Mental Health Flashcards
Mental Health Module Aims & Learning Objectives
Aims:
* Mental health and mental health disorders
(continued from Level 1)
- Mental health and wellbeing
- High and low prevalence mental illness
- Social and emotional wellbeing (SEWB) for
Aboriginal and Torres Strait Islander peoples, and - Treatment approaches for psychological disorders
and mental health
Learning Objectives:
* Demonstrate an understanding of mental health and
wellbeing
* Describe high and low prevalence mental health
disorders
* Discuss SEWB in Aboriginal and Torres Strait Islander
peoples
* Demonstrate a basic understanding of treatment
approaches for mental health, including approaches to
supporting positive mental health
Classifying Mental Ill-health
DSM-5 & ICD-11
DSM-5
* American Psychiatric Association
* Mental health conditions only
* Widely used in Australia in clinical
settings
* Published 2013, text revision 2022
ICD-11
* World Health Organisation
* Includes both physical and mental
health conditions
* More often used in research settings
* Published July 2018
Changes over DSMs II-IV
- Shifting from theory based to symptom focused, using lists of observable signs to define
criteria - Increased emphasis on research evidence for disorders
- Increased number of disorders defined, inclusion of disorders relevant to outpatient mental
health (e.g., anxiety disorders, depression, disorders of childhood) - Changes in labelling of disorders (e.g., ‘mental retardation’ to ‘intellectual disability’)
The Diagnostic and Statistical Manual of
Mental Disorders (DSM)
- First published in 1952 (DSM-I)
- 132 pages, 128 diagnoses
- Inpatient psychiatry focused - disorders with and without organic basis, psychoneurotic
disorders, personality disorders, “mental retardation” - No inclusion of conditions of childhood and adolescence
- Predominantly based on theoretical constructs
Potential benefits of diagnostic classification systems
- Standardisation: standardizing the language of diagnosis helps clinicians communicate effectively and
promotes consistency in research and treatment. - Accessibility: The manual is widely used (albeit at a cost), making it easier for professionals across the world
to communicate and collaborate on diagnosis and treatment. - Research and Treatment: The DSM has facilitated research by providing a common framework for studying
and understanding mental health disorders. It has also assisted in guiding treatment decisions. - A person experiencing difficulty can benefit from having a name and framework for understanding these
difficulties/differences
DSM-5 Broad changes
- Revised text for almost all disorders in accordance with
updated research evidence (e.g., prevalence, risk factors) - Improvements in ‘harmonisation’ with ICD-11
- Comprehensive review and update of terminology to more
inclusive terms (e.g., race -> racialized, removal of ’minority’) - Consideration of impact of racism and discrimination on
disorders integrated throughout - Updated details on cultural considerations related to
illness and distress - Male/female checkbox options removed in assessment
tools - recognition that gender is not a binary construct
Mental Illness: Define
The World Health Organisation (WHO) defines mental health as:
“a state of well-being in which every individual realizes his or her own potential,
can cope with the normal stresses of life, can work productively and fruitfully,
and is able to make a contribution to her or his community.”
Mental disorders (or mental illness) are defined by the American
Psychiatric Association as:
“A syndrome characterized by clinically significant disturbance in an individual’s
cognition, emotion regulation, or behavior that reflects a dysfunction in the
psychological, biological, or developmental processes underlying mental
functioning. Mental disorders are usually associated with significant distress or
disability in social, occupational, or other important activities.” (APA, 2013)
DSM-5
- Published in 2013
- 947 pages, covering 541 diagnostic categories
- Shift toward ‘dimensional’ approach and use
of ‘spectra’ rather than discrete categories - For each disorder:
- Diagnostic features and criteria
- Prevalence rates
- Development and course (etiology)
- Risk and prognostic factors
- Differential diagnosis
Disorders (example)
Neurodevelopmental Disorders
Schizophrenia Spectrum and Other Psychotic Disorders
Bipolar and Related Disorders
Depressive Disorders
Anxiety Disorders
Obsessive-Compulsive and Related Disorders
Trauma- and Stressor-Related Disorders
Dissociative Disorders
Somatic Symptom and Related Disorders
Feeding and Eating Disorders
Elimination Disorders
Sleep-Wake Disorders
Sexual Dysfunctions
Gender Dysphoria
Disruptive, Impulse-Control, and Conduct Disorders
Substance-Related and Addictive Disorders
Neurocognitive Disorders
Personality Disorders
Paraphilic Disorders
Other Mental Disorders and Additional Codes
Some criticisms of the DSM-5
- Large number of disorders - over pathologizing?
