R., Singh, R., (2014) - Developing outcome measures for a Family Intensive Support Service for Children presenting with challenging behaviours. British Journal of Learning Disabilities March

    John M, Jeffries F, Acuña-Rivera M, Warren F, Simonds L. (2014) 'Development of measures to assess personal recovery in young people treated in specialist mental health services'. Clinical Psychology & Psychotherapy, 21(3) 1063-3995 doi: 10.1002/cpp.1905

    Simonds LM, Pons RA, Stone NJ, Warren F, John M. (2014) 'Adolescents with Anxiety and Depression: Is Social Recovery Relevant?'. Clin Psychol Psychother, 21 (4), pp. 289-298.doi: 10.1002/cpp.1841

    Atkins, E., Colville., G and John. M. A 'biopsychosocial' model for recovery: a grounded theory study of families' journeys after a Paediatric Intensive Care Admission Intensive Crit Care Nurs. 2012 Jun;28(3):133-40

    John, M. Shortlisting from the Clearing House Application form: Is it fit for purpose? A commentary Psychology Learning and teaching 9 (2) 37-39

    Lee, K. Vandrevela,T and John A.M (2008). The challenges and experiences of Trainees pursuing Clinical psychology training straight from and undergraduate degree

    Hewitt, O and Roose, G and John, M, Yazdani, A (2006) Young people with learning disability views on mental health. Young Minds

    John, A.M. and Vetere, A It's Important, and Its' One Way of Helping, and One Way of Helping Only. Clinical Psychology Forum (2008)

    Vandrevala, T, Hayward, M, Willis, J. and John, M. (2007). A move towards a culture of involvement: involving service users and carer in the selection of future clinical psychologists. Journal of Mental Health Training, Education and Practice.

    Carlisle A. S., John A., Fife-Schaw, .C. and Lloyd. M (2006) The Self-Regulatory Model in Women with Rheumatoid Arthritis: Relationships between Illness Representations, Coping Strategies, and Outcome. J. Health Psychology.

    Hewitt, O and Roose, G and John, M, (2004) View finder User consultation is seen as key to improving outline how children and young people view mental health services. Young Minds 71

    Roose, G and John, A. (2003) Young children's understanding of mental health their help seeking behaviour and ideas for a mental health service. Child Health care and development

    Adams, S., Dowdney, L., John, A, and Hill, V. (2003) Expanding the profession of clinical psychology- clinical psychologists views on providing training placements. Clinical Psychology 22- February

    Bradford, R., Rutherford, D. L. and John, A. (2002) Quality of life in young people ratings and factor structure of quality of life profile-adolescent version. J of Adolescence Vol 25 no 23, 261-74

    Bowen, A and John, A. M. (2001) Gender differences in presentation and conceptualisation of adolescent self-injurious behaviour: implications for therapeutic practice Counselling psychology quarterly vol. 14 357-379.

    Spender. Q, and John, A. (2001) Psychological and psychiatric perspectives. In Legal concepts of childhood. Editors Fionda, J. Hart Publishing

    John A.M, (2001) Psychological considerations in the child patient. Introduction to podopediatrics. Editors Thompson, P and Volpe, R Churchill Livingston

    Skinner, C. John, M, and Hampson, S. (1999). Social support and personal models of diabetes as predictors of self care and well being A Longitudinal study of adolescents with Diabetes. J. of Pediatric Psychology.

    Tomes, J and John, A. (1994). 'The Psychological Effects of Chronic Illness on Children and their Families.' In Paediatrics for Chiropodists. Edits. Thomson P. Harcourt Brace & Jovanovich.

    John A, (1993) 'Emotional Problems of Children,' In: The Royal Society of Medicine. Child Health Guide. Edited West .R. Octopus.

    John, A. & Bradford, R. (1991). Integrating Family Therapy into Paediatrics. A Model. Journal of Family Therapy. Vol. 13 p 207-223.

    Bradford, R. & John, A. (1991). The Psychological effects on disaster work, implications for disaster planning. Journal of Royal Society of Health. Vol. 111 June, p 107-110

    Publications

    May Christine (2020)The construction of friendship for looked after children. University of Surrey
    Looked After Children (LAC) are associated with poor outcomes, but they also demonstrate resilience and strength, particularly when placed in stable, supportive environments. Friendship is known to support resilience in children and adolescents and may be particularly useful to LAC, but there is limited research into LAC’s experiences of friendship. Objective: This study aimed to explore what LAC value in their friendships in order to understand what support may help them gain the maximum benefits from these relationships. Design: Seven 11 to 16 year olds, living in foster care took part in semi-structured interviews using sociograms to discuss their past, present and ideal friendships, particularly focusing on what they valued and how the friendships changed over time. Findings: Results were analysed using inductive thematic analysis resulting in six themes; “They’re like me”, which had two subthemes; “We like to do the same things” and “We are the same”, “They keep my secrets”, which had two subthemes; “I trust them” and “People finding out I’m in care”, “They spend time with me”, “They help me with my feelings”, “They understand me” and “They’re on my side”. Conclusions: This sample of LAC showed similar values and friendship expectations to other adolescents, and had formed and maintained positive relationships, albeit with some challenges relating to their care status, such as fears of disclosure, placement and school disruption. They provide an example of what can be achieved by LAC in a stable environment, but should not necessarily be considered typical of LAC in general. Practice recommendations include open discussion with LAC about their friendships, disclosure of LAC status and support with friendships with children with other difficulties, who may offer increased understanding. Future research with a wider range of LAC and looking at the costs of friendships is also recommended.
    Objectives: The aim of this study is to investigate the relationship between perfectionism and quality of life in people with Irritable Bowel Syndrome (IBS). It was hypothesised that people with IBS who score highly on perfectionism will experience a poor quality of life, and that perseverative thinking will mediate this relationship. Methods: A quantitative cross-sectional design was used. Online questionnaires were completed by 418 adults with a diagnosis of IBS. Perfectionism was measured using Hewitt & Flett’s Self-Orientated and Socially Prescribed Perfectionism subscales. Other measures included The Perseverative Thinking Questionnaire and IBS Quality of Life. Correlational and regression analyses were performed in SPSS and mediation analyses using Hayes PROCESS for bootstrapping. Results: Self-Orientated and Socially Prescribed Perfectionism were both found to predict poorer IBS quality of life. Perseverative thinking was found to mediate the relationship between both dimensions of perfectionism and IBS quality of life. Moreover, these associations remained after accounting for the effects of age, gender, comorbidity and duration of IBS. Conclusions: People with IBS who have elevated levels of perfectionism are likely to suffer poorer quality of life, and this is mediated through perseverative thinking. This suggests perfectionism and perseverative thinking are possible perpetuating factors of IBS. Clinicians should consider specifically assessing and targeting these areas for intervention among people with IBS.
    Purpose: To explore the lived experiences of young men in the United Kingdom (UK) who became a father for the first time at a young age. Methods: The study used Interpretative Phenomenological Analysis (IPA) of interviews with four young men in the UK who had become a father for the first time between the age of 16 and 25 years old. Recruitment was via organisations that provide practical and emotional support to young people. These include children’s centres and charities aimed at facilitating young people to increase their social support networks. The IPA process involved analysing the data from in-depth semi-structured interviews individually and eventually identifying superordinate themes from across the interviews. Results: Three superordinate themes emerged from the interviews that were thought to be most pertinent to understanding the experiences of the young fathers: Developing an identity as a father; Coming to terms with the responsibilities of fatherhood; and Networks. Interviewees spoke of a gradual process of adjustment to becoming a father whilst reflecting on their readiness for fatherhood at their specific age. They described struggles in supporting their family and the increased sense of responsibility that they experienced. Participants did not discuss these challenges as being directly linked to their young age. Interviewees discussed the varying degrees of support they had received, particularly commenting on negative interactions with health professionals. Experiences of support from friends and family members varied. Conclusions: This study provides an in-depth insight into the experiences of four young men becoming a father for the first time. It highlights both the challenges and the gratifications that the transition to fatherhood at a young age can have and the impact that the transition can have upon wider relationships. While participants did not explicitly relate any difficulties as being a direct result of their age, the findings do suggest that transition to fatherhood at a young age may create a conflict in identity development which can lead to an increased need for support.
    Objectives: Colouring books for adults have become increasingly popular. Some of these books are marketed on the basis that they improve mindfulness and promote wellbeing. Using a randomised design, this study aimed to empirically explore whether the provision of guidance on how to colour mindfully is necessary to increase mindfulness, and to reduce worry, perceived stress and work-related rumination. Moreover, the study aimed to assess whether changes in mindfulness predicted changes in worry, perceived stress and work-related rumination. The extent to which trait perfectionism might impact on possible beneficial effects of colouring was also explored. Design: Sixty-four participants (49 female, 15 male, 84% Caucasian, mean age 36) were randomly assigned to either a mindfulness-instructed condition (MI) or non-mindfulness instructed condition (NI). Participants were instructed to colour in designs in a book on 10 occasions over a two-week period. Mindfulness, worry, perceived stress and work-related rumination were measured pre and post the colouring intervention and at one-month follow up. Perfectionism was measured once, prior to the two-week colouring period. Results: Analysis of Covariance indicated no significant differences between conditions in post-colouring and follow up levels of mindfulness, perceived stress, worry or work-related rumination whilst controlling for pre-intervention scores. Oneway Repeated Measures Analysis of Variance for the whole sample indicated significant increases in acting with awareness and nonreacting mindfulness subscales, and a significant decrease in worry, affective rumination and problem-solving pondering pre-to post intervention. Changes in the nonjudging mindfulness facet pre-to post intervention were found to predict changes in worry from pre-intervention to follow up. There was little evidence of a relationship between perfectionism and change in wellbeing variables. Conclusions: Colouring, with or without mindfulness guidance, appears to increase aspects of mindfulness and improve wellbeing. Replication of these results, and further research exploring whether colouring is intrinsically mindful is warranted
    Simonds LM, John M, Fife-Schaw C, Willis S, Taylor H, Hand H, Rahim M, Winstanley H, Winton H (2015)Development and Validation of the Adolescent Shame-Proneness Scale., In: Psychol Assess American Psychological Association
    Like other self-conscious emotions, shame takes on particular significance during late childhood and adolescence because of a developing capacity for self-reflection, self-other comparisons, and sensitivity to the views of others. Shame is a potentially important variable in adolescent well-being given its established associations with depression, reduced feelings of self-worth, and problematic anger. Three studies are reported that describe the development and validation of the Adolescent Shame-Proneness Scale (ASPS), a novel semi-idiographic measure of shame-proneness. The ASPS is a 19-item measure assessing 3 components of shame-proneness-negative self-evaluation, externalization, and emotional discomfort. Taken together, the studies support the reliability and validity of the ASPS as a semi-idiographic measure of shame-proneness in adolescents aged 11 to 18 years. ASPS scores correlate as expected with scores on existing measure of shame-proneness and with measures of anger, negative affect, and self-esteem. More important, the data suggest that ASPS scores are related to, but distinct from, guilt. Confirmatory factor analysis supported the validity of the ASPS factor structure (RMSEA = .08, SRMR = .05, CFI = .97, NNFI = .97). The ASPS represents a unique contribution to existing options for measuring shame-proneness in research and clinical contexts. Further work is required to assess the ASPS' temporal stability and its viability and psychometric properties in more culturally diverse samples. (PsycINFO Database Record

