module 5 Flashcards
A normal part of life involves
being faced with various disappointments and stressful life events. It’s
important to be able to adapt and cope within reason with your ever-changing environment.
Resiliency
is the ability to adjust or recover from a stressor, threat, or
adversity.
Managing Distress
learning how to cope with negative or difficult emotional states
- form of self-regulation
tipping point- what is it?
when the challenges and cumulative stress exceed the optimal performance level
Tipping Point definitions
the point at which someone begins showing signs and symptoms of the
strain/burden of perceived stress. The tipping point will be different for each individual; what might be your tipping point will be different than others.
One way to conceptualize the idea of this tipping point
the stress diathesis model*
Stress
triggers several interconnected biological systems. The process by which the body adapts to changes in the body, such as stress, is called allostasis.
Diathesis
refers to the concept of vulnerability. Specifically, a person’s predisposition or vulnerability to a medical condition.
examples of what A diathesis can be
biological through genetic inheritance, a psychosocial vulnerability created by
exposure to a stressor early in life, or a vulnerability created by the interaction between hereditary
(genetic) and environmental factors (Gx E).
what does the stress diathesis model explain?
a disorder or behaviour through an interaction between genetic predispotion and a stressful exposure
Results from a study by McEwan and Gianaros (2010)
indicate that stress can trigger allostasis-induced brain plasticity*. This suggests that stressful experiences can affect brain structure and function.
the findings from the publication “Stress- and Allostasis-Induced Brain Plasticity”
- The Brain & Regulation
- Stress
- Stress and Health
- Brain Structure
- The Brain & Regulation
- central in the stress diathesis model
- determines what are threatening/adverse and what are positive experiences/exposures
- responsible for regulating an individual’s physical, emotional, behavioural, and cognitive response to stressors, events, and experiences.
- Stress
- Stress must be balanced.
- Stress, if manageable, can lead to positive growth and adaptation (steeling
effect)- which promotes resilience and good health
- Stress and Health
Too much stress, either chronic (cumulative) or acute overwhelming stress, takes a toll on the brain
and body, and is associated with poor mental and physical health outcomes.
- Brain Structure
- When stressed, the brain changes its structure in an adaptive or maladaptive way in response.
- the loss of resilience (physiologically, neurologically, and behaviourally) is a key feature of disorders
related to stress (i.e. anxiety and depression).
Steeling Effect:
Refers to evidence of more resistance to later stress having successfully coped with a stress or challenge.
adaptation process- stress diathesis model
Perceived Stress
Physiologic Responses-
Allostatic Load-
the brain and perceived stress
- The brain processes information from your internal (e.g. level of hydration, hormonal state) and
external (work, friends, family) environment. - Given your genetics and life experience, your brain reacts differently to the same stress. Taken
together, these factors determine your individual perceived level of stress.
physiologic responses
- brain then controls and coordinates the physiological, psychological, and behavioural response to
perceived stress - these responses include influencing metabolism, heart rate, anxiety levels,
emotions, what you tell yourself, and how you behave - The responses result through signalling of various systems including the H P A axis*, autonomic nervous system, the metabolic system, the gut, and the immune system.
allostatic load
refers to the wear and tear on the body and brain resulting from chronic dysregulation or overactivity/strain related to the process of allostasis
Interventions that alleviate allostatic load
healthy diet, regular cardiovascular exercise, social
support, connectedness (sense of belonging), and good quality sleep.
- can help develop resilience in the event of adversity
how G x E interactions appear to influence susceptibility to all experiences, good and bad.
Reduces Risks
Flourish
Reduces Risks
- Your genetic make-up interacts with life experiences good and bad to determine resiliency and
sensitivity to stress - Developing healthy ways to cope with stress and adversity can reduce
the risk of feeling overwhelmed and developing symptoms
Flourish
Young people are at a particularly important time in development when a healthy lifestyle together
with accelerated brain development increases the likelihood of positive effects on well-being.
what are the 2 most common mental health disorders in Canada
anxiety disorders and
depressive disorders
Prevalence in Canada of anxiety disorders and depressive disorders
- In 2013, an estimated 3 million Canadians reported that they live with an anxiety and/or mood disorder.
- Almost a quarter of these individuals reported that they have not sought treatment in the last 12 months.
- rates are similar to those reported in the UK and other Western countries.
Comparing Depression & Anxiety in canada
One study found that 10.2% of Canadian youth have experienced a depressive disorder and 12.1%
have experienced an anxiety disorder.
Comparing Males & Females Depression & Anxiety in Canada
more prevalent in females compared to males
signs and symptoms associated with anxiety disorders.
Emotional Signs and Symptoms
Physical Signs and Symptoms
Behavioural Signs and Symptoms
Cognitive Signs and Symptoms
Emotional Signs and Symptoms associated with anxiety disorders.