- Categorical classification
- Comorbidity
- Reliability
- It is WEIRD!
Western, Educated, Industrialized, Rich, and Democratic.
How do psychologists understand mental ill health?
How do psychologists understand mental ill health?
An hypothesis about causes, precipitants, and
maintaining influences of a person’s
psychological, interpersonal and behavioural
problems
Aboriginal
and/or Torres
Strait Islander
perspectives on
mental health
Social and Emotional
Wellbeing (SEWB)
Historical Determinants - Political Determinants - Social Determinants
infuence self
- connection to the body
- connection to the mind and emotions.
- connection to family and kinship
- connection to community
- connection to culture
- connection to country
- connection to spirit and spirituality and ancestors
Case formulation - “4 P’s”
Predisposing - factors that make a person more vulnerable to experiencing a problem
Precipitating - factors that have triggered a person to experience a difficulty at
this time
Perpetuating - factors that maintain the problem
Protective - factors that help alleviate the problem or difficulty
Benefits of case formulation
- Organises information about a person and difficulties they are experiencing
- Guides intervention
- Helps to measure change
- Helps psychologist/clinician understand the client and supports development of a positive
client-therapist relationship
What are the
determinants of
mental ill health?
- macro level context
- wider society
- systems
- life-course stages
accumulation of positive and negative effects on health and well-being over the life-course
prenatal - early years - working age - older ages
^family-building^
prepetuatuon of inequities
Social determinants of Mental Disorders and the Sustainable Development Goals: A Systematic Review of Reviews
Refer to diagram - slide 20 Lecture 1: Mental Health
summary
- Mental health vs mental illness
- Diagnosing mental health conditions
- Case formulation
- Determinants of mental health
Wellbeing
Optimal functioning in many domains of life (mental, emotional, social,
physical, etc.)
* Historical perspectives: hedonia & eudaimonia
* Subjective wellbeing Diener (1984)
* Psychological wellbeing Ryff (1989)
* Authentic happiness (2002) to PERMA Seligman (2011)
* PERMA = Building blocks of wellbeing
Bronfenbrenner’s Ecological Systems Model
Refer to diagram - slide 21 Lecture 1: Mental Health
Lecture 2: Overview
Part 1: Positive aspects of mental health
* Mental health model
* Positive Psychology
* Wellbeing
* Research
* Factors that contribute to wellbeing
Part 2: High and low prevalence MH disorders
* Anxiety and depression
* Obsessive compulsive disorder
* Eating disorders
Dual model of mental health
“…mental health and mental illness are
not opposite ends of a single
continuum; rather, they constitute
distinct but correlated axes that suggest
that mental health should be viewed as
a complete state. Thus, the absence of
mental illness does not equal the
presence of mental health.” (Keyes,
2005, p. 546).
refer to diagram page7: Lecture 2 and 3
Positive Psychology
- Moving away from a perspective that only considers alleviating suffering, to focus
on “what makes life worth living” - “A science of positive subjective experience, positive individual traits, and
positive institutions…”
History - Psychoanalysis > Behaviour > Humanistic > Cognitive > Third wave > Positive
- Martin Seligman
- Learned Helplessness
- President of APA
- Positive psychology: an introduction
- Today…
Research
Scoping Review (including 190 studies)
* PERMA components were positively correlated
with or described as important for resilience,
wellbeing and positive mental health. All
components were found to negatively correlate
to mental disorders or symptoms.