    Background: There are growing numbers of smartphone apps to support the mental health of young people (YP). The NHS Long Term Plan outlines a key focus on the use of technology to support health and wellbeing. Mental health apps (MHapps) have potential to help YP, but the evidence base for their efficacy is not clear, and research exploring young people’s attitudes towards MHapps is lacking. Further in depth investigations and methodologically robust research are needed, where diverse populations of YP are included in research process, examining the development, content, safety, efficacy, and effectiveness of MHapps.

    Objective: This study explores the attitudes of university students (age 18 – 19) towards smartphone apps for mental health, and perspectives on their use. The purpose is to continue to inform effective design, engagement and evaluation of MHapps for YP.

    Method: This study used a qualitative research design, conducting five focus groups with young people aged 18 - 19 years. The data was analysed using Thematic Analysis.

    Results: Two major themes emerged: value and engagement – each contained a number of subthemes. Findings are discussed in context of functionality and delivery of apps; help-seeking and engagement; evidence base; co-production and evaluation of apps; and universality. Implications for policy, practice and future research are discussed.

    Conclusions: MHapps have numerous merits among young people, but concerns relating to app design, function and credibility need to be addressed. We should be cautious about a ‘one size fits all’ approach. There is a need to better understand how YP use MHapps, and it is essential that MHapps are co-designed with young people, clinicians and app developers, and are subject to evaluation.

    Introduction: Teachers are often faced with incidences of young people who self-harm but can feel ill-equipped to offer support. The United Kingdom (UK) government state that all staff working in schools should be trained on how to deal with self-harm, yet a large proportion of teachers identify a lack of training as a barrier to supporting students. Barriers to receiving training are a lack of time and resource in schools.

    Aim: This study seeks to investigate whether a bespoke eLearning module, designed for UK secondary school teachers, helps to increase knowledge and confidence in supporting young people who self-harm.

    Method: Twenty-one schools across the West Midlands and South West of England were contacted via email and invited to complete a 30-minute web-based eLearning module on self-harm in schools. Participants were also invited to complete pre-and post-intervention measures and a follow-up questionnaire. The data was analysed using non-parametric statistics and the free-text comments using Thematic Content Analysis.

    Results: 173 teachers completed the eLearning and pre-and post-measures and 16 completed a follow-up questionnaire. The eLearning significantly enhanced participants’ perceived knowledge, actual knowledge and confidence in talking to and supporting young people who self-harm. 90.7% of participants felt that eLearning was a good way to receive training. The following themes emerged from the qualitative data: Learning about self-harm is important; eLearning is convenient and accessible; eLearning is less engaging than other modes of training delivery; Training improved my confidence and understanding; The module could be enhanced with further detail and guidance; Wanting ongoing support.

    Background: Due to rising in rates in deliberate self-harm (DSH) and increasing pressure on NHS services, the government is looking to schools to provide a front-line response. Previous adolescents have indicated that more information on distress and alternative ways of coping would be helpful. However, teachers have raised concerns that talking about DSH in schools could lead to an increase in prevalence i.e. contagion. Therefore, this study aimed to explore student’s views of a classroom-based intervention on DSH and any potential consequences resulting from this teaching. It hoped to ascertain whether pupils had similar concerns to teachers around contagion following exposure to an intervention.

    Method: Sixty-one students in England (years 7-10) participated in 11 focus groups which were conducted in three secondary schools. They discussed their thoughts on having teaching on DSH and what the potential consequences of any teaching might be. Only one of the schools already provided teaching on DSH in the classroom and wider school environments, and their ideas appeared to be informed their experiences of this teaching.

    Results: Two themes emerged from the data which were ‘Should we talk openly about DSH?’ and ‘How to talk to openly about DSH’.

    Conclusions: The majority of the students within the focus groups expressed a desire to learn about DSH in lessons, with a few expressing concerns about the potential for contagion. All groups discussed ways to reduce the likelihood of contagion occurring. Most felt teaching would have a protective element and reduce DSH. The results indicate teaching on DSH in an open manner in the classroom is warranted, although further research measuring contagion following any intervention would add to the evidence.

    Background: Eating disorders are most commonly diagnosed in adolescence and when left untreated cause serious psychological and physical harms. Early intervention is most effective at reducing negative outcomes, however there are delays to adolescents recognising a problem and seeking help for eating disorders (Beat, 2017).

    Aims: The present study aimed to address a gap in the literature by investigating the gender differences in how young adolescents recognise early signs of eating disorders in their peers, and their intentions to seek help for the problem. The study also aimed to investigate whether a brief film intervention that is focused on adolescent males’ experiences of body image concerns had a positive impact on problem-recognition and help-seeking intentions.

    Methods: Participants (N=194, 12-13 years, 57% female) from two secondary schools in the UK completed online measures of their recognition of a mental health problem and help-seeking intentions at three time points: before and immediately after watching the film intervention, and at one-month follow up.

    Results: Females recognised a mental health problem in a vignette at a higher rate compared to males. Recognition of a mental health problem improved for males and females after the film intervention but more so for males. Help-seeking intentions also improved after the film intervention. However, at one-month follow up much of the gains in recognition and help-seeking intentions were lost.

    Conclusions: Adolescent males are poorer at recognising and intending to seek help for eating disorders compared to females, but males can catch up with females following a brief film intervention. More investigation is required into whether gender-sensitive interventions can help maximise the effectiveness of interventions particularly toward gender-related mental health inequalities.

