Clinical Psychology - Lecture 2: Understanding Mental Health Problems

Question 1

Approaches to understanding MH problems

Answer 1

• 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

Question 2

The Medical Model

Answer 2

• 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

Question 3

Advantages of medical model

Answer 3

• 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

Question 4

Disadvantages of medical model

Answer 4

• 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

Question 5

How can medication be helpful?

Answer 5

Can help ppl to be bought to space at which they can engage with psychologist

Question 6

Psychoanalytics/psychodynamic approaches

Answer 6

• 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

Question 7

Id

Answer 7

Immediate radification

Question 8

Superego

Answer 8

Impose moral compass

Question 9

Ego

Answer 9

Balance above superego and Id

Question 10

Different parts of psyche when using the psychoanalytics/psychodynamic approach

Answer 10

Trying to make these parts of the psyche more conscious for person

Question 11

Blue-print for relationship

Answer 11

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

Question 12

Psychodynamic therapy

Answer 12

• 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.

Question 13

What can unconscious competing demands do?

Answer 13

Create Psychological symptoms e.g. anxiety, depression

Question 14

What is there a heavy focus on in psychodynamic therapy?

Answer 14

Heavy focus on therapeutic process rather than content -> may not be as much structure as in behavioural appraoches

Question 15

Behavioural model (learning theory)

Answer 15

• Assumes behaviour is learned -> therefore behaviour can be unlearnt
• Three main ways of producing behaviour
• > Classical conditioning
• > Operant conditioning
• > Social learning

Question 16

Classical conditioning

Answer 16

• Associative learning

- Unconditioned stimulus (food) paired with neutral stimulus (bell) to produce conditioned response

Question 17

How do you learn in operant conditioning

Answer 17

Learn based on contingencies of behaviour

Positively reinforced - likely to repeat that behaviour

Question 18

Social learning

Answer 18

Learn from ppl around us/what we see around us

Question 19

Behavioural approaches compared to psychology

Answer 19

Much more content focused

Question 20

Sex/Gender causing MH problems

Answer 20

• 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

Question 21

Why are women more likely to experience major depressive episodes over their lifetime as well as in their past compared to males?

Answer 21

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

Question 22

Genetics causing MH problems

Answer 22

• 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

Question 23

Problem when trying to figure out whether genetics is part of MH problem cause

Answer 23

When it comes to MH problems in families -> can’t tease apart if genetics or enviro because they live in same/similar enviro

Question 24

Why are MH rates in twins not perfect?

Answer 24

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)

Question 25

Traumatic brain injury

Answer 25

• 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

Question 26

Brain abnormalities

Answer 26

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

Question 27

Poverty

Answer 27

- 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

Question 28

The prevalence of mental illness is higher in more unequal rich countries

Answer 28

As income inequality increases so does %age with MH problems

Question 29

Ethnicity

Answer 29

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)

Question 30

Ethnicity Discrimination

Answer 30

Less likely with own people but increase in MH problems not due to being from ethnic minorities but because of what they experience

Question 31

NZ Research: Te Rau Hinengaro: The New Zealand Mental Health Survey (2006)

Answer 31

• 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

Question 32

NZ Research: Psychiatric inpatient admissions in Auckland (Wheeler et al., 2005)

Answer 32

60% European, 23% Māori, 11% Pacific
people, 4% Asian
-> Also to do with less common MHPs -> overrepresentation of Maori

Question 33

Ethnicity

Answer 33

• 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

Question 34

Trauma takes many forms

Answer 34

Child abuse (physical, emotional, sexual) 
Child neglect
Bullying
Rape and physical assault
War trauma

Question 35

Prevalence of Abuse in Psychiatric Inpatients

Answer 35

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%

Question 36

Loss

Answer 36

• 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

Question 37

The Adverse Childhood Experiences (ACE) study

Answer 37

• 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

Question 38

What is ACE interested in?

Answer 38

Accumulation of different MHPs/adversities

Question 39

What happens as ACE score increases?

Answer 39

Physical medical problems + also related to MH

Question 40

Biopsychosocial approach

Answer 40

• 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)

Question 41

What is commonly used to explain the development of diathesis?

Answer 41

Mental Health Problems