* Relationships were the most represented of
PERMA in the literature, and parent-child
relationships were found to be particularly
important for the outcomes.
Intervention research
- A meta-analysis of positive psychology interventions has shown an
increase in wellbeing and a decrease in depressive symptoms with
low to medium effect sizes (Bolier et al., 2013) - Interventions:
- Gratitude
- Optimism
- Kindness
- Savouring
- Hope
Factors that contribute to wellbeing
PERMA
Positive Emotion
Enagement
Relationships
Meaning
Achievement
Factors that contribute to wellbeing
- Character strengths
What is “…right about people and specifically about the
strengths of character that make the good life possible”
(p. 4) - Hope
- Gratitude
- Kindness
(Peterson & Seligman, 2004)
To see all 24 character strengths (or take a free test
to find out your greatest strengths):
https://www.viacharacter.org/
Factors that contribute to wellbeing
- Research also supports
- Mindfulness (e.g., Amundsen et al., 2020)
- Physical health – exercise, sleep & diet (e.g., Mikkelsen et al., 2017),
- Self-compassion (https://self-compassion.org/)
- The Five Ways to Wellbeing initiative - Connect, Be Active, Keep Learning, Be
Aware and Help Others (https://www.5waystowellbeing.org.au/) - Mindfulness activity:
https://www.youtube.com/watch?v=IQYjWv59VYU
Three Good Things
- List 3 things you’re grateful for
- Research suggests:
- This task improves positive affect, prosocial motivation, sleep and results in
fewer health complaints - This task appears to be more effective when completed daily as opposed to
weekly
(Emmons & McCullough, 2003)
Lecture 3: Mental Health Disorders
Anxiety disorders in the DSM-5
▪ Separation Anxiety Disorder 309.21 (F93.0)
▪ Selective Mutism 312.23 (F94.0)
▪ Specific Phobia (300.29)
▪ Social Anxiety Disorder 300.23 (F40.10)
▪ Panic Disorder 300.01 (F41.0)
▪ Agoraphobia 300.22 (F40.00)
▪ Generalised Anxiety Disorder 300.02(F41.1)
▪ Other specified Anxiety Disorder 300.09 (F41.8)
▪ Unspecified Anxiety Disorder 300.00 ( F41.9)
Anxiety disorders in
Australia -
prevalence
In 2020-21:
- 17% of people aged 16-85 years had
a 12-month Anxiety disorder - Female-identifying adults were
almost twice as likely than males to
have had a 12-month Anxiety
disorder - 44.7% of LGBTQIA+ identifying
adults had a 12-month Anxiety
disorder - Almost one third (31.5%) of people
aged 16-24 years had a 12-month
Anxiety disorder
Anxiety disorders – key concept:
Fight/Flight/Freeze response
- Hands Sweaty
- Fast Breathing
- Feet Feel Frozen
- Muscles Tense/Shaking
- Rapid Heart Beat
Anxiety disorders – key concept:
Safety behaviour
CYCLE
Situation - Anxiety - Avoid/Escape - Relief (short term) - (back to) Situation etc.