    Barnfield Carys (2020)Materialism and well-being in adolescents. University of Surrey
    Materialism is associated with negative personal outcomes including reduced well-being, increased risk behaviours, lower quality relationships and reduced pro-social behaviours. Self-determination theory has been used to explain these links, suggesting that dissatisfaction with basic psychological needs underpins this relationship. The majority of the research addressing the effects of materialism is based on adult populations. This thesis aimed to determine the impact of materialism on adolescents.. Part one presents an empirical paper that investigated the association between materialism and well-being within an adolescent sample using comprehensive measures of well-being and materialism. The study also looked at whether satisfaction and frustration with basic psychological needs played an explanatory role within this relationship. Materialism within adolescence was found to be associated with reduced life satisfaction and psychological needs satisfaction had an explanatory role in this relationship. Materialism was not universally related to all well-being dimensions measured. Applications of these findings and future research directions are discussed. Part two of this portfolio is a systematic review of the literature on materialism and well-being within adolescent populations. The findings of the review suggested that materialism was associated with increased health risk behaviours and reduced life satisfaction within adolescent populations. However, the review found large variations in the findings with some contradicting evidence. The review identified methodological issues which limited the conclusions drawn
    Background: Auditory hallucinations (voices) in people with a diagnosis of borderline personality disorder (BPD) have traditionally been regarded as ‘pseudohallucinations’. However, recent research suggests that these voice hearing experiences can be highly distressing and share many of the same qualities as those found in diagnoses such as schizophrenia. Given these similarities, can any psychological therapies effectively treat distressing voices in the context of a BPD diagnosis? Aim: To add to the growing literature exploring voice-related distress in people with a diagnosis of BPD and to answer the unique question of whether brief psychological therapy is effective at reducing voice-related distress for people with a diagnosis of BPD. Methods: 37 people with a diagnosis of BPD and 49 with a diagnosis of schizophrenia received up to four sessions of Coping Strategy Enhancement therapy. The primary outcome measure at baseline and post intervention was the distress subscale of the Psychotic Symptoms Rating Scales (PSYRATS). The frequency, attribution and loudness subscales of the PSYRATS, the Depression Anxiety and Stress Scales (DASS21), the CHoice of Outcome in Cbt for PsychosEs (CHOICE), the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) and drop-out rates were secondary measures. Results: The BPD group reported significantly greater voice-related distress at baseline. The BPD group, but not the schizophrenia group, reported statistically significant improvements on voice-related distress at post-therapy. Only a small minority of participants (BPD = 15% and schizophrenia = 16.7%) showed reliable improvements in voice-related distress, with this not differing significantly between the groups. When controlling for baseline distress and other covariates, the BPD group reported statistically greater improvement in voice-related distress than the schizophrenia group. Withdrawal rates were low for both groups. When controlling for covariates, the attribution dimension of the PSYRATS, the stress subscale of the DASS21, and well-being were the only secondary measures that was predicted by diagnosis. Conclusion: Voices can be experienced as highly distressing for people with a diagnosis of BPD. Brief psychological therapy appears to be appropriate for helping people who experience distressing voices to engage with therapy as part of a stepped-care process, but it is unlikely to produce reliable and clinically meaningful improvements as a standalone treatment.
    In the general population, confiding in others is typically related to a plethora of individual and interpersonal benefits. However, there is a lack of research which has examined how confiding may be experienced by young people who have been in the care system. The current study employed Interpretative Phenomenological Analysis (IPA) to guide the analysis of semi-structured interviews with eight young people, all of whom had care experience, on the topic of confiding in others. Five superordinate themes emerged from the data analysis. These included: difficulties negotiating an acceptable sense of self and ‘in-care’ identity that can be shared with others; the anticipation and expectation that confiding would lead to harm; subsequent internal conflict between being open or remaining closed; and the variable opportunities to develop trusted, confiding relationships across different environments. The findings suggest a need for young people in the care system to have safe, secure and stable environments, which can enable the development of trusted, confiding relationships within which one’s identity can be explored. The findings are considered in relation to existing theory and research. Implications for clinical practice and future research are discussed.
    Previous research has demonstrated the high prevalence of internalised stigma, depression and anxiety in people living with HIV. Mindfulness based interventions such as MBSR and MBCT have yielded positive findings for alleviating depression and anxiety in health populations. Online mindfulness-based approaches show equitable results when compared to face-to-face interventions, and can be considered as a way to bridge the gap for individuals living with HIV that may be hard to reach. The current study aimed to explore the feasibility and acceptability to recruit to a randomised control design for a 4-week online mindfulness-based course for people recently diagnosed with HIV. The study used a pre-post research design to assess the 4-week online mindfulness-based course. In the second phase semi-structured interviews took place with people living with HIV (N=8), to further understand feasibility and acceptability of the study. Fifteen participants showed an interest in the online mindfulness based intervention phase of the study. Four gave consent to participate, three dropped out, leaving one participant who was successfully recruited into the study. Reliable and clinically significant improvement was only demonstrated for negative repetitive thinking, at post-intervention and follow-up. Eight participants took part in the semi-structured interview, Thematic analysis demonstrated the following themes in relation to feasibility and acceptability Where I am in my HIV Journey Matters, Will it be Worthwhile? Trust is Key, Is it Accessible and Relatable to me, A human connection improves the online mindfulness experience. The study indicated that an online mindfulness-based course for people recently diagnosed with HIV was not feasible, due to recruitment difficulties. Future studies may benefit from implementing adaptations to the focus and recruitment when conducting research within this population, suggestions of these adaptations can be considered within the themes that emerged.

    Purpose: Carers of stroke survivors face a range of challenging demands. There is an increasing interest in using mindfulness-based interventions (MBIs) to provide support for carers. The main aims of this study were to assess the acceptability of an online MBI for carers of stroke survivors and the feasibility of recruiting into a wait-list controlled study design.

    Methods: Carers of stroke survivors were recruited through charitable and voluntary organisations. Participants were randomised to the intervention (an online, four-week MBI) or waitlist control group. Primary outcomes included participant feedback and/or interview, recruitment and retention rates and reports of intervention adherence. Outcome measures assessing burden, quality of life, stress, depression, anxiety, mindfulness and coping were also administered.

    Results: Twenty-seven people requested or made contact regarding the study and 15 consenting participants were screened and randomised. At six weeks, attrition was 40%. Overall, 12/15 participants accessed the MBI. Five participants completed it and feedback indicated the MBI was acceptable to them. Qualitative data from one withdrawn participant identified barriers to taking part. Intervention adherence could not be reliably assessed. Group medians, interquartile ranges and individual change analyses did not indicate a clear pattern of changes on outcome measures, although evidence of improvement and deterioration were identified on some.

    Conclusions: Results suggest limited feasibility of extending the current methodology to a larger trial. Carers’ situations may pose limitations on their ability to engage in an online MBI, although for a subset of carers, this intervention appears acceptable. Recommendations for future trials are made.

    Objective: Most child development research has focused on the mother-child dyad, with little research on whole-family processes or the father-child dyad. There is little is known about the development of prosocial behaviour in toddlers with high externalising behaviour. Findings on this could help to inform intervention work. This pilot study sought to investigate the association between parental overreactive discipline, supportive and undermining coparenting and prosocial behaviour in toddlers with high externalising behaviours. Mothers’ and fathers’ influences were explored separately, to allow comparison. This pilot study also sought to evaluate the appropriateness of the observational coding training and measures used. Design: This pilot study employed a within-groups, cross-sectional design. Participants: The participants were 49 heterosexual parent couples (approximately 70% from a White ethnic group) and their child displaying high externalising behaviour (average age: 21.92 months). Results: The relationships found were mostly non-significant and small. The exploratory findings indicated that maternal discipline and undermining coparenting were associated with prosociality increases, that coparenting predicted prosociality better than discipline and some differences between parents’ socialisation factors. More effects were found for mothers than for fathers. Difficulties were identified with coding training, as well as limitations to the measures’ psychometric properties. Conclusions: The exploratory findings were small and mostly non-significant but some were found in the directions predicted by the hypotheses. Benefits of replicating this work in a larger study include drawing more conclusive theoretical inferences, determining whether parents contribute differently to child prosocial behaviour, and informing clinical practice and intervention design for children with high externalising behaviours. Future work could continue to compare parents’ contributions whilst investigating the influence of whole-family processes and could investigate additional dynamics including from multiple, different subsystems. Several methodological refinements were identified including to help address limitations of the coding training and the measures used.
    Crowter L, Carroll C, John M, Brown R, Greenwood K, Ferraresi L, Johnstone T, Jamieson K (2012)Early intervention for stigma prevention: Talking to young children about severe mental illness, In: EARLY INTERVENTION IN PSYCHIATRY6pp. 86-86 WILEY-BLACKWELL
    Frogley Catherine, John Mary, Denton Ruth, Querstret Dawn (2019)‘They don’t meet the stereotypes in the boxes…’ - Foster carers' and clinicians' views on the utility of psychometric tools in the mental health assessment of Looked After Children, In: Adoption and Fostering43(2)pp. 119-136 SAGE Publications

    Background: Looked-after children (LAC) frequently experience greater mental health challenges than the general child population. There has been a call for greater focus on early preventative interventions and priority access to specialist mental health support for this population. Brief mental health screening tools often provide the gateway to services and yet there is a lack of suitable assessment tools available for LAC. The current study is the first to explore the perspectives of foster carers and CAMHS clinicians’ in relation to the use of two brief screening tools; the Strengths and Difficulties Questionnaire (SDQ) and the Brief Assessment Checklists (BAC’s).

