Stress Psychology and Psychological Therapies Flashcards
Describe the interaction between psychological, social and physical processes in wellbeing and disease.
COMPLETE
Describe the interaction between environment and genes.
COMPLETE
Describe the contribution of psychological factors to specific disease groups e.g. cardiovascular disease.
COMPLETE
Define psychoneuroimmunology.
COMPLETE
List commonly used psychological therapies available on the NHS. (9)
Counselling CBT Mindfulness (stress reduction or CBT) Interpersonal therapy EMDR Humanistic therapies Psychodynamic therapies Group or family therapy Dialectic behaviour therapy
What was the average work days lost per case for stress, depression or anxiety in 2014/15?
23 days
Depression doubles the risk of developing what physical health condition?
CHD
At what age do half of all mental illness begin?
By age 14
How are mental disorders linked to smoking?
People with a mental disorder smoke almost half of all tobacco consumed, and account for almost half of smoking-related deaths.
How much does the risk of depression increase by for those with 2+ long-term physical illnesses?
Seven-fold
How many years younger do people with schizophrenia and bipolar disorder die by?
20 years earlier
How many % of the adult population meet the criteria for at least one mental health disorder?
16%
Where does mental health promotion take place? (5)
Schools, colleges and universities Workplaces With pregnant women and families With elderly people In relation to debt and unemployment
What non face-to-face formats of therapy are there? (3)
Beating the Blues computerised CBT
Phone and email counselling
Reading Well Books on Prescription
Who delivers psychological therapies? (6)
Counsellors
Psychologists (clinical, health or counselling)
Some psychiatrists
Psychological Wellbeing Practitioners in CBT (bands 4-6)
Graduate mental health workers
Psychotherapists
What is IAPT? When did it launch?
Improve Access to Psychological Therapies - it provides talking therapies (either low or high intensity)
2008
Which accrediting/regulating bodies are there? (4)
British Association for Behavioural and Cognitive Therapies
British Psychological Society
Healthcare Professions Council
British Association for Counselling and Psychotherapy
What is the role of psychological therapies in medicine? (7)
Dealing with mental health issues Behaviour change Stress management Self-management Symptom management (e.g. pain) Crisis intervention Counselling for life events e.g. bereavement, infertility
Compare counselling to psychotherapy.
Counselling is when there is no diagnosable disorder, whereas psychotherapy there is.
Counselling explores emotional problems, psychosocial issues, current crises (e.g. bereavement or infertility), etc using supportive listening. Psychotherapy is structured and systematic, exploring both past and current behaviour.
They require different training.
What different approaches of psychotherapy are there? (6)
Psychodynamic CBT Cognitive Analytical Therapy Interpersonal Therapy Humanistic Therapy Systemic Therapy
What is psychotherapy used to treat? (9)
Depression Anxiety disorders Borderline personality disorder OCD PTSD Long-term illnesses Eating disorders Drug misuse Emotional problems relating to bereavement, redundancies etc
What is psychodynamic therapy?
What is it recommended for?
It is based on Freud’s theories and focuses on the past/childhood experience and how this affects interpersonal relationships. It explores maladaptive personal defences.
Longer term problems e.g. addiction, depression with complex illness.
What is the stepped care model for depression?
Step 1 – recognition in primary care and hospital
Step 2 – treatment of mild depression in primary care
Step 3 – treatment of moderate to severe depression in primary care
Step 4 – treatment of depression by mental health specialists
Step 5 – inpatient treatment for depression
What is CBT?
This is a type of therapy developed from Learning Theory that focuses on the here and now. There is less emphasis on client-practitioner relationship as client learns to ‘do it themselves’.
What two techniques are used in CBT?
COGNITIVE RESTRUCTURING
BEHAVIOURAL EXPERIMENTS
Explain cognitive restructuring.
Addressing and challenging thinking errors, such as:
Catastrophising (magnification and minimisation)
Jumping to conclusions
Overgeneralising
This is done by socratic questioning.
Explain behavioural experiments.
This entails exposure to feared objects/situations and habituation means that anxiety will reduce.
What is CBT based on?
The idea that thoughts, behaviours and feelings are linked.
What can CBT be used to treat?
Chronic pain, chronic fatigue syndrome, IBS, alcohol and illicit drug use, long term sickness and work absence, chronic headache disorders, skin disorders, anxiety and depression….
Dialectical Behavioural Therapy - what is it mainly used to treat? What is it?
Mainly used to treat Borderline Personality Disorder.
Similar to CBT but emphasising relationship between client and therapist, and a focus on self-acceptance as well as need to change behaviour.
What is BPD?
How many % of the population does it affect?
What is it usually the result of?
What can it result in?
Borderline Personality Disorder
1%
Childhood abuse/neglect
Self-harming, alcohol misuse, suicide attempts
Mindfulness techniques - what are the recommended for? What are they not suitable for?
Recommended as part of CBT for recurrent depression
Not suitable for PTSD, psychosis, dissociative disorders
What is mindfulness?
Non-judgemental awareness of current moment. It reduces stress and improves mood by preventing rumination.
It can include yoga, tai chi and meditation.
Stress, depression or anxiety and musculoskeletal disorders accounted for the majority of days lost due to work-related ill health.
What were the numbers in 2014/15?
9.9 and 9.5 million days respectively
In 2014/15 how many % of work related ill health was due to stress?
How many % of working days lost due to ill health?
35%
43%
What is the rate of stress in health professionals?
3000 per 100,000
In this lecture, stress is talked about as three things. What are they?
Stimulus (engineering model)
Response (medicophysiological model)
Transaction (psychological model)
What is stress?
