Mental Health and Wellbeing

Question 1

what is diagnostic classification

Answer 1

Based on recurring and reliable patterns of these human experiences

Attempts to categorise and classify these into discrete entities called ‘diagnoses’.

There is nothing inherently wrong with such an approach.

Question 2

what are the aims of classification systems

Answer 2

Reliability: to ensure that when we talk about these experiences we are all confident that we are talking about and studying the same phenomena.

Assumption: identification and categorisation will lead to understanding of mechanism and cause, which will lead to treatment

Question 3

name two popular classification systems

Answer 3

Diagnostic and Statistical Manual of Mental Disorders (DSM5)

International Classification of Diseases – 11th Edition

Question 4

how was the DSM developed

Answer 4

Taskforces – committees of experts in clinical practice of the field. Determine the kinds of categories of mental health difficulties then describing them based on criteria that defines the conditions themselves. Define through consensus and study

Lists of disorders and criteria required to be diagnosed

Question 5

what are the requirements for being diagnosed with major depressive disorder

Answer 5

The individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.

Question 6

symptoms of major depressive disorder

Answer 6

Depressed mood most of the day, nearly every day.
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
Fatigue or loss of energy nearly every day.
Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
Diminished ability to think or concentrate, or indecisiveness, nearly every day.
Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms must also not be a result of substance abuse or another medical condition.

Question 7

what is the difference between normal and severe mood fluctuations

Answer 7

Everyone experiences normal mood fluctuations. Sustained mood change becomes more severe, number of people experiencing reduces. Then by the end it interferes with life, even less people have this, its very different from normal mood fluctuations. The dotted line is arbritrary and made up, there is no one point where people suddenly switch into depression. The time length for symptoms is also arbritrary could’ve been 3 weeks instead of two.

Question 8

what are the critiques of diagnostic systems

Answer 8

In other branches of medicine careful study of symptoms led to the identification of diseases and causes
Our understanding of biological causes in psychiatric disorders is limited, so we don’t know if the recurring patterns we see are actually discrete ‘things’
Unlike other branches of medicine there is no test to confirm

Question 9

critiques of dsm 5

Answer 9

lacks validity diagnoses based on consensus about cluster of symptoms - not an objective measure

Search for causes has so far not delivered – biomedical causes have not been found convincingly.

Proliferation of mental disorders – more and more added between each edition

Minor changes to criteria make big differences in the rates of diagnosis (e.g. ADHD, ASD, Childhood Bipolar Disorder) – e.g major depressive disorder used to state if they were grieving a death they couldn’t be diagnosed

Financial links between DSM5 task force members and pharmaceutical companies – they received benefits from the companies (motives and biases called into question)
American Psychiatric Association and DSM book as an income stream – psychologists buy = income, the production of the book was delayed, sufficient testing wasn’t done and moved straight to publication for money

Question 10

what do intrapersonal influences focus on

Answer 10

psychological processes
personal historical factors
cognitive factors
behavioural factors

Question 11

idea behind personal history

Answer 11

it suggests early history is very informative the idea here is compelling but there is there evidence

Question 12

describe the systematic review of the evidence for personal history

Answer 12

44 articles between 2001 2011
145,000 ppt
strong association between early life adversity and all forms of psychological disorder in development persistence and severity
events can include Emotional sexual abuse
Emotional physical neglect all found psychological problems but less so for physical

Question 13

what are the mechanisms behind early history being a factor in mental illness

Answer 13

Intrusions of unprocessed memories - mind attempts to make sense of it they are unpleasant and makes them avoid activation of memory leads to suppression and incoherent story of self

Formation of negative expectancies and self beliefs - blame themselves, person who abused them may have made it seem like their fault as a form of control

Disruption of developmental pathways

Disruption of social bonds - diff to trust others

Question 14

how are cognitive factors responsible for mental illness

Answer 14

information processing biases can lead to faulty thinking across all parts of the processing chain

Question 15

what are the well established biased processes

Answer 15

Selective attention to threat stimuli in anxiety - social threats on mind due to evolution

