psychological health and when it goes awry Flashcards
what are psychological health problems
human experiences
emotions, perceptions, judgements, thoughts, physiological sensations, urges, motivations, behaviours - that cause distress to self and others, difficulties in daily living and lie outside of a normal range of function
positives of receiving a diagnosis
can help things make sense
reduce self blame
help find access to services
help find support
negatives of receiving a diagnosis
stigma
sense of difference
defeat
may feel trapped by label
how is diagnosis usually classified
based on recurring and reliable patterns of human experiences
categorises and classifies into discrete entities called diagnosis or disorder
nothing inherently wrong with this - in fact it is highly useful in scientific perspectives
what are the aims of classification
reliability - to ensure confidence that the talking about and study of these experiences are about the same phenomena
underlying assumption- furthers understanding of mechanisms and causes, which leads to effective treatment
2 types of classification systems
DSM 5 - diagnostic and statistical manual of mental disorders
ICD 11 - international classification of diseases
symptoms of major depressive disorder
experience 5+ symptoms during the same 2-week period, at least 1 symptoms should be
1 - depressed mood or 2 - loss of interest/pleasure
depressed mood most of day, nearly every day
diminished interest in almost all activities most of day nearly every day
significant weight loss when not dieting, weight gain or appetite change nearly every day
thought has slowed, physical movement decreased (observable by others)
fatigue or low energy nearly every day
feelings of worthlessness, excessive or inappropriate guilt
recurrent thoughts of death, suicidal ideation without specific plan, recurrent attempts, or plan for attempts
diminished ability to think, concentrate or indecisiveness nearly every day
symptoms must cause clinically significant distress, social/occupational and functional impairment
must not be result of substance abuse, medical condition or recent bereavement
DSM 5 critiques
understanding of biological causes in psychiatric disorders isn’t happening so we don’t know if diagnoses are actually discrete things
there are no confirmation tests
ultra common comorbidity (simultaneous presence of another disorder)
ultra common diagnostic differences among clinicians
it is a dictionary and lacks validity - based on consensus about clusters of symptoms not objective measure (Insel 2013)
minor changes to criteria make big difference in diagnostic rates (especially for ADHD and ASD)
diagnoses have proliferated over time but arbitrary deletions too
financial linked between DSM5 task force and pharmaceutical companies
DSM is income for APA
what is a psychological formulation and what is it used for
a person specific theories in an attempt to use existing psychological knowledge to understand origins, mechanisms, maintenance of an individual persons problems
can be alternative to diagnostic criteria, and/or complement them
- emphasise collaboration, meaning and understanding
the 5 p’s
- predisposing factors, precipitating factors, protective factor, perpetuating factor, presentation of problem
how to use the psychological formulation for interventions
build collaboratively with person over time
not imposed, it is explained, practised and encouraged
puts meaning and understanding into the problems and cycles
highlights places needing intervention in therapy but also with surrounding others and other support agencies
factors with influence psychological health and wellbeing
macro
interpersonal
intrapersonal
- these overlap and intertwine
macro level influences
justice failures
- poverty
- social exclusion (stereotypes and stigma can be harmful and internalised, childhood poverty is particularly damaging, intergenerational transmission of poverty)
- discrimination (associated with many diagnosed disorders (depression, anxiety, PTSD, eating disorders)
- intersectionality (resilience VS cumulative risk, depression and anxiety are most common, strong evidence for cumulative risk and weak evidence for resilience)
intrapersonal influences
psychological processes
- personal history factors (associations between early life adversity and all psychological disorders developing, persisting severely, general processes such as unprocessed memory intrusions and formation of negative experiences and self-belief (cognitive processes), disruption of social bonds and developmental pathways)
- cognitive factors (selective attention to threat stimuli, selective memory of negative self related information, overly general memory, absence of selective memory, selective interpretations/judgements, intrusive repetitive thinking, difficulty with inhibitory control, psychopathology)
- behavioural factors (classical - avoidance, escape create habituations, prevents extinction, safety behaviours)
interpersonal influences
family, friends, society
- attachment (secure and insecure - avoidant, ambivalent, disorganised -> a general risk factor for poor psych health)
- family dynamics/parenting (lack of maternal warmth controversially suggests this as a cause for autism, established links to depression and anxiety)
- peer groups (overt bullying linked to later psych health problems, more likely to happen to children of lower SES)
- authority/leadership figures
- social support /connectedness (buffering hypothesis - social support prevents individual from negative consequences of stressful events, acting as buffer (Cohen and Wills, 1985))
- sources of alienation (discrimination, bullying)
prior to WW2 - overarching goals of psychology
curing psychological illness
making everyone’s life more productive and fulfilling
identifying and nurturing giftedness is all forms
after WW2 - overarching goals of psychology