A negative experience accompanied by predictable biochemical, physiological, cognitive and behavioural changes that are directed either toward altering the stressful event or accommodating to its effects.
What types of stress response are there? (4)
Cognitive, emotional, behavioural, physiological
Who introduced the fight or flight response and when?
Walter Cannon, 1932
What is the fight or flight response?
Perceived threat results in the activation and mobilization of the body’s coping resources - immediate physiological arousal to prepare for struggle or escape. These changes are positive as they help you respond more quickly to a threat, but are harmful to health if prolonged.
How does stress influence the HPA axis?
It stimulates it
What was Hans Selye’s theory? What does it attempt to explain?
General Adaptation Syndrome
How stress affects our physical body
How did Selye go about examining how stress affects the body? What did he see and what was the conclusion?
Injected rats with ovarian hormone extract
Enlargement of adrenal cortex, shrinking of thymus gland, and bleeding ulcers
Body’s reaction to stress was general, as these effects were seen with injection of other fluids.
What are the three stages in the General Adaptation Syndrome model?
Alarm: acute response to threat. Immune system is down so resistance levels are lowered. If stress is not severe/long-lasting, we bounce back and recover rapidly.
Resistance: occurs with continued exposure to stressor – efforts to cope with stress – adaptation and high resistance.
Exhaustion: stressor too severe or continues too long that ability to resist breaks down – diseases of adaptation.
What are the strengths of Selye’s model? (5)
- Popularisation of stress concept
- General theory (applies to a variety of stressors)
- Interaction between physiology and environment
- Underlying structure is valid
- Explains physiological mechanism for stress-related illness
How do stress-related illnesses come about according to Selye’s model?
Cumulative stress = chemical scars = wear and tear of resources = diseases of adaptation
What are the weaknesses of Selye’s model? (4)
- Stress responses are not uniform and non-specific
- Considers stress as an outcome only
- Limited role for psychological factors/processes
- Physiological responses more complex
Mason (1975) argued that the endocrine system reacts different to different types of stress. How does it react to uncertainty? How does it react to anger/fear?
Uncertainty – releases catecholamine and cortisol
Anger/fear – releases noradrenaline and cortisol
How many % of people are “highly reactive” to stress? What does this mean?
15-20%
Extreme stress responses to non-extreme stimuli
Babies of mothers stressed and anxious during pregnancy show more…?
Anxiety, fearfulness, cognitive and attentional problems
Stress as a stimulus - what is the taxonomy of stressors? (3)
- cataclysmic events (e.g. natural disaster; WTC tragedy)
- major life events (e.g. bereavement)
- minor events (e.g. Daily hassles) - environmental conditions, laboratory stressors…
What is the stressor taxonomy time frame? (4)
- Acute time limited stressors
- Stressor sequences
- Chronic intermittent stressors occurring once a day, week, month
- Chronic stressors
For the Social Readjustment Rating Scale, what does a score of 0-150 mean?
Very low stress level
For the Social Readjustment Rating Scale, what does a score of over 300 mean?
Severe crisis - very high risk of illness
How is stress related to the common cold?
Those who got a cold when exposed to the virus had significantly more life events in the previous year. The duration of the stress life event was even more important than the severity.
i.e. Severe/chronic stress > 1 month –> more colds
What are the issues with the social readjustment rating scale? (8)
Doesn’t consider issues of control
Doesn’t discriminate between positive and negative events
Doesn’t distinguish between unexpected vs expected events, recurrent events, acute or chronic
Doesn’t recognise that the significance of events will vary across people, time and life course
Ratings given retrospectively
Self-report tends to be biased
Items may now lack relevance
Cultural biases
Which contributes more the illness - daily hassles or major life events?
Accumulation of daily hassles
PTSD - when does this usually happen (in how many % of people)?
What are the symptoms? (3)
Usually after an acutely stressful event (10-30%)
Flashbacks, insomnia, nightmares
Memory and concentration problems
Increased sensitivity to new events
What is stress best understood as?
A transaction between the person and the situation
How is stress understood as a transaction (flow chart)?
Event -> primary appraisal -> secondary appraisal -> stress -> coping (and reappraisal)
What is the cognitive-transactional view of stress?
Stress is not a property of the person or the environment but of the relationship between an individual and the environment that is appraised as taxing or exceeding that individual’s resources and as endangering his or her well-being.
What are the strengths of the cognitive-transactional view of stress? (2)
- Psychologically based approach -explicitly deal with individual perceptual factors
- Provides clear guidelines for the study and alleviation of stress
What are the weaknesses of the cognitive-transactional view of stress? (4)
- Model descriptive, not explanatory
- The situation dimension is poorly described
- Insufficient attention to social support
- Stress in the eye of the beholder -‘blaming the individual’
What is job strain linked to? (4)
What is job stain associated with? (3)
Accidents, burnout, health complains, and illness Cardiovascular disease, left ventricular hypertrophy, and cardiovascular disease risk factors
How do stress transaction influence health?
Through altering the frequency or pattern of health behaviours
Patients with depression are __ times more likely to die from their illness.
Three times
What else does negative mood suppress?
Immune function
What physical disorders are related to stress? (7)
Cardiovascular and gastrointestinal diseases Some cancers Immunological disorders Migraine Infertility Burnout Exacerbates Parkinson’s
Depression predicts the development of ___ in initially healthy people.
CHD
What can moderate the way stress affects us? (5)
Personality Social support Coping Control Exercise
Resilience - what term is this related to?
Relates to our older terms of coping, buffering and so on - meaning some people exposed to stress/life events/risk factors but still flourish.