- Feeling on edge
- Feeling irritable
- Not fully enjoying things
Physical Signs and Symptoms associated with anxiety disorders.
- Restlessness
- Chest tightness
- Muscle tension
- Shortness of breath/hyperventilation
- Gastrointestinal upset
- Headaches
- Sweaty palms
- Butterflies
- Changes in appetite
- Blushing/flushing
- Fatigue or low energy
- Rapid pressured speech
Behavioural Signs and Symptoms
associated with anxiety disorders.
- Avoidance of feared situations (i.e. public speaking)
- Short temper and at times angry
- Difficulty sleeping (falling and/or staying asleep)
- Difficulty concentrating, distracted by worries, forgetfulness (mind goes blank)
Cognitive Signs and Symptoms associated with anxiety disorders.
- Apprehension (i.e. a sense something unpleasant is going to happen)
- Over-worry
- Distracted
what can the symptoms of anxiety overlap with?
A D H D, depression, or cardiovascular problems.
Emotional Signs and Symptoms associated with depression.
- Feeling sad
- Non-reactive mood
- Feeling despair
- Loss of enjoyment of normally enjoyable experiences
Physical Signs and Symptoms associated with depression.
- Changes in sleep (sleeping a lot less or a lot more than is usual for you)
- Changes in appetite (eating a lot less or a lot more than is usual for you)
- Feeling slowed down in your movements, or agitated and restless
- Pain, headaches
Behavioural Signs and Symptoms associated with depression.
- Withdrawing from friends and family
- Staying in more, missing work or university
Cognitive Signs and Symptoms associated with depression.
- Feelings of guilt
- Suicidal thoughts
- Feelings of hopelessness
- Difficulty concentrating
- Dwelling on the negative (i.e. glass half empty rather than half full)
- Thinking over past bad memories and experiences
- Difficulty making decisions
- Negative thinking (e.g., negative judgements about self, world, future)
four main indicators that point to a mental health disorder
Disproportionate Reaction
Time
Impairment
Out of Character
Disproportionate Reaction
Severity or intensity of symptoms and level of distress are disproportionate to the situation.
Time
Symptoms persistent for an extended period of time (past the stressor).
Impairment
Symptoms are associated with impairment and interfere with day-to-day life.
Out of Character
Others notice that the person does not seem themselves or is “off”.
Mental health concerns and conditions what do they require to be clinical diagnosed
assessment by a mental health professional who takes into account the whole person (i.e. life course, family history, current context, and symptoms)
what are examples are included in the medical assessment for mental health concerns
Bullying, academic problems, relationship problems, substance misuse, family history, recreation,
and exercise
information that is important to assessing mental health status.
Developmental History
Family History
Symptoms
Treatment
Other Factors
Relational and Social Factors
Developmental History
learning, communication and/or neuromotor
problems, childhood adversity
Family History
The family history of mental disorders to identify a predisposition, or genetic and familial vulnerability.
Symptoms
The clinical course of distressing and impairing symptoms, in terms of onset and nature (i.e. chronic or
episodic) and relationship to context/stressors.
Treatment
The response or paradoxical worsening to any treatment tried to date and other physical or medical
problems that might be contributing.
Other Factors
lifestyle (exercise, recreation), misuse of alcohol and/or recreational/illicit drugs, current
stressors,
Relational and Social Factors
The nature of the relationships, social connectedness, and environment.
what should university student with mental health concern reach out to
help on campus at student health or wellness services or through local family practice
what are care options for university student with mental health
Primary Care Provider-
Psychiatry-
Self-Help and Peer Support
Counselling-
Psychological Therapy-
Primary Care Provider
family doctor or nurse practitioner should be thought of as central to
coordinating (or quarterbacking) your health and mental health care
- should be kept up to date with any health or mental health
support or care you receive.
Psychiatry
well-suited for assessing and treating moderate to severe mental health
conditions or disorders that require a combined psychological and pharmacological treatment
approach
Self-Help and Peer Support ; Peer support
- Being able to talk to other students who are going through - or who have been through - similar
experiences as you can be helpful for support. - Many universities have peer mentor schemes, a ‘buddy’
system, and/or a confidential listening service where you can talk to other students
Peer mentors
are student volunteers and can help by empathizing, sharing information and resources and sharing their
own personal experiences. It can sometimes feel easier and less daunting to speak to a fellow-student
and they can guide you where to go for further help if needed.
