Mental Health and Wellbeing Flashcards

Question

how does poverty impact mental health

Answer 1

reciprocal relationship and feed into one another | poverty = resources not sufficient to meet minimal needs

Answer 2

social causation - poverty and stress associated with it leads to mental health problems. Global financial crisis confirmed this with worsening mental health rates, mental illness where not been before due to stress of unemployment social drift hypothesis - mental health problems leads to difficulties keeping job leads to poverty 2 reports investigate this do find evidence of social drift but evidence for social causation higher

Answer 3

Perceptions of people in poverty are extremely negative Stereotypes abound and are harmful – seen as lazy self centred lacking in competence, blaming stereotypes Stigma can be internalised – start to think this about themselves Childhood poverty is particularly damaging – sets up cascade of consequences

Answer 4

review of 12 studies from 2007 – 2013, Primarily cross sectional, with over 55,000 participants Discrimination associated with a range of diagnosed disorders (depression, anxiety, PTSD, eating disorders) Statistical controls for poverty, gender, ethnicity, etc etc

Answer 5

also called multiple discrimination - interconnected nature of social categorisations e.g race gender etc. these features create interdependent networks of discrimination

Answer 6

``` Resilience = weather further discrimination further Cumulative = each one added = greater risk for developing mental health issues ```

Answer 7

Systematic review, 40 studies ‘Resilience’ versus ‘cumulative risk’ Depression and anxiety most common outcome but others studied too Strong evidence for cumulative risk and weak evidence for resilience Methodological flaws outlined, but even in the stronger studies racism and heterosexism particularly associated with outcomes

Answer 8

Critical suggesting intra individualization perpetuates a system that ignores these factors. Nowadays calls to work in policy to influence advocacy for influence of large scale factors, sometimes called upstream or downstream hypothesis. Mh treatment as if standing by the river, people drifting down with difficulties so pull them out but more people come down. Go up the stream and discover why they are falling in. rather than curing people why don’t we understand how to prevent people getting it

Answer 9

An attempt to use psychological knowledge to understand the origins, mechanisms and maintenance of a person’s problems.

Answer 10

Fives p = diff aspects used to understand the problem. Predisposing factors can be macro or micro – macro = societal micro = personal Precipitating factors = triggers what lead to this particular problem Perpetuating = features of environment lead to perpetuating factors e.g harassment or crime or their perpetual tendency to not leave the house Protective factors = their ability to cope with the problem e.g good social networks intelligence etc. which leads to presentation of the problem

Answer 11

yes, they aren't limited to only clinical psychology but can also use theories from other disciplines

Answer 12

predisposing = early loss of parent, sexual abuse by step father precipitating = loss of job, workplace bullying perpetuating = isolation rumination unprocessed trauma intrusions protective = intelligence, determination, resilience, awareness outcome = hearing voices

Answer 13

Harder to integrate different elements Can be more precise Due to research base can be linked more strongly to a certain definition of evidence-based practice Can be limited by syndrome classification Can also be transdiagnostic

Answer 14

early life events (sexual abuse), core beliefs (i am damaged, it was my fault) and conditional assumptions (if i keep quiet it will be ok) followed by a critical incident (loss of job, bullying) triggering negative automatic thoughts = behaviour physiological symptoms and emotions

Answer 15

Formulations are built collaboratively over time with a person They are not imposed They put meaning and understanding into problems and cycles They point at places to intervene both in therapy but also in teams and other agencies

Answer 16

Attachment Family function / parenting Peer group influences Social support / connectedness

Answer 17

secure insecure - Avoidant doesn’t seek contact Ambivalent sometimes seek sometimes not Disorganised All these thought to be related to different degrees of consistency

Answer 18

Strong evidence that attachment insecurity is a general risk factor for poor mental health (depression, anxiety, personality) Some specific relations observed: childhood separation anxiety, pathological grief Personality disorders: anxious attachment = emotional dysregulation avoidant attachment = avoidant and inhibited personality Unlikely to be a sufficient cause and require interaction with other factors

Answer 19

Controversial literature about family function, high expressed emotion and ‘double bind’ as risk factors for later psychosis. More recently this has been conceptualised as ‘Negative Family Emotional Climate’

Answer 20

say one thing but body language expresses another, e.g oh don’t worry about me then in a negative way

Answer 21

high negative emotional expression poorly managed parental emotion psychologically controlling behaviours Lack of warmth / positivity

Answer 22

Well established link to depression and anxiety Direct links and also indirectly through emotion suppression

Answer 23

Sample 779 children over longitudinal time. What factors longitudinally predict mental health factors. Surveys through schools identify relative proportion of these factors that contributed to mental health problems SES = socioeconomic status, fam structure = nuclear family or other

Answer 24

10. 5% adverse life events and instability 40. 5% parenting practices 19. 2% parental verbal conflict and mood problems parental antisocial and disturbed behaviour 13.6% family structure and Socioeconomic status 16.2%

Answer 25

Overt bullying strongly linked to later mental health, but so too is frequent teasing Teasing and bullying is also more likely to children of lower SES

Answer 26

The buffering hypothesis – buffer between stress and mental health difficulty (social support does) quality of social support reduces the impact of stresses on a person. Nuance that its not the amount but the quality and if it matches the expectations of the person. If someone prefers a little too much could feel overwhelming

Answer 27

stressor = appraisal (social support may prevent negative appraisal) - response (s s lead to reappraisal inhibition of maladaptive response or facilitation of adaptive responses)

Answer 28

feeds into forgiving a bad day. Social support may mediate the perception of an unstigmatized view, allows people to get help with social support. Study found direct correlation between the stigmatized view of mental health and mh problems and also social support being important factor

Answer 29

Prior to WWII ‘Curing mental illness’ ‘Making the lives of all people more productive and fulfilling’ Identifying and nurturing ‘giftedness’ After WWII founding of the Veterans Administration Founding of the US National Institute for Mental Health

Answer 30

