Psychological Health Flashcards
what are psychological health problems?
- human experiences, emotions, judgements, thoughts etc.
1/5 people live with a psychological disorder and most people will qualify for one at some point in their life
effects of receiving a diagnosis
positives:
- can make sense
- reduces self-blame
- allows access to support services
negatives:
- stigma
- sense of defeat
- can feel trapped
- no ‘cure’ so might not be helpful
diagnostic classification
Diagnostic classification is based on recurring and reliable patterns of these human experiences, classifying and categorising them into discrete entities called ‘disorders’. This is useful practically.
the classification aims to be reliable and has the underlying assumption that understanding mechanisms will aid treatment.
DSM development
the DSM contains classifications of mental ‘disorders’ and criteria to diagnose them
critiques of the diagnostic system
- no confirmation tests so can’t know for sure
- common comorbidity of multiple disorders
- diagnostics differ between clinicians
- minor changes in criteria can lead to big diagnostic changes
- DSM creates a large stream of income for US psychiatric association and pharmaceutical companies
psychological formulation
Psychological formulation is an attempt to use existing psychological knowledge to understand origins, mechanisms, maintenance of an individual person’s problems
perspectives of psychological formulation
presentation of the problem
- e.g. hearing voices
predisposing factors
- e.g. loss/grief, trauma etc.
precipitating factors
- e.g. bullying, loss of job etc.
perpetuating factors
- e.g. isolation, rumination etc.
protective factors
- e.g. intelligence, resilience, awareness etc.
theory specific formulation (of disorders)
pros:
- can be more precise
- research based = evidence based practice
- can be used to straddle diagnoses
cons:
- harder to integrate various elements
- can be limited in diagnosis by blind spots in the theory
formulation for intervention
- built collaboratively, over time with the person
- not imposed, it is explained/practiced/ encouraged
- puts meaning/understanding into problems
- highlights specific places to intervene
macro level influences on mental health
justice failures
- poverty = stigma/stereotypes can be internalised
- social exclusion
- discrimination (especially multiple discriminated identities
these large scale factors have important psychological health consequences and studies can only do so much to address this - activism is needed for change to occur
intrapersonal influences on mental health
personal historical factors
- clear associations between early life adversity and disorders (Carr et al, 2013) as they lead to unprocessed memories/disruption of social beliefs / disruption of developmental pathways etc.
cognitive factors = information processing distortions in many cognitive domains can be distorted
- cognitive models can be informed by studies of disorders
behavioural factors = classical avoidance / ‘safety’ behaviours / avoidance behaviours
interpersonal influences on mental health
family, friends and society
- attachment type (Ainsworth) = insecure attachment can be an indicator of future disorder
- negative family emotional climate e.g. refrigerator mother
- peer group = bullying linked to later problems
- authority/leadership figures
- social support = buffering hypothesis (friends can help cope with stigma/problems)
overarching goals of psychology
prior to WW2 = ‘curing of illness’
after WW2 = founding of NHS and US national institute for mental health lead to the decline in stigma surrounding mental illness
assigning - positive psychology intervention
expressing gratitude / doing acts of kindness / mindfulness exercises e.g. meditation
psychotherapy ‘packages’ include a more positive focus
flourishing - positive psychology intervention
pathways to flourishing (Vanderweele, 2017) suggests that family, work, education and community all contribute to satisfaction, wellbeing, quality of life, good health etc.
flourishing is a broad construct and suffers from measurement problems and contradictions
critiques of positive psychology
- Subjective = ‘valued’ experiences and emotions
- Individual = perseverance/optimism/courage
- Social – civility/altruism/pro-sociality
In response to these critiques, balanced positive psychology recognises that life with no ‘bad times’ would be rather superficial.
‘balanced’ positive psychology
- avoids extremes
- develops complementarity among areas of good and bad stuff
- temper construct definitions
- contextual sensitivity
- acknowledge both conscious and unconscious phenomena
positive psychology in CBT
- less focus om symptom reduction
- greater focus on building adaptive behaviours
- trains positive approaches e.g. self-acceptance
compassionate mind training
based on Paul Gilbert’s work with shame-prone people. it actively trains a kindly stance towards oneself and cultivates soothing. draws on Buddhist conceptualisations
- self-compassion is related to less pathology (MacBeth and Gumley, 2012)
- compassion based intervention is effective in increasing compassion and reducing distress (Wilson, Mackintosh, Power and Chan, 2019)
three systems in compassion-focused therapy
- threat system
- drive system
- soothing system
psychological flexibility
Psychological flexibility underpins a clinical model of acceptance and commitment therapy (ACT) - this is an updated form of CBT.
- acceptance of unpleasant thoughts / feelings to let them go
- articulates personal values
- commitment to actions
- open, aware and engaged responses
evidence it is associated with less distress and psychopathology (Hayes et al, 2006)
lab studies show flexibility procedures produced large effects (Levin et al, 2012) - all metanalytic effects favour ACT to CBT
power threat meaning framework
brings macro factors together - proposed as an alternative to diagnostic classification.
asks:
- what has happened to you? (what role did power play?)
- how did it affect you? (what threats did it pose?)
- what sense did you make of it?
- what did / do you have to do to survive? (what threat responses are you using?)
- what are your strengths? (what powers do you have?)
- what is your story?
classic trauma bind
traumatic events -> extreme threat appraisals -> fear activated -> avoids cues/stimuli -> memories/events go unprocessed -> intrusions: nightmares/flashbacks -> extreme threat appraisals -> and so on
therapies aim to break this cycle by allowing the person to talk once they trust their therapist and work through the stages to eliminate the extreme reactions
what can we change?
we can’t change our situation but we can change how we react to it - this is psychological flexibility
the ACT model
ACT is transdiagnostic. it is a theoretical clinical model that is composed of 6 overlapping and independent processed called the ‘hexaflex’.
psychological inflexibility hexaflex
- dominance of past and future
- lack of clarity/contact with values
- lack of effective action
- attachment to a self-story
- cognitive fusion
- experiential avoidance
psychological flexibility hexaflex
openness = acknowledging/validating experiences
- willingness/acceptance
- cognitive diffusion
engaged = generating goals/actions
- contact with the present moment
- flexible perspective about ‘stories’
awareness = mindfulness/meditation etc.
- clarity/contact with personal values
- committed actions towards values
reality of ACT
Ideas here are likely exactly what’s needed
- But getting people to accept/commit is tricky
- People have to want to change/be willing to work at it
Data on all the above exercises is very mixed
- For some they work great but for others they are silly and useless
- Placebo effect is real
‘recovery’ from mental health disorders?
clinical approach is to relieve suffering but this usually doesn’t mean living without the mental disorder - they usually don’t go away.
e.g. only 10% of those diagnosed with depression are symptom free after 10 years
how can we progress in the treatment of mental disorders?
- measure good outcomes more thoroughly / accurately / often
- Measure good function as potential protective factor too
- Don’t focus simply on risk factors
-Root out implicit attitude that full recovery doesn’t happen - Research how to help people live well