Self-Help and Peer Support ; Self-help
- refers to using available resources, such as books, websites, or apps, to work through a
problem or difficulty. - very effective for many different types of problem and is accessible and
convenient to work through at a time and pace that suits you.
examples of self-help guides
digital platform Silvercloud is a self-help programme using cognitive
behavioural therapy for low mood and anxiety; the ‘Overcoming…’ series of self-help books offer
information and exercises to work through for many different problems
Counselling
provided through Student Wellness Services is often short-term and problem-focused, addressing healthy coping during periods of stress, strengthening problem-solving skills, and managing emotional responses to an identified stressor
Psychological Therapy
are often well-suited to help with and support young people with emotional, social, and mental health problems, typically of moderate severity
A stepped care approach
aims to match individual patients to the level of service indicated based on
intensity of need.
what does the model (step approach) assume?
(1) The minimally required intervention has itself benefits and gains
(2) this is a way to rationalizes and economize healthcare resources that are often limited, so that we want individuals to have the indicated level of treatment but not more than they need.
3. that the care provided is acceptable to patients so that it each level is convenient, accessible, and has flexibility so that if the clinical need should change individuals can move up and down levels of care
mental health professionals that can support you
Occupational Therapist-
Counsellor
Psychotherapists-
Clinical Psychologist-
Psychiatrist-
Occupational therapists (OTs)
are regulated healthcare professionals who specialize in assessment and intervention focused on helping people resume or maintain participation in a variety of activities,
including work, school, recreation, and activities of daily living.
Occupational therapists (OTs) in uni setting
are particularly well-suited to help with learning approaches and improving performance in the context of learning activities, and achieving a healthy schedule/study-life balance
Counsellor
- have variable training, which may include a graduate degree in educational counselling.
Counselling provided is often short-term and problem-focused.
what do counsellors support
support healthy coping, emotional and behavioural regulation, and healthy lifestyle choices, as well as achieving a good study-life balance
Psychotherapist
- are licensed healthcare professionals with training in group and individual
psychological talking therapies - support individuals with
emotional, social, and mental health problems of mild to moderate severity.
different “schools” or models of psychotherapy
including cognitive behaviour therapy (C B T), interpersonal psychotherapy (I P T), and psychodynamic
psychotherapy.
Clinical Psychologist
receive extensive training in psychological, cognitive, and psychoeducational assessment,
and in providing manualized effective group and individual therapeutic approaches to help with a variety of mental health problems and conditions
what are Clinical Psychologist well-suited for
provide psychological support and treatment for mild to moderate mental health problems and disorders and to work as part of a multidisciplinary team supporting patients with more moderate to severe mental disorders
Psychiatrist
are medical doctors with extensive speciality training in the diagnosis and treatment of mental disorders, integrating pharmacological treatment (i.e., medication) with other aspects of
educational, psychological, and social and family care
- occurs through a referral from a responsible family
doctor.
Psychiatric assessment
asks into account developmental and family history, psychosocial context, early adversity, onset and clinical course and nature of symptoms, and
any contributing risk factors (stress, substance use, comorbid medical illness, medication)
IDEAL MENTAL HEALTH SYSTEM MODEL
would start with a welcoming clinic visit to determine each student’s support need, followed by referrals to the appropriate level of service and support
- also be a seamless flow between levels of service and between community-based
and campus-based services
on-campus resources at Queen’s University
Queen’s Student Health and Wellness Services (Q S W S)
Queen’s Student Accessibility Services (Q S A S) (part of Q S W S)
Psychology Clinic at Queen’s University
Queen’s Student Health and Wellness Services (Q S W S)
Q S W S supports the personal, academic, and social health development of students at Queen’s
University by providing a range of programs and services, including physical and mental healthcare
Queen’s Student Accessibility Services (Q S A S) (part of Q S W S)
QSWS supports the personal and mental health of students, and their academic success through
providing a range of resources and services.
Psychology Clinic at Queen’s University
provides psychological assessments, treatment, and consultation for Queen’s students and members of the Kingston community. Unlike QSWS, the Psychology Clinic operates on a
fee-for-service model. However, a sliding scale is offered based on family income.
different types of community-based services.
Hospital-Based Services
Publicly Funded Community-Based Services
Private and Fee-for-Service Options
Hospital-Based Services
include emergency or urgent care (walk-in basis) and various subspecialty programs (i.e. eating disorders, early psychosis) which typically have defined criteria for admission.
Publicly Funded Community-Based Services:
- High demand plus limited funding often means that publicly funded community-based services have long waitlists and prioritize the most ill people
- Often hospital-based services and publicly-funded community services do not line up with the university
student demographic or the specific needs of university students
Private and Fee-for-Service Options:
Because many provincial health plans such as OHIP do not cover psychotherapy outside of what is offered on campus, many people have to rely on private and fee-for-service options. or there insurance
do young people face barriers to accessing and receiving mental health care
yes.
types of barriers
Stigma-Related Barriers-
Attitudinal Barriers
Practical Barriers
Stigma-Related Barriers
Stigma and fear of being evaluated negatively as a result of a mental health problem
- found that only one third of students entering university with a mental health condition actually intend to disclose it.
how is stigma being fixed?