    Method: Qualitative data was collected via semi-structured telephone interviews and face-to-face focus groups with female foster carers (N=13) and clinicians working in a CAMHS setting (N=9).

    Results: Thematic analyses generated six themes which were organised into three superordinate themes centred around: 1) relevance to LAC, 2) using measures to inform care planning and; 3) current problems when using psychometric measures within the LAC population. Foster carers and clinicians emphasised the need for a comprehensive understanding of LAC given the complexity of their difficulties. There was acknowledgement that psychometric measures could facilitate and contribute to this by highlighting difficulties, providing accurate feedback to carers and clinicians, and enabling access to support. However, both groups seldom felt that current measures were nuanced enough to adequately capture the needs of LAC.

    Conclusion: Screening tools play a crucial role in identifying the mental health needs of LAC and facilitating access to services. Further research is needed to establish the ability of such measures to increase the sensitivity of the complex needs’ assessment of LAC. A number of clinical recommendations are also discussed in relation to the assessment of mental health in the LAC population.

    Much of the burden associated with poor mental health is associated with symptom experience in the general population. We conducted a systematic review and meta-analysis of studies conducted in non-clinical samples, evaluating Mindfulness-Based Programs (MBPs) for outcomes related to psychological health and well-being. We focussed on Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) because they have the strongest evidence base. We searched MEDLINE, PsycINFO, EMBASE and CINAHL (2006 – February, 2019) for published peer-reviewed journals articles of intervention studies evaluating MBCT or MBSR for psychological health and well-being in non-clinical samples. Data were pooled using a random-effects model and effect estimates were reported as Hedges’ g. We included 49 studies conducted in non-clinical samples (n=4733). When compared to a passive control, MBPs significantly reduced symptoms of rumination/worry (g=-1.13, [-2.17, -0.08]), stress/psychological distress (g=-0.52 [-0.68, -0.36]), depression [g=-0.45 [-0.64, -0.26]), and anxiety (g=-0.44 [-0.65, -0.23]); and significantly improved quality of life/well-being (g=0.32 [0.10, 0.54]). In general, MBCT generated larger effect sizes than MBSR for all outcomes. This study provides evidence that in non-clinical samples, MBPs are associated with benefits to health and well-being. These findings add to the growing evidence-base suggesting that MBSR and MBCT may be effective approaches for sub-clinical levels of mental ill-health and could form part of the public mental health agenda.
    John M, Vetere A (2008)It's important, and it's one way of helping, and one way of helping only, In: Clinical Psychology Forum181pp. 25-27
    John M, Jeffries F, Acuña-Rivera M, Warren F, Simonds L (2014)Development of measures to assess personal recovery in young people treated in specialist mental health services, In: Clinical Psychology & Psychotherapy Wiley
    Background Recovery has become a central concept in mental health service delivery, and several recovery-focused measures exist for adults. The concept's applicability to young people's mental health experience has been neglected, and no measures yet exist. Aim The aim of this work is to develop measures of recovery for use in specialist child and adolescent mental health services. Method On the basis of 21 semi-structured interviews, three recovery measures were devised, one for completion by the young person and two for completion by the parent/carer. Two parent/carer measures were devised in order to assess both their perspective on their child's recovery and their own recovery process. The questionnaires were administered to a UK sample of 47 young people (10–18 years old) with anxiety and depression and their parents, along with a measure used to routinely assess treatment progress and outcome and a measure of self-esteem. Results All three measures had high internal consistency (alpha ≥ 0.89). Young people's recovery scores were correlated negatively with scores on a measure used to routinely assess treatment progress and outcome (r = −0.75) and positively with self-esteem (r = 0.84). Parent and young persons' reports of the young person's recovery were positively correlated (r = 0.61). Parent report of the young person's recovery and of their own recovery process were positively correlated (r = 0.75). Conclusion The three measures have the potential to be used in mental health services to assess recovery processes in young people with mental health difficulties and correspondence with symptomatic improvement. The measures provide a novel way of capturing the parental/caregiver perspective on recovery and caregivers' own wellbeing. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message •No tools exist to evaluate recovery-relevant processes in young people treated in specialist mental health services. •This study reports on the development and psychometric evaluation of three self-report recovery-relevant assessments for young people and their caregivers. •Findings indicate a high degree of correspondence between young person and caregiver reports of recovery in the former. •The recovery assessments correlate inversely with a standardized symptom-focused measure and positively with self-esteem.
    Objective Social and occupational functioning are important for psychological health. However, quantitative research has suggested that these areas can be adversely affected by multiple chemical sensitivity (MCS). This systematic review therefore sought to explore what qualitative research has suggested about how people with MCS perceive it to affect their social and occupational functioning. Method Journal articles were included if they were 1) peer reviewed 2) qualitative or mixed methods 3) published in English 4) reported qualitative findings relevant to the review. Studies were excluded if they were 1) descriptive only 2) primarily concerned with environmental intolerances other than chemicals or 3) focussed on specific populations such as veterans. Quality was assessed using the National Institute for Health and Care Excellence (NICE, 2018) qualitative quality criteria. However, quality was not used to determine eligibility for inclusion. Six databases (CINAHL, Medline, PsychArticles, PsychInfo, Scopus and Web of Science) were searched between the 24th of February 2019 and 2nd of March 2019. Results Having removed duplicates, database searches identified 388 potential articles. Thirteen of these articles were eligible for inclusion. Following review, no more articles were included from the reference lists of these studies. Meta-aggregation of the findings identified seven categories. These were synthesised into three themes; ‘limited access’, ‘loss & anxiety’ and ‘seeking engagement’. Conclusions The findings suggested that MCS limits some people's social and occupational functioning. The results warrant further research, and, the development of prevention and intervention strategies. Studies predominantly recruited United States and Canadian females and had several limitations.
    Morison L, Trigeorgis C, John M (2014)Are mental health services inherently feminised?, In: PSYCHOLOGIST27(6)pp. 414-416 BRITISH PSYCHOLOGICAL SOC
    Green-Armytage M, Simonds Laura, John Mary, Woodger Nigel (2018)Depictions of acne and psoriasis influence interpersonal aversion, In: Psychology, Health and Medicine24(1) Taylor & Francis
    The presence of a dermatological condition may deter contact with the affected person because it falsely signals the threat of infection. The current study investigated interpersonal aversion towards individuals with the appearance of acne and psoriasis. Participants (N=196) either viewed a female face with the appearance of acne, psoriasis, or no visible dermatological condition. Participants rated the attractiveness of the person, and indicated their willingness for social and indirect contact with them. The person depicted with acne was rated significantly less attractive than the person with psoriasis or no dermatological condition. Participants reported significantly less willingness for indirect contact with the person depicted with acne or psoriasis compared to the person with no visible dermatological condition. In contrast, participants expressed more willingness for social contact with a person with acne than with the person with psoriasis or no dermatological condition. Group differences were significant when controlling for attractiveness ratings. Unwarranted fear of infection might underpin avoidance and discriminatory behaviour towards those with skin conditions. Further research is required to understand factors that influence avoidance of contact.
    Atkins E, John M, Colville G (2012)A 'biopsychosocial' model for recovery: A grounded theory study of families' journeys after a Paediatric Intensive Care Admission, In: Intensive and Critical Care Nursing28(3)pp. 133-140
    Paediatric intensive care has a significant impact on the children and families who experience it. This effect continues post-discharge as the family attempt to recover from their ordeal. This article begins with an exploration of what makes a Paediatric Intensive Care Unit (PICU) admission potentially so traumatising and then examines current models for recovery which exist in the literature. These remain sparse and do not provide a coherent model for recovery after PICU. This paper therefore presents research which aimed to develop a model to understand the recovery journey for families. Children who had been PICU patients and their parents were interviewed and the transcripts analysed using grounded theory. Participants highlighted the importance of physical, psychological and social recovery and these have been integrated into a biopsychosocial model of recovery. Finding and accepting a 'new normal' were the culmination of this biopsychosocial journey. This paper concludes that an integrated approach to recovery is necessary and makes some recommendations for further research and clinical practice. © 2011 Elsevier Ltd.
    Mulligan B, John M, Coombes R, Singh R, John M (2015)Developing outcome measures for a Family Intensive Support Service for Children presenting with challenging behaviours, In: BRITISH JOURNAL OF LEARNING DISABILITIES43(3)pp. 161-167 WILEY-BLACKWELL
    Denton Ruth, Frogley Catherine, Jackson Sue, John Mary, Querstret Dawn (2016)The assessment of developmental trauma in children and adolescents: A systematic review, In: Clinical Child Psychology and Psychiatry22(2)pp. 260-287 SAGE Publications
    Background:

    The assessment of children and young people with history of complex developmental trauma presents a significant challenge to services. Traditional diagnostic categories such as post-traumatic stress disorder (PTSD) are argued to be of limited value, and while the proposed ‘Developmental Trauma Disorder’ definition attempts to address this debate, associated assessment tools have yet to be developed. This review builds on a previous review of assessment measures, undertaken in 2005.