``` Gratitude expression and writing Doing acts of kindness Positive future thinking Savouring the moment Meditations (loving kindness meditation) Fuller packages of psychotherapy (with positive focus) ```

Answer 31

39 studies, evaluating 6139 participants Mostly healthy populations but some aimed at depression or anxiety problems Small to moderate effects for wellbeing, and depression (large range d = 0 – 2.4) Small effects at 3 to 6 month follow up Larger effects for individual delivery, face to face, healthcare settings, longer duration of intervention. Smaller effects observed in better quality interventions

Answer 32

``` broad concept covers lots of dimensions Character and virtue as well with moral behaviour Having close social relationships, being involved in a community Have stable resources physical health mental health happiness spirituality life satisfaction etc ```

Answer 33

Such a broad construct – hard to isolate elements to see causal relations. Issues of measurement – how define and measure flourishing Contradictions – not possible to flourish and have a physical health problem – can still with these (e.g. meaning and purpose within adversity?) Lack of critical thinking – gender differences (and other factors) are avoided, family function more important than family structure. E.g criticism of divorce not fair may allow a happier home

Answer 34

Balance as mid range Balance as complementarity – balance between variables rather than focussing on one at a time Balance as a tempered view of constructs – look not as a negative vs positive as positively viewed charactersitics can lead to selfishness etc. more important to view in a consequential way Balance as contextual sensitivity – right thing to do in ind situations, sometimes perseverance is good sometimes its bad Balance between conscious and unconscious phenomena – neglected unconscious processes. Need to study pre conscious influential variables. field improved to move towards studying a mid range of feelings

Answer 35

Less exclusive focus on reduction of symptoms Greater focus on building adaptive behaviours ‘Broaden and Build’ Theory As well as targeting maladaptive processes also training in positive approaches such as self acceptance, self compassion

Answer 36

compassionate mind training Based on the work of Paul Gilbert Highly shame prone and self-critical people Draws on evolutionary theory about ‘social mentalities’ Actively trains and cultivates a more self soothing and self kindly stance towards the self Draws on Buddhist conceptualization of compassion as: Sensitivity towards suffering + Motivation and courage to relieve it

Answer 37

``` Threat = social threats “im inadequate” leads to fear withdrawal shame people highly shame prone have over activation og this and are overly sensitive to others Drive = persue goal negotiate set backs can overwork and set unrealistic standards = perfectionism Soothing = close attachment reltaionships first, consistent and children learn how to sooth and care for themselves if the parent develops the soothing for htem in infancy. Nothern places don’t teach this very well in school, people have troubles with self compassion, they need to be taught how to engage in such practices ```