The Canadian Mental Health Association is working to combat mental health stigma by educating the
public of outdated terms and encouraging person-first language
Attitudinal Barriers
It is not uncommon for people to invalidate their own or others’ mental health concerns or diagnosis as
there is not a clear diagnosable test such as an x-ray or lab test to provide clear objective proof and validation of a mental health disorder
Practical barriers
include problems related to things such as cost, time, or availability of services.
three examples of practical barriers.
Long Wait Times
Financial Barriers
Challenges Navigating the System
Long Wait Times
High demand plus limited funding for resources often means that there are long wait times for
accessing mental health services.
Financial Barriers
Finance can limit timely access and access to certain specialized services.
Challenges Navigating the System
It can be difficult to know what level of services you need and where you can best access those services. This can make it confusing and challenging to navigate the mental health system, creating additional barriers in accessing services.
No symptoms
Prevention and health promotion
Mild symptoms
Self-Help for Targeted Signs and Symptoms
Mild to Moderate symptoms
Social and/or Psychological Approaches
Moderate to Severe symptoms
Pharmacological and Psychological Approaches
MENTAL HEALTH PROMOTION
- healthy study-life balance
- getting good quality sleep, and
making healthy lifestyle choices helps maintain well-being and resiliency - spending time in nature
- Regular cardiovascular exercise, reducing use of alcohol and caffeine, and avoiding recreational
self-help resources available
there is lots of resources for people experiencing mild mental health symptoms or problems
- such as workbooks and apps that allow for self-directed treatment can be useful for managing these types of symptoms or problems
e U-Flourish and Nurture-U University well-being and mental health research
funded by the Canadian Health Institutes of Research and the Medical Research Council respectively, teams
across Canada and the U K will be collaboratively testing out digital interventions to reduce anxiety,
stress, and low mood and to tackle worry, self-criticism, and low confidence
- free of charge to interested, eligible, and consenting students across Canadian and U K universities in
research trials.
SOCIAL APPROACHES
- Mild mental health symptoms may benefit from social approaches
- include a variety of supports that can improve your social support and well-being
examples of why social approaches
social skills workshops, interest groups and clubs, health promotion, and support groups.
what can psychological approaches and treatment be effective for
reducing and managing moderate symptoms of anxiety, depression, and sleep problems
PSYCHOLOGICAL APPROACHES
Mindfulness-Based Stress Reduction:
Behavioural Activation:
Supportive Counseling:
Interpersonal Psychotherapy (I P T):
Cognitive Behavioural Therapy (C B T):
Cognitive Processing Therapy (C P T):
Mindfulness-Based Stress Reduction:
Mindfulness-based stress reduction and other mindfulness
approaches are useful for being mentally present, focused, and relaxed.
Behavioural Activation:
Behavioural activation is an evidence-based treatment based on increasing your activity level,
especially in pleasurable activities to combat low mood.
Supportive Counseling:
Counselling involves having a supportive person to explore current issues and difficulties, gain insight
into difficulties, and look for different ways of approaching them.
Interpersonal Psychotherapy (I P T):
focuses on relieving symptoms by improving interpersonal functioning. It
focuses on understanding and strengthening your relationship with yourself and others.
Cognitive Behavioural Therapy (C B T): what does it help with
been shown to be effective in treating
mild-moderate sleep problems, anxiety, and depression.
Cognitive Processing Therapy (C P T):
Cognitive processing therapy is another type of C B T that focuses on evaluating and changing upsetting
thoughts. It has been used for reducing symptoms of Post Traumatic Stress Disorder.
what is CBT
n evidence-based therapy that involves addressing and
changing maladaptive* thinking patterns (cognitions) as well as modifying behaviour. C B T and C B T
based therapies can be effective treatment options for a variety of mental health disorders, including
anxiety, depression, eating disorders, and trauma.
when mental health disorders become more severe
C B T is often especially useful when combined with other psychosocial and educational approaches including medication.
the effect of practing mindfulness how long
1-year of observation
what else can be used for treatment of mental health disorder’s
medical and pharmacological approaches
Alternative Medical Explanation
- It can be important to consider whether there might be a medical explanation for symptoms
- family history (genetic predisposition) is an important
lens to understand emerging symptoms taken together with other risk factors such as psychosocial
context and risk exposures (substance use, trauma/abuse).
Medication
can be an important, and sometimes central part of treatment for specific disorders and severity of disorders. Family doctors often work in collaboration with psychiatrists to identify when medication is required and to assess the tolerability and treatment response.
Physical and Mental Health Interaction
consider the interaction between physical and mental health. Often physical illnesses are associated with mental health problems and vice versa. When thinking of assessment and treatment, it is important to take a holistic approach and develop a care plan that considers the whole
person.