- ‘Safety behaviours’ refer to the behaviour a
person engages in to reduce their anxiety
(e.g., avoiding situations that bring on
anxiety) - Anxiety reduces in the short term, but
anxious beliefs not challenged - When faced with the situation again,
anxiety returns
Depressive disorders – DSM
5
▪ Disruptive Mood Dysregulation Disorder 296.99
(F34.8)
▪ Major Depressive Disorder
▪ Persistent Depressive Disorder (Dysthymia) 300.4
(F34.1)
▪ Premenstrual Dysphoric Disorder 625.4 (N94.3)
▪ Substance / medication - Induced depressive Disorder
▪ Depressive Disorder Due to another Medical Condition
▪ Other Specified Depressive Disorder
▪ Unspecified Depressive Disorder
Affective (mood)
disorders in Australia
- prevalence
In 2020-21:
* 7.5% of people aged 16-85 years had
a 12-month affective disorder
* Female-identifying adults were more
likely than males to have had a 12-
month affective disorder
* 30% of LGBTQIA+ identifying adults
had a 12-month affective disorder
* Approximately 20% of people aged
16-24 years had a 12-month
affective disorder
Cognitive model of depression (Beck, 1976)
Negative early life experiences
(e.g., critical parenting)
Dysfunctional beliefs
(e.g., “I am unlovable”)
Critical incident
(e.g., relationship breakdown)
Dysfunctional belief activated
(e.g., I am unlovable)
Negative cognitive triad
Symptoms of depression (e.g.,depressed mood, loss of interest in socialising)
Self
“I am no good”
Future
“Nothing will improve”
World
“Bad things happen”
Obsessive-
Compulsive and
Related Disorders –
DSM 5
- Obsessive-Compulsive Disorder
- Body Dysmorphic Disorder
- Hoarding Disorder
- Trichotillomania (Hair - Pulling Disorder)
- Excoriation ( Skin - Picking Disorder)
- Substance / Medication - Induced Obsessive -
Compulsive and Related Disorder
Obsessive-Compulsive Disorder (OCD) – DSM 5
A. Presence of obsessions, compulsions or both:
Obsessions:
1. Recurrent and persistent thoughts, urges, or images that are experienced as intrusive, unwanted and inappropriate or
distressing
2. The person attempts to ignore or suppress these thoughts, urges or images, or to neutralize them with some other
thought or action (i.e., performing compulsion).
Compulsions:
1. Repetitive behaviours (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words
silently) that the person feels driven to perform in response to an obsession, or according to rigid rules
2. The behaviours or mental acts are aimed at preventing or reducing anxiety / distress or preventing some dreaded
event or situation; but the behaviours or mental acts are not connected in a realistic way with what they are designed
to neutralize or prevent, or are clearly excessive.
B. Obsessions / compulsions are time-consuming (take more than 1 hour per day) or cause clinically significant distress /
impairment in social, occupational / other important areas of functioning.
Obsessive-compulsive disorder
- Common obsessions:
- Fear of contamination/germs, fire, robbery, rape or assault, becoming ‘insane’, insulting
others, impulsive swearing, harming another person by acting on a sudden impulse (e.g.,
stabbing a friend), engaging in an inappropriate sexual act, blasphemy… - Common compulsions:
- Checking (e.g., power points, door locks), counting, washing/cleaning, ritualistic thoughts/mantras, tapping a surface, leaving and re-entering a room, arranging objects in a certain order…
- Lifetime prevalence of OCD in Australia approximately 2-4%
- 80% of adults with OCD report symptom onset before 18 years
OCD – cognitive model (adapted from Whittal & Robichaud, 2010)
diagram page 28 of Lecture 2&3.
