Clinical Psychology - Lecture 2: Understanding Mental Health Problems Flashcards
Approaches to understanding MH problems
- Medical model
- Psychoanalytic/Psychodynamic – unconscious conflict
- Behaviourism (learning theory)
- Cognitive model -cognitive processes -> underlying beliefs about self and others in the world
- Humanism – external environment impedes natural development - opportunities had to experience validation and empathy
- Sociocultural model (emphasises social context) - various cultural models
- Cultural models
The Medical Model
- Focuses on physiological explanations
- Borrows language from medicine
- Genetic and neurological explanations - Genetic -> extent found in family members, Neurological -> brain imaging - looking at differences in brains of those with and w/out MH problems
- Tends to ignore psychological and social explanations
Advantages of medical model
- If it works, it often works quickly - compared to therapy/long-term processes
- > often takes time for drug to reach therapeutic level for person
- Avoids dealing with causes (which can be painful/difficult)
- Cheaper
Disadvantages of medical model
- Suggests problems are illness
- Ignores psycho-social causes
- Doesn’t help ppl to help themselves
- Potential for adverse effects (e.g. side effects, addictions) -> MH deterioration
How can medication be helpful?
Can help ppl to be bought to space at which they can engage with psychologist
Psychoanalytics/psychodynamic approaches
- Psychological difficulties understood as conflicts between different parts of the psyche (Id, Ego, Superego)
- Most conflicts relate to early experiences in relationships with attachment figures
- Early relationships with attachment figures
form a blue-print for later relationships
Id
Immediate radification
Superego
Impose moral compass
Ego
Balance above superego and Id
Different parts of psyche when using the psychoanalytics/psychodynamic approach
Trying to make these parts of the psyche more conscious for person
Blue-print for relationship
When see secure attachment between adults/caregivers and kids -> grow up to be secure attachment styles as adults
-> What happens when young has huge impact on how we relate to others as adults
Psychodynamic therapy
- Originated with Freud in the early 1900s, substantially transformed since
- Focuses on psychological roots of emotional suffering
- Hallmarks in self-reflection and self-examination, and the use of the relationship between therapist and patient as a window into problematic relationship patterns in the patient’s life.
What can unconscious competing demands do?
Create Psychological symptoms e.g. anxiety, depression
What is there a heavy focus on in psychodynamic therapy?
Heavy focus on therapeutic process rather than content -> may not be as much structure as in behavioural appraoches
Behavioural model (learning theory)
- Assumes behaviour is learned -> therefore behaviour can be unlearnt
- Three main ways of producing behaviour
- > Classical conditioning
- > Operant conditioning
- > Social learning
Classical conditioning
- Associative learning
- Unconditioned stimulus (food) paired with neutral stimulus (bell) to produce conditioned response
How do you learn in operant conditioning
Learn based on contingencies of behaviour
Positively reinforced - likely to repeat that behaviour
Social learning
Learn from ppl around us/what we see around us
Behavioural approaches compared to psychology
Much more content focused
Sex/Gender causing MH problems
- Almost all mental health problems are more
common in females, e.g., Depressive Disorders,
Anxiety Disorders, Eating Disorders - Exceptions:
- Adults
-> Substance Related Disorders
-> Antisocial Personality Disorder - Children
-> Attention Deficit Hyperactivity Disorder (ADHD)
-> Conduct Disorder
Why are women more likely to experience major depressive episodes over their lifetime as well as in their past compared to males?
Generally comes down to females expressing more depressive things
But other factors may include:
-> Dealing in different way - males - substance-use/self-medicate
-> Hormonal differences
-> Social pressures
-> More acceptable for females to express emotion -> they’re more likely to seek help
-> Men don’t have vocab to express difficulties
Genetics causing MH problems
- Mental illness runs in families
- E.g., Obsessive Compulsive Disorder (OCD):
first-degree relatives of individuals with OCD
have a risk for OCD two times greater than
general population (10x greater for childhood
onset). - Concordance rate higher in monozygotic vs.
dizygotic twins -> higher heritability of MH problems in monozygotic twins
Problem when trying to figure out whether genetics is part of MH problem cause
When it comes to MH problems in families -> can’t tease apart if genetics or enviro because they live in same/similar enviro
Why are MH rates in twins not perfect?
