Psychological Factors Associated with Service Engagement and Dimensions of Psychosis

Abstract

The current thesis titled ‘Psychological factors associated with service engagement and dimensions of psychosis’ has been prepared by Greta McGonagle in the year 2017. The thesis has been submitted to The University of Manchester for the degree of Doctor of Clinical Psychology in the Faculty of Biology, Medicine and Health (School of Health Sciences). The thesis has been prepared in paper based format and comprises three papers. The overall theme of the thesis is the investigation of attachment and its association with psychosis. Firstly, a systematic literature review sought to identify, summarise and critically evaluate studies that investigated associations between adult attachment and relationships with mental health services in people with psychosis. There was some evidence of associations between insecure attachment (namely avoidant attachment) and therapeutic alliance and insecure attachment and engagement with services. Secure attachment was also associated with self-reported attachment to services as a whole. Secondly, research was carried out to explore the potential mediating role of fearful attachment and dissociation between childhood interpersonal trauma and auditory verbal hallucinations (AVHs). The results showed that fearful attachment was statistically significantly associated with childhood interpersonal trauma, dissociation and paranoia but not AVHs. Dissociation was associated with fearful attachment, childhood interpersonal trauma, AVHs and paranoia, although, depersonalisation/derealisation was a stronger predictor of AVHs than other types of dissociation. A serial mediation analysis highlighted a possible causal pathway between childhood interpersonal trauma and AVHs, mediated by fearful attachment and dissociation, however further prospective research is needed to confirm this. Finally, the third paper is a critical evaluation and reflection of the design, decision making processes, methodology, clinical implications and proposed future research in papers one and two. Personal reflections of the overall research process are also presented.

Date of Award	31 Dec 2017
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Katherine Berry (Supervisor) & Sandra Bucci (Supervisor)