Answer 38

Compassion is strongly related to less pathology Compassion based intervention is effective in increasing compassion and reducing distress

Answer 39

Underpinning clinical model for Acceptance and Commitment Therapy (ACT) ACT is a modern form of CBT Emphasises letting go of ineffective attempts to control thoughts and feelings Establishing personal values and commitment to actions Open, Aware, Engaged response style

Answer 40

Strong evidence that Psychological Flexibility is associated with less distress and ‘psychopathology’ Lab studies: psychological flexibility procedures produce large effects Clinical Trials: combined effects across problems, (20 meta analyses, 133 trials, total n = 12,477) ACT compared to: wait list/placebo, active treatment not cbt, cbt All metanalytic effects favour ACT Across a very broad range of conditions and outcomes

Answer 41

formerly called hypochondriasis = fear of having an illness

Answer 42

In DSMV “Illness anxiety disorder’ Preoccupation with having an illness Excessive or disproportionate estimation of risk or severity High level of anxiety Excessive checking or reassurance seeking, or maladaptive avoidance (e.g. missing a routine check due to fear) For at least six months (though focus of preoccupation may change over time)

Answer 43

Central concern is the threat of having a serious illness. The prob of having it and the nastiness of it results in a higher perception of threat than is actuallt rhere. Doesn’t come from nothing its from sensations they have but leads to an excessive concern about an illness experience. It leads to arousal and physiological reactions e.g heart rate increasing chest tightness dizziness which feeds into fueling their health threat. Person engages in safety behaviours – go to doctor too much or avoidance of health information entirely, short term reduction in anxiety but their underlying sense of threat returns. Maintenance of threat is there

Answer 44

52-year-old man, married, two teenage boys, all doing fine. Plumber, currently unemployed due to chest pains Otherwise good health, no previous mental health history, or serious illness Problems began two years previously Sudden onset of pains in the chest and left arm whilst on a job Had the thought that he was having a heart attack, called an ambulance

Answer 45

Paramedics took him to hospital, kept overnight, investigations revealed he had not had a heart attack. After discharge: intermittent episodes of severe chest pain, lasting from a few minutes to hours, like an ache (not sharp) Tends to sit and recover, seeing general practitioner a lot Followed up as an out-patient by cardiologist – thorough work up: ‘Pain is not cardiac in origin’ went to pain clinic, pain is a result of a mild nerve compression

Answer 46

Although Paul had had an explanation of his pain it is common for that not to be fully understood or retained. Sensations: Dull ache in chest and down left arm Fluttering sensations in heart, fast beating, irregularities in rhythm Occasional breathlessness Beliefs: ‘It’s a heart condition’ ‘The doctors have missed something’ Processes: Worry / rumination Emotions: Anxious, panicky behaviour = stopped work, rest during day sit down if breathless. frequent see gp attentional focus on chest

Answer 47

Misinterpretation of pain – no lasting diagnosis in his mind, not enough to combat threat thoughts, emotionally resistant to the explanation Knowledge of pain and mechanism Understandable conclusion of ‘cardiac’ Emotions ‘resistant’ to diagnosis of ‘non cardiac’ Threat mechanisms of attention focus: noticing sensations more (fluttering, beating irregular or fast) Processes of worry and rumination = high arousal Breath holding and tension = breathless Interpretation of symptoms as serious, potential to die of a heart attack Reassurance seeking and avoidance of work, exertion etc

Answer 48

Structured Here and now focus Collaborative relationship Containing and exploratory Build shared understanding of problem development and maintenance Teach and train specific skills for management of thoughts, behaviours and emotions Involves homework tasks between sessions

Answer 49

Then two hypotheses are presented: H1: These symptoms are a heart condition and the doctors have missed something H2: These symptoms are natural consequences of threat. The threat comes from not knowing why you have pain Our work becomes about examining which of these is most likely

Answer 50

needed to build deeper knowledge of pain to reduce fear Detailed explanation of pain mechanisms Hand drawn diagrams of nerve function, compression, referred pain – build up slowly, allow to ask questions Plenty of opportunity for questions, and for phenomena that don’t fit the alternative explanation Smoke alarm metaphor worked better

Answer 51

Nerves = smoke alarms in diff rooms, smoke detected in 3 no smoke so theres a fault in smoke alarm but theres nothing wrong with it replace the wiring, still alarm, control panel is it broken, smoke alarm = heart, control panel = brain, must be in nerve or the processing of the input.