    Aim:

    To identify trauma assessment tools developed or evaluated since 2004 and determine which are developmentally appropriate for children or adolescents with histories of complex trauma.

    Method:

    A systematic search of electronic databases was conducted with explicit inclusion and exclusion criteria.

    Results:

    A total of 35 papers were identified evaluating 29 measures assessing general functioning and mental health (N = 10), PTSD (N = 7) and trauma symptomatology outside, or in addition to, PTSD (N = 11). Studies were evaluated on sample quality, trauma/adversity type, as well as demographic and psychometric data. Distinction was made between measures validated for children (0–12 years) and adolescents (12–18 years).

    Conclusion:

    Few instruments could be recommended for immediate use as many required further validation. The Assessment Checklist questionnaires, designed with a developmental and attachment focus, were the most promising tools.

    Simonds LM, Pons RA, Stone NJ, Warren F, John M (2014)Adolescents with Anxiety and Depression: Is Social Recovery Relevant?, In: Clin Psychol Psychother21(4)pp. 289-298 Wiley
    Social recovery has become a prominent aspect of mental health service design and delivery in the past decade. Much of the literature on social recovery is derived from first-person accounts or primary research with adult service users experiencing severe mental illness. There is a lack of both theoretical and empirical work that could inform consideration of how the concept of social recovery might apply to adolescents experiencing common (non-psychotic) mental health problems such as anxiety and depression. The current study was conducted to understand the process of experiencing anxiety and depression in young people. Semi-structured interviews were conducted with nine adolescents with anxiety and depression (seven girls and two boys aged 14-16 years) and 12 mothers who were recruited from a specialist Child and Adolescent Mental Health Service in the South of England. Thematic analysis indicated that young people do experience a process of 'recovery'; the processes participants described have some congruence with the earlier stages of adult recovery models involving biographical disruption and the development of new meanings, in this case of anxiety or depression, and changes in sense of identity. The accounts diverge with regard to later stages of adult models involving the development of hope and responsibility. The findings suggest that services should attend to social isolation and emphasise support for positive aspirations for future selves whilst also attending to young people's and parents' expectations about change. Methodological challenges face enquiry about 'recovery' given its connotations with cure in everyday language. Copyright © 2013 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Theoretical and empirical work on social recovery in young people and families is lacking. Using interviews, this study sought to understand the relevance of social recovery for adolescents with anxiety and depression and their mothers. Findings suggest some congruence with the earlier stages of adult recovery models involving meaning and identity. Findings diverge with regard to later stages of adult recovery models involving hope and responsibility. Social recovery in mental health services for young people needs significant empirical attention and critical debate.
    Objectives: Adult colouring books often claim increased mindfulness and reduced stress through their use. However, limited research exists as to the relationship between colouring and mindfulness and wellbeing. Whilst these books tend to market themselves as mindfulness tools, previous researchers have questioned if the psychological state of flow may be induced during colouring. Using a randomised design, this study aimed to empirically explore whether mindfulness colouring (with the use of an audio guide) is more effective at increasing mindfulness and flow than non-mindfulness colouring. Moreover, the study aimed to explore if either condition is more effective at improving worry, perceived stress, work-related rumination, and sleep, and whether or not increases in mindfulness and flow are related to this. Design: 149 participants (95.9% female, 96% Caucasian, median age 30), predominantly working in health or education settings, were randomly assigned to either an audio guided-mindfulness colouring condition (GM) or non-mindfulness condition (NM). Participants were asked to colour in designs on 10 occasions over a 14 day period. Participants in the GM condition were asked to listen to an audio guide on at least two occasions whilst colouring. Mindfulness, flow, perceived stress, worry, work-related rumination, and sleep were measured pre and post the colouring intervention as well as at one-month and three-month follow-up. Results: A mixed between-within groups Multivariate Analysis of Variance (MANOVA) found neither condition more effective than the other at increasing mindfulness or flow. A mixed MANOVA found the GM condition not to be more effective at improving wellbeing than the NM condition. An exploratory analysis of change over time including only participants who completed the study through to three-month follow-up found an increase in all five facets of mindfulness, the flow facets challenge-skill balance and concentration on the task at hand, stress, worry, and affective rumination. Correlation analyses found mixed evidence of a relationship between changes in mindfulness and flow with changes in wellbeing. The mindfulness facets non-reactivity to inner experience and acting with awareness were most associated with changes in wellbeing. Substantial attrition occurred; t-tests and chi-square analyses found differences between those who completed the study and those who did not. Conclusions: Colouring, both mindfully and non-mindfully, appears to be associated with an increase in mindfulness and some facets of flow, as well as aspects of wellbeing. Colouring mindfully was not associated with greater increase in mindfulness or flow than colouring non-mindfully. Further research is warranted as to the mechanisms by which colouring may operate upon mental wellbeing, given initial research suggests beneficial effects and that is it both a cheap and easily accessible intervention.
    Objective : Guilt is a self-conscious emotion with cognitive, affective and behavioural components. In young people, it has been linked with prosocial behaviour and academic achievement but, when excessively or insufficiently expressed, can adversely impact on mental health. Most existing measures of guilt-proneness for adolescents have scenario-based designs, which may not capture unique personal and cultural experiences of guilt. Semi-idiographic measures, where respondents rate responses based on a subjectively recalled guilt-experience, have been recommended as an alternative, yet no existing measure for young people has used this format. The main objective was to therefore develop, pilot and validate a new semi-idiographic measure of guilt-proneness for adolescents aged 11 to 18. Design and Participants: The design comprised two studies. Study one involved measure development and interviews with nine young people. Items were compiled using interview data and a review of relevant literature. A subsequent focus group was conducted, during which the drafted measure was piloted. In Study two, the new guilt measure was validated against measures of anxiety, depression, self-compassion, shame, guilt and anger with a sample of 412 young people. Results: Content analysis was used to extract guilt-related thoughts, feelings and behaviours from the interviews. The Guilt Scale for Adolescents (GSA) was then drafted. Exploratory factor analysis was conducted on the GSA to examine its underlying structure and refine and reduce items. A final 19-item GSA was produced, with four subscales: ‘Inner Turmoil’, ‘Reparation’, ‘Physiological Reactions’ and ‘Regret and Self-Blame’. Validity and reliability hypotheses were supported. Conclusions: The GSA is the first semi-idiographic measure of guilt for adolescents. It uniquely breaks down guilt experiences into four different sub-components and scores. The GSA therefore has the potential to promote further understanding of guilt-proneness in young people. Limitations and future implications are discussed. Keywords: Guilt, Adolescence, Assessment, Self-Conscious Emotions
    Objective: Previous research suggests that female partners have a key role in encouraging men to seek help from a mental health professional. Men are most likely to talk to a female partner if either are concerned for the men’s mental health. This study investigated the communications female partners use to successfully encourage their male partners to seek help for a mental health problem. Participants/Design: Fifteen women aged 28 to 71 years (M = 38) participated in a 30-50 minute semi-structured interview about their experiences of discussing mental health with their partners. The interviews reached saturation, and were analysed using Thematic Analysis to identify processes used by participants. Results: Five main themes were identified, which took the form of stages in help-seeking. Initially women took “Role Adaption”, and changed their behaviours and roles to reduce the stress on their male partners. Second, the women made “attempts to activate engagement” by having conversations about mental health and the benefits of help-seeking with their male partners, however the men did not always engage in this conversation. Third, men responded with “men’s management”, where they considered their coping mechanisms, managed stigma and thought about the cause of their mental health issues. In the fourth stage, the majority of couples entered “resolution” where they had two-way conversations which resulted in the men either seeking help, carrying on without change or considering and attempting suicide. The fifth theme captured the “dynamics of control” where the women usually assumed responsibility for the man’s safety, but would offer him control to help-seek. Conclusions: Female partners have a key role in supporting men to seek help from a professional and in maintaining their safety. Women strive to make this communication adaptive and useful, and these strategies could be utilised by others to encourage men to seek help from professionals.