founding of the NHS and US national institute for mental health
how are people assigning positive psychology interventions
expressing gratitude, listing things they are grateful for
acts of kindness
thinking positively about the future
savouring the moment
smiling
mindfulness exercises
meditation
pathways to flourishing
longitudinal, cross sectional, and experimental research indicates that each area (family, work, education, and religious community) contributes to satisfaction, wellbeing, quality of life, good health, life meaning
subjective positive psychology
valued experiences and emotions
individual positive psychology
perseverances, optimism, courage
social positive psychology
civility, altruism, pro-sociality
what are the 5 conceptual aspect that balance positive psychology
avoid extremes
develop complementarity among areas
temper construct definitions
require contextual sensitivity
acknowledge both conscious and unconscious phenomena
what are some things to recognise in positive psychology
life with no bad times would be rather superficial
out of bad can come good and vice versa
how to put more positivity in CBT
less exclusive focus on symptom reduction
greater focus on building adaptive behaviours
broaden and build theory which posit that experiences of positive emotions broaden people’s momentary thought-action repertoire, which served to build enduring personal resources, from physical and intellectual resources to social and psychological resources
beyond retraining maladaptive processes, train positive approaches (self acceptance, compassion)
compassionate mind training
based on Paul Gilbert’s work with highly shame prone and self critical patients
- draws on evolutionary theory about social mentalities
- actively trains, cultivates soothing, kind stances towards self
- draws on buddhist conceptualisation of compassion as sensitivity to suffering + motivation to address relieving it
what are the 3 systems in compassion focused therapy
threat system
soothing system
drive system
how are self-compassion and psych health intertwined
self compassion is related to less pathology
compassion based interventions are effective in increasing self compassion, and reducing distress
what is psychological flexibility
- spans range of human abilities to recognise and adapt to various situational demands
- shift mindsets or behavioural repertoires when strategies compromise personal or social functioning
- maintain balance among life domains
- be aware, open and committed to behaviours that are congruent with deeply held values
what is ACT
acceptance and commitment therapy
- updated clinical model from CBT
how does ACT work
uses psychological flexibility
emphasises accepting unpleasant, painful thoughts, feelings in order to let them go
articulates personal values
garners commitments to actions
teaches ‘ open, aware, engaged’ responses
how are psychological flexibility and psychological health intertwined
psychological flexibility is substantially associated with less distress and ‘psychopathology’
what is the power threat meaning framework
brings together macro factor into useable explanatory framework and was proposed as an alternative to diagnostic classification
what questions does ‘power threat meaning’ ask
what has happened to you (what role did power play on you, whose power)
how did it affect you (what threats did power pose)
what sense did you make of it (what meanings do these situations and experiences have for you)
what did you do to survive (what kinds of threat responses did you use)
what are you strengths (what power do you have, access to power)
what is your story (how do these fit together)
the 6 inflexible and flexible processes of the ACT model
- experiential avoidance / willingness and acceptance
- cognitive fusion / cognitive defusion
- attachment to a self story / flexible perspective about stories
- dominance of past and future / contact with the present moment
- lack of clarity and/or contact with values / clarity about and contact with personal values
- lack of effective action / committed action towards values
acts of awareness - ACT model
mindfulness meditation
daily diary tracking psychological flexibility
paying attention while doing 3 tasks
acts of openness - ACT model
acknowledging and validating experiences
- knowing it is normal to be upset about things
noticing tendencies to avoid, encouragement not to run
singing difficult thoughts, saying them in a funny voice
‘leaves on a stream’ exercise
containment metaphors (you can have thoughts and feelings but they do not define you)
acts of engagement - ACT model
sweet spot exercise (bring happy memory to mind, a vivid one which represents love, affection, achievement, connection or pleasure)
qualities of heroes and heroines exercise
generating actions
making public commitments
SMART goal setting
what are SMART goals
specific, measurable, achievable, relevant and time bound
- defining these parameters as they pertain to your goals helps ensure they are attainable within a certain time frame
how do we not know how people recover from psychological health disorder diagnoses
the clinical approach is primarily to relieve overt suffering
research focuses in on understanding the risks of disorders
involves long term follow ups which are difficult and expensive
what are the 8 variables linked to good outcomes after trouble
cultural, community and family resources
treatment variables
social interactions and relationships
personal goals and projects
habits and self regulation
emotional and cognitive resources
temperamental and genetic factors
premorbid functioning
how to navigate progress
measure good outcomes more thoroughly, accurately and often
measure good function as a potential protective factor
do not focus just on risk factors
root out implicit attitude that full recovery does not happen
research how to help people live well