Intrusive thought E.g., “John might have a car accident”
Personality
traits, core
beliefs
Life
experiences
Genetic and
biological
factors
Maladaptive appraisal
E.g., “Because I have thought this, John
is more likely to have a car accident”
Negative emotion
E.g., guilt,
fear
Maladaptive coping
strategies (compulsions)
E.g., repeated praying ritual
OCD - Treatment
- Exposure and response prevention (ERP)
- Strongest evidence for efficacy
- Subjective Units of Distress (SUDS) ratings for feared
situations - Gradually work up hierarchy of feared situation (lowest
SUDS to highest SUDS) - Cognitive restructuring
- Addressing maladaptive appraisal of intrusive thoughts
- Use of behavioural experiments (in ERP) to assist with
restructuring - Medication
Eating Disorders
Eating disorders in Australia and worldwide
- Lifetime prevalence in Australia is approximately 9% (NEDC, 2017)
- Worldwide, lifetime prevalence of eating disorders is 8.4% (3.3-18.6%) for
women and 2.2% (0.8-6.5%) for men. (Galmiche et.al., 2019). - Of people with eating disorders:
- 47% - Binge Eating Disorder,
- 12% - Bulimia Nervosa
- 3% - Anorexia Nervosa
- 38% - other eating disorders (Paxton et al., 2012)
Eating Disorders in the
DSM 5
- Pica
- Rumination Disorder
- Avoidance/Restrictive Food Intake Disorder
- Anorexia Nervosa
- Bulimia Nervosa
- Binge-Eating Disorder
- Other Specified Feeding or Eating Disorder
- Unspecified Feeding or Eating Disorder
Evidence-based treatment for eating disorders
- CBT-E (CBT for Eating Disorders or CBT-Enhanced)
- Maudsley Model of Anorexia Nervosa Treatment
- Family Based Treatment (Adolescents)
- Other promising approaches:
- Dialectical behaviour therapy
- Acceptance and Commitment Therapy
- Mindfulness-Based Interventions
- Compassion-Focussed Therapy
Eating Disorders Victoria (2021)
Linardon et al. (2017)
Lecture 4 – Social and Emotional wellbeing for
Aboriginal and Torres Strait Islander peoples/ Social and emotional wellbeing (SEWB)
Social and emotional wellbeing (SEWB) is the term used to best define health
in Aboriginal and/or Torres Strait Islander communities
- All about connections:
To body
To spirit, spirituality and ancestors
To mind and emotions
To family and kinship
To community
To culture
To country
Mental health is only one aspect of wellbeing
Pre-disposing factors for poor SEWB
▪ Poor SEWB often stem from wider socio-political factors
▪ History and the impacts of colonisation
Colonisation
Assimilation
Integration
Self-Determination
Self- Management
▪ Stolen Generations
▪ Intergenerational trauma
▪ Access and Equity
▪ Racial Discrimination
Pre-disposing factors for poor SEWB
Evidence shows that exposure to stressful life events or conditions can adversely effect the lives of
individuals, families and communities. Aboriginal and Torres Strait Islander people are exposed to
stressful life events at a ratio of 1:4 times that of Australians and at 2 to 5 times greater risk of exposure
to these events then non-Aboriginal people.
▪ Discrimination and Racism
▪ Widespread Grief and Loss
▪ Child Removals and Unresolved Trauma
▪ Life Stress
▪ Social Exclusion
▪ Economic and Social Disadvantage
▪ Child Removal by Care and Protection Orders
▪ Violence
▪ Family Violence
▪ Substance Use
▪ Physical Health Problems
Protective factors for SEWB
There are unique aspects of Aboriginal and Torres Strait Islander cultures that
influence SEWB. These are said to serve as sources of resilience and as a unique
reservoir of strength and recovery when faced with adversity.