    Objective: Existing research suggests that men are less likely to be diagnosed with common mental illnesses, but are more likely to drink to hazardous levels and attempt and complete suicide, suggesting that mental illness is prevalent among men, but how they express their distress can be externalised. The need to attend to men’s help-seeking behaviour has been recognised and is extensively researched; but, the role of the medical system in supporting this access is less researched. However, the role of General Practitioners (GPs) in supporting men’s access is recognised. This study explored how GPs encourage their patients to disclose symptoms of psychological distress, and how they make decisions regarding treatment. The results with a specific focus on men were highlighted. Design: A qualitative inductive Thematic Analysis was undertaken to identify themes emerging from the data. Method: Nine GPs (mean age = 35) were recruited. Data was collected using semi-structured interviews about their consultations with patients presenting with psychological distress. Results: Three themes emerged; 1) “Facilitating Techniques” which captured factors assisting consultations, encompassing five subthemes; Interpersonal Skills, Masking and Unmasking, Specific methods used to Gather Information, Mental Health Awareness and Organisational Influences; 2) “Recognition of the Patient’s Treatment Preferences”, which captured how GPs are guided by their patient’s preferences, men’s preference of medication, and the immediate availability of medication; and 3) “Cultural Prism”, which captured cultural factors through which help-seeking is governed from the GPs’ perspectives. Conclusions: This research has improved the understanding of how GPs elicit men’s disclosure of psychological distress, and their decision-making processes about treatment. It also highlights the benefits of inviting men to attend regular health checks, which has important implications in reducing some of the barriers of help-seeking in men. However, the clinical implications and conclusions are drawn tentatively given the perceived limitations of the study.
    Conduct disorder (and associated anger and aggression) is the most common mental health difficulty experienced by adolescent males. Given the detrimental impact of poorly managed anger and aggression to both the individual and society, investment in effective interventions for this client group is warranted. Research into effective therapeutic interventions for anger and aggression in adolescents has historically been somewhat narrow, focusing largely on a social-cognitive-behavioural framework. In addition, little work focusing specifically on males exists. This thesis aims to develop, implement and evaluate a new intervention for adolescent males with anger difficulties. Part one of this portfolio presents a systematic literature review of recent research into psychological interventions for adolescent males with difficulties managing anger and aggression. The findings of the review highlighted that the field is still predominated by interventions based on a social-cognitive-behavioural approach. Whilst this is effective for some, it is not effective for all. Further issues included methodological difficulties, a continued lack of interventions specifically for males, and a lack of UK-based studies. Part two presents an empirical paper of a feasibility study investigating the acceptability and effectiveness of a novel intervention for adolescent males with anger difficulties. The intervention was a short-term group programme based on Acceptance and Commitment Therapy (ACT), delivered in a school setting. Qualitative findings suggested that the participants experienced a number of benefits from the programme and found it acceptable. Quantitative findings suggested a more mixed picture of results; however, inferences made from the quantitative data were limited by the small sample and difficulties with measures. Suggestions for future research are provided.
    Despite studies identifying the challenges looked after children (LAC) may experience in their peer relationships, there has been no research addressing school-aged children’s understandings of LAC. The current research aimed to increase our knowledge of children’s social understanding of LAC, and to recognise how this understanding informs children’s behaviour towards LAC. Forty participants, aged between eleven and twelve years of age, took part in focus groups exploring these two questions. The resulting data was analysed using the qualitative methodology of Inductive Thematic Analysis. The results identified one overarching superordinate theme, ‘looked after children are different’, reflecting participants’ overall understanding that LAC are different to themselves and that LAC are treated differently by their peers. This superordinate theme had two main sub-themes ‘why LAC are different’ and ‘LAC should be treated the same but...’. Participants’ understanding of why LAC are different fell into three further sub-themes; ‘there is something wrong with LAC’; ‘LAC have problematic behaviour’ and; ‘LAC have a hard, sad life’. These understandings seemed to inform how participants would treat LAC, as well as, how they thought others would treat them. The sub-theme ‘LAC should be treated the same but...’ demonstrated participants’ views that LAC should be treated the same, despite participants describing the ways in which they, and others, would treat them differently. This sub-theme was separated into three further sub-themes; ‘LAC need extra care, love and attention’; ‘walking on eggshells with LAC’ and; ‘LAC are treated badly by other children’. These results are discussed in detail, and in relation to current research around LAC children’s peer relationships.
    Abstract Objective: Previous work suggests that the coparenting relationship may be associated with the development of prosocial behaviour in young children, which is in turn associated with decreased externalising behaviours. Some evidence also suggests that male and female infants may be differentially impacted by coparenting. However, no study has examined the impact of a range of coparenting behaviours, both supportive and undermining, on the development of prosocial behaviour in children with behavioural difficulties, or determined whether infant gender might moderate this association. The primary aim of this study was to examine the association between supportive and undermining coparenting and the development of prosocial behaviour in young children with behavioural difficulties. The secondary objective was to determine whether child gender moderated the relationships between coparenting and child prosocial behaviour. Participants: Participants were 49 mother, father and child triads who lived in the United Kingdom. Mean age of participants was 34.4 years for mothers, 35.9 years for fathers and 24 months for children. Research design and methods: The current pilot study employed a cross-sectional design. Parents participating in a larger trial were video recorded taking part in two triadic interaction tasks with their child to assess coparenting behaviours. Parents also completed questionnaire measures relating to their child’s prosocial behaviour. Data was analysed using hierarchical regression to determine the direct association between coparenting behaviours and parental report of children’s prosocial behaviour. Moderation analysis was conducted to investigate if gender moderated the relationship between coparenting and infant prosocial behaviour. Results: Gatekeeping coparenting was positively correlated with child prosocial behaviour (rs = .403, p=.004). Coparenting behaviours were not found to be predictive of children’s prosocial behaviour after adjusting for all covariates (F(6, 42) = 2.156, p = 0.067). Child gender did not moderate the relationship between supportive (F(3, 45) = 2.30, p = 0.60) or gatekeeping (F(3, 45) = 3.22, p=0.23) coparenting and prosocial behaviour. Conclusion: This study does not support a direct relationship between supportive coparenting and the development of prosocial behaviour in young children with behavioural difficulties. Child gender did not moderate the relationship between coparenting and prosocial behaviour. Findings of a positive association between gatekeeping and children’s prosocial behaviour indicate the need for further research concerning the relationship between coparenting and prosocial development of children with behavioural difficulties.
    Background: Looked after children (LAC) are a unique clinical group who, as a result of multiple trauma and disrupted attachment in early life, often present with complex mental health needs. In order to develop a meaningful formulation and provide suitable treatment for these children, the assessment of mental health difficulties in LAC is paramount. However, limited measures have been developed with LAC in mind and very few have been validated in this population. A recent literature review (Denton, Frogley, Jackson, John & Querstret, 2016) identified the Brief Assessment Checklist for Children (BAC-C; Tarren-Sweeney, 2007) as a potential screening tool for LAC aged 4-11 years. The aim of the current study was to explore the utility and psychometric properties of the BAC-C in a UK LAC population. Design: The study used a mixed-method design. A total of 178 foster/kinship carers completed two questionnaires about a LAC aged 4-11 years: the BAC-C and Strengths and Difficulties Questionnaire (SDQ). Participants were also asked questions about the utility of both questionnaires. Secondly, telephone interviews with five foster carers and two focus groups with professionals working in Child and Adolescent Mental Health Services (CAMHS) were conducted to gather qualitative data about the utility of the BAC-C. Results: The BAC-C total score was significantly correlated with exposure to sexual abuse, a previous referral to CAMHS, SDQ total and subscale scores. The SDQ total scale was the strongest predictor of the BAC-C score, followed by Emotional Problems, Conduct and the remaining SDQ subscales. The factor analysis could not determine a clinically meaningful factor structure. Finally, the thematic analysis revealed three overarching themes regarding the BAC-C: content, format and design and ways of using the information. Conclusion: The BAC-C demonstrated many psychometric strengths in terms of reliability and validity. This was also supported by the qualitative data. However, several limitations of the measure were also revealed and were discussed in the context of mental health services for children.
    This qualitative grounded theory study aimed to explore experiences of placement moves for young people in foster care, an area neglected in previous studies. For young people these moves were distressing experiences of loss and uncertainty that they frequently lacked support to manage. Consequently the young people felt the need to be self-sufficient for their emotional needs. However this self-sufficiency often increased instability and distress as they struggled to influence others or withdrew in self-protection. Despite this, the young people displayed resilience and were hopeful for a better life after care.
    The dominant identity of UK clinical psychologists is that of the reflective scientist-practitioner. However, some have claimed that the profession has increasingly emphasised the practitioner element through its provision of psychological therapies. This therapeutic focus has been criticised for failing to address the social gradient in health. The current study therefore sought to explore how UK clinical psychologists perceive the profession’s role in addressing health inequalities. The study employed a qualitative, cross-sectional design. Semi-structured interviews were undertaken by telephone and video conferencing. A purposive sample of 20 participants were recruited. Participants were trainee and qualified UK clinical psychologists (45% trainee, 25% male, mean age = 35.4, SD = 8.7). A thematic analysis identified two overarching themes. These were ‘oppressed’ and ‘leadership’. Oppressed included the sub-themes ‘constrained’, ‘powerless’ and ‘distressed’. Leadership contained the sub-themes ‘united’, ‘aware’ and ‘influential’. Nearly all participants implied that clinical psychologists could contribute to distributed leadership in relation to health inequalities. Most perceived action in this area to be a moral duty. Despite this, many seemed to feel powerless to take an agentic role because of perceived constraints across the social, political and organisational levels. The findings have potential implications for clinical psychologists’ identity and practice.