If MH problems were purely based on genetics would see perfect concordance rates in monozygotic twins which is not seen
-> Genes play some role but not the only role in MH problems -> genetics may make ppl vulnerable - pre-genetic position to developing certain conditions - but may not manifest if something else present (enviro)
Traumatic brain injury
- Research suggests causal link between traumatic brain injury and depression and anxiety disorders
- > Traumatic brain injury acted as a stressor -> increased vulnerability for depression/anxiety disorders
Brain abnormalities
Read et al. (2004) highlighted similarities found
in brains of severely abused children and adults
diagnosed with Schizophrenia
-> Acquired brain injuries - tumours, hemorrhages, birth defects, surgery, abuse as child (can change physiological structure of brain), substance abuse
Poverty
- Relative poverty = difference between richest and poorest - Strong predictor of the rates of mental health problems in different countries – even when comparing relatively wealthy countries
The prevalence of mental illness is higher in more unequal rich countries
As income inequality increases so does %age with MH problems
Ethnicity
Relationship between high rates of mental health problems and being a member of an ethnic minority or of a colonised indigenous people: E.g., in the UK, African-Caribbeans are 9 to 12 times more likely to
be diagnosed with Schizophrenia than white people (Read, 2004)
Ethnicity Discrimination
Less likely with own people but increase in MH problems not due to being from ethnic minorities but because of what they experience
NZ Research: Te Rau Hinengaro: The New Zealand Mental Health Survey (2006)
- 20.7% of NZ population met criteria for a
disorder in the past 12 months - 29.5% for Māori, 24.4% for Pacific people,
19.3% for Others
NZ Research: Psychiatric inpatient admissions in Auckland (Wheeler et al., 2005)
60% European, 23% Māori, 11% Pacific
people, 4% Asian
-> Also to do with less common MHPs -> overrepresentation of Maori
Ethnicity
- Relationship between high rates of mental
health problems and being a member of an
ethnic minority or of a colonised indigenous
people explained by:
-> Poverty
-> Level of discrimination experienced
-> Isolation from ethnic group/loss of cultural identity
Trauma takes many forms
Child abuse (physical, emotional, sexual) Child neglect Bullying Rape and physical assault War trauma
Prevalence of Abuse in Psychiatric Inpatients
Average child abuse rates from review of inpatient studies - Female inpatients: O Sexual abuse: 50% (Incest: 29%) O Physical abuse: 48% O Either sexual or physical: 69% - Male inpatients: O Sexual abuse: 28% O Physical abuse: 51% O Either sexual or physical: 60%
Loss
- Loss is an inevitable part of life – and
comes in many forms
Factors predicting an extreme response to
loss:
O Previous losses
O Lack of support/understanding
O Importance of lost person or thing
The Adverse Childhood Experiences (ACE) study
- 17,337 participants who sought health services
from Kaiser Permanente - 10-item ACE survey
- Abuse (emotional, physical, sexual)
- Neglect (emotional and physical)
- Household dysfunction (domestic violence,
divorce, presence of substance-abusing, mentally
ill, or incarcerated member of the household) - An individual’s ACE score reflects total number
of adverse experiences endorsed by individual
What is ACE interested in?
Accumulation of different MHPs/adversities
What happens as ACE score increases?
Physical medical problems + also related to MH
Biopsychosocial approach
- Psychologists generally believe that mental
health problems are caused by interactions
between biological, psychological, and
social/environmental factors - Vulnerability stress model/diathesis-stress
model integrates different factors, assumes
mental health problems result from a
biological or psychological vulnerability
together with stressful life event(s)
What is commonly used to explain the development of diathesis?
Mental Health Problems