Biases in explicit memory for negative self related information in depression
Over-general memory in depression - unable to define specific times when they felt something as rumination reduces specificity of coding

Lack of memory bias in anxiety disorders

Interpretation / judgement bias - what if ideas

Intrusive repetitive thinking: worry and rumination

Inhibitory control processes - so overused they backfire the more they try to repress intrusive thoughts it comes back stronger, more intrusive thoughts = further anxiety about not being able to control them

Question 16

how are cognitive models used

Answer 16

experimental studies of biases have informed cognitive modelling of emotional disorders e.g anxiety

Question 17

describe the model for anxiety

Answer 17

internal or external trigger - perceived threat - anxiety - physiological and cognitive symptoms - catastrophic misinterpretation - safety behaviours that feed back into catastrophic misinterpretation

Question 18

how are safety behaviours harmful

Answer 18

They dampen the threat they never learn the symptoms aren’t harmful so the beliefs aboiut meaning of the symptoms are maintained

Question 19

is mental health illness and biased thinking have a cause or correlation relationship

Answer 19

people with biased processing dont have it anymore once they have recovered.

precursors to mh difficulties, not conclusive as could be related to other factors e.g neuroticism

could also be the stress diathesis model - activated by stressful circumstances, once people recover from depression the cognitive biases don’t occur but if put in an experiment that induces a certain mood the biases are activated again more than someone who has never had it

Question 20

explain how behavioural processes feed into experiences of mental health problems

Answer 20

Avoidance and escape: habituation / extinction – stimulus is unpleasant try to escape it, run away, prevent extinction where it can evoke less anxiety

‘Safety behaviours’: failure to disconfirm – they reduce anxiety but prevent the person from confirming the unpleasant symptoms aren’t actually harmful.

Recent rethinking of avoidance – limited forms of safety behaviour can help, can help them protect and stay in extinction condition for longer.

Question 21

what are mental health problems

Answer 21

Human experiences
Emotions, perceptions, judgements, thoughts, physiological sensations, urges, motivations and behaviours
That cause distress and difficulties in daily living
That are considered outside of the ‘normal’ range of functioning….?

Question 22

positive effects of living with a diagnosis

Answer 22

Can make sense
Reduce self blame
Can access services
Can find support

Question 23

negative effects of receiving a diagnosis

Answer 23

Stigma
Sense of difference
Defeat

Question 24

what are the macroinfluences on mental health problems

Answer 24

poverty - income inequality
social exclusion
discrimination
multiply discriminated identities

Question 25

how does poverty impact mental health

Answer 25

reciprocal relationship and feed into one another

poverty = resources not sufficient to meet minimal needs

Question 26

what are the two hypotheses for the relationship between poverty and mental health illness

Answer 26

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

Question 27

how does social exclusion and poverty stigma affect people with poor mental health

Answer 27

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

Question 28

is discrimination associated to mental health problems and backed by a study?

Answer 28

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

Question 29

what is intersectionality

Answer 29

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

Question 30

what is resilience vs cumulative risk?

Answer 30

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

Question 31

what is the evidence supporting either resilience or cumulative risk

Answer 31

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

Question 32

macro influences are important - how do we demonstrate this with the river analogy

Answer 32

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

Question 33

what is a psychological formulation

Answer 33

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

Question 34

what are the five ps of general formulations

Answer 34

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

Question 35

can general formulations integrate ideas from different theories and perspectives

Answer 35

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

Question 36

examples of the 5 ps of general formulation

Answer 36

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

Question 37

positives and negative of theory specific formulation

Answer 37

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

Question 38

what is the structure of CBT formulation

Answer 38

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

Question 39

how do formulations lead to intervention

Answer 39

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

Question 40

what are the interpersonal influences on mental health

Answer 40

Attachment

Family function / parenting

Peer group influences

Social support / connectedness

Question 41

recap on insecure and secure attachment

Answer 41

secure

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

Question 42

how is attachment related to mental health

Answer 42

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

Question 43

what is the conclusions on family life

Answer 43

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’