▪ Connection to Land, Culture, Spirituality and Ancestry
▪ Kinship
▪ Self determination, Community Governance and Cultural Continuity
…..good mental health is indicated by feeling a sense of belonging, having strong
cultural identity, maintaining positive interpersonal relationships, and feeling that life
has purpose and value (Dudgeon et al. 2014; Dudgeon & Walker 2015)
SEWB:
9 Guiding
Principles
https://timhwb.org.au/
1. Holistic Health
2. Self-determination
3. Culturally valid understandings
4. Trauma and Loss
5. Human rights
6. Racism, Stigma
7. Family and Kinship
8. Ways of Living
9. Strengths, Creativity, Endurance
2018-2019 National Aboriginal and Torres Strait Islander Health Survey: Statistics
Mental health related findings:
24% of Aboriginal and Torres Strait Islander people reported having a mental or behavioural condition
Rates for mental health and behavioural conditions were about the same for males (23%) and females
(25%)
Mental health conditions were experienced by around 3 in 10 people for all age groups apart from 2-14
years (15%) and 15-24 years (24%)
Mental health conditions were twice as likely to have been reported by Aboriginal and Torres Strait
Islander people in non-remote areas than in remote areas (28% compared with 10%)
National Aboriginal and Torres Strait Islander Social Survey: Aboriginal and Torres Strait Islander people with a mental health condition were -
▪ Less likely to have had daily face-to-face contact with family or friends outside their household
▪ Less likely to receive support from a family member in a time of crisis,
▪ Less likely to feel that they were able to have a say within their community on important issues
▪ Less likely to have participated in selected cultural activities (e.g., hunting or gathering bush food,
storytelling or performing music, dance or theatre)
▪ A smaller proportion of Aboriginal people with a mental health condition said they could speak an
Australian Indigenous language (compared to Aboriginal people with no mental health condition)
Aboriginal
Culturally appropriate assessment
▪ Assessment of both clinical and cultural concepts are important to assist with diagnosis and
understanding
▪ Understanding cultural limitations of psychological assessment tools -
▪ Do not fit with holistic perspective of mental health (social, emotional, spiritual & cultural)
▪ Cultural bound syndromes
▪ Not standardised within cultural group
▪ Over/under diagnosis; biased intelligence testing; legal implications
▪ To prevent misdiagnosis, over diagnosis and under diagnosis
▪ To obtain useful clinical and cultural information to determine variations in symptoms associated with
risk, resilience and outcomes
▪ To understand whether person meets criteria for DSM disorder and/or whether cultural explanations for
presentation are more appropriate
Mental Health Presentations
Cultural Differences seen as deficits
Attention Deficit Hyperactivity Disorder (ADHD)
Cultural Triggers are not identified in mainstream assessment tools
Spiritual Visits Vs Psychosis
Symptoms misinterpreted
Longing for country vs Major Depression
Normality seen as abnormality
Sorry cuts vs Suicide attempts
Examples of culturally responsive healing
practices
▪ ‘Clinical Yarning’, ‘Yarning with purpose’
▪ Indigenous healing practices (including Bush Medicines)
▪ Ngangkari
▪ Narrative therapy
▪ Art Therapy
▪ Aboriginal therapists operating in a culturally safe and responsive way
▪ Community-lead healing approaches
Ways of Healing & Building Cutural Competence
Refer to diagram slide 17: Lecture 4&5
Lecture 5: Evidence-based practice and
Psychological therapy approaches - What is it?
- Formulating your clinical question
- Searching for Evidence
- Appraising Evidence
- Applying Evidence to Practice
Ethical and legal context
Australian Psychological Society Code of Ethics
Mental Health Act 2009
South Australian Mental Health Act Guiding principle:
Mental health services should be designed to bring
about the best therapeutic
outcomes for patients
National Practice Standards for the Mental Heath Workforce 2013 Standard 7: Treatment and support
To meet the needs, goals and aspirations of
people and their families and carers, mental health
practitioners deliver quality, evidence-informed health
and social interventions.
NHMRC levels of evidence and grades for recommendations for developers of guidelines
1-5
(table on page 23- Lecture 4&5).
Evidence Based treatment approaches (APS)
CBT for everyone!
Limitations to ‘evidence based practice’
Research on effectiveness of psychological interventions has been:
⚬ Predominantly conducted in W.E.I.R.D. countries
⚬ Predominantly used quantitative approaches
⚬ Often with strict protocols and highly motivated participants
Psychologists typically use a combined approach involving evidence-based practice AND practice-based
evidence:
“…a process of systematic, continual refinement of the evidence
base for a program or complex intervention through rigorous
gathering and continual testing of evidence” (Dudgeon et al., 2021, p. 6)
Brief history of psychological therapy
300-400 BC
Disordered Humours
1800s
BioMedical Model
1900s
Psychoanalysis
1930s
Behaviourism
1960s
Cognitive Behaviour Therapy
1970s
Biopsychsocial Model
1990s
Third Wave Therapies
2000s
Positive Psychology
Three ‘waves’ of cognitive behaviour therapy
Behaviour
therapy
Cognitive
behaviour
therapy
Third
wave
approaches
Wave 1 - behavioural approaches
Mouse and the Lever
- Based on learning principles
- Focus on observable behaviour
- De-emphasises inner experiences (e.g., thoughts, emotions)
“…the proper domain of psychology includes observable, measurable stimuli and responses” (Watson)
View Watson’s Little Albert film
Wave 2 – Cognitive behavioural approaches
CBT = thoughts, feelings and behaviour.