Answer 52

gather data and evaluate the evidence for and against one hypothesis at a time The symptoms are a heart condition: I have chest pain - the doctor said my heart is healthy the symptoms are due to referred pain from my back - when working with david i felt it was understandable - still not 100% sure i understand

Answer 53

gradual resumption of normal activities gardening and working clear predictions - what do you think will happen - test it out - what did happen when you gardened.

Answer 54

Over six sessions we explored the two competing hypotheses His belief in H1 dropped from 90% to 20% and in H2 increased from 0% to 75% He resumed work and hobbies (gardening, DIY) He was still cautious about exertion, but had a plan for gradually increasing activity He reported that the chest pain was much less interfering with his daily life

Answer 55

brings together some macro factors brought into a useable explanatory framework proposed as an alternative to diagnostic classification

Answer 56

what has happened to you (how is power operating in your life) how did it affect you? (what kind of threats does this pose?) What sense did you make of it (what is the meaning of these situations and experiences to you) What did you do to survive? (what kind of threat response are you using?) what are your strengths (what access to power resources do you have?) what is your story? (how does all this fit together)

Answer 57

marko had nice life in eastern europe had to leave due to experience of war, ethnic crimes and attempted genocide, taken to internment camp by a friend beaten and fearful of death every day after liberation joined wife and child in uk wasnt working in uk due to mental health

Answer 58

Flat in mood, lack of pleasure, frequently tearful, low motivation Easily startled, frequent panic attacks, constantly on edge, nightmares, Avoidant of anything associated with his experiences Numbing out / blunting – no sense of future Some suicidal thoughts but no plans or actions

Answer 59

State sanctioned legal violence against his ethnic group Forced removal from his home by militia Daily abuse / dominance / imprisonment / threat After liberation: forced refugee status Becoming an ethnic minority in the UK Neighbourhood harassment Unemployment, social stigma and social exclusion

Answer 60

In an instant – robbed of sources of security and identity: work, community, wife, family, culture, fun, hobbies Extreme threat response: hypervigilant, startled, nightmares, constant high arousal / anxiety / anger / frustration Ongoing low-level social threat: not belonging, being unwelcome,

Answer 61

You can not trust anything, it can all vanish Some people are evil The international community ignored what was happening, we were not worth it I couldn’t protect my family It is impossible to rebuild a life All I can do is try to survive each day Paradox of refugee status: grateful for safety, resentful for dependency

Answer 62

Numbing – blunting feelings, thinking of the future Avoiding news (reports of other conflicts) Avoiding talking with others Not letting sons go far from home, walking them to school Loss – so many losses: sadness

Answer 63

Wife and family very supportive He is a loving and caring father, available to his children His sense of history, politics of the situation, awareness of lack of social justice

Answer 64

traumatic events = appraisal of extreme threat = fear activation = avoidance of cues and stimuli = memories and narrative of events unprocessed = intrusions, flashbacks and nightmares = appraisal of extreme event

Answer 65

Marko found it hard to talk Would be more fearful and more intrusions for days Felt trust in me and that he could continue As he felt more comfortable, he gradually revealed more of his story It began through his expression of his anger at the injustice

Answer 66

He came to understand that his numbing was a way of dealing with his experiences Loss of hope, feeling disconnected, not going outside his community could be understood as expressions of avoidance ‘It can all be taken away’ But it was costing him connection with his children, wife, developing his own life

Answer 67

He began to go out more He talked to his wife a little more He encouraged others in his community to open up and talk about what they had experienced He felt he could come to terms better with what had been done to him He recognised that the UK was now home to him

Answer 68

We worked together for around 2 years I referred him onwards to receive specialist trauma intervention He was glad to have been able to begin the journey with me Though he was fearful about starting again with a new therapist he was OK with it

Answer 69

The PTM describes mechanisms that can be thought of as at work in Marko’s situation The narrative and meaning making we did was therapeutic I was guided by a more classic model of trauma that gave me suggested mechanism – exposure, reduction of avoidance, adaptive meaning making Those mechanisms are linked to a DSMV defined disorder PTSD, but it’s the mechanisms that were important, not so much the characteristics of the ‘disorder’.