    Objectives: Central to models of social recovery is the process of finding meaning in life whilst mental health symptoms remain. Critical to this is having hope and optimism for the future. To date, there has been little exploration of the application of recovery models to young people and their families. Research suggests parents of children with a mental health problem display uncertainty and pessimism about their child’s future. The current study assessed factors related to parents’ ability to think about the future and whether they conceptualised positive or negative events in their child’s future. This has potential importance in informing recovery-oriented practice for young people and their families. Method: Participants were recruited through parenting websites and social media. 95 parents/carers of young people aged 3-18 completed online measures of perceived child symptom severity, parents’ internalising problems, optimism and intolerance of uncertainty. Perceived child symptom severity ranged from non-clinical to clinical levels of severity. Participants listed experiences they anticipated for their child’s future and rated the likelihood of their child encountering a number of positive and negative life events. Results: Parents who perceived their child’s symptoms as more severe and those with higher intolerance of uncertainty and lower trait optimism rated future negative events as more likely, and future positive events as less likely. Parents of older children rated future negative events as more likely. Perceived child problem severity mediated the relationship between intolerance of uncertainty/optimism and negative/positive future thinking. Conclusions: Findings have implications for the application of recovery models to young people and families. To facilitate the recovery dimension of hope and optimism for the future, psychoeducation may enhance parents’ optimism and reduce uncertainty, helping parents better understand their child’s difficulties and their potential impact on the present and future. Key Practitioner Message • Parents’ optimism and intolerance of uncertainty should be incorporated and explored in assessment and formulation. • Intervention should aim to enhance parents’ optimism and reduce uncertainty. • Psychoeducation may inform parents’ expectations of treatment and short- and long-term outcomes.
    Alexithymia and experiential avoidance have both been shown to share substantial relationships with poor mental health outcomes. Both constructs may have heightened importance for men, as male gender is associated with higher rates of alexithymia as well as the increased use of harmful experientially-avoidant coping strategies. Recent research has turned its attention towards the hypothesis that the relationship between alexithymia and negative psychological wellbeing may be as a result of the inflexible application of broader belief systems endorsing the benefits of experientially avoidant coping. This may be particularly relevant for men, who are arguably socialised into suppressing emotional states viewed as unacceptable within dominant masculinity scripts. This thesis aimed to explore the impact of experiential avoidance on the relationship between alexithymia and psychological wellbeing. Specifically, Part One of this portfolio contains a systematic literature review exploring the current evidence base pertaining to the question: how are alexithymia and experiential avoidance related? The findings of the review suggest that studies consistently report positive, significant relationships between alexithymia and experiential avoidance. Additionally, although there have been some mixed findings from mediation analyses, the weight of evidence currently appears in support of experiential avoidance being a critical mediator in the relationship between alexithymia and poorer psychological wellbeing. Part Two presents an empirical paper that investigated the mediating role of experiential avoidance in the relationship between alexithymia and experiential avoidance in men. Findings supported experiential avoidance having a mediating role in this relationship, consistent across depression, anxiety and stress. Findings support the conceptualisation of alexithymia as a learned coping response, which develops alongside preferences for avoidant coping more generally i.e. psychological inflexibility. Parts Three and Four of this portfolio contain details of the clinical experience and academic assignments also completed as part of this clinical doctorate programme.
    Empirical Paper Abstract Objective: This study aimed primarily to evaluate: (1) the acceptability and meaning of a novel PICU storybooks intervention from the perspective of parents; and (2) the acceptability and feasibility of research procedures designed to investigate its efficacy. Background: Admission to a Paediatric Intensive Care Unit (PICU) can be extremely stressful for patients and their parents. Both are at heightened risk of psychological distress, including enduring post-traumatic stress symptoms (PTSS). Individualised PICU ‘storybooks’ aiming to contextualise the potentially traumatic events may support parents to engage with their children in psychological processing thought to alleviate PTSS. However, documented challenges in PICU research (e.g. low recruitment and high attrition) means acceptability and feasibility issues require investigation before investing resources in novel intervention trials. Method: This mixed methods case-series feasibility study involved the provision of PICU storybooks to a small sample of parent-child dyads and outcome monitoring over 6 months post-discharge. Alongside quantitative information regarding feasibility (e.g. recruitment rates and success of data collection), how parents experienced the intervention and research procedures were explored qualitatively. Results: Problems with recruitment and data collection mean the current methods are not feasible to transfer to a full-scale evaluation trial, although procedures were largely acceptable to parents. Storybooks were perceived by parents as beneficial for helping them and their children to talk and make sense of their experiences. Conclusion: While not possible to conclude that PICU storybooks have a beneficial effect in reducing post-traumatic stress and other forms of distress, parent perceptions of helpfulness suggest this is worth further exploration. Adaptations to the research methodology to improve feasibility are discussed, alongside additional clinical and research implications.
    Empirical Paper Abstract Objective: This study aimed primarily to evaluate: (1) the acceptability and meaning of a novel PICU storybooks intervention from the perspective of parents; and (2) the acceptability and feasibility of research procedures designed to investigate its efficacy. Background: Admission to a Paediatric Intensive Care Unit (PICU) can be extremely stressful for patients and their parents. Both are at heightened risk of psychological distress, including enduring post-traumatic stress symptoms (PTSS). Individualised PICU ‘storybooks’ aiming to contextualise the potentially traumatic events may support parents to engage with their children in psychological processing thought to alleviate PTSS. However, documented challenges in PICU research (e.g. low recruitment and high attrition) means acceptability and feasibility issues require investigation before investing resources in novel intervention trials. Method: This mixed methods case-series feasibility study involved the provision of PICU storybooks to a small sample of parent-child dyads and outcome monitoring over 6 months post-discharge. Alongside quantitative information regarding feasibility (e.g. recruitment rates and success of data collection), how parents experienced the intervention and research procedures were explored qualitatively. Results: Problems with recruitment and data collection mean the current methods are not feasible to transfer to a full-scale evaluation trial, although procedures were largely acceptable to parents. Storybooks were perceived by parents as beneficial for helping them and their children to talk and make sense of their experiences. Conclusion: While not possible to conclude that PICU storybooks have a beneficial effect in reducing post-traumatic stress and other forms of distress, parent perceptions of helpfulness suggest this is worth further exploration. Adaptations to the research methodology to improve feasibility are discussed, alongside additional clinical and research implications.
    Introduction: Research into parenting programmes has typically found that parental wellbeing, parenting practices and child wellbeing are linked, with increased parental wellbeing and supportive parenting practices resulting in better wellbeing and outcomes for children. As such, parenting programmes have focussed on supporting parents in how to best manage their child’s behaviour. However, these programmes have been largely based on professional opinion and ignore parental perspective. Research has suggested that what parents want and need from a programme may be different to what is being offered (Hill et al., 2007). Aims: The research aimed to understand what a group of parents thought about elements within current parenting programmes. Method: A q-sort methodology was used to elucidate parental opinion about the parts of a programme that would have the most impact on their ability to parent effectively. 64 parents were asked to sort a number of statements about current parenting programmes on offer using an online tool. Results: A principal components analysis was undertaken with 60 statements and 64 q-sorts. This yielded three factors that were interpreted to represent three different understandings of parenting programmes. “A parenting toolkit of skills”, “Fix me first” and “Nurture the nurturer”. The factors shared some similarities of what parents report with current programmes on offer (e.g. therapeutic relationship, universal, childcare provision) but also highlighted areas where parents wanted different things. The results are discussed in light of the demographics of the individuals assessed and how this may impact on future parenting programmes. Conclusion: the results indicated that the main theme overlapped with the typical concepts embedded in well-established programmes in services. There are however a small group of parents where these concepts did not meet their needs. Consideration needs to be given to more mature parents, single parents and fathers.