- Merged behavioural approaches with cognitive
approaches - Cognitive approaches include identification of
thinking errors, cognitive restructuring - Mental health problems (and treatment for
problems) considered to result from an interaction
between thoughts, feelings, and behaviour - CBT still most widely researched psychological
approach to mental health concerns
Case formulation in CBT
Early life experiences
influences
Core beliefs/schemas
influences
TRIGGER
influences
Cognitions/Thoughts
and there is a cycle between this and
Physical sensations
Emotions/Feelings
and behaviour
(diagram on page 30 of Lecture 4 and 5)
Third wave approaches
- Mindfulness Based approaches
⚬ Mindfulness Based Stress Reduction
⚬ Mindfulness Based Cognitive Therapy - Acceptance and Commitment Therapy
Mindfulness based interventions:
Mindfulness- Based Stress Reduction
- Derived from Buddhist meditation practices
- Prof John Kabat-Zinn - 1970s - applied to psychological therapy for
chronic pain
⚬ Mindfulness-Based Stress Reduction (MBSR)
⚬ 8 week group program
⚬ Good evidence for chronic pain, somatic symptoms, and has been
applied to anxiety and depression
Mindfulness based interventions:
Mindfulness-Based Cognitive Therapy
- Early 2000’s - Segal, Williams and Teasdale adapted MBSR –
focus on address relapse prevention for depression - This became Mindfulness-Based Cognitive Therapy
- Found to be as effective as anti depressants at reducing risk for
relapse
Acceptance and Commitment Therapy (ACT)
- Developed by Steve Hayes and colleagues in the 1990s
- Goal is not to reduce mental illness symptoms, but instead develop
‘psychological flexibility’ - Focus on accepting difficult thoughts and experiences rather than
attempting to change them (as in cognitive restructuring) - Combined with this focus is the identification and clarification of
one’s core values, and committed action towards those values (even
in the presence of struggle and difficulty)
Acceptance and Commitment Therapy - ‘Hexaflex’
A hexigon
1. present moment awareness
2. values
3. committed action
4. self as context
5. defusion
6. acceptance
and in the centre
psychological flexibility
(diagram page 35 of Lecture 4 and 5).
Process based approaches
- Recognition of limitations to therapeutic protocols for specific disorders
approach - Identification of underlying factors connected to psychological difficulty and
therapeutic change - Includes client based factors (e.g., skills developed, motivation) and therapist
factors (e.g., competence, alliance with therapy model) - Some researchers suggest common factors like therapeutic alliance explain
as much variance in treatment outcomes as specific therapeutic approaches
⚬ Note: other researchers suggest that specific modalities are necessary
(e.g., in OCD treatment )
Transdiagnostic factors
Limitations to therapeutic protocols for specific
disorders - failure to account for contextual and
situational factors, focus on techniques and specific
symptoms
Recognition that there is considerable overlap
between psychological disorders and across
psychotherapeutic approaches
Research domain criteria initiative
Transdiagnostic approaches – four
perspectives
- Universal multiple processes maintain all or most psychological disorders
- Particular problematic cognitive and behavioural processes relate a limited
range of disorders - Symptom or psychological phenomena themselves, rather than diagnostic
categories or labels, should be targeted - One universal, single process is largely responsible for the maintenance of
psychological distress across all or the majority of psychological disorders –
the ‘p’ factor (in summary this is not clear yet but research is promising).
Lecture 4 & 5 conclusion
Take home message - mental health and mental health treatment is
complex, and context is important
