Research Portfolio submitted for Doctorate in Clinical Psychology

  • Sarah Mills

Student thesis: Doctoral ThesisDoctor of Clinical Psychology (DClinPsy)


Main Project abstractObjectives: Bitterness has been suggested to be a common psychological reaction to persistent adversity; however it has thus far been understudied. The objectives of the current study were therefore to: i) Develop a reliable and valid English language measure of bitterness, ii) Pilot this new measure within a clinical population, iii) Explore how the construct of bitterness relates to treatment outcome in psychological therapy, and iv) Determine whether bitterness accurately predicts suicidal ideation in clinical populations. Design: a cross sectional questionnaire design was used. Method: A new bitterness measure was developed incorporating ideas from existing literature and suggestions from experienced clinicians. This measure was completed by a non clinical group (n = 313) and factor analysis was carried out on these data. The measure was then completed by a group of secondary care mental health service users (n = 31) and compared with the non clinical sample,. Additional symptom focussed measures were also completed by the clinical group. Results: Factor analysis showed that the bitterness measure was comprised of four subscales (labelled here as “experience of a negative event”,” nihilism”, “unfairness” and “negative interpersonal experiences”). Good internal consistency and acceptable test-retest reliability was found. Bitterness was found to be related to rumination, in particular the brooding / analytical subtype of rumination. A significant relationship was found with some measures of anger, but no significant relationship was found between bitterness and depression. Conclusions: Bitterness may be a unique construct, conceptually distinct from anger and depression and closely associated with analytical rumination.Service Improvement Project abstractObjective: The birth of a pre-term baby is an acutely stressful event for parents. Medical advances in the UK mean that more babies than ever before are requiring NICU care. Consideration of the psychological needs of parents will help them cope with the NICU environment, develop a bond with their baby and will create the best possible outcome for NICU babies. The study objective was therefore to interview parents in order to better understand factors which supported coping. Design: A consecutive sample of NICU parents participated in semi-structured interviews which focussed on their experience. Setting: A Level 2 NICU in the UK which had recently been rebuilt. Participants: Nine parents representing seven families from a UK NICU. Methods: Parents participated in semi-structured interviews about their experience of NICU. Thematic analysis was used to extract key themes from the data. Results: The main theme described the Emotional Rollercoaster of NICU. Additional themes identified factors which helped or hindered coping: Baby Wellbeing, Physical Environment and Other People. Conclusion: Parents identified a number of factors affecting how they cope with the NICU experience. None of these alone explains positive coping, however the findings of this study give useful information about optimal NICU conditions to parental promote psycho-social wellbeing.Critical Literature Review abstractA substantial amount of high quality research has been conducted exploring the development and maintenance of Post Traumatic Stress Disorder (PTSD) among people who witness or are victims of traumatic events. Well validated models of the disorder have led to the development of robust and effective treatment protocols. Scant attention has however been paid to the exploration of PTSD within individuals who perpetrate violent acts. There were, therefore, two broad aims of this review. The first was to review and summarise available evidence for the existence of PTSD in perpetrators, and the second was to synthesise this evidence in order to draw conclusions regarding the development and maintenance of PTSD in perpetrators and whether existing theoretical models may be applicable to this group of people. Overall, very few studies have been published in this area. There is preliminary evidence that PTSD can develop after perpetration of a violent act and that psychological therapy for such PTSD based on a cognitive model may be effective, taking account of key emotions such as guilt and shame.
Date of Award10 Sep 2014
Original languageEnglish
Awarding Institution
  • University of Bath
SupervisorPaul Salkovskis (Supervisor), Claire Lomax (Supervisor) & Josie Millar (Supervisor)


  • Bitterness

Cite this