Lecture 13: Resilience & Positive Clinical Psychology Flashcards
1
Q
What were the early observations on resilience?
A
- Many children of mentally ill parents do not develop mental illness or behaviour problems.
- Psychology historically studied those who suffered consequences from trauma, but why didn’t we study the people who didn’t? Parent with a mental illness does not mean that this is your destiny
- Many low SES children grow up to be competent, caring adults
- Many adults adapt to inevitable stressors
- People do not become miserable with old age and its challenges
2
Q
What is resilience?
A
- Resilience now seen as a process, rather than an individual difference (someone may have characteristics that promote resilience but we don’t know if resilience is there until they face a challenge)
- It requires challenge to see it/ measure it. These can be chronic (Low SES) or events (disaster)
- Resilient outcomes are broad (vague?) Consider many dimensions of mental health. Consider in relation to the degree of challenge
3
Q
Describe the method of the study that looked at heart attacks and resilience
A
- health and retirement study (Galatzer-Levy & Bonnanno, 2014)
- about 2000 participants, mean age 71
- data 6 years before and 4 years after heart attack
- assessed ‘optimism’ before heart attack (leave inheritance, live to 85 etc)
- assessed depression symptoms (CES-D)
- mortality
4
Q
What did the study that looked at heart attacks and resilience find?
A
- Most people were resilitent (68%)
- Developing depression post heart attack predicted mortality (emerging depression seemed the most lethal, those who were already depressed were less likely to die)
- Otherwise depression not predictive
- (time 1) optimism predicted resilience (people who thought they would live long, thought they would have lots to offer to loved ones when they die)
- [Note: there is some debate about the statistical procedures that produce the 68%. Regardless the robust finding is that most people are resilient]
5
Q
What did the challenge for inequality study find?
A
- From MIDUS large, longitudinal data set
- SES and health, Generally, an average linear relationship
- PWB (e.g., mastery/control) buffers for lower SES
- “I can do just about anything I really set my mind to”
- Subjective health
- Il-6
- Along with other Ryff PWB indicators, PA)
6
Q
What are some protective factors?
A
- Less direct exposure to or duration of the challenge E.g., 9/11 responders vs. NYC residents (PTSD Considerably higher (double the rates of symptoms) if you were in the trade center or responded to the scene compared to just living in NYC.)
- Positive emotionality, emotional stability (prone to positive emotions before an event happens)
- Optimism, positive thoughts (but possibly ‘realism’ too)
- Sense of control (master, self-efficacy)
- Intelligence & high SES
- Religion, faith (recall GWP religion & SWB paper)
- Social support (family cohesion, community, peers)
- Problem focused & positive reinterpretation coping
- (difficulty of separating outcome vs. protective factor)
7
Q
How does past experience play a role
A
- History of severe trauma and mental illness predicts poor responses to new challenges
- However, some moderate challenge might be protective
- Squirrel monkey studies (somewhere completely separated from their moms and thus did not do well later in life / developed dysregulated coping mechanisms. Different group faced a little bit of challenge and stress but still did well later in life)
- Curvilinear link between adversity and mental health (it’s not the people who have had nothing bad ever happen to them that score higher on mental health, it’s the people who have experienced a little bit or moderate challenge. Whereas, the people who have experienced a lot have the worst)
- Older people often recover more quickly than kids
8
Q
What is post traumatic growth?
A
- TED talk
- Trauma is obviously bad
- Some people reported benefits, growth
- Sense of reconstructing the self, meaning, relationships
9
Q
What does the post traumatic growth inventory measure?
A
- Relating to others (I have a greater sense of closeness with others)
- Personal strength (I have a greater feeling of self reliance)
- New possibilities (I am able to do better things with my life)
- Appreciation of life (I can better appreciate each day)
- Spiritual change (I have a stronger religious faith)
- (rated with regard to change since trauma)
10
Q
What are the challenges in assessing growth?
A
- PTG or ‘benefit finding’ has become big, especially with surge in positive psychology
- Perceived growth has positive correlates
- BUT, do perceptions match actual change? Consider research on personality, relationships. A couple prospective studies of PTG
- Are measures of PTG valid measures of (actual) growth? (like have you become a deeply spiritual person i.e., actually changed or is it a perception of that?)
- A retrospective measure of PTG requires participants to
- Evaluate their current standing on a dimension
11
Q
What is an example of a prospective PTG study?
A
- Prospective, longitudinal method:
- Recruit lots of people (>1,500)
- Assess levels of well being, etc. In PTGI domains
- Wait 2 months
- ‘hope’ some experienced traumatic events
- Assess perceived change (PTGI)
- Assess well-being, etc. again (actual change)
- Perceived post traumatic change not strongly related to actual changes
- There was some actual ‘growth’ (from trauma)
12
Q
Should we encourage growth?
A
- Actual growth is good by definition
- It does occur sometimes (longitudinal studies)
- Yet interventions can backfire (sex, self esteem)
- Potential for ‘failed search for meaning’ (C. Davis)
13
Q
But, what about perceptions of growth?
A
- May be a part of a positive coping strategy (looking for the silver lining as a coping mechanism)
- Associated with higher initial distress (people who had a worse trauma are more likely to report growth later. You get PTG when expectations are shattered because it facilitates seeing the world in a new way. This distress may actually be the catalyst for growth)
- Mixed results RE increasing or decreasing distress over time
- Strong advice to seek growth seems pre mature
14
Q
Where does clincal psych borrow its language and ideology from?
A
- Clinical psych currently/historically follows illness ideology
- History of psychodynamic & hospital influence (psychodynamic assumptions are pretty dark and clinical- Freud thought most individual had some kind of neuroses.
- Concerned with problems (pathology)
- Problems are in kind (categorical rather than dimensional)
- Internal, similar to biology (rather than context)
- Role is to diagnose & treat person
- Clinical psych uses/borrows medical language
- Symptom, disorder, pathology, illness, diagnosis, co-morbidity, treatment, doctor, patient, clinic…
15
Q
Does the concept of a disorder exist?
A
- (nature deficit disorder)
- ADHD (is it something internal that should be treated? Or is it high activity kids who annoy teacrhers?)
- Nicotine disorder (is this a habit? Or a disorder?)
- Body dysmorphic disorder (is this a disorder?)
- Hypoactive sexual desire disorder (is this a disorder or do you not want to have sex?)
- Orgasmic disorder
From 1952 to 1994, the DSM increased from 86 to almost 900 pages