    Abstract Background: A growing concern within the looked after community is that there is an over-representation of Black, Asian and minority ethnic young people in the care system; the largest group being children from Black and mixed heritage backgrounds. Aim: The purpose of this research is to contribute to our understanding of the processes involved in peer support development for Looked After Children (LAC) from minority communities Method: The study gathered information through face-to-face multi-method, interviews informed by a topic guide. The sample comprised of eight young people, both male and female, with their ages ranged from 11- 16 (mean age = 12.88). Results: The three main themes emerged from the data were: learning about each other, levels of closeness, and a sense of belonging. It also found young people from back and dual heritage background hold fairly realist views of LAC by believing they feel sad, experience stigma, struggle with building trusting relationships but should be treated no differently to others. Discussion: This research has also highlighted the potential process used to inform their inclusive nature towards LAC and how this may be related to prosocial qualities and past experiences that are unique to black and dual heritage young people. Conclusion: This research has extended our knowledge on what the views and perceptions black and dual heritage young people have of LAC and can serve as a preliminary base for future studies.
    Prevalence rates of mental health difficulties in UK youth are high and increase with age. The majority of lifetime mental health difficulties emerge by adolescence and young adulthood. Even sub-clinical difficulties occurring in adolescence can have detrimental impact upon future social, health and financial well-being. This age group requires interventions tailored to the specific developmental, social and emotional changes occurring in adolescence. Acceptance and commitment therapy (ACT) offers an intervention, which can be adapted to suit to these requirements. The current systematic review explored all peer-reviewed literature of ACT interventions with adolescents addressing emerging or pre-existing mental health difficulties. Searches produced 21 articles, which covered 20 intervention studies. All studies were assessed for methodological quality, effectiveness and acceptability. The most striking factor was the recentness of the articles, with all but one published after 2011. In line with this emerging field of literature, the majority were described as pilot, feasibility or preliminary research. Methodological weaknesses and small sample sizes resulted in cautionary interpretations of findings, however many studies offered preliminary support for the use of ACT with adolescents. Directions for future research are discussed.
    Background: There is an established association between parental Expressed Emotion (EE) and mental health disorders in children and adults. Most research has focussed on parental EE regarding under 12s or adult offspring, with very little attention devoted in the literature to the impact of parental EE regarding adolescent offspring. Furthermore, most studies have used methods of coding EE that were designed for use in relation to adult offspring, raising questions about the validity of their findings. The aim of this study was to compare level of parental EE regarding adolescent offspring (12-18 years) referred for treatment for depression and/or anxiety with parental EE regarding adolescent offspring recruited from the community. Design: A cross-sectional, between-subjects’ design was used. A clinical group of adolescents and one of their parents were recruited from a Child and Adolescent Mental Health (CAMH) service. A community group of adolescents and a parent were recruited as a comparison group. EE was assessed using the Five Minute Speech Sample (FMSS) with a coding scheme adapted for use with adolescent offspring. Parents completed the FMSS and a measure of psychopathology. Adolescents completed a questionnaire measure of their own anxiety and depression. Results: Level of parental EE, Criticism and Emotional Over-Involvement was non-significant between the two groups. Level of Warmth and number of positive comments was significantly lower in the clinical group. Parental EE was significantly associated with higher adolescent self-reported symptoms of depression. Parental psychopathology was not associated with parental EE. Conclusions: EE may be more normative in relation to adolescents compared to other studies. Lack of positive elements of EE may be more of a risk factor for adolescents. However, the cross-sectional design of this study means that causality cannot be inferred. Key words: Expressed Emotion, Parents, Adolescents, Internalising disorders.
    Background: The presence of a dermatological condition may deter contact with the affected person because it falsely signals the threat of disease to others. The current study investigated whether avoidance of anticipated contact was expressed towards individuals with visible dermatological conditions, and was associated with disgust, health anxiety and contamination fear. Method: 236 participants completed an online survey. They were randomly allocated to one of three conditions where they viewed a face with the appearance of acne, psoriasis, or no visible dermatological condition. Participants rated the attractiveness of the face, and indicated their willingness for social and indirect contact with the person. Measures of disgust, health anxiety and contamination fear were completed. Results: Consistent with the prediction, participants reported significantly less willingness for indirect contact with a person with acne or psoriasis. Contrary to prediction, participants expressed more willingness for social contact with a person with acne or psoriasis compared to a person with no dermatological condition. Contrary to prediction, there was not a consistent relationship between willingness for contact and disgust, health anxiety or contamination fear. Instead, the perceived attractiveness of the person depicted in the acne and psoriasis conditions was positively correlated with willingness for social and indirect contact. Conclusion: The findings suggest that people respond differently to individuals with dermatological conditions. Reported willingness for social contact may be motivated by socially desirable responding, yet as the potential for immediate physical contagion increases, indirect contact is possibly avoided. The positive association between perceived attractiveness and increased willingness for contact with individuals with dermatological conditions substantiates appearance-related concerns reported by this population. Further research investigating observed behaviour in interactions with individuals with dermatological conditions is required to examine what underpins willingness for contact in light of the limited association between disgust, health anxiety, contamination fear, and contact.
    Objective: The study aimed to investigate the suitability of the Brief Assessment Checklist for Adolescents (BAC-A) as a mental health screening tool for Looked-after adolescents compared to the Strengths and Difficulties Questionnaire (SDQ). Design: The study was a mixed methods design incorporating quantitative and qualitative data. Data was gathered via: Online survey, telephone interviews with foster carers, and focus groups with mental health professionals. Participants: A volunteer sample of foster carers (N = 111) completed an online survey after which eight foster carers volunteered to participate in qualitative interviews. In addition, two focus groups were conducted with mental health practitioners from Child and Adolescent Mental Health Services in the South of England (N = 9). Results: The findings of a correlational analysis confirmed predicted associations between BAC-A and SDQ scores. Multiple regression analyses suggested BAC-A Total score was significantly predicted by SDQ Total and subscales Emotional and Conduct Difficulties. The BAC-A evidenced good internal reliability (α = .89) however analyses suggested some instability across SDQ subscales (range .89 to .66). Exploration of BAC-A internal structure yielded inconclusive results which may have been due to sample size limitations. Qualitative analyses suggested the BAC-A is relevant for Looked-after adolescents but participants raised concerns about item wording and measure specificity. Conclusions: The results provided evidence of scale validity and internal reliability and suggested the BAC-A may be valuable when screening for externalising attachment behaviours. Further investigation with a larger sample is required before conclusions can be made regarding the BAC-A’s internal structure. The BAC-A is relevant to Looked-after adolescents and may raise the profile of trauma amongst professionals. However limitations of scope and wording suggest it would be most valuable when used in conjunction with existing measures of general psychopathology. Keywords:Looked-after, adolescents, developmental trauma, assessment
    Abstract Objective: Consistent self-care is vital to maintaining good health and quality of life for people with type 1 diabetes (T1D), as well as avoiding life-limiting conditions. Evidence suggests depression impacts on T1D self-care, but research into what might influence this is lacking. The aim of the current study was to explore whether shame-proneness predicts diabetes self-care in an emerging adult population and whether this relationship is mediated by depression. Method: 292 participants between the ages of 16 and 25 and with T1D took part in an online survey. They completed measures of shame-proneness, depression and adherence to diabetes self-care activities, and provided their most recent HbA1c reading. Results: As hypothesised, all four shame subscales showed a significant correlation between high shame and low self-care. All four types of shame evidenced some partial mediation by depression, though this was only marginal for diabetes shame. There was evidence of stronger mediation by depression in the models of behavioural and character shame. For the models assessing diabetes-related and body shame on self-care outcomes, the direct effect of shame generally remained significant. HbA1c levels in the sample were high (mean=64 mmol/mol) and uptake of attendance at structured diabetes education courses was low (40%). Conclusion: Preliminary support was found for a model whereby diabetes and body shame directly affect T1D self-care in emerging adults. Depression remains an important factor in T1D self-care and for some may be influenced by character and behavioural shame. Potential ways of reducing shame for people with T1D are discussed. Further research is needed to establish causality and measure factors which may play a role in triggering and maintaining shame.
    Recovery from mental health problems is a key target for the NHS today. The philosophy of personal recovery is included within government policies and the design of some mental health services in the UK. Research into recovery has focused largely on service-users and there is a lack of information about lay perceptions of recovery. This study sought to examine lay constructions of recovery from two mental health problems - depression and psychosis - using Q methodology. Seventy-two participants sorted 47 statements about recovery based upon their level of relative agreement or disagreement with each one after reading a vignette describing either symptoms of depression or of psychosis. Three subtly different constructions emerged from participants in the depression condition and two from those in the psychosis condition. Lay constructions of recovery from each of these conditions overlapped to some extent, with differences emerging around the centrality of professional input and the eradication of symptoms. The study demonstrated that the constructions of lay people in this sample comprised elements of both personal and clinical recovery. Generally, participants seemed to have an optimistic view on the possibility of recovery from both conditions.