PERSONAL CONSTRUCTS IN SECONDARY HYPOTHYROIDISM Submitted in partial fulfilment of the requirements of the University of Hertfordshire for the degree of Doctor in Clinical Psychology

Secondary hypothyroidism is caused by treatment for hyperthyroidism and is a chronic condition. After adequate treatment, people can continue to experience persistent physical and depressive symptoms. There is a lack of research into the psychological factors involved in the condition, such as how people adjust to hypothyroidism. The study used Kelly‘s (1955) Personal Construct Theory to explore the way in which patients construe (appraise) themselves with hypothyroidism and how this relates to coping, depression and hypothyroid symptoms. Twenty participants were recruited from an endocrinology clinic and online, through thyroid support organisations. Participants completed a semi-structured interview called a repertory grid and self-report measures of coping (Brief COPE), depression (HADS) and hypothyroid symptoms (ThySRQ). Repertory grid measures were extracted such as distances between different views of the self. The results showed that how unfavourably the self now was viewed compared to self before a thyroid disorder was positively correlated with depression, dysfunctional coping and hypothyroid symptoms. Identification with a negative view of hypothyroidism was associated with poorer mental and physical health and with dysfunctional coping. Polarized (i.e. black-and-white) construing and tight (i.e. rigid) construing were significantly and positively related to depression scores. Tightness of construing was also related to the number of hypothyroid symptoms experienced. Dysfunctional coping was positively correlated with depression and hypothyroid symptoms. Those with a history of depression experienced significantly more hypothyroid symptoms. Exploratory multiple regression analyses uncovered that how unfavourably the person viewed themselves now compared with before any thyroid problem, hypothyroid symptom frequency and dysfunctional coping accounted for 82.9% of the variance in depression. This highlights the importance of understanding how people construe the experience of hypothyroidism and their coping strategies and therefore psychological interventions may be helpful. Limitations include a small sample size and a correlational design, whereby cause and effect conclusions cannot be drawn.