Question 44

what does double bind mean

Answer 44

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

Question 45

what contributes to a negative family emotional climate

Answer 45

high negative emotional expression

poorly managed parental emotion

psychologically controlling behaviours

Lack of warmth / positivity

Question 46

how is a negative emotional family climate linked to mental health

Answer 46

Well established link to depression and anxiety

Direct links and also indirectly through emotion suppression

Question 47

what is the cumulative risk factors approach based on

Answer 47

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

Question 48

what are the factors that comprise the cumulative risk approach

Answer 48

10. 5% adverse life events and instability
11. 5% parenting practices
12. 2% parental verbal conflict and mood problems

parental antisocial and disturbed behaviour 13.6%

family structure and Socioeconomic status 16.2%

Question 49

what are the peer group influences on mental health

Answer 49

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

Question 50

how does social support affect someones experience of mental health issues

Answer 50

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

Question 51

where in the process does social support intervene

Answer 51

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

Question 52

how do less stigmatised attitudes about mental health change things

Answer 52

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

Question 53

what were the overarching goals of psychology pre and post ww2

Answer 53

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

Question 54

what are the positive psychology interventions

Answer 54

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)

Question 55

what is the evidence to support positive psychology interventions

Answer 55

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

Question 56

what is flourishing

Answer 56

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

Question 57

what are the negative aspects of the idea of flourishing

Answer 57

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

Question 58

what are we advocating for with a balanced positive psychology

Answer 58

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

Question 59

how can we inform CBT with greater positivity

Answer 59

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

Question 60

applying CBT to shame prone depressed people isn’t always the best, what other option is there

Answer 60

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

Question 61

what are the three systems in the compassion focussed therapy

Answer 61

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

Question 62

how is self compassion related to mental health

Answer 62

Compassion is strongly related to less pathology

Compassion based intervention is effective in increasing compassion and reducing distress

Question 63

what is ACT

Answer 63

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

Question 64

how is psychological flexibility (used in ACT) associated with mental health

Answer 64

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

Question 65

what is health anxiety

Answer 65

formerly called hypochondriasis = fear of having an illness

Question 66

symptoms of health anxiety

Answer 66

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)

Question 67

what is the CBT model of health anxiety

Answer 67

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

Question 68

example case study - background

Answer 68

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

Question 69

medical investigation results of the case study

Answer 69

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

Question 70

psychological assessment of case study

Answer 70

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

Question 71

what was the case studies formulation

Answer 71

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

Question 72

how was the CBT applied to this

Answer 72

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

Question 73

what were the two hypotheses of intervention

Answer 73

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

Question 74

how did the patients lack of pain knowledge contribute to the worries

Answer 74

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

Question 75

what was the smoke alarm metaphor used in the end to help with the understanding of pain

Answer 75

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.

Question 76

how did they tackle the hypotheses

Answer 76

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

Question 77

how was the case study then put into practice in every day life

Answer 77

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.

Question 78

what was the outcome for the case study

Answer 78

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

Question 79

what does the power threat meaning framework utilise

Answer 79

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

Question 80

what questions do we ask in the power threat meaning framework

Answer 80

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)

Question 81

background of case study

Answer 81

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

Question 82

how were marko’s symptoms presented

Answer 82

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

Question 83

how did power operate in markos life

Answer 83

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

Question 84

how did this affect marko

Answer 84

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,

Question 85

what sense did marko make of these events and his mental illness

Answer 85

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

Question 86

what was he doing to survive

Answer 86

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

Question 87

what were his strengths

Answer 87

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

Question 88

what is the classical trauma response

Answer 88

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

Question 89

how was marko treated in early sessions

Answer 89

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

Question 90

how was marko treated in the mid sessions

Answer 90

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

Question 91

how was marko treated in the end sessions

Answer 91

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

Question 92

what was the ending for marko

Answer 92

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

Question 93

how can the PTM be applied to markos case

Answer 93